Introduction Tracheostomy is a common surgical procedure used to create a secure airway in patients, now performed by a variety of specialties, with a notable rise in critical care environments. It is unclear whether this rise is seen in units with large head and neck surgery departments, and how practice in such units compares with the rest of the UK. Methods A three-year retrospective audit was carried out between anaesthetic, surgical and critical care departments. All tracheostomy procedures were recorded anonymously. Results A total of 523 tracheostomies were performed, 66% of which were in men. The mean patient age was 60 years. The majority (83%) were elective, performed for various indications, while the remaining 17% were emergency tracheostomies performed for pending airway obstruction. A fifth of the tracheostomies were percutaneous procedures. Most emergency tracheostomies (78%) were performed by otolaryngology. Three cricothyroidotomies were performed within critical care and theatres. Complications related to tracheostomy occurred in 47 cases (9%), most commonly lower respiratory tract infection. The mean time to decannulation was 12.8 days. Conclusions This paper discusses the findings of a comprehensive, multispecialty audit of tracheostomy experience in a large health board, with over 150 tracheostomies performed annually. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies. Around a quarter of those requiring tracheostomy ultimately died, mostly as a result of advanced cancer.

In The Almost Thirty Years that I have been involved in College activities the subject of workforce, its mass, density and distribution have appeared as major problems in the field of psychiatric health care. I intend to suggest today that the problem is essentially insoluble and then, paradoxically, to offer some suggestions towards finding solutions to the grossest and most obvious difficulties. Before proceeding it is probably desirable that I spend a few minutes talking about psychiatry itself, the need for these services and the current demography of the services which attempt to meet this need.

The results of a study investigating the relationship of psychiatric and cognitive disorder with strabismus and its treatment in primary school aged children are reported. Results suggest that children with strabismus have a higher prevalence of psychiatric disorder, particularly an emotional disorder or psychosis. Subjects also had an increased risk of having educational problems and of exhibiting difficulties with tasks involving visual perception. Variables related to the nature and treatment of the strabismus did not appear influential in the development of the psychiatric disorder. Family disruption was significantly associated with both the presence of strabismus and emotional and behavioural problems in the children reported by parents and teachers.

A casemix dialect based on clinical diagnosis, which describes mental health and substance abuse problems in terms which should be familiar to clinicians, has been developed. Its applications and limitations are briefly discussed.