scholarly journals EP.WE.802Are we over-zealous in our management of acute diverticulitis?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Guillaume Lafaurie ◽  
James Butterworth ◽  
Alec Engledow
Keyword(s):  
Biochemical Markers ◽  
Acute Diverticulitis ◽  
Vital Signs ◽  
District General Hospital ◽  
Ambulatory Setting ◽  
Nice Guidelines ◽  
Intravenous Antibiotics ◽  
Review Management ◽  
Nice Guidance ◽  
Austere Environment

Abstract Aims Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis. However according to the latest NICE guidance those with diverticulitis who are not systemically unwell may not require either admission or antibiotics. In the financially austere environment facing the NHS within the COVID 19 pandemic, prudence in such resource allocation is of vital importance. We aim to review management of patients with acute diverticulitis over a 6-month period in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed. Biochemical markers, lactate and vital signs were used to assess if attending patients were systemically unwell. Results 23 patients were admitted and 6 managed as outpatients via the surgical ambulatory unit. Of the 29 patient cohort, 9 (31%) were systemically unwell. All 9 unwell patients received antibiotics. Of the 20 patients not considered systemically unwell, 11 (55%) received antibiotics. 16 (80%) that were admitted did not require admission on retrospective review. Conclusion Prompt administration of intravenous antibiotics for septic patients with diverticulitis reduces associated morbidity and mortality and the observed adherence to this principle is encouraging. For systemically well patients, increased clinical discernment is required to consider managing patients in the surgical ambulatory setting, avoiding unnecessary admissions. Similar caution must be used in appropriate use of antimicrobials to avoid unnecessary adverse consequences.

EP.TU.809Challenges in management of acute diverticulitis within a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James William Butterworth ◽  
Guillaume Lafaurie ◽  
Blessing Fabowalwe-Makinde ◽  
Lois Aikins ◽  
Tayo Olatokunbo Oke
Keyword(s):  
General Hospital ◽  
Acute Diverticulitis ◽  
District General Hospital ◽  
Disease Classification ◽  
Perforated Diverticulitis ◽  
Cross Sectional ◽  
Unique Challenge ◽  
Review Management ◽  
Cross Sectional Imaging ◽  
Sigmoid Diverticular Disease

Abstract Aim Incidence of perforated sigmoid diverticular disease is estimated at 3.4 to 4.5 per 100,000. Perforation may be the first manifestation of complicated diverticulitis with a range of 50% to 70%. We aim to review management of systemically unwell patients with acute diverticulitis in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting septic with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed over a 6-month period. Results Mean time to antibiotics was 3.96 hours (range 0-23.11). Of the 7 with perforated diverticulitis severity classification included: Hinchey I – n = 1, 3.4%; Hinchey IIa – 5 (17.2%), and; Hinchey IIb – 1 (3.4%). Time to CT abdomen pelvis was 3.38 hours (range 0-16.4 hours). Two pericolic abscesses met NICE drainage criteria at 3.7 cm and 3.9 cm respectively. The 3.7 cm abscess was drained radiologically at 7 days post-admission and was re-admitted 6 days later requiring further radiological drainage. The patient with a 3.9 cm abscess received a Hartmann’s procedure and had multiple re-admissions requiring a hospital stay of 34 days. There was 0% mortality at 30 days. Conclusion Management of acute diverticulitis continues to present a unique challenge. For systemically unwell patients, timely administration of antibiotics within an hour of sepsis recognition is encouraged to optimise outcomes. Timely cross-sectional imaging is pivotal in disease classification and decision-making regarding acute management. Interventional drainage and surgical resection remain important therapeutic strategies for unwell patients with Hinchey grade II diverticulitis.

Referral patterns for catheter-directed thrombolysis for iliofemoral deep venous thrombosis

2021 ◽  
pp. 026835552097728
Author(s):  
Kirtan D Patel ◽  
Alison YY Tang ◽  
Ashik DJ Zala ◽  
Rakesh Patel ◽  
Kishan R Parmar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Management Option ◽  
Venous Anatomy ◽  
Nice Guidelines ◽  
Patient Demographics ◽  
Radiology Reports ◽  
Catheter Directed Thrombolysis ◽  
Nice Guidance ◽  
Icd 10 ◽  
Venous Thromboses

Objectives Post thrombotic syndrome (PTS) is a serious complication of deep venous thromboses (DVTs). PTS occurs more frequently and severely following iliofemoral DVT compared to distal DVTs. Catheter directed thrombolysis (CDT) of iliofemoral DVTs may reduce PTS incidence and severity. We aimed to determine the rate of iliofemoral DVT within our institution, their subsequent management, and compliance with NICE guidelines. Methods Retrospective review of all DVTs diagnosed over a 3-year period was conducted. Cases of iliofemoral DVT were identified using ICD-10 codes from patient notes, and radiology reports of Duplex scans. Further details were retrieved, such as patient demographics and referrals to vascular services. NICE guidance was applied to determine if patients would have been suitable for CDT. A survey was sent to clinicians within medicine to identify awareness of CDT and local guidelines for iliofemoral DVT management. Results 225 patients with lower limb DVTs were identified. Of these, 96 were radiographically confirmed as iliofemoral DVTs. The median age was 77. 67.7% of iliofemoral DVTs affected the left leg. Right leg DVTs made up 30.2% and 2.1% were bilateral DVTs. Of the 96 iliofemoral DVTs, 21 were deemed eligible for CDT. Only 3 patients (14.3%) were referred to vascular services, and 3 received thrombolysis. From our survey, 95.5% of respondents suggested anticoagulation alone as management for iliofemoral DVT. Only one respondent recommended referral to vascular services. There was a knowledge deficiency regarding venous anatomy, including superficial versus deep veins. Conclusions CDT and other mechanochemical procedures have been shown to improve outcomes of patients post-iliofemoral DVT, however a lack of awareness regarding CDT as a management option results in under-referral to vascular services. We suggest closer relations between vascular services and their “tributary” DVT clinics, development of guidelines and robust care pathways in the management of iliofemoral DVT.

NICE gets tooled up

2001 ◽  
Vol 6 (4) ◽  
pp. 231-232 ◽  
Author(s):  
Valerie Beattie ◽  
Brian Hockley
Keyword(s):  
Essential Element ◽  
Clinical Governance ◽  
Audit Process ◽  
Nice Guidelines ◽  
Practical Support ◽  
Nice Guidance ◽  
Multi Level ◽  
Minimum Dataset

To date over 20 guidelines or technology appraisals have been issued. At first, it seemed implicit that these guidelines would be subject to the audit process and that NICE would provide guidance and practical support for undertaking this activity. NICE have now issued a template for the audit of NICE guidelines based on a multi‐level approach. While audit of NICE guidance is an essential element of the whole clinical governance agenda, the burden of work that this could introduce to Trusts may be unsustainable. Suggests possible alternatives to auditing NICE guidance and proposes the use of a minimum dataset and full exploitation of electronic means of data harvesting.

scholarly journals Dynamics of Antibiotic Prescription in Royal Hampshire County Hospital in November 2016: A Prospective Study

2017 ◽  
Vol 5 (3) ◽  
pp. 99-103
Author(s):  
Kathrine Lee-A-Ping ◽  
Kordo Saeed ◽  
Matthew Dryden ◽  
Gavin Sim
Keyword(s):  
Antibiotic Resistance ◽  
Prospective Study ◽  
Antibiotic Prescription ◽  
District General Hospital ◽  
Antibiotic Use ◽  
County Hospital ◽  
Nice Guidelines ◽  
Increasing Trend ◽  
A Prospective Study ◽  
Focus Strategy

  Background: Antimicrobial Stewardship and The Start Smart – Then Focus strategy provide guidelines aimed at improving the increasing trend of antibiotic resistance. The aim of this study was to assess whether antibiotics were being prescribed at Royal Hampshire County Hospital (a district general hospital), in accordance with the hospital’s and the NICE guidelines and whether this followed the Start Smart – Then Focus approach.   Methods: During November 2016, medical notes of 12 randomly selected in-patients of Royal Hampshire County Hospital on 45 antibiotics, were used to measure the dynamics of their prescriptions.   Results: 91% of the 45 prescriptions were in accordance with hospital guidelines, 82% of cases had appropriate samples sent before commencing antibiotics, 5% out of 27% had a planned switch from intravenous administration to oral (the remaining 73% were initially started on oral regimes) and 80% had planned stop dates.   Conclusion: Appropriate samples, stop dates, planning and documentation in patient notes must be improved with regards to antibiotic use.  

scholarly journals Induced by infection? A case of acute myocardial infarction with hypothermia

2019 ◽  
Vol 47 (8) ◽  
pp. 3963-3967
Author(s):  
Liang Li ◽  
Shudong Xia ◽  
Chao Feng
Keyword(s):  
Myocardial Infarction ◽  
Abdominal Pain ◽  
Body Temperature ◽  
Vital Signs ◽  
Reactive Protein ◽  
St Segment ◽  
Intravenous Antibiotics ◽  
St Elevation ◽  
Electrocardiographic Findings ◽  
The Right

A 52-year-old man was admitted to our hospital because of abdominal pain, nausea, and vomiting. On arrival, his body temperature was <35°C. Although his other vital signs and electrocardiographic findings were normal, his white blood cell count and C-reactive protein concentration were elevated. He was diagnosed with severe infectious disease and treated with intravenous antibiotics and rewarming therapy. Two hours later, his body temperature had increased to 38.4°C, but his abdominal pain persisted. A repeat electrocardiographic examination showed an elevated ST-segment in leads II, III, and aVF. He was then diagnosed with ST-elevation myocardial infarction. Coronary angiography showed occlusion of the right coronary artery, and he underwent implantation of two stents. His symptoms were relieved soon thereafter, and his body temperature returned to normal without antibiotics.

scholarly journals Erratum

1996 ◽  
Vol 116 (3) ◽  
pp. 383-383
Keyword(s):  
General Hospital ◽  
Broad Spectrum ◽  
Varicose Veins ◽  
District General Hospital ◽  
Operating Theatre ◽  
Necrotising Fasciitis ◽  
Tissue Sections ◽  
Intravenous Antibiotics ◽  
Epidemiol Infect ◽  
Gram Positive Cocci

Epidemiol. Infect. 115 (1995), 387–97K.Cartwright, M.Logan, C.McNulty, S.Harrison, R. George, A.Efstratiou, M.McEvoy and N.BeggA cluster of cases of streptococcal necrotising fasciitis in GloucestershirePage 389,final paragraph should read:Patient BThree days later (7 February), patient B underwent a routine sapheno-femoral disconnection for varicose veins in the same operating theatre. In the evening she developed diarrhoea which persisted overnight; gastroenteritis was suspected. Early the next morning she was re-examined by her surgeon and was transferred to the district general hospital at about midday. NF was suspected, broad-spectrum intravenous antibiotics were commenced and surgery arranged. The diagnosis was confirmed at operation. The affected tissues were excised and specimens sent for culture and histology. Chains of Gram-positive cocci were seen in tissue sections and later, S. pyogenes was isolated.

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