MINOR surgery for minors. . . only tonsillectomies aren't minor, and the parents can help instead of hinder.
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Humans↗
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[Effectiveness of dermatologic minor surgery in the office of the family physician and patient satisfaction in relation with ambulatory surgery].
BACKGROUND: The minor surgery by family physicians increase the primary care competences. The purpose of this work is to prove patients' satisfaction and minor surgery effectiveness practiced by family physicians in health centers with respect to ambulatory's general surgeon. MATERIAL AND METHODS: Case-control retrospective study, comparing dermatological surgical procedures performed by 4 family physicians and 8 3rd-year Family Physician residents with surgical procedures wade made by a surgeon over one a year period. Variables analysed include: descriptive samples homogeneity, surgery effectiveness (waiting time, esthetic results, healing time and number of visits, and histopathologic correlation) and patients' satisfaction (with the waiting time, with the results of surgery and with the physician). RESULTS: Minor surgical procedures carried out by 146 family physicians and 61 general surgeons were compared, in congruence with the analyzed descriptive homogeneity's parameters. Family physicians average waiting time was the lower, with a mean of 45 days less than the surgeon. Patient's satisfaction with the physician was higher when family physician were involved (p < 0.001); the same could be applied for the waiting time (p < 0.001). There were no significant differences over the effectiveness and patients' satisfaction. CONCLUSION: The dermatologic minor surgery by family physician is effective, satisfactory for patients, and has less waiting time. This results justify the introduction of minor surgery in the family physicians office.
Adolescent↗
[Minor surgery by general practitioner; exploratory excision in the minor surgery].
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Biopsy↗
Analgesic side effects and minor surgery: which analgesic for minor and day-case surgery?
A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. Less than 50% of the orthopaedic patients in these groups required any postoperative analgesia. However, there was a high incidence of vomiting (40%) in those receiving an opioid during operation, associated with overnight admission in more than 50% of those who vomited. In the patients undergoing oral surgery, ibuprofen administered before operation significantly reduced analgesic requirement, without unwanted side effects. The use of codeine-paracetamol or a non-steroidal anti-inflammatory agent before body surface surgery appeared to be advantageous in reducing postoperative analgesic needs, without causing problems associated with the stronger opioids.
Acetaminophen↗
[Our experience with althesin and hydroxyzine combined in the same syringe in minor surgery].
Personal experience in minor surgery with Althesin alone (200 cases) and in association with hydroxyzine in the same syringe (250 cases) is reported. Comparison showed that the association is useful, particularly in cases where the operation lasts longer and involves greater pain stimuli. It is felt that the method described will extend the use of Althesin in minor surgery.
Adolescent↗
Adequacy of general practitioners' premises for minor surgery.
OBJECTIVE: Assessment of facilities for minor surgery in general practitioners' premises. DESIGN: Independent inspection of premises and equipment. SETTING: Large urban district. SUBJECTS: Premises of all general practitioners who applied to be reimbursed for minor surgery. MAIN OUTCOME MEASURE: Fullfilment of 14 pre-selected criteria. RESULTS: 69 of 111 premises met all criteria and were approved; 23 failed on only one criterion. The commonest reasons for failure were inadequate record keeping and lack of resuscitation equipment. Twelve practices had out of date adrenaline. CONCLUSIONS: Most premises are suitable for minor surgery, some with attention needed to record keeping. Practices must pay careful attention to the expiry date of adrenaline.
Ambulatory Surgical Procedures↗
[Cutaneous cysts, minor surgery].
For the nursing profession, the practice of minor surgery means the recovery of an activity which possesses a long historical tradition in our profession and an experience for nurses to provide a specific service in health care. The incorporation of minor surgery as one of the services offered by Primary Outpatient Clinic Care is taking place slowly but surely, especially in light of the advantages it provides. For several years now, some health professionals, nurses and doctors belonging to the Andalucian Health Services, have been actively working on the development and implementation of Minor Surgery Programs inside the Health Clinics of our community. One of our lines of work has been the development of protocols for the treatment of the most habitual lesions by means of minor surgery. Among these are cutaneous cysts whose protocol we present in this article.
Ambulatory Surgical Procedures↗
Initiation and evaluation of a pilot scheme for minor surgery in general practice.
This study evaluated minor surgery in seven general practices in Stockport during the last six months of 1988. Information was collected from general practitioners followed by a survey on patient and doctor satisfaction with the scheme. A total of 361 minor surgery procedures were undertaken with no serious consequences of intervention; the post-operative infection rate was less than 1%. Financial implications were identified, including the effect on the District histology services. The results suggest high doctor/patient satisfaction rates, and support the hypothesis that minor surgery in general practice presents a practical alternative to hospital provision.
Ambulatory Surgical Procedures↗
Effects of minor surgery and endotracheal intubation on postoperative breathing patterns in patients anaesthetized with isoflurane or sevoflurane.
We studied the effects of minor surgery and endotracheal intubation on postoperative breathing patterns. We measured breathing patterns and laryngeal resistance during the periods immediately before intubation (preoperative) and immediately after extubation following minor surgery (postoperative) in eight patients anaesthetized with sevoflurane and eight patients anaesthetized with isoflurane, breathing spontaneously through a laryngeal mask airway at a constant end-tidal anaesthetic concentration (1.0 MAC). In both sevoflurane-anaesthetized and isoflurane-anaesthetized patients, expiratory time was reduced and inspiratory and expiratory laryngeal resistance increased after surgery. In sevoflurane-anaesthetized patients, occlusion pressure (P0.1) increased without changes in inspiratory time (T(I)). Occlusion pressure did not change and T(I) was greater in isoflurane-anaesthetized patients after surgery. Minor surgery may have a small but significant influence on breathing and increased laryngeal resistance following endotracheal intubation may modulate these changes. The difference in breathing pattern between sevoflurane and isoflurane may be a result of different responses of the central nervous system to different anaesthetics in the presence of increased laryngeal resistance.
Adult↗
Evaluation of minor surgery courses for general practitioners.
This paper describes the evaluation of a two-day minor surgery training course for general practitioners and vocational trainees. The course was developed by a team from a wide range of specialties. A pilot run of six of these courses was held in various locations in the United Kingdom during 1994, organized by the Royal College of General Practitioners and supported by the Department of Health. The courses were attended by 144 participants in total: 52 general practitioners and 92 vocational trainees. The evaluation addressed (a) the process of training which resulted in substantial changes being made to the original design and content of the courses; and (b) the outcome of the training in terms of knowledge, confidence and competence. A central feature of the course was the use of sophisticated simulated tissue. Participant feedback indicated that although the simulated tissue was not considered to be very realistic it substantially increased levels of confidence and competence to carry out minor surgery. Knowledge on various aspects of minor surgery increased significantly. The feedback from the evaluation was forwarded to a minor surgery working party at the Department of Health whose remit was to prepare guidelines for teaching, authorising and carrying out minor surgery in general practice.
Education, Medical, Continuing↗
Training for minor surgery in general practice during preregistration surgical posts.
OBJECTIVE: To study the teaching of minor surgery to preregistration house officers in surgery and their confidence in their skills. DESIGN: Questionnaire survey of consultants and vocational trainees. SETTING: Trent, Oxford, and East Anglian Regional Health Authorities. SUBJECTS: All consultant surgeons (n = 148) with preregistration house officers on their firm and all first year vocational trainees in general practice (n = 165). MAIN OUTCOME MEASURES: Time spent teaching minor surgery to preregistration house officers; source of teaching; trainees' confidence in their skills in 15 minor surgical procedures and degree of confidence that consultants expected their junior house officers to achieve. RESULTS: 137 (93%) consultants and 139 (84%) vocational trainees replied; 131 of the consultants' replies and all the trainees' replies were analysable. Only 14 consultants had a curriculum for teaching junior house officers, and 90 offered less than four hours' teaching a week. Only 11 trainees thought that their firm had had a curriculum, and 102 reported having received under two hours' teaching a week. The consultants indicated that they did most of the teaching, but the trainees reported having received most of their teaching from junior registrars. Seventy nine consultants attempted to teach minor surgery. They expected their junior house officers to acquire greater confidence in their skills in minor surgery than did the other consultants, but overall the confidence expected was low. The trainees were more confident than the consultants expected them to be, but overall confidence was still low. Those who had received more teaching were significantly more confident. CONCLUSIONS: The educational potential of the post of preregistration house officer in surgery seems underexploited, particularly with regard to teaching skills in minor surgery.
Attitude of Health Personnel↗
Survey of minor surgery in general practice in the west of Scotland.
Since April 1990 certain minor surgical procedures have attracted an item-of-service payment for general practitioners (GPs). A postal survey was undertaken to obtain information about minor surgery in general practice in the West of Scotland and to find out whether further postgraduate education is required in this field. From a random stratified sample of 356 GPs, 311 (87.4 per cent) responded. Practitioners on health board minor surgery lists have increased minor surgery activity since April 1990; they prefer to perform the less technically demanding and time-consuming procedures on the eligible list. It is concluded that there is scope for increasing postgraduate education in minor surgery for GPs.
Adult↗
Visual hallucinations and racing thoughts on eye closure after minor surgery.
Two hours after minor surgery under local anesthesia, a 67-year-old man developed vivid visual hallucinations that were present only when he closed his eyes. After lasting 4 hours, the hallucinations were succeeded by racing thoughts, lasting 2 hours, and then by illusionary movements of his body. The reaction was attributed to the effect of lidocaine. The case resembles one previously reported.
Aged↗
Training for minor surgery in general practice: is it adequate?
To assess training and operative practice in minor surgery a postal questionnaire was sent to all general practitioners practising in the Scottish Highlands and Western Isles in 1992. Information was requested regarding the type and adequacy of surgical training, operations performed, the desire for surgical skills training and possible methods of assessment. Seventy per cent (144/205) of general practitioners (GPs) replied to the questionnaire. Teaching in minor surgery had been received by 74% of GPs (107/144), yet 43% (62) considered their training inadequate. Although confident to suture simple wounds or excise skin lesions from the trunk, significantly fewer were confident to excise such lesions from the face (P < 0.001, 1 df, Chi square test). From 86% of GPs (124/144) who wished to attend a training course on minor surgery, 62% (77) would prefer to be taught on patients and 36% (45) on a realistic skin simulator. Assessment of technical competence by a hospital consultant was considered desirable by 56% (80/144) either on patients 40% (57), or using a skin simulator 38% (54). While most GPs receive some training in minor surgery, there is a perceived need for improved training. The use of a skin simulator may allow both the teaching and assessment of surgical competence for GPs who undertake minor surgery.
Adult↗
A review of minor surgery in general practice in the United Kingdom.
Few general practitioners in the United Kingdom do minor surgery, in contrast to their colleagues in other countries. The reasons are largely historical and relate to the structure and function of the National Health Service. This history of minor surgery describes its common occurrence before the NHS, its virtual disappearance after the NHS came about, and later revival by a few enthusiasts. The state of the art describes the wide range of surgical procedures in general surgery, orthopaedics, ear-nose-and-throat, gynaecology and ophthalmology. There are few complications, and very short waiting times in general practice minor surgery. The workload is not great. Economic studies show great saving may be made. Patients strongly prefer general practice minor surgery. In conclusion, despite many advantages, there remain major financial disadvantages for general practitioners in the United Kingdom to provide minor surgery for their patients.
Consumer Behavior↗
[Minor surgery in primary care: consumer satisfaction].
OBJECTIVE: To find the satisfaction of patients undergoing minor surgery at health centres and describe the processes. DESIGN: Retrospective study of population seeking the service. SETTING: Health district. PATIENTS: 160 people who had minor surgery during a year. MEASUREMENTS AND MAIN RESULTS: Descriptive variables of everyone who had minor surgery were analysed: age, sex, type of intervention, pre-surgical diagnosis, anatomical-pathological diagnosis and informed consent. Over three weeks the patients were interviewed by phone with use of a satisfaction questionnaire. 160 interventions took place, 80% of which were then studied histologically, with an 83.16% concordance index. 65% of patients were interviewed. 15% had no telephone, 20% were not found, 95.56% considered they were well attended and 3.17% badly attended. 92.06% would choose the health centre again for procedures of a similar nature. 89.9% thought that the explanations they had received were sufficient. 4.4% thought that the room's hygiene was poor. CONCLUSIONS: Minor surgery in primary care was favourably received by users. Activity at our centre had good anatomical-pathological concordance.
Adolescent↗
Effects of major and minor surgery on plasma glutamine and cytokine levels.
The plasma levels of glutamine and cytokines have been measured frequently in patients before, during, and after elective abdominal aortic aneurysm surgery ("major surgery") or inguinal hernia repair ("minor surgery"). The plasma glutamine level declined rapidly following major surgery and remained markedly below preoperative levels until at least 7 days after surgery. This response of the plasma glutamine levels was significantly correlated with the production of interleukin 6 but not with that of interleukin 1, tumor necrosis factor, or interferon gamma. In contrast, following minor surgery, the plasma glutamine level was unchanged and the elaboration of interleukin 6 was attenuated. The decrease in the plasma glutamine level following major surgery may contribute to the state of immunosuppression, which follows major surgery, and the relationship between amino acid and cytokine metabolism is worthy of further study.
Aged↗
General practitioners as providers of minor surgery--a success story?
BACKGROUND: It is now recognized that many minor surgical procedures can be appropriately performed in a general practitioner setting; the government has introduced a list of minor operations, for which it is prepared to pay a limited fee, and it is now time to see whether this service can be expanded. AIM: To demonstrate that a group of general practitioners (GPs) with a particular interest in minor surgery can offer an expanded service both to their own patients and also to the patients of neighbouring colleagues, whether fundholding or non-fundholding, within a health authority area. METHOD: The West Kent Health Authority awarded a contract for 500 minor operations to a group practice of five GPs. At the end of the first year, 511 operations had been performed, and the results and implications are discussed. RESULTS: The target of 500 minor operations was met and passed in the first year. Thirty-five neighbouring GPs referred their patients directly. All were offered an initial appointment within one week and had their operation performed within one month, unless they had expressed a preference for an alternative date. Several unsuspected malignancies were discovered-no complications were recorded, patients' and referring doctors' satisfaction was high and the scheme was judged to have been a success in their eyes. CONCLUSION: GPs can provide an efficient, cost-effective minor surgery service, which is popular with patients and referring colleagues. Whether this is the way we wish to organize minor surgery in the future needs further discussion.
Delivery of Health Care↗