scholarly journals 406 Audit of Current COVID-19 Consent Process

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Goldmann ◽  
C Brown
Keyword(s):  
Best Practice ◽  
Closed Loop ◽  
Morbidity And Mortality ◽  
Single Centre ◽  
Operative Morbidity ◽  
Consent Forms ◽  
Emergency Procedures ◽  
Audit Data ◽  
Audit Period ◽  
Standard Of Practice

Abstract Aim Contracting COVID-19 increases the risk of serious peri-operative morbidity and mortality. The current best practice for informed consent is to make patients aware of the risk of contracting COVID-19. We aimed to determine if our local orthopaedic unit was meeting this standard of practice. Method We performed a single centre, retrospective, closed loop audit. Data was collected using Bluespeir© and Clinical Portal© software. We first audited all emergency and elective consent forms (n = 51) between September-October 2020; mean age 58 years old (range 17-87). Results were circulated to all orthopaedic departmental staff in poster format and given 2 weeks of educational awareness before re-audit of all consent forms (n = 59) in November 2020; mean age 54 years old (range 17-80). Any patient with an Adults With Incapacity (AWI) form in place was excluded. Results Initially, COVID-19 was included as a risk in 21/51 (41.2%) of all consent forms; elective procedures 10/24 (41.7%) and emergency procedures 11/27 (40.7%). On re-audit this increased to 32/59 (54.2%) of all consent forms; elective procedures 23/47 (48.9%) and emergency procedures 9/12 (75%). During the audit period, 1 patient tested positive for COVID-19 pre-operatively and 1 patient post-operatively. Conclusions This audit improved local adherence to COVID-19 consent guidelines. There remains significant room for improvement, especially in elective practice. Further research is required to determine the true impact of COVID-19 on morbidity and mortality.

Operative morbidity and mortality in octogenarians after carotid endarterectomy: a propensity score matching study

2020 ◽  
Vol 60 (6) ◽  
Author(s):  
Laura Pasin ◽  
Massimiliano M. Marrocco Trischitta ◽  
Giovanni Landoni ◽  
Desiderio Piras ◽  
Pasquale Nardelli ◽  
...  
Keyword(s):  
Propensity Score ◽  
Carotid Endarterectomy ◽  
Propensity Score Matching ◽  
Morbidity And Mortality ◽  
Operative Morbidity

scholarly journals 289 Detection of Falls in Older Patients by Medical Professionals on Admission to Hospital: An Audit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Emily Buckley ◽  
Mazen Alalawi
Keyword(s):  
Practice Guidelines ◽  
Older Patients ◽  
Best Practice ◽  
Acute Hospital ◽  
Medical Professionals ◽  
Medical Patients ◽  
Screening Questionnaire ◽  
Best Practice Guidelines ◽  
Audit Data ◽  
History Of

Abstract Background A history of a previous fall is one of the best predictors of future falls, increasing its risk 3-fold. The Health Service Executive (HSE) best practice guidelines recommend that all patients aged over 65 years in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the fall-frequency, context and characteristics. The aim of this audit was to increase falls recognition by medical professionals following the implementation of a falls screening questionnaire into the admission proforma of an acute hospital. Methods This was a clinical audit. Data was collected on 29 consecutive patients aged > 65 who were admitted via the emergency department of an acute hospital over a 6 day period. Data on falls was collected using the medical admissions hospital proforma during the first 72 hours. Following the initial audit, a new proforma containing a falls screening questionnaire (as per best practice guidelines) was introduced and an information session provided on its use. A re-audit of 17 admitted medical patients was then completed over the next 72 hours. Results The initial audit highlighted poor assessment of falls with only 3 (25%) patients being screened at admission. 1 (33%) had a fall; described as mechanical. Following introduction of a falls screening questionnaire into the admission proforma, a re-audit showed a significant increase, with 58% of admissions now being screened. Of these, 40% had fallen in the last year: 75% of falls were mechanical and 25% due to other causes. Conclusion This audit shows that falls in this patient population was largely unrecognised by medical professionals. Following implementation of a screening questionnaire, significant improvements were made. This audit concludes that implementation of a falls screening questionnaire into the medical admissions proforma is an effective method in identifying falls in older patients admitted to hospital.

Caecal volvulus: untwisting the mystery

2021 ◽  
Vol 14 (3) ◽  
pp. e237165
Author(s):  
Martha Sara Kedrzycki ◽  
Jaya Roy Choudhury ◽  
Sherif Hakky
Keyword(s):  
Differential Diagnosis ◽  
Small Bowel ◽  
Closed Loop ◽  
Early Recognition ◽  
Case Series ◽  
University Hospital ◽  
Single Centre ◽  
Bowel Ischaemia ◽  
Prompt Treatment ◽  
Mobile Cecum

Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.

scholarly journals Thoracic surgery during the coronavirus disease 2019 (COVID-19) pandemic in Madrid, Spain: single-centre report

2020 ◽  
Vol 58 (5) ◽  
pp. 991-996
Author(s):  
Lucas Hoyos Mejía ◽  
Alejandra Romero Román ◽  
Mariana Gil Barturen ◽  
Maria del Mar Córdoba Pelaez ◽  
José Luis Campo-Cañaveral de la Cruz ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Infection Control ◽  
Thoracic Surgery ◽  
Hospital Care ◽  
Test Results ◽  
Single Centre ◽  
Emergency Procedures ◽  
Related Symptom ◽  
Hospital Stays ◽  
Lung Transplants

Abstract OBJECTIVES We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient.

scholarly journals A single-centre retrospective study of systemic reactions to subcutaneous immunotherapy

2020 ◽  
Author(s):  
Kara Robertson ◽  
Nazanin Montazeri ◽  
Urvashi Shelke ◽  
Samira Jeimy ◽  
Harold Kim
Keyword(s):  
Incidence Rate ◽  
Best Practice ◽  
Systemic Reaction ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Subcutaneous Immunotherapy ◽  
Single Centre ◽  
Epinephrine Administration ◽  
Epinephrine Injection ◽  
Systemic Reactions

Abstract BackgroundSubcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual. MethodsA single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University.Results28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered extract. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance.ConclusionsThis is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy extract, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT.

scholarly journals Morbidity and mortality on chronic haemodialysis: A 10-year Swiss single centre analysis

2011 ◽  
Author(s):  
T Breidthardt ◽  
CN Moser-Bucher ◽  
C Praehauser ◽  
D Garzoni ◽  
K Bächler ◽  
...  
Keyword(s):  
Morbidity And Mortality ◽  
Chronic Haemodialysis ◽  
Single Centre

Diabetes mellitus in anaesthesia

2012 ◽  
Vol 12 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Jadelis Giquel ◽  
Yiliam F Rodriguez-Blanco ◽  
Christina Matadial ◽  
Keith Candiotti
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Immune Deficiency ◽  
Autonomic Neuropathy ◽  
Endocrine System ◽  
Morbidity And Mortality ◽  
Cardiovascular Autonomic Neuropathy ◽  
Operative Morbidity ◽  
Endocrine Diseases ◽  
Collagen Tissue

Anaesthesiologists frequently encounter patients with diseases of the endocrine system, in particular diabetes mellitus. The major risk factors for people with diabetes undergoing surgery are the associated end-organ diseases: cardiovascular autonomic neuropathy, joint collagen tissue, and immune deficiency. Due to the fact that endocrine diseases can be associated with significant peri-operative morbidity and mortality, it is critical that anaesthesiologists understand these disorders and when indicated request the appropriate investigations.

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