References 1. National Confidential Enquiry into Patient Outcome and Death. Elective & emergency surgery in the elderly: an age old problem. 2010. London, NCEPOD, 2010. www.ncepod.org.uk/2010report3/down loads/EESE_fullReport.pdf (accessed 05/ 05/2018). 2. O’Neill BR, Batterham AM, Hollingsworth AC, et al. Do first impressions count? Frailty judged by initial clinical impression predicts medium-term mortality in vascular surgical patients. Anaesthesia 2016; 71: 684–91. 3. Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia 2014; 69(Suppl 1): 26–34. 4. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. Journal of the American College of Surgeons 2012; 215: 453–66. 5. Griffiths R, Beech F, Brown A, et al. Peri-operative care of the elderly 2014: association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2014; 69 (Suppl 1): 81–98. 6. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatrics 2008; 8: 24. 7. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal 2005; 173: 489–95. 8. Office for National Statistics. National Population Projections: 2014-based statistical bulletin. www.ons.gov.uk/peo plepopulationandcommunity (accessed 05/05/2018). 9. Culliford D, Maskell J, Judge A, et al. Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthritis Cartilage 2015; 23: 594–600.

Good communication between healthcare professionals is required to provide continuity of care for patients being discharged from the ICU [1]. It is our unit's practice to send a copy of a patient's computerized ICU discharge summary to both the hospital team with ongoing responsibility and to their general practitioner (GP). The aim of this study was to establish and compare the quality and value of the summaries as judged by ICU doctors and GPs.

The AAGBI guidelines for checking the anaesthetic machine states that ‘a clear note must be made in the patient’s anaesthetic record that the anaesthetic machine check has been performed, that appropriate monitoring is in place and functional, and that the integrity, patency and safety of the whole breathing system has been assured. There must also be a logbook kept with each anaesthetic machine to record the daily presession check and weekly check of the oxygen failure alarm' [1]. In a recent audit at the East Surrey Hospital, we noted the completion of documentation regarding the anaesthetic machine check. At our hospital a logbook is kept next to each anaesthetic machine and a space is also provided on the anaesthetic chart to document the machine check. The audit showed that the log book had been completed on 19% of occasions (August 2005-December 2005) and the anaesthetic chart had been completed on 90% of occasions (100 charts). There was also a disparity between the morning and afternoon session. In the morning, 46% of the machine checks were documented but only 6% in the afternoon. We presume the reason for the difference between logbook and anaesthetic chart is because the anaesthetic chart is ‘to hand’ and familiar to the anaesthetist. Perhaps the AAGBI should alter the guidelines to advise that documentation on the anaesthetic chart is an adequate alternative to maintaining an anaesthetic machine logbook?

Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. Faecal peritonitis was induced in pigs that were killed 8 h later and frontal cortex samples were taken immediately after death. The tissue was investigated using light and electron microscopy and compared with frontal cortex samples taken from sham-operated controls. Septic pigs had 49.5% more perimicrovessel oedema than sham pigs. However, the tight junctions between cerebral microvessel endothelial cells appeared morphologically intact in both septic and sham pigs. Sepsis also resulted in neuronal injury, disruption of astrocytic end-feet and swollen, rounded erythrocytes. These morphological changes may be sufficient to underlie the clinical features seen in septic encephalopathy.

Background and objectives: The optimal mode of treatment in spontaneous supratentorial intracerebral hemorrhage (SICH) is controversial.We assessed the value of hematoma evacuation in SICH in a case-control study.Methods: One hundred and forty-five patients with SICH without tumor or vascular abnormalities.Indication for surgery were made upon admission in 11 and after clinical deterioration in 13 patients.Assessed were age, sex.Glasgow Coma Scale (GCS), pupillary reaction on admission, localisation, etiology and hematoma volume, presence of ventricular blood, and Glasgow Outcome Scale on discharge.From further analysis patients > 80 years or with hematoma volume < 10 ml were excluded.Statistical analysis included: (i) a multiple regression model to determine prognostic factors; (ii) comparison between medical and surgical patients; (iii) matching the 24 evacuated with 24 medical patients according to those parameters retained from the regression model and additionally to other suspected factors influencing outcome; (iv) comparison between both groups to confirm comparability; and (v) testing for different outcome between the groups.Results: Prognostic factors were GCS, hematoma volume and location.All 24 evacuated patients could be matched to a medically treated patient regarding age, hematoma volume and location.GCS and pupillary reaction.Differences between both groups could not be detected.Outcome was not different between the medical and surgical group.Conclusions: Hematoma evacuation does not improve outcome in supratentorial spontaneous hemorrhages.Since mainly deteriorating patients were evacuated, the only effect of hematoma evacuation may be to stop deterioration rather than to improve overall outcome.