scholarly journals 1118 The Role of Emergency Surgery in Diverticular Strictures of Those Who Were Initially Managed Conservatively

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Jayawardena ◽  
O Jayawardena ◽  
R Peris ◽  
A Rafie
Keyword(s):  
Medical Treatment ◽  
Emergency Surgery ◽  
Medical Records ◽  
Elective Surgery ◽  
Bowel Perforation ◽  
Safety Net ◽  
Undergo Emergency Surgery ◽  
The Uk ◽  
Surgical Admission

Abstract Aim The presence of diverticulosis can lead to several different complications including formation of strictures. However, the literature concerning management of diverticular strictures is poor. The purpose of this study is to evaluate the patients who were initially treated non surgically and had to undergo emergency surgery. Method A retrospective study was performed using a cohort of patients between 2016 and 2020 where 84 patients with diverticular strictures were identified and followed up. Data on the management of diverticular stricture was captured using the hospital’s electronic medical records. Results Out of 84 patients with diverticular strictures, 9 had elective surgery without any medical treatment while 75 had medical treatment first. Out of the 75 patients who were medically treated, 12 underwent emergency surgery while 2/75 underwent elective surgery after receiving medical treatment due to ongoing symptoms. Out of the 12 patients that underwent emergency surgery, 9 patients presented with obstruction while 3 had a bowel perforation. 6 patients had Hartmann’s procedure, 5 had defunctioning colostomy and 1 patient had adhesiolysis. No patient deaths were recorded at 12 months. Conclusions Although medical management remains the preferred method of managing diverticular strictures in the UK, it is not without its complications. 1 in 5 patients had an acute surgical admission requiring emergency surgery. This raises the importance of a good ‘safety net’ in those managed non-surgically, to reduce delays associated with seeking medical advice. We also appreciate the importance of carrying out more extensive studies to establish the best way to manage diverticular strictures.

Convergence from below? The reform of minimum income protection in France and the UK

2014 ◽  
Vol 30 (2) ◽  
pp. 147-164 ◽  
Author(s):  
Daniel Clegg
Keyword(s):  
Safety Net ◽  
Welfare States ◽  
Economic Life ◽  
Minimum Income ◽  
Political Economies ◽  
Working Age ◽  
The Uk ◽  
Institutional Legacies ◽  
European Welfare States

Through a systematic comparison of major reforms to minimum income benefits for people of working age in France and the UK, this paper assesses the scope for cross-national convergence in this growing sector of European welfare states. It shows that while differing institutional legacies have shaped the precise design of the new minimum income systems that have been put in place on each side of the Channel in recent years, there is also evidence of an increasingly common conceptualisation of the function of the last safety net and its articulation with the labour market, despite the two countries' still very different political economies. This suggests the potential across welfare states for convergence “from below” on broader understandings of the role of social security provisions in regulating economic life.

scholarly journals A multi-centre analysis of cardiac surgery referral patterns and resource allocation during the COVID-19 pandemic

2021 ◽  
Author(s):  
Damian Balmforth ◽  
Ana Lopez-Marco ◽  
Martin Yates ◽  
Benjamin Adams ◽  
Alex Cale ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Cardiac Surgery ◽  
Emergency Surgery ◽  
Clinical Decision Making ◽  
Elective Surgery ◽  
Treatment Strategies ◽  
Referral Patterns ◽  
Surgical Services ◽  
Bed Capacity ◽  
The Uk

Background and aims: The COVID-19 pandemic caused a dramatic shift in the provision of cardiac surgical services in the United Kingdom (UK) with all elective surgery suspended. We sought to explore referral patterns, changes in clinical decision making and resource allocation to adult cardiac surgical services in the UK during the first wave of the pandemic. Methods: Data from 11 UK centres on referrals and available health resources (operating theatre and bed capacity) for urgent or emergency adult cardiac surgery between the 1st March 2020 and the 1st August 2020 was collated, and securely transferred to the lead centre for analysis. Results: 1113 patients were referred for cardiac surgery over the study period. Following UK lockdown in March 2020 the number of referrals initially fell to 39% of pre-lockdown levels before recovering to 211% of that seen prior to the pandemic. A change in treatment strategies was observed with a trend towards deferring surgery entirely or favouring less invasive, non-surgical treatments. At the peak of the pandemic in April 2020, theatre availability and bed capacity fell to 26% and 54% of pre-lockdown levels, respectively. Provision for emergency surgery was maintained throughout at 1 to 2 emergency lists per unit weekly. Conclusion: During the first wave of the UK COVID-19 pandemic cardiac surgical operative activity dropped acutely before increasing over the next four months. Despite this drop, provision for emergency surgery was retained throughout. In the event of further waves of COVID-19 pandemic, maintaining essential cardiac surgical services should be prioritised.

scholarly journals Angka Mortalitas dan Faktor Risiko pada Pasien Geriatri yang Menjalani Operasi Emergensi Akut Abdomen di RSUP Dr. Hasan Sadikin Bandung Tahun 2014−2015

2017 ◽  
Vol 5 (2) ◽  
pp. 94
Author(s):  
Donny Prasetyo Priyatmoko ◽  
Reza Widianto Sudjud ◽  
Rudi Kurniadi Kadarsah
Keyword(s):  
Risk Factor ◽  
Severe Sepsis ◽  
Mortality Rate ◽  
Acute Abdomen ◽  
Emergency Surgery ◽  
Geriatric Patients ◽  
Elective Surgery ◽  
The Body ◽  
Old Patients ◽  
Undergo Emergency Surgery

Geriatri memiliki kekhususan yang perlu diperhatikan dalam bidang anestesi dan tindakan operasi karena terdapat kemunduran sistem fisiologis dan farmakologis sejalan dengan penambahan usia. Penelitian di Yunani tahun 2007 menjelaskan bahwa angka mortalitas akibat tindakan operasi setelah usia 65 tahun menjadi 3 kali lipat dibanding dengan usia 18−40 tahun. Angka mortalitas geriatri tahun 2007 pada operasi elektif sebesar 5%, sedangkan operasi emergensi sebesar 10%. Tujuan penelitian ini adalah memperoleh angka mortalitas dan faktor risiko pada pasien geriatri yang menjalani operasi emergensi akut abdomen tahun 2014−2015. Tipe penelitian ini merupakan deskriptif dengan pendekatan retrospektif terhadap 180 subjek penelitian yang diambil di bagian rekam medis sejak Juli−Oktober 2016 pada pasien geriatri yang menjalani operasi emergensi akut abdomen di RSUP Dr. Hasan Sadikin Bandung tahun 2014−2015. Hasil penelitian ini memperlihatkan angka mortalitas sebesar 9% dengan faktor penyebab mortalitas paling dominan adalah syok sepsis sebesar 50%. Faktor predisposisi disebabkan oleh indeks massa tubuh <18,5 kg/m2 sebesar 56,3%, diagnosis primer tumor intestinal sebesar 31,3%, penyakit penyerta diabetes melitus sebesar 31,3%, sepsis sebesar 93,8%, hipoalbumin sebesar 56,3% dan status fisik ASA 4E sebesar 62,5%. Simpulan, faktor presipitasi disebabkan oleh waktu respons penanganan >6 jam sebesar 93,8% dan komplikasi pascaoperasi severe sepsis disertai pneumonia sebesar 50%. Kata kunci: Akut abdomen, angka mortalitas, geriatri, operasi emergensi Mortality Rate and Risk Factor in Geriatric Patients Undergo Emergency Surgery for Acute Abdoment in Dr. Hasan Sadikin Hospital Bandung in 2014−2015Geriatric has special anesthetic and surgical consideration because of reducing physiologic function and pharmacodynamic as the age increase. A study in Greece in 2007 shows that surgery in patient more than 65 year old has three times mortality rate than 18–40 years old patients. Geriatric mortality rate in 2007 undergo elective surgery is 5%, while the emergency surgery 10%. Purpose of this study was to obtain mortality rate and risk factor in geriatric patients underwent emergency surgery for acute abdomen in 2014−2015. This was a descriptive retrospective study of 180 subjects taken from the medical records in July to October, 2016 in geriatric patients underwent emergency surgery for acute abdomen at the Dr. Hasan Sadikin hospital in 2014−2015. Results of this study showed a mortality rate of 9%, with most dominant factors that cause mortality was septic shock (50%). Predisposing factors was the body mass index <18.5 kg/m2 (56.3%), the diagnosis of primary tumor intestinal amounted to 31.3%, comorbidities of diabetes mellitus at 31.3%, sepsis (93.8%), hipoalbumin (56.3%) and ASA physical status 4E (62.5%). In conclution, precipitation factors caused by response time >6 hours (93.8%) and postoperative complications of severe sepsis with pneumonia (50%).Key words: Acute abdomen, emergency surgery, geriatrics, mortality rate

scholarly journals Assessing the role of the universal addition of CT thorax to CT abdomen and pelvis in the COVID era. A retrospective multicentre cohort study

BJR|Open ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 20200044
Author(s):  
Christopher Anthony Brennan ◽  
Brian Morrissey ◽  
Sylvie Dubois-Marshall ◽  
Dympna McAteer ◽  
Abdul Qadir ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Entire Cohort ◽  
Staff Members ◽  
The United Kingdom ◽  
Undergo Emergency Surgery ◽  
Multicentre Cohort Study ◽  
The Uk ◽  
Low Prevalence ◽  
Multicentre Cohort

Objective: The SARS-CoV2 infection is associated with high mortality for individuals who undergo emergency surgery. The United Kingdom surgical associations and Colleges of Surgeons collectively recommended the addition of CT Thorax to all emergency CT abdomen/pelvis imaging in order to help identify possible COVID-19 patients. Early identification of these patients would lead to optimal treatment strategies for the patient and protection for staff members. However, an extension of CT would be associated with increased irradiation doses for the patient, and its diagnostic relevance was unclear. Methods: This was a retrospective observational review looking at all surgical admissions that required a CT Thorax/Abdomen/Pelvis across 7 weeks during the COVID-19 pandemic, across four Scottish Hospitals. CT thorax investigations (of non-surgical patients) were also re-assessed by a single radiologist to assess the extent of pathology identified at the lung bases (and therefore would be included in a standard CT abdomen and pelvis). Results: Of 216 patients identified who had a CT thorax/Abdomen/Pelvis during the timeframe, 5 were diagnosed with COVID-19. During this timeframe, 77 patients underwent solely CT thorax. Across the entire cohort, 98% of COVID pathology was identified at the lung bases. The estimated sensitivity and specificity of CT thorax was 60 and 86.4% respectively. Conclusions: In a region with relatively low prevalence of SARS-COV2 infection, inclusion of CT Thorax in surgical admission imaging does not significantly contribute to identification and management of SARS-COV2 patients. We therefore suggest that imaging the lung bases can be sufficient to raise clinical suspicion of COVID-19. Advances in knowledge: This paper adds further evidence to that from other single UK centres that the addition of CT chest for all patients does not yield any further diagnostic information regarding coronavirus. Additionally, rapid SARS-CoV-2 testing in the UK (which is currently widely available) further demonstrates that inclusion of the entire chest during CT examination of the acute abdomen is not required.

scholarly journals Improving the Quality of Operation Notes by Using a Mnemonic and Proforma

2013 ◽  
Vol 95 (6) ◽  
pp. 200-202
Author(s):  
NJG Bauer ◽  
A Wilson ◽  
RJ Grimer
Keyword(s):  
Medical Records ◽  
General Medical Council ◽  
Professional Standards ◽  
Medical Council ◽  
The Public ◽  
Health And Wellbeing ◽  
Standards And Regulations ◽  
The Uk

The General Medical Council is assigned the role of safeguarding and maintaining the health and wellbeing of the public by the Medical Act 1983. All doctors and surgeons in the UK are bound by their professional standards and regulations. Surgeons have to abide by the standards set by The Royal College of Surgeons of England (RCS), which are deemed 'reasonable, assessable and achievable by all competent surgeons'. One of these standards is the overriding duty to ensure that 'all medical records are legible, complete and contemporaneous'. It is vital that all medical and surgical notes document each consultation or procedure that the patient has undergone during his or her stay in hospital.

Management of deradicalisation in the UK: reflections of a clinical psychologist

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Feryad A. Hussain
Keyword(s):  
Clinical Psychologist ◽  
Healthcare Team ◽  
Psychosocial Issues ◽  
Muslim Community ◽  
Home Office ◽  
Terrorist Groups ◽  
Violent Action ◽  
Clinical Counselling ◽  
The Uk

Radicalisation to violent action is not just a problem in foreign lands. Research has identified numerous politico–psychosocial factors to explain why young people from the UK are now joining terrorist groups such as ISIS. Our understanding has been expanded by the accounts of “returnees” who have subsequently either self-deradicalised or joined a government deradicalisation programme in the role of an Intervention Provider (IP). These individuals are now key to the deradicalisation programme. This article presents the reflections of a clinical psychologist who worked within a social healthcare team managing psychosocial issues related to radicalisation, in conjunction with an allocated IP. The project involved individuals from the Muslim community and, as such, issues discussed are specific to this group. It is acknowledged that the process in general is universally applicable to all groups though specifics may vary (under Trust agreement, details may not be discussed). This article also aims to share basic information on the current Home Office deradicalisation programme and raises questions about the current intervention. It also offers reflections on how the work of IPs may be facilitated and supported by clinical/counselling psychologists and psychotherapists.

Monitoring the marine environment for small round structured viruses (SRSVS): a new approach to combating the transmission of these viruses by molluscan shellfish

1998 ◽  
Vol 38 (12) ◽  
pp. 51-56 ◽  
Author(s):  
K. Henshilwood ◽  
J. Green ◽  
D. N. Lees
Keyword(s):  
Enteric Virus ◽  
Winter Period ◽  
Rt Pcr ◽  
Cloning And Sequencing ◽  
New Approach ◽  
Human Enteric Virus ◽  
Different Strains ◽  
The Uk ◽  
Public Health Protection

This study investigates human enteric virus contamination of a shellfish harvesting area. Samples were analysed over a 14-month period for Small Round Structured Viruses (SRSVs) using a previously developed nested RT-PCR. A clear seasonal difference was observed with the largest numbers of positive samples obtained during the winter period (October to March). This data concurs with the known winter association of gastroenteric illness due to oyster consumption in the UK and also with the majority of the outbreaks associated with shellfish harvested from this area during the study period. RT-PCR positive amplicons were further characterised by cloning and sequencing. Sequence analysis of the positive samples identified eleven SRSV strains, of both Genogroup I and Genogroup II, occurring throughout the study period. Many shellfish samples contained a mixture of strains with a few samples containing up to three different strains with both Genogroups represented. The observed common occurrence of strain mixtures may have implications for the role of shellfish as a vector for dissemination of SRSV strains. These results show that nested RT-PCR can identify SRSV contamination in shellfish harvesting areas. Virus monitoring of shellfish harvesting areas by specialist laboratories using RT-PCR is a possible approach to combating the transmission of SRSVs by molluscan shellfish and could potentially offer significantly enhanced levels of public health protection.

Sign in / Sign up

Export Citation Format

Share Document