Navigating the post-operative nose as a primary care physician.

BACKGROUND: Rhinology procedures represent a wide and diverse category of procedures, which, on the surface, can appear very similar. Thus, it is difficult to navigate postoperative presentations in the general practice setting. OBJECTIVE: This article provides a comprehensive guide to managing acute presentations that might arise in primary care settings following common rhinology surgeries. It outlines common complications, their potential aetiology and first-aid measures that might be employed to temporise patients prior to escalation. It also provides a guide as to potential red flag symptomatology, and when and how to escalate specific presentations. DISCUSSION: Most acute postoperative complications can be effectively managed, or at the very least temporised, in the community setting. When in doubt, discuss with your local otolaryngologist or nearest centre with otolaryngology cover.

Management of metastatic spinal cord compression: awareness of NICE guidance.

OBJECTIVE: The spine is the most common site for bony metastases. It can lead to the development of significant complications and morbidity if appropriate treatment is not provided. National Institute for Health and Clinical Excellence (NICE) issued new guidance in 2008 with regard to the management of patient with metastatic spinal cord compression (MSCC) to assess the awareness of the NICE guidelines for MSCC. METHODS: We contacted doctors in oncology, trauma and orthopaedics, palliative care and general medicine and assessed their knowledge of MSCC using a questionnaire based on the salient points of the NICE guidance. This was a UK-wide questionnaire. RESULTS: We contacted 96 trainee doctors (oncology, palliative care, general medicine and orthopaedics) and found that 74 % felt adequately informed to diagnose metastatic cord compression although only 11 % considered a sensory level as a potential sign of cord compression. Neurological symptoms (91 %) were the main reason for referral to a tertiary spinal service. MRI was the investigation of choice. There was a poor knowledge of metastatic scoring systems and only 8 % would consider assessing the patient's fitness for surgery. Most of the respondents felt that they had been poorly taught at undergraduate and postgraduate level on MSSC. CONCLUSION: Our audit shows that MSCC is poorly understood in general and that greater understanding of the NICE guidance is required to allow for better management of these patients and more prompt referral for appropriate surgical assessment.