ICAR: endoscopic skull‐base surgery

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The United Kingdom's role in North Sea demersal fisheries:A hundred year perspective

This study compiles 100 years of North Sea demersal landings, focusing on the UK, and relating them to historical events and political, technological and economical drivers that influenced demersal fisheries. In the early twentieth century, aided by technological advances, the UK, and in particular England, had unchallenged dominance in North Sea demersal fisheries. Since then, the two World Wars and other political developments have had a great impact on British fisheries. Between the 1920s and 1960s, English ports shifted their interests away from the North Sea towards highly profitable distant waters, whereas the Scottish fleet relied less on these fishing grounds. Meanwhile, especially in the 1960s, other European countries expanded their fisheries, undermining Britain's lead. In the 1970s and 1980s, Scotland benefitted from mainly fishing in the North Sea. Firstly, the assertion of 200 nautical miles Exclusive Economic Zones made the distant waters inaccessible to English fleets at a time when England's fisheries were highly dependent on them. Secondly, the relatively minor activity in the North Sea by the English compared to the Scottish fleets coincided with the establishment of the Common Fisheries Policy. This had implications when total allowable catches were first implemented because quota allocations to countries were based on their recent catches from the North Sea. Thus, after the loss of fishing opportunities in distant waters, the North Sea once more became an important fishing ground for Britain, just as in the early twentieth century, however, the emphasis of fisheries had shifted from England to Scotland

GUIDELINES FOR THE MANAGEMENT OF HAEMODYNAMICALLY STABLE PATIENTS WITH STAB WOUNDS TO THE ANTERIOR ABDOMEN

Clinical practice guidelines have been shown to improve the delivery of care. Anterior abdominal stab wounds, although uncommon, pose a challenge in both rural and urban trauma care. A multidisciplinary working party was established to assist in the development of evidence-based guidelines to answer three key clinical questions: (i) What is the ideal prehospital management of anterior abdominal stab wounds? (ii) What is the ideal management of anterior abdominal stab wounds in a rural or urban hospital without an on-call surgeon? (iii) What is the ideal emergency management of stable patients with anterior abdominal stab wounds when surgical service is available? A systematic review, using Cochrane method, was undertaken. The data were graded by level of evidence as outlined by the Australian National Health and Medical Research Council. Stable patients with anterior abdominal stab wounds should be transported to the hospital without delay. Any interventions deemed necessary in prehospital care should be undertaken en route to hospital. In rural hospitals with no on-call surgeon, local wound exploration (LWE) may be undertaken by a general practitioner if confident in this procedure. Otherwise or in the presence of obvious fascial penetration, such as evisceration, the patient should be transferred to the nearest main trauma service for further management. In urban hospitals the patient with omental or bowel evisceration or generalized peritonitis should undergo urgent exploratory laparotomy. Stable patients may be screened using LWE. Abdominal computed tomography scan and plain radiographs are not indicated. Obese and/or uncooperative patients require a general anaesthetic for laparoscopy. If there is fascial penetration on LWE or peritoneal penetration on laparoscopy, then an urgent laparotomy should be undertaken. The developed evidence-based guidelines for stable patients with anterior abdominal stab wounds may help minimize unnecessary diagnostic tests and non-therapeutic laparotomy rates