Nurse-led ‘one stop’ clinic for elective tonsillectomy referrals

2007 ◽  
Vol 121 (4) ◽  
pp. 378-381 ◽  
Author(s):  
K Wu ◽  
E Walker ◽  
G Owen

Objectives: Balancing new referrals with limited clinic capacity is a challenge. At Lincoln County Hospital, referrals for tonsillectomy have been managed by an experienced ENT nurse practitioner, in order to deal with this problem more effectively. We reviewed tonsillectomy referrals made in a one year period to determine if surgical outcomes were satisfactory. Results were compared with figures available from the national prospective tonsillectomy audit.Methods: This was a retrospective study, assessing patients referred to the ENT department at Lincoln County Hospital. We reviewed the number of patients who had proceeded to surgery and the rate of complications.Results: One hundred and fifty-nine patients had been referred for tonsillectomy over the one year period. One hundred and forty-seven patients had been seen in clinic and 12 had not attended their clinic appointment. Following consultation with the nurse practitioner, 125 patients had proceeded to surgery. Five episodes of bleeding were recorded as complications postoperatively; giving a bleeding complication rate of 4.7 per cent, compared with a rate of 5.7 per cent from the national prospective tonsillectomy audit.Conclusion: A trained nurse practitioner can safely and effectively facilitate the complete process of managing a routine pre-operative tonsillectomy patient, from primary care referral to arranging admission for surgery.

2021 ◽  
Vol 23 (2) ◽  
pp. 155-164
Author(s):  
Vladislav E. Moiseenko ◽  
Alexander V. Pavlovsky ◽  
Dmitry A. Granov ◽  
Larisa V. Kochorova ◽  
Inna V. Dodonova ◽  
...  

Morbidity and mortality from pancreatic cancer is an urgent medical and social problem. Evaluation of statistical indicators in dynamics makes it possible to identify organizational and clinical problems in providing care to patients with malignant neoplasms of the pancreas. Medical and statistical indicators of incidence of malignant pancreatic neoplasms in St. Petersburg residents are evaluated. The assessment of medical and statistical indicators of the incidence of malignant neoplasms of the pancreas in residents of St. Petersburg. Statistical data were studied for the period from 2014 to 2019. The increase in the "rough" indicator of primary morbidity changed from 417.99 per 100 thousand population in 2014 to 505.6 in 2019. In the structure of primary cancer incidence, the indicator of active detection of pancreatic cancer glands in 2014 amounted to 3.6%, in 2019 3.8%. The proportion of patients with diagnoses confirmed morphologically increased from 48.9% to 61.4%. The proportion of patients with newly diagnosed stage IV of the disease changed from 39.5% in 2014 to 51.4% in 2019, and in patients with stage III in 2019 it was 33.3% (a decrease in comparison with 2014 15.3%). In 2019, the disease was diagnosed at stage II in 15.2% of patients. The proportion of patients with stage I in 2019 was 6.6%, this indicator in 2014 was registered at the level of 19.2%. From 2014 to 2019, the one-year mortality rate did not change and amounted to 67.9 and 67.4%, respectively (the decrease was 0.7%). Over the past 5 years, there has been no significant downward trend in the "rough" incidence and mortality rates from pancreatic cancer. However, in the dynamics, there was an increase in the number of patients registered for 5 or more years, and an increase in the accumulation index of the contingent of patients with pancreatic cancer.


2009 ◽  
Vol 76 (2) ◽  
pp. 87-89 ◽  
Author(s):  
C. Giberti ◽  
M. Schenone ◽  
P. Cortese ◽  
F. Gallo ◽  
E Gastaldi ◽  
...  

The RALP is the most modern technology available for the treatment of intracapsular prostate cancer (CaP), which can produce a shorter learning curve and better results than the traditional techniques. Methods Between March 2005 and March 2008, 90 patients (64.3 ys, range 52–71) with intracapsular CaP underwent RALP at our institute. Before surgery the patients underwent routine examinations and filled in IIEF, IPSS and EORTC-QLQC30/PR 25 questionnaires. Patients were followed up with PSA assay, physical examination and compilation of the questionnaires. Median follow-up was 12.5 months (range 1–35 months). Results Mean operative time was 230 min. Discharge and catheter removal were at day 7.4 and 8.2, respectively, after surgery. Pathological staging reported pT2 and pT3 in 57 (63%) and 33 patients (37%), respectively. Positive surgical margins were assessed in 30 patients (33%), particularly 8.7% in pT2 tumors. The one-year biochemical disease-free survival rate was 90%. Regarding the functional results, 81 patients (90%) were perfectly continent while a mild and a moderate incontinence were reported in 7 (8%) and 2 (2%) patients, respectively. Mean IPSS score decreased from 8 to 4; among the patients who underwent bilateral nerve sparing RALP and no adjuvant therapy, 31 (70.4%) reported satisfactory sexual intercourses. Concerning postoperative quality of life, mean EORTC-QLQC30/PR 25 questionnaires scores were very similar before and after RALP. Conclusions After 90 cases of RALP the oncological and functional results are definitely promising. However, a wider number of patients and a greater follow-up are needed to confirm these data particularly as regards the functional results.


2020 ◽  
Vol 66 (4) ◽  
pp. 364-369
Author(s):  
Vladislav Petkau ◽  
V. Breder ◽  
E. Bessonova ◽  
A. Tarkhanov

HCC epidemiologic data in Sverdlovsk region are presented in current issue. 1293 of new cases of HCC were diagnosed since 2015 till 2019. The incidence rate of HCC in 2019 was 6,53 cases per 100000 people and standardized incidence ratio was 3,48 per 100000 people. The maximum of new cases was among the people older than 70 years. HCC developed in cirrhotic liver in 70,2% of cases. The main risk factors were virus hepatitis (49,6%), regular alcohol consumption (23%) and obesity (9,9%). The post-mortem diagnosis exceeds 40% of cases. The one-year mortality was 72-73%. The number of patients with HCC sent to the regional oncology dispensary increased in the last 5 years in 5 times. There were 124 of such patients in 2019. The majority has HCC at BCLC D stage (56,5%). Only 16,7% of patients received specialized treatment. The introduction of multidisciplinary team led to a doubling of annual number of treated patients with HCC.


2018 ◽  
Vol 6 (7) ◽  
pp. 341-347
Author(s):  
Uğurkan Erkayıran ◽  
Bülent Köstü ◽  
Alev Özer ◽  
Abdullah Tok ◽  
Selim Karaküçük

Background: Medroxyprogesterone acetate (MPA) and levonorgestrel intrauterine device (LNG-IUD) are two drugs used to treat abnormal uterine bleeding in women with myoma. We organized this study to compare the effectiveness of these two treatments. Methods: This was a retrospective one-year-long cohort study of 95 women with uterine leimyoma. Fifty three women who had received LNG-IUD formed the LNG-IUD group while 42 women who received regular intramuscular injections of 150 mg MPA at every 3 months for one-year period made up the MPA group. Both groups were compared in aspect of demographic, clinical and biochemical characteristics. Results: At the end of one year, the LNG-IUD group had significantly smaller fibroid size, lower visual analogus scale score for pelvic pain, for dysmenorrhea and dyspareunia than the MPA group. There were a significant reduction in the number of patients with menorrhagia and a significant increase in serum hemoglobine levels both in  LNG-IUD and MPA groups at the end of the one-year long study period. Conclusions: LNG-IUD appears as a good choice for the reduction in fibroid size and associated pelvic pain.


Author(s):  
Geetha K. Gopalakrishnan ◽  
V. Bindu ◽  
Najeeba Riyaz

<p class="abstract"><strong>Background:</strong> Vesiculobullous diseases are mostly immune mediated and diagnosed based on the clinical features, histology and Immunofluorescence. The aim of the study was to identify the immunofluorescence pattern in auto immune vesiculobullous diseases and correlate it with the clinical profile and histology.</p><p class="abstract"><strong>Methods:</strong> Patients attending the dermatology outpatient department in a tertiary hospital with vesiculobullous diseases, suggestive of auto immune aetiology were evaluated clinically. Histopathology and direct immuno-fluorescence were done in all patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the one year period from June 2008 to July 2009, 40 patients with vesiculobullous disorders clinically suggestive of auto immune aetiology attended the outpatient department. Out of the 40 patients, 22 (55%) patients were diagnosed to have intraepidermal with female preponderance and 18 patients (45%) sub epidermal blistering diseases. Bullous pemphigoid was the commonest sub epidermal disease, seen in 8 patients.</p><p class="abstract"><strong>Conclusions:</strong> In all cases diagnosed clinically as pemphigus a histological diagnosis of pemphigus was made (100%). The clinical variants of pemphigus could also be diagnosed in all cases histologically (100%). The positive and negative predictive value was 100% in pemphigus group cases. Histology of all patients showed subepidermal bulla (100%). A specific diagnosis could be made in 18 patients with sub epidermal disease (100%). DIF was found to be an invaluable tool in diagnosing different diseases belonging to the sub epidermal group, but it was not of much help in sub classifying variants of pemphigus.</p><p class="abstract"> </p>


2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Jonathan Wheeler

Objective: This article attempts to understand the number of complications arising in patients returning to New Zealand from cosmetic surgery tourism destinations with reference to the number of patients with complications from cosmetic surgery undertaken in New Zealand. Methods: Data were requested under the New Zealand Official Information Act 1982 from the Accident Compensation Corporation (ACC) regarding the number of claims for treatment injury following cosmetic surgery undertaken both in New Zealand and overseas for the period 1 July 2014 to 30 June 2019. Also, a prospective audit was conducted of patients admitted to Middlemore Hospital over the one-year period March 2018 to March 2019 for complications arising as a result of cosmetic surgery tourism.  Results: A total of 1048 claims were made to the ACC for treatment injuries arising from cosmetic surgery in New Zealand and from overseas treatment over the five-year period to 30 June 2019. Of these, 738 were accepted by the ACC, with the leading three events being breast reduction/reconstruction, breast implant/augmentation and septorhinoplasty. Bariatric surgery, vein treatment/sclerotherapy, orthodontics and isolated septoplasties were excluded by the ACC as not being ‘cosmetic surgery’. The ACC valued the total cost of treatment of these accepted claims at NZ$6.3 million dollars.  Conclusion: Data outlining the complications arising from cosmetic surgery in New Zealand and overseas indicate a concerning burden of care required for patients who have had cosmetic surgery overseas.


2019 ◽  
pp. 37-42
Author(s):  
Talgat Tajibaev ◽  
Bolatbek Baimakhanov ◽  
Ulugbek Medeubekov ◽  
Shokan Kaniev ◽  
Bekzhan Issamatov

Hepatocellular carcinoma is the most common primary tumor pathology of the liver (> 85%), an aggressive course with an unfavorable prognosis. Objective: To analyze the results of transarterial chemoembolization in the intermediate stage of hepatocellular carcinoma. Materials and methods: The study was conducted on the basis of the JSC “National Scientific Center of Surgery” named after A.N. Syzganov in the period 2013-2018. Statistical calculations were performed using Excel, SPSS Statistics by estimating the survival rate using the Kaplan-Meier method. Results: The study included 58 patients with HCC in the B stage of BCLC. The average age of the patients was 60.4 years. The follow-up period was 6–64 months. In 42 patients, the test results for viral hepatitis were positive. 58 patients underwent 103 TACE interventions. After chemoembolization, 8 patients subsequently underwent surgery (liver resection). The one-year survival after TACE in the total cohort was 42%, 2-year - 15% and 3-year - 5%, respectively. In patients older than 60 and 70 years, the 3-year and 5-year survival rates were 0%, the one-year survival rate of the subjects studied in the group over 70 years old was 14.3%. The survival rate among patients in stage B on the Chile-Pugh scale was significantly lower to patients in stage A (82% versus 56% for 6 months and 50% versus 31% for the year, respectively). Statistically significant differences were found in the group with a substantial increase in AFP (> 1000 IU / ml), the Kaplan-Meier survival curve showed a survival rate of 0% after 18 months since the first TACE. Six months after TACE contrast enhanced CT was performed on 36 patients, of which 15 patients showed positive dynamics, in the form of a reduction in size or transformation of the formation, in 6 patients a negative dynamics in the form of an increase in the size of the formation. Conclusion: Despite the small number of patients studied, TACE showed good results in the intermediate stage of HCC. Elderly and senile age, a high degree of liver dysfunction, as well as high AFP values are additional factors that dramatically reduce the life expectancy of patients after TACE with HCC in stage B-BCLC.


PEDIATRICS ◽  
1953 ◽  
Vol 12 (1) ◽  
pp. 38-55

Two combinations of drugs were compared in a cooperative study of 32 children with acute hematogenous miliary tuberculosis treated at seven different pediatric centers under a common protocol. Eighteen children were given intramuscular streptomycin with oral para-aminosalicylic acid and promizole®; 14 children were given streptomycin and para-aminosalicylic acid without promizole®. A one year follow-up of this small group showed no significant differences in the results due to the use of promizole®. However, 5 of 10 children treated initially with a streptomycin dose of 20 mg./kg. intramuscularly twice a day were either dead or had developed meningitis, while only 2 of 22 children treated with a 50 mg. dose died, one of these having developed meningitis. Twenty-six of the original 32 patients were alive 12 months after the start of treatment. Relapse of miliary disease was not encountered during the first year of this study. The optimum duration of treatment is still uncertain. The combination of para-aminosalicylic acid with streptomycin may be assumed to delay the emergence of streptomycin-resistant organisms in miliary and meningeal diseases just as it does in pulmonary tuberculosis. Thus, a six month or even one year course of streptomycin can now be considered feasible. Although some patients may have been treated longer than necessary, the observation that three patients developed meningitis at 110, 125 and 130 days of study suggests that treatment should be relatively long. A child who survives miliary tuberculosis only to develop tuberculous meningitis has received little real benefit from therapy. As the over-all mortality in miliary tuberculosis is lowered, the prevention of meningitis in the survivors becomes an increasingly important goal. Disturbing side effects of promizole® therapy were less frequent among the patients reported here than among other reported groups. The daily dose, however, was small in comparison with the amounts recommended by Lincoln. Ninety-three children with tuberculous meningitis, 23 of whom also had miliary tuberculosis, were observed for a period of one year while under treatment with a combination of tuberculostatic agents. Half the patients were given intramuscular streptomycin, intrathecal streptomycin, and para-aminosalicylic acid and promizole® by mouth. The remainder received an identical regimen except that promizole® was omitted. Forty-two patients (45%) survived the first year; 24 of these had no serious sequelae from the disease. No differences were noted in the course of the disease among those who received promizole® and those who did not, and the one year survival rates in the two groups were practically identical. Revision of the streptomycin dosage, which took place after the study had been in progress seven months, produced results which appear to justify the change. An intramuscular streptomycin dose of 50 mg./kg. twice daily to a maximum of 1.5 gm. twice daily was apparently more effective than 20 mg./kg. twice daily. Lincoln whose results in childhood meningitis are the most successful yet reported and the British Medical Research Council both depend on a regimen which includes intrathecal streptomycin. The investigators in this study favor its use and had no unusual difficulty with it. Relapse occurred in eight children, all of whom survived the first year. A poorer prognosis was noted in infants, in nonwhites, and in patients with miliary tuberculosis. The most common toxic effects were due to streptomycin, which caused vestibular damage in a large number of patients, but the capacity of children to compensate for this dysfunction is so great that this risk is minor in the face of the otherwise hopeless outcome. Streptomycin may have been partially responsible for marked hearing loss in six. Para-aminosalicylic acid and promizole® act less rapidly than streptomycin. They are easily administered and rarely produce significant toxicity even when given over extended periods. They appear to reinforce the effect of streptomycin, and para-aminosalicylic acid at least postpones the emergence of streptomycin resistance. Their use appears to decrease the likelihood of relapse. Finally, their daily use at home maintains the patient's awareness that he requires prolonged medical supervision and brings him back for examination when his drug supply needs replenishing. The use of these drugs with streptomycin in tuberculous meningitis is recommended.


1998 ◽  
Vol 91 (10) ◽  
pp. 524-527 ◽  
Author(s):  
M D Rutter ◽  
A F Michie ◽  
P N Trewby

The most sensitive investigative tool for the upper gastrointestinal tract is endoscopy, and many gastroenterologists offer an open-access endoscopy service to general practitioners. However, for patients with dyspepsia, endoscopy is not always the most appropriate initial investigation, and the one-stop dyspepsia clinic allows for different approaches. We have audited, over one year, the management and outcomes of patients attending a one-stop dyspepsia clinic. All patients seen in the clinic were included, and for those not endoscoped the notes were reviewed one year after the end of the study to check for reattendances and diagnoses originally missed. Patients' and general practitioners' views of the service were assessed by questionnaire. 485 patients were seen, of whom 301 (62%) were endoscoped at first attendance. In 66 patients (14%), endoscopy was deemed inappropriate and only one of these returned subsequently for endoscopy. 118 patients (24%) were symptom-free when seen in the clinic and were asked to telephone for an appointment if and when symptoms recurred; half of these returned and were endoscoped. Oesophagitis and duodenal ulcer were significantly more common in this ‘telephone endoscopy' group than in those endoscoped straight from the clinic. Overall, 25% of patients referred were not endoscoped. Important additional diagnoses were made from the clinic consultation. General practitioners and patients valued the system, in particular the telephone endoscopy service. 84% of general practitioners said they would prefer the one-stop dyspepsia clinic to open-access endoscopy.


Knygotyra ◽  
2019 ◽  
Vol 72 ◽  
pp. 62-89 ◽  
Author(s):  
Alma Braziūnienė

Based on the initiative of Duke Nicolaus Christophorus Radziwill the Orphan (1549–1616), Great Marshal of Lithuania (1579–1586) and Voivode of Vilnius (1604–1616), a map of the Grand Duchy of Lithuania, titled Magni Ducatus Lithuaniae caeterumque regionum illi adiaciencium exacta descriptio…, was printed in 1613 in the printing house of Willem Janszoon (Blaeu), which was famous at that time for the manufacture of globes and wall maps. It was drawn by Hessel Gerritsz (Lat. Gerardus) and prepared by a team of professionals gathered by N. Ch. Radziwill. The written part of the map (which addresses the reader), separately published also in 1613, glued together from three pages, and designated to the buyers of the wall map of the GDL, was prepared by the famous GDL painter Tomasz Makowski (1575–1630). From 1613 to 1631, this map of the GDL functioned only as a wall map. When W. Blaeu began to publish atlases as well, he included the 1613 wall map of the GDL, which was pressed from four copper plates and included a narrow ornamental edging, in his atlas Appendix Theatri A.Ortelii et Atlantis G. Mercatoris. The readers of the atlas could not observe the territory of the GDL in its entirety, as it was depicted in four pages. Thus, already in another edition of the atlas that was published during the same year of 1631, the map of the GDL was changed and its copper plates were reordered: the segment depicting the lower part of the Dnieper was cut away, and the whole ornamental edging of the map was discarded. Two maps then took shape: one of the GDL’s territory, glued together from four disproportionate plates, and one depicting the lower part of the Dnieper, glued together from two plates. Such a large map of the GDL’s territory (73 × 75 cm) was collapsible and would be included in Blaeu’s atlases near a written piece on Lithuania in the editions of 1631, 1634–1649, and even in one that was published in c. 1670. This map, unconventional for usage in atlases (as it was not bound), was replaced in 1649 by another map made on the basis of the original 1613 variant by W. Blaeu’s son, Joan. This particular specimen was a smaller-scale version of the GDL’s map and was oriented toward the west, not the north. However, as Blaeu’s printing house began to include the 1613 map of the GDL in its atlases, this does not mean that it had also stopped publishing it as a wall map – the buyer could have it made in the same printing shop and purchase, for example, a wide ornamental edging as a supplement to their order (e.g., the specimen belonging to the Uppsala University Library). Only two copies of this 1613 wall map of the GDL are extant, and these can be found in the Uppsala University Library and the Herzogin Anna Amalia Library in Weimar. These specimens are unique in that they allow us to see how an authentic 1613 wall map of the GDL looks like, together with T. Makowski’s text about Lithuania, also marked by a 1613 date. Knowing the history of how the copper plates of this map were used, we may state that the Weimar copy is of earlier origin than the one housed in Uppsala (at least by one year within the 1631 period). This article examines the 1613 map of the GDL from the perspective of book science – we provide an analysis of the publications devoted to the 1613 map of the GDL based on the aspect of how it was published. An all-encompassing historiographical study of the 1613 GDL map is not the goal of the present paper. By chronologically analyzing the works of Lithuanian and foreign authors in an historiographical retrospective, it is emphasized how the various authors writing about this map chose to consider its bibliographical information, how did the perspective regarding the structure of this map shift, etc. An historiographical analysis of the publications on the 1613 map of the GDL has demonstrated that the formal aspects of the map’s origins (what kind of copper plates were prepared for the wall map, of what structure was the map used by William Janszoon Blaeu in the atlases of his printing house and how exactly was it used, etc.) are important in attempting to discern how its functioning had developed over the years.


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