Does the introduction of a formal neutropenic sepsis protocol improve therapeutic radiographer confidence and competence at recognising sepsis within the radiotherapy department?

2021 ◽  
pp. 1-7
Author(s):  
Adam Clayton ◽  
Siân Griffiths ◽  
Philippa Gilbert
Keyword(s):  
Clinical Observation ◽  
Early Warning Score ◽  
Formal Training ◽  
Online Questionnaire ◽  
Training Package ◽  
Neutropenic Sepsis ◽  
Number Of Patients ◽  
Radiotherapy Department ◽  
Disease Site ◽  
Assessment And Monitoring

Abstract Aim: The aim of this service review was to review whether implementing a formal training package increased therapeutic radiographer confidence and competence in recognising neutropenic sepsis in radiotherapy patients. In addition, authors also investigated whether the introduction of a weekly National Early Warning Score (NEWS) protocol had been successful in identifying cases of neutropenic sepsis. Material and Methods: Therapeutic radiographer (n = 13) views on the new protocol were collected through an online questionnaire. A review of the clinical observation sheets of patients who received chemo-radiotherapy (n = 49) between 18 April 2019 and 31 October 2019 was undertaken. Information on disease site, NEWS scores, number of patients who had become neutropenic and action taken by therapeutic radiographers was collected. Results: The majority of respondents to the questionnaire found that training benefitted both professionals and patients. Some challenges were highlighted relating to increased workload. For patients receiving regular observations, NEWS scores ranged from 0 to 4. When a patient scored on NEWS, the most common score was 1 across all treatment sites except cervix. Findings: Implementing a neutropenic sepsis protocol appears to be beneficial to therapeutic radiographers as professionals, increasing their confidence in patient assessment and monitoring. Regular observations may help to identify deteriorating patients alongside clinical judgement and symptom reviews.

Clinical case of periostitis in pregnant women complicated by sepsis

2020 ◽  
pp. 61-63
Author(s):  
S. Sh. Kakvaeva ◽  
M. A. Magomedova ◽  
A. N. Dzhalilova
Keyword(s):  
Pregnant Woman ◽  
Multiple Organ Failure ◽  
Pregnant Women ◽  
Organ Failure ◽  
Clinical Case ◽  
Clinical Observation ◽  
Infectious Agent ◽  
Modern Medicine ◽  
Multiple Organ ◽  
Number Of Patients

One of the most serious problems of modern medicine is sepsis. The number of patients undergoing this complication is 20–30 million (WHO) annually and has no tendency to decrease. Sepsis is characterized by severe multiple organ failure due to a violation of the response of the macroorganism to an infectious agent. Moreover, it is dangerous with high mortality. Sepsis often develops in patients with immunodeficiency conditions, which primarily include pregnant women. The article presents a clinical observation of a case of periostitis in a pregnant woman complicated by a septic state.

scholarly journals Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital

2020 ◽  
Vol 102 (6) ◽  
pp. 457-462 ◽  
Author(s):  
R Patel ◽  
AJ Hainsworth ◽  
K Devlin ◽  
JH Patel ◽  
A Karim
Keyword(s):  
Teaching Hospital ◽  
General Surgery ◽  
Trauma Centre ◽  
Early Warning Score ◽  
Emergency General Surgery ◽  
Number Of Patients ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. Materials and methods This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. Results A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). Conclusion Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.

scholarly journals Severe idiopathic pulmonary fibrosis: what can be done?

2017 ◽  
Vol 26 (145) ◽  
pp. 170047 ◽  
Author(s):  
Antonella Caminati ◽  
Roberto Cassandro ◽  
Olga Torre ◽  
Sergio Harari
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Clinical Observation ◽  
Anxiety And Depression ◽  
Neoplastic Disease ◽  
Therapeutic Approaches ◽  
Slow Disease Progression ◽  
Open Label ◽  
Number Of Patients

Idiopathic pulmonary fibrosis (IPF) remains a challenging disease to manage. Two drugs are now available that can slow disease progression in patients with mild-to-moderate IPF. This means that early diagnosis is mandatory, because there are no proven effective therapies for severe IPF. This lack of proven therapies may be at least partially due to the fact that severe IPF patients are usually not enrolled in randomised, prospective, multicentre, international trials. Clinical observation experiences and preliminary results of long-term, open-label extensions of clinical trials suggest that both pirfenidone and nintedanib may also slow or decrease progression in patients with severe IPF. However, data are sparse and obtained from a relatively small number of patients. Lung transplantation should be taken into account early and discussed with patients, when indicated. Rehabilitative strategies are important and effective supportive therapies. The needs of patients with severe IPF are similar to those of patients with an advanced neoplastic disease. Palliative care and psychological support play an important role in the relief of symptoms of anxiety and depression. Accordingly, these therapeutic approaches should start early in IPF patients.

Distress, Stress and Solidarity in Palliative Care

1993 ◽  
Vol 27 (1) ◽  
pp. 5-15 ◽  
Author(s):  
Johanne De Montigny
Keyword(s):  
Palliative Care ◽  
Clinical Observation ◽  
Terminally Ill ◽  
The Other ◽  
Terminal Cancer ◽  
Physical Energy ◽  
Number Of Patients ◽  
The Family ◽  
Good Number

What does the stoic, silent expression of the terminal cancer patient signify? Clinical observation suggests that this emotional silence is often a physical energy-saving device, essential for survival to the very last breath. Caregivers and survivors may also experience a variety of contradictory and inexpressible emotions in silence. The role of the psychologist on the palliative care unit is to be there for the terminally-ill, as well as for the family/friends, both during the dying and bereavement, and for the caregiver team. This article focuses on the work of decoding ordinary words which for a good number of patients hide a painful past. It also stresses the necessity to remain open to the unexpected and to allow and trust the other to live what happens since there is a constant and unconscious effort to fill the void.

scholarly journals Is Host Metabolism the Missing Link to Improving Cancer Outcomes?

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2338
Author(s):  
Christopher M. Wright ◽  
Anuradha A. Shastri ◽  
Emily Bongiorno ◽  
Ajay Palagani ◽  
Ulrich Rodeck ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Tumor Cells ◽  
Treatment Options ◽  
Detailed Knowledge ◽  
Pharmacological Agents ◽  
Molecular Alterations ◽  
Number Of Patients ◽  
Disease Site ◽  
New Treatment ◽  
The Impact

For the past 100 years, oncologists have relentlessly pursued the destruction of tumor cells by surgical, chemotherapeutic or radiation oncological means. Consistent with this focus, treatment plans are typically based on key characteristics of the tumor itself such as disease site, histology and staging based on local, regional and systemic dissemination. Precision medicine is similarly built on the premise that detailed knowledge of molecular alterations of tumor cells themselves enables better and more effective tumor cell destruction. Recently, host factors within the tumor microenvironment including the vasculature and immune systems have been recognized as modifiers of disease progression and are being targeted for therapeutic gain. In this review, we argue that—to optimize the impact of old and new treatment options—we need to take account of an epidemic that occurs independently of—but has major impact on—the development and treatment of malignant diseases. This is the rapidly increasing number of patients with excess weight and its’ attendant metabolic consequences, commonly described as metabolic syndrome. It is well established that patients with altered metabolism manifesting as obesity, metabolic syndrome and chronic inflammation have an increased incidence of cancer. Here, we focus on evidence that these patients also respond differently to cancer therapy including radiation and provide a perspective how exercise, diet or pharmacological agents may be harnessed to improve therapeutic responses in this patient population.

scholarly journals Attending Physician Perceptions of the Benefits and Disadvantages of Teaching Medical Students on Clinical Clerkships at a Regional Medical Campus

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
William Cathcart-Rake
Keyword(s):  
Job Satisfaction ◽  
Medical Students ◽  
Underserved Populations ◽  
Online Questionnaire ◽  
Healthcare Needs ◽  
Number Of Patients ◽  
Regional Medical ◽  
Attending Physicians ◽  
The Impact ◽  
Clinic Hospital

BACKGROUND: North American medical schools are now creating regional medical campuses (RMCs) to train more physicians to meet the healthcare needs of rural and underserved populations. Part-time and volunteer faculty must be recruited and retained to teach medical students engaged in clinical experiences at these RMCs. Physician educators report being positively motivated by the presence of medical students but also report increased time constraints. There is a paucity of information regarding the impact on attending physicians of teaching medical students at RMCs. The aim of this study was to investigate the benefits and disadvantages for attending physicians at a rural regional medical campus on having medical students on their services during clinical rotations. METHODS: An online questionnaire was sent to 62 Kansas University School of Medicine-Salina (KUSM-S) clinical faculty members that supervised third and/or fourth year medical students in clinics and/or the hospital. Physicians were queried as to the benefits and disadvantages of supervising medical students. RESULTS: Thirty-six physicians completed the survey, yielding a response rate of 58%. The majority of respondents felt positively about having medical students on their service: 92% of respondents enjoyed having medical students in clinic/hospital, 81% agreed that having a medical student working with them was personally beneficial, and 72% agreed that the presence of medical students increased their job satisfaction. Fifty-six percent of respondents reported that having medical students with them in the clinic/hospital decreased the number of patients they were able to see and that additional incentive would encourage them to remain a teaching faculty member. CONCLUSIONS: Attending physicians at KUSM-S report that they enjoy having medical students on their service and that it increases job satisfaction; however, teaching medical students is time consuming and may decrease productivity. Adequate financial compensation for physician teachers at RMCs may be necessary to ensure successful delivery of the educational product.

Impact of COVID-19 Pandemic on Ophthalmology Trainees in Southern India - A Prospective Observational Study

2021 ◽  
Vol 8 (22) ◽  
pp. 1786-1791
Author(s):  
Chethana Warad ◽  
Arvind Tenagi ◽  
Arya Wakankar ◽  
Pranitha Satarasi ◽  
Umesh Harakuni ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Elective Surgery ◽  
Psychological Impact ◽  
High Stress ◽  
Severe Depression ◽  
Online Questionnaire ◽  
Number Of Patients ◽  
The Government ◽  
The Impact

BACKGROUND COVID-19, caused by a new strain of corona virus 2019-nCoV led to a global pandemic after first manifesting in humans in December 2019 in Wuhan, China. The government of India ordered a nationwide lockdown for 21 days, which was then extended. Hence, ophthalmology, being a branch which largely deals with elective surgeries, was majorly affected. We need to evaluate the impact of the COVID-19 crisis on ophthalmology trainees during pandemic in India. METHODS A prospective, observational study in which an online questionnaire (on Google forms) was circulated between 9 th September and 15th September 2020 among ophthalmologists in training. RESULTS 260 of the 550 training ophthalmologists who were approached responded. They were given 31 questions to answer. The average age of the respondents was 27.39 ± 1.92 years of which 72.69 % (189 / 260) were females. 68.08 % (177 / 260) of the respondents had been posted on COVID-19 related duties. 76.5 % (198 / 260) of the respondents agreed that the outpatient load had dropped to < 50 patients per day and 100 % (260 / 260) of the respondents stated that there had been a reduction in number of patients posted for elective surgery. As a result, 64.23 % (167 / 260) responded that it had led to a loss of interest in their daily activities. 74.23 % reported different levels of stress, 73.46 % reported anxiety and some 24.23 % even experienced sleep deprivation. CONCLUSIONS This study has demonstrated that majority of the training ophthalmologists were affected psychologically during the COVID-19 pandemic to varying degrees which included both groups of training ophthalmologists who did or did not perform any COVID related duties. The study therefore has highlighted the increased need for psychologists to identify and help these individuals who may suffer from severe depression, insomnia and high stress levels and provide the necessary help. KEYWORDS COVID-19, Pandemic, Psychological Impact, Ophthalmology Trainees

scholarly journals Practice Variation in the Management of First Trimester Miscarriage in The Netherlands: A Nationwide Survey

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Marianne A. C. Verschoor ◽  
Marike Lemmers ◽  
Malu Z. Wekker ◽  
Judith A. F. Huirne ◽  
Mariëtte Goddijn ◽  
...  
Keyword(s):  
The Netherlands ◽  
Expectant Management ◽  
Nationwide Survey ◽  
First Trimester ◽  
Practice Variation ◽  
Teaching Hospitals ◽  
Online Questionnaire ◽  
Academic Hospitals ◽  
Number Of Patients ◽  
First Choice

Objectives. To survey practice variation in the management of first trimester miscarriage in The Netherlands.Methods. We sent an online questionnaire to gynecologists in eight academic, 37 nonacademic teaching, and 47 nonteaching hospitals. Main outcome measures were availability of a local protocol; estimated number of patients treated with curettage, misoprostol, or expectant management; misoprostol regimen; and estimated number of curettages performed after initial misoprostol treatment. Outcomes were compared to the results of a previous nationwide survey.Results. The response rate was 100%. A miscarriage protocol was present in all academic hospitals, 68% of nonacademic teaching hospitals, and 38% of nonteaching hospitals (P=0.008). Misoprostol was first-choice treatment for 41% of patients in academic hospitals versus 34% and 27% in teaching-and nonteaching hospitals (P=0.045). There were 23 different misoprostol regimens. Curettage was first-choice treatment in 29% of patients in academic hospitals versus 46% and 50% in nonacademic teaching or nonteaching hospitals (P=0.007). In 30% of patients, initial misoprostol treatment was followed by curettage.Conclusions. Although the percentage of gynaecologists who are aware of the availability of misoprostol for miscarriage treatment has doubled to almost 100% since 2005, practice variation is still large. This practice variation underlines the need for a national guideline.

Disseminated lung damage with non-tuberculous mycobacteriosis (lady Windermere syndrome)

MedAlliance ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 75-79
Keyword(s):  
Clinical Picture ◽  
Clinical Observation ◽  
Middle Lobe ◽  
Lung Damage ◽  
Timely Manner ◽  
Close Attention ◽  
X Ray ◽  
Number Of Patients

Currently, close attention to mycobacteriosis is due to an increase in the number of patients with a confirmed diagnosis of bacteriological studies. Objective. Demonstration of literature data and clinical observation of a bronchiectasis disseminated form of non-tuberculous mycobacteriosis, which allows predicting the identification of a culture of pathogens of the MAC complex. Results. The literature data and clinical observation of a 56-year-old woman with a bronchiectatic form of non-tuberculous mycobacteriosis (Lady Windermere syndrome) are presented. Conclusion. Despite the fact that in most cases the X-ray and clinical picture of non-tuberculous mycobacteriosis is nonspecific, there are clinical and radiological syndromes highly specific for non-tuberculous mycobacteriosis. An isolated lesion of the middle lobe and reed segments and a combination of multiple foci and bronchiectasis (Lady Windermere syndrome) require the mycobacteriosis caused by representatives of the MAC complex to be suspected and the etiological verification of the process to be carried out in a timely manner.

Palliative chemotherapy during the last month of life.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20662-e20662
Author(s):  
Vladimir Andelkovic
Keyword(s):  
Targeted Therapy ◽  
Cause Of Death ◽  
Palliative Chemotherapy ◽  
Oral Treatment ◽  
Medical Futility ◽  
Curative Intent ◽  
Neutropenic Sepsis ◽  
Number Of Patients ◽  
Cytotoxic Treatment ◽  
Treatment Intent

e20662 Background: There is no uniform definition of medical futility, but most accept treatments offering no reasonable chance of benefiting patients will fall into this category. According to literature, chemotherapy given in the last month of life has little or no benefit to patients. Various studies suggest 9-43% of patients receive palliative chemotherapy during the last month of life. Methods: Retrospective analysis was done on electronic medical records of patients who received systemic anti cancer therapy (SACT) - cytotoxic and/or targeted therapy for solid or haematological malignancies at The Gold Coast hospital within one year period. Patients that died within 30 days of SACT administration were further classified based on their diagnosis, treatment intent, type of treatment and cause of death. Results: 770 patients received SACT between 1 November 2011 and 31 October 2012. 53 deaths (6.9%) occurred within 30 days of receiving SACT. 35 (66%) of those were due to progression of disease and 6 (11.3%) were treatment related. All treatment related deaths were due to neutropenic sepsis. For 12 deaths (22.7%), there was insufficient documentation to establish the cause of death. Only one patient with acute myeloid leukaemia (1.9%) died as a result of treatment given with curative intent. 20 patients (37.7%) were on combination treatment while 33 (62.3%) were treated with single agents. 42 patients (79.2%) received treatment that included intravenous agents, while remaining 11 patients (20.8%) were on oral treatment only. 37 patients (69.8%) were on cytotoxic treatment, 12 (22.6%) patients were on targeted therapy, and remaining 4 (7.6%) were on a combination protocol. Conclusions: Results of this audit show a lower number of patients who received palliative chemotherapy in a metropolitan public hospital in Australia during the last month of life. Defining the goal of treatment and assessing functional status of patients regularly while on treatment may help identify deteriorating patients and could avoid medically futile treatment. [Table: see text]

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