scholarly journals Pediatric Circumcision in the 21st Century National Health Service: A Snapshot of Practice in a United Kingdom Center

2020 ◽  
Vol 06 (04) ◽  
pp. e188-e191
Author(s):  
Patrick Jones ◽  
Helen Rooney ◽  
Amr Hawary
Keyword(s):  
United Kingdom ◽  
Average Length ◽  
Pediatric Population ◽  
Late Complication ◽  
Lichen Sclerosus ◽  
Late Complications ◽  
Minor Bleeding ◽  
Meatal Stenosis ◽  
Care Services ◽  
Unplanned Admissions

Abstract Introduction Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. Aim The aim of this study was to report outcomes of therapeutic circumcision from our center. Methods Prospective registry of elective circumcisions was maintained and analyzed at a single institution in the United Kingdom. Data collected included information on complications (early and late), emergency presentations, and referrals back from primary care services. Results Between August 2015 and June 2019, 300 patients (mean age: 9 years; range: 3–16 years) underwent therapeutic circumcision. The average length of follow-up data available was 2.1 years (range: 6 months to 4 years). The overall complication rate was 4.7% (n = 16). There were no unplanned admissions and no cases returned to the operating room as emergency. Only 1% (n = 3) of patients presented with an early complication (minor bleeding, pain, urinary retention), and 3.7% (n = 11) suffered a late complication (meatal stenosis [2.7%]). All cases of meatal stenosis had lichen sclerosus confirmed on histology. Cosmetic satisfaction was 99%. Conclusion Therapeutic circumcision is an effective procedure in the pediatric population, which carries a low risk of early and late complications. Our study found that meatal stenosis only occurred in those patients with confirmed lichen sclerosus histology.

Volunteering in hospice and palliative care in the United Kingdom

2018 ◽  
Author(s):  
Ros Scott
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Care Services ◽  
The United Kingdom ◽  
Strategic Direction ◽  
Palliative Care Services ◽  
History Of ◽  
The Uk ◽  
Hospice And Palliative Care ◽  
Changing Role

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.

Alternative pulmonary artery reconstruction technique in the arterial switch operation

2021 ◽  
Author(s):  
Hisayuki Hongu ◽  
Masaaki Yamagishi ◽  
Yoshinobu Maeda ◽  
Keiichi Itatani ◽  
Masatoshi Shimada ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Late Complication ◽  
Late Complications ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Arterial Switch ◽  
Switch Operation ◽  
Longitudinal Extension

Abstract OBJECTIVES Late complications of arterial switch operations (ASO) for transposition of the great arteries, such as neo-pulmonary artery (PA) stenosis and/or neoaortic regurgitation, have been reported. We developed an alternative reconstruction method called the longitudinal extension (LE) method to prevent PA bifurcation stenosis (PABS). METHODS We identified 48 patients diagnosed with transposition of the great arteries and performed ASO using the Lecompte manoeuvre for neo-PA reconstruction. In 9 consecutive patients (from 2014), the LE method was performed (LE). Before 2014, conventional techniques were performed in 39 patients (C). The median body weight and age in the LE and C groups were 3.0 and 3.1 kg and 12 and 26 days, respectively. In the LE group, 1 patient underwent bilateral PA banding before ASO. In C, PA banding and arch repair were performed in 1 patient each. Patients who received concomitant procedures were included. RESULTS The median follow-up in LE and C groups was 1.9 and 10.1 years, respectively. Early mortality/late death was not found in group LE and in 1 patient in group C. Only 1 case required ascending aorta sliding plasty in LE, and 8 patients needed PA augmentation for PABS in C. The median velocity of right/left PA was measured as 1.6/1.9 m/s in LE and 2.1/2.3 m/s in C, so it showed a lower value in LE. CONCLUSIONS Excellent mid-term results were obtained with the LE method. It was considered a useful procedure in preventing PABS, which is a primary late complication of ASO. Further follow-up and investigations are needed.

scholarly journals A Comparison of Outcomes and Complications of Totally Implantable Access Port Through the Internal Jugular Vein Versus the Subclavian Vein

2014 ◽  
Vol 99 (2) ◽  
pp. 182-188 ◽  
Author(s):  
Yoshinobu Nagasawa ◽  
Tomoharu Shimizu ◽  
Hiromichi Sonoda ◽  
Eiji Mekata ◽  
Masato Wakabayashi ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Statistical Significance ◽  
Late Complication ◽  
Insertion Site ◽  
Multivariate Logistic Regression Analysis ◽  
Late Complications ◽  
Complication Rates ◽  
Access Port

Abstract Totally implantable access ports (TIAPs) are generally used in oncology. Few studies have addressed complications associated with the insertion site. A total of 233 consecutive oncology patients were enrolled to receive TIAP inserts via internal jugular vein (IJV) or subclavian vein (SV). Data on clinicopathologic parameters and early/late complications were retrospectively collected. No differences were found early and late complication rates. Catheter injury was observed more frequently in the IJV group (2.9%) than in the SV group (1.0%) without statistical significance. Multivariate logistic regression analysis showed that age, switch to palliative use of TIAP, and the distribution of diseases (low risk in patients with colorectal cancer) were independent risk factors for determining complications. In conclusion, TIAP insertion site showed no impact on the early and late complication rates. Catheter injury appears to occur at the same frequency with both approaches. Therefore, medical doctors may choose their preferred puncture site when performing TIAP insertion.

scholarly journals The Impact Of COVID-19 On Out-Of-Hours Adult Hospice Care: An Online Survey

2021 ◽  
Author(s):  
Felicity Hasson ◽  
Paul Slater ◽  
Anne Fee ◽  
Tracey McConnell ◽  
Sheila Payne ◽  
...  
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Community Based ◽  
Out Of Hours ◽  
Care Services ◽  
The United Kingdom ◽  
Palliative Care Services ◽  
The Impact

Abstract BackgroundGlobally COVID-19 has had a profound impact on the provision of healthcare, including palliative care. However, there is little evidence about the impact of COVID-19 on delivery of out-of-hours specialist palliative care services in the United Kingdom. The aim of the study is to investigate the impact of the COVID-19 pandemic on the delivery of out-of-hours community-based palliative care services.Methods A national online census survey of managers of adult hospices in the United Kingdom was undertaken. Survey were emailed to managers of adult hospices (n=150) who provided out-of-hours community palliative care services. Fifteen questions related specifically to the impact of COVID-19 and data were analysed thematically.ResultsEighty-one responses to the survey were returned (54% response rate); 59 were complete of which 47 contained COVID-19 data. Findings indicated that COVID-19 impacted on out-of-hours community-based palliative care. To meet increased patient need, hospices reconfigured services; redeployed staff; and introduced new policies and procedures to minimize virus transmission. Lack of integration between charitably and state funded palliative care providers was reported. The interconnected issues of the use and availability of Personal Protective Equipment (n=21) and infection control screening (n=12) resulted in changes in nursing practices due to fear of contagion for patients, carers and staff. Conclusions Survey findings suggest that due to increased demand for community palliative care services, hospices had to rapidly adapt and reconfigure services. Even though this response to the pandemic led to some service improvements, in the main, out-of-hours service reconfiguration resulted in challenges for hospices, including workforce issues, and availability of resources such as Personal Protective Equipment. These challenges were exacerbated by lack of integration with wider healthcare services. More research is required to fully understand the implications of such changes on the quality of care provided.

scholarly journals Pancreatic window and open necrosectomy; a surgical alternative for walled-off pancreatic necrosis in a second level hospital in Mexico

2020 ◽  
Vol 8 (11) ◽  
pp. 4158
Author(s):  
Pedro A. Alvarado-Bahena ◽  
Enrique Chavez-Serna ◽  
Jonatan Salgado-Vives ◽  
Uraik F. Hernandez-Bustos ◽  
Dante A. Saldivar-Vera ◽  
...  
Keyword(s):  
Developing Countries ◽  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Late Complication ◽  
Late Complications ◽  
Open Approach ◽  
Invasive Procedures ◽  
Open Necrosectomy ◽  
Level Hospital

Walled-off pancreatic necrosis is defined as a necrotic collection with a defined wall, which generally occurs in 15% of patients in the fourth week after acute pancreatitis. Actually, open surgery is reserved for selected cases, with minimally invasive treatments such as image-assisted percutaneous drainage or endoscopic ultrasound being the procedures of choice. However, in developing countries the open approach continues to be an effective therapeutic alternative. We present the case of a 47-year-old male patient with no significant history who developed severe acute pancreatitis secondary to hypertriglyceridemia and who later developed walled-off pancreatic necrosis as a late complication. As a treatment, a debridement of the necrotic tissue with marsupialization was performed using the bradley III technique, secondary to the procedure, a pancreatic fistula was developed. After 8 weeks of hospitalization, in which he had a favourable response to surgical treatment, with spontaneous closure of the fistula without complications. Surgical management of late complications of acute pancreatitis remains controversial. Although minimally invasive procedures are the first option nowadays, in developing countries, open necrosectomy remains a good option for the treatment of these types of complications.

scholarly journals Service innovations: the Orchard Clinic: Scotland's first medium secure unit

2003 ◽  
Vol 27 (03) ◽  
pp. 105-107 ◽  
Author(s):  
D. Nelson
Keyword(s):  
United Kingdom ◽  
Forensic Psychiatry ◽  
Psychiatric Care ◽  
Government Policies ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Care Services ◽  
The United Kingdom ◽  
Secure Unit ◽  
The Government

The development of forensic psychiatry provision in Scotland lags behind that in other parts of the United Kingdom. Until recently, there were no medium secure units in the country and mentally disordered offenders (MDOs) requiring such care had to be managed in intensive psychiatric care unit (IPCU) settings. In November 2000, The Orchard Clinic, a medium secure unit sited at the Royal Edinburgh Hospital, was opened. This paper discusses the background to this development, the government policies setting out plans for the care, services and support of MDOs in Scotland, progress and work of the new unit to date and plans for developments in other parts of Scotland.

Service innovations: the Orchard Clinic: Scotland's first medium secure unit

2003 ◽  
Vol 27 (3) ◽  
pp. 105-107 ◽  
Author(s):  
D. Nelson
Keyword(s):  
United Kingdom ◽  
Forensic Psychiatry ◽  
Psychiatric Care ◽  
Government Policies ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Care Services ◽  
The United Kingdom ◽  
Secure Unit ◽  
The Government

The development of forensic psychiatry provision in Scotland lags behind that in other parts of the United Kingdom. Until recently, there were no medium secure units in the country and mentally disordered offenders (MDOs) requiring such care had to be managed in intensive psychiatric care unit (IPCU) settings. In November 2000, The Orchard Clinic, a medium secure unit sited at the Royal Edinburgh Hospital, was opened. This paper discusses the background to this development, the government policies setting out plans for the care, services and support of MDOs in Scotland, progress and work of the new unit to date and plans for developments in other parts of Scotland.

Abstract TP405: IV TPA Utilization and Outcomes in Young Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pamela Cheng ◽  
Ling Zheng ◽  
Steven Cen ◽  
Peggy Nguyen ◽  
Sebina Bulic ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Pediatric Population ◽  
Cerebrovascular Disorders ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Total Charge ◽  
Inpatient Mortality ◽  
Stroke Patients

Objective: Cerebrovascular disorders are among the top ten causes of death in the pediatric population. The incidence is felt to be 1-2 per 100,000, although this number could be higher due to poor recognition. Our objective is to describe the incidence, tPA utilization, inpatient mortality, length of stay, and cost associated with stroke in pediatric population. Methods: Ischemic stroke cases between the ages of 1 and 17 years were obtained from the Nationwide Inpatient Sample (NIS) for the period from January 1, 2000 through December 31, 2014. The primary outcome was inpatient mortality. The secondary outcome was LOS and total cost per day. National trend estimate followed HCUP methodical standard which adopted the design change at 2012 with appropriate trend weight. Weighted estimates were made via SURVEYMEAN procedure and presented as national estimate ± standard error from sampling. SAS9.4 was used for the analysis. Results: From January 2000 through December 2014, there were an estimated 12908±1087 pediatric cases with ischemic stroke, 157±28 (1.2%±0.2%) had TPA. Pediatric ischemic stroke patients were predominantly discharged from urban, large-bed-size, teaching hospitals (40.7%±3.9%), more likely to be white (39.3%±1.8%) and male (52.5%±1.2%), most prevalent among those aged 16 years old (10.3%±0.8%). Overall inpatient mortality was 3.0±0.3 per 100 discharges. Median LOS was 4.0±0.1 days. Median total charge per day was $ 8162±348. Majority of pediatric ischemic stroke patients discharged routinely to home or self-care (75.8%±1.2%). Conclusion: This study highlights that during the prespecified time frame of four years there was an estimated 12908±1087 ischemic strokes in the pediatric population and less than 2% of children received alteplase. Hospital mortality was 3.0% ± 0.3%. The average length of stay was 4 days with an estimated cost of $8162+/- 348 per day. The majority of pediatric patients were discharged home.

scholarly journals Understanding variation in unplanned admissions of people aged 85 and over: a systems-based approach

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026405 ◽  
Author(s):  
Andrew Wilson ◽  
Richard Baker ◽  
John Bankart ◽  
Jay Banerjee ◽  
Ran Bhamra ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Care ◽  
Primary Care Trust ◽  
Community Health Services ◽  
Shared Vision ◽  
Admission Rates ◽  
Care Services ◽  
Health And Social Care ◽  
Study Sites ◽  
Unplanned Admissions

AimTo examine system characteristics associated with variations in unplanned admission rates in those aged 85+.DesignMixed methods.SettingPrimary care trusts in England were ranked according to changes in admission rates for people aged 85+ between 2007 and 2009, and study sites selected from each end of the distribution: three ‘improving’ sites where rates had declined by more than 4% and three ‘deteriorating’ sites where rates had increased by more than 20%. Each site comprised an acute hospital trust, its linked primary care trust/clinical commissioning group, the provider of community health services and adult social care.ParticipantsA total of 142 representatives from these organisations were interviewed to understand how policies had been developed and implemented. McKinsey’s 7S framework was used as a structure for investigation and analysis.ResultsIn general, improving sites provided more evidence of comprehensive system focused strategies backed by strong leadership, enabling the development and implementation of policies and procedures to avoid unnecessary admissions of older people. In these sites, primary and intermediate care services appeared more comprehensive and better integrated with other parts of the system, and policies in emergency departments were more focused on providing alternatives to admission.ConclusionsHealth and social care communities which have attenuated admissions of people aged 85+ prioritised developing a shared vision and strategy, with sustained implementation of a suite of interventions.

scholarly journals Right lumbar abscess containing a gallstone—an unexpected late complication of laparoscopic cholecystectomy

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
André Marçal ◽  
Ricardo Vaz Pereira ◽  
Ana Monteiro ◽  
José Dias ◽  
António Oliveira ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Late Complication ◽  
Late Complications ◽  
Gallbladder Perforation ◽  
Past Medical History ◽  
Symptomatic Gallstones ◽  
History Of ◽  
Gallstone Spillage ◽  
Saline Lavage

Abstract During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.

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