Invited Gold Medal lecture. "How not to be a surgeon!" Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Closed virtual event. 2021. The pdf file is only pictures. The original presentation has sound and video, the file is too big for ResearchGate, contact me for a DropBox Link.
In 2005-6 I was surgical senior editor of the SIGN Guidelines. This guideline was superseded by guideline 151. The recorded prevalence of angina varies greatly across UK studies. The Scottish Health Survey (2003) reports the prevalence of angina, determined by the Rose Angin questionnaire to be 5.1% and 6.7% in males aged 55-64 and 65-74 respectively. For the same age groups in women the equivalent rates were 4% and 6.8%. This compares with general practitioner (GP) record data in the British Regional Heart Study from across the UK of 9.2% and 16.2% for men in the same age groups. The average GP will see, on average, four new cases of angina each year. Practice team information submitted by Scottish general practices to Information Services Division (ISD) Scotland allows the calculation of an annual prevalence rate for Scotland (the proportion of the population who have consulted their general practice because of a definite diagnosis of angina based on ISD’s standard morbidity grouping). In the year ending March 2005 the annual prevalence rate is given as 8.3 for men and 7.6 for women per 1,000 population. This equates to an estimated number of patients seen in Scotland in that year for angina of 42,600 with 68,200 patient contacts. A diagnosis of angina can have a significant impact on the patient’s level of functioning. In one survey, angina patients scored their general health as twice as poor as those who had had a stroke. In another survey, patients had a low level of factual knowledge about their illness and poor medication adherence. A Tayside study showed that in patients with angina, symptoms are often poorly controlled, there is a high level of anxiety and depression, scope for lifestyle change and an ongoing need for frequent medical contact.
In 2005-6 I was surgical senior editor of the SIGN Guidelines. This guideline was withdrawn in 2015. Peripheral arterial disease (PAD) in the legs, sometimes known as peripheral vascular disease, is caused by atheroma (fatty deposits) in the walls of the arteries leading to insufficient blood flow to the muscles and other tissues. Patients with PAD may have symptoms but can also be asymptomatic. The commonest symptom, intermittent claudication, is characterised by leg pain and weakness brought on by walking, with disappearance of the symptoms following rest. Patients diagnosed as having PAD, including those who are asymptomatic, have an increased risk of mortality, myocardial infarction and stroke. Relative risks are two to three times that of age and sex matched groups without PAD.1,2 Management of PAD provides an opportunity for secondary prevention of cardiovascular events. Both lifestyle changes and therapeutic interventions to reduce risk need to be considered. Patients with claudication can have a significantly reduced quality of life due to their restricted mobility. Careful consideration needs to be given to drug and lifestyle management of claudication so that patients can achieve an optimum quality of life within the limitations of their condition. In the primary care setting, the methods of diagnosis and the criteria for referral to a specialist vary between general practitioners, while in secondary care the use of diagnostic investigations and the routine follow up of patients varies between specialists. These differences in clinical practice suggest that, where feasible, guidance is required on the best approach to managing patients with PAD.
In 2005-6 I was surgical senior editor of the SIGN Guidelines. This guideline was withdrawn in 2015. National Head and Neck Cancer Guideline for SIGN