Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

Esophagogastroduodenoscopy can be uncomfortable and distressing with many patients opting for conscious sedation over topical local anesthetic spray. Transnasal endoscopy is an alternative and we sought to assess how easily it could be introduced to a district general hospital and how acceptable patients found it. Selected patients requiring diagnostic endoscopy were offered transnasal endoscopy with topical nasal anesthetic by clinicians new to transnasal endoscopy but competent at esophagogastroduodenoscopy. Postal feedback questionnaires were used to assess comfort, distress, recollection of periprocedural consultation, and overall experience (visual analog scale 1-10). A total of 213 transnasal endoscopy procedures were undertaken with 207 completed successfully (97.2%). Two patients (0.9%) had self-limiting epistaxis and no patient required admission. One hundred (47%) questionnaires were returned including 98 from those with completed transnasal endoscopy. Thirty-three (33%) had previous esophagogastroduodenoscopy and 28 (85%) reported a preference for transnasal endoscopy. Fifty-eight patients (59%) found transnasal endoscopy comfortable (visual analog scale >6) with 17 reporting discomfort (visual analog scale <5). Seventeen patients found the procedure distressing (visual analog scale >6) but 70 (73%) did not (visual analog scale <5). Eighty-four patients (85.7%) had clear recollection of their procedure (visual analog scale >6) and overall satisfaction was reported as good (visual analog scale >6) by 94.7%. Transnasal endoscopy can be adopted by clinicians competent with conventional esophagogastroduodenoscopy with expectation of high procedure completion rate and low complication rate. Our patients reported high levels of satisfaction with few reporting distress. Perhaps as a consequence, most patients had a clear recollection of their procedure.

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Aim Pelvic floor dysfunction (PFD) is a major health care problem predominately affecting the elderly female. It impairs quality of life and patients increasingly expect a solution. Barium defaecating proctography (BDP) is frequently used in the assessment of patients with PFD. The aim of this study was to present our findings from BDP and to look at the proportion of patients who went on to have surgery following their investigations. Methods All patients who underwent BDP in a tertiary referral center were identified retrospectively from the computerized radiology information system. Demographic data and radiologic findings were extracted. Data regarding those who had surgery were retrieved from the anonymized patient registry. Results A total of 671 patients had a BDP during the study period. The main symptoms investigated were obstructed defecation or chronic constipation (64%). Complete barium evacuation was observed in 70% of the patients, while 17% were noted to have incomplete and 13% no evacuation. A large rectocele (>5 cm) was noted in 38% while nearly 5% had frank prolapse. There was no significant association between a rectocele and any of the presenting symptoms. Seventy-eight (12%) patients went on to have operation, of which 17 (22%) had multiple procedures. Three patients ended up with a permanent stoma. Conclusion BDP contributes to decision making in patients with PFD. However, results need to be interpreted with caution and in conjunction with other tests and clinical examination to maintain a low rate of operation and reduce the risk of adverse outcomes for these patients.

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