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Does Preoperative Biliary Drainage Influence The Outcome Of Resectional Surgery For Ampullary Carcinoma?
A research article published in the World Journal of Gastroenterology addresses this question. This is believed to be the first study to investigate the effect of PBD in ampullary cancer. A team of gastroenterologists led by Dr Steven Joseph Mesenas and hepatobiliary surgeons at Singapore General Hospital divided 82 patients with ampullary cancer planned for surgical resection into those with PBD (n = 35) and those without (n = 47). The authors looked into various outcomes after surgery, such as pancreatic leakage, wound infection, bile leakage, infectious morbidity, intra-abdominal or gastrointestinal bleeding, intra-abdominal abscess, delayed gastric emptying and mortality. They found that the PBD group had a significantly reduced wound infection rate compared to the non-PBD group. More studies should be conducted to assess this benefit, especially in ampullary cancer patients.
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Family Doctors Condemn Cuts To Funding, Northern Ireland

Commenting on the publication of the results of a national patient access survey today (Tuesday, 30 June 2009) local general practitioners expressed anger that a survey which shows how well general practice is delivering care to patients has resulted in the expected loss of up to ÷£2 million of funding for local GP services. For example, one practice in Northern Ireland with a list size of over 9,000 has lost all of its funding for patient access. Despite providing both 48 hour access and offering the option for patients to book ahead, the perception of just 3% of its patients has resulted in a loss of approximately ÷£15,000 in funding for services. BMA Northern Ireland said that although it was pleased that the majority of patients are satisfied with the care they receive at their surgery (94%), it warned that the headline figures hide a gross unfairness, with surgeries losing funding based on perceptions of patients. Dr Brian Dunn, Chairman of the BMA"s Northern Ireland General Practitioners Committee, said: "GPs have always welcomed patient feedback to enable us to improve the services we offer and to continue to deliver high standards of patient care. "However, despite our repeated warnings that this survey is fundamentally flawed, the previous, more meaningful, practice-based survey was scrapped and this new survey brought in, with the results having devastating effects on some practices. "A balanced approach to making advanced or emergency appointments is offered by all practices; yet the opinion of patients over perceived access has resulted in cuts to GP service funding". Dr Dunn continued, "If there is evidence to show genuine concerns over access to family doctor services, then we need to know about it, and practices need be supported to improve access, rather than having their funding cut which will make things even more difficult. Some practices will have to choose between making staff redundant or keeping services". The BMA believes that the disparity between funding in primary and secondary care has been highlighted by this survey approach. Dr Brian Patterson, Portglenone GP and chairman of the BMA"s NI Council said, "This bizarre situation, whereby funding has been cut instead of being allocated to GP practices which need to improve access, is in direct contrast to what has happened in our hospitals. Poor access to hospital care resulted in vast sums of public money being used to address the situation and reduce waiting times, but in general practice perceived poor access has resulted in res being taken away". Dr Patterson concluded, "This is another example of the need for the Northern Ireland Minister for Health, the DHSSPS, to work with the profession to develop policies that are practical and importantly, that deliver real improvements to patients." British Medical Association Northern Ireland 16 Cromac Place Cromac Wood, Ormeau Road, Belfast BT7 2JB


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