scholarly journals EP.FRI.96 Negative appendectomy rate in young females, between theory and practice. Full audit cycle

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fady Hatem ◽  
Samir Mostafa ◽  
Rebecca Ross ◽  
Basel Chamali ◽  
Andrea Ivanov ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Action Plan ◽  
Theory And Practice ◽  
Negative Appendectomy ◽  
Improvement Project ◽  
Young Females ◽  
Child Bearing ◽  
Audit Period ◽  
Negative Appendectomy Rate ◽  
Audit Cycle

Abstract Aims Females of child bearing age are at higher risk of negative appendectomy rate, the accepted overall NAR is up to (20-25%). Presented is our study to examine the real NAR in the female’s cohort aged (15-45 years) in the form of quality improvement project to improve patient’s outcome. Methodology Retrospective study in the form of Full audit cycle over 18 months, the first cycle was conducted over 12 months period, followed by the action plan and reassessment over 6 months. Preoperative clinical, laboratory, radiographic and histopathological data were collected. Results Over the whole audit period 632 cases were analysed, 238 cases were females in the child bearing age included in our cohort. Over the first phase 419 appendectomy cases were performed, among those 156(37%) were females in child bearing age. Overall NAR was 29% and in our females cohort was 43.5%. Over the second cycle, 213 cases performed, out of which 82(38%) cases included in our cohort. Overall NAR reduced to 25% and in our cohort was 37% Conclusions Despite the advances in diagnostic modalities, Females are at significantly higher risk of NAR 37%. Our overall NAR reduced from 29% to 25% compared to the young females cohort, the rate dropped from 43% to 37%. specific consideration and regular auditing of results regards this cohort are highly recommended. Validation of appendicitis scores for risk stratification, Serial examinations and radiological adjuncts are possible solutions to reduce the NAR among this group.

scholarly journals EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fady Hatem ◽  
Samir Mostafa ◽  
Basel Chamali ◽  
Andrea Ivanov ◽  
Rebecca Ross ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Published Data ◽  
Negative Appendectomy ◽  
Child Bearing ◽  
Single Centre Study ◽  
Positive Scan ◽  
Negative Appendectomy Rate ◽  
The Mean ◽  
Low Sensitivity ◽  
The Uk

Abstract Aims Appendicitis remains the most common acute surgical condition.  No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis.  Methods A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done. Results 632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan.  Conclusions Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis.  However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.

Surgical Case

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ali Hameed Al-Badri
Keyword(s):  
Diagnostic Delay ◽  
Small Population ◽  
Negative Appendectomy ◽  
Time Cost ◽  
Voluntary Cough ◽  
Suspected Appendicitis ◽  
Sharp Pain ◽  
Clinical Syndromes ◽  
Negative Appendectomy Rate ◽  
Classical Symptom

Appendicitis is a common and urgentsurgical illness with protean manifestations,generous overlap with other clinical syndromes,and significant morbidity,whichincreases with diagnostic delay. No single sign,symptom,or diagnostic test accurately confirms the diagnosis ofappendiceal inflammation in all cases. The surgeon's goals are to evaluate a relatively small population of patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. The emergency department clinician must evaluate the larger group of patients who present to the ED with abdominal pain of all etiologies with the goal of approaching 100% sensitivity for the diagnosis in a time-,cost-,and consultation-efficient manner.IN 1886Reginald fitz, pathologist 1st described the clinical condition of A.A.Fewyears laterCharles mcBurney describe the clinical finding ofA.A.55% of patients presented with classical symptom of A.A so complication occurbecauseof atypical presentation which due to variation in app. Position, age of patient & degree of inflammation.Migrating pain 80% sensitive and specific Vomiting 50% Nausea60 -90 %Anorexia 75 % Diarrhea18 % 32 % has similar attach 90 % RLQ tenderness Marklesign 74 %Dunphy's sign (sharp pain in the RLQ elicited by a voluntary cough) may be helpful in making the clinical diagnosis of localized peritonitis. Similarly,RLQ pain in response to percussion of a remote quadrant of the abdomen,or to firm percussion of the patient's heel,suggests peritoneal Inflammation

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

scholarly journals The actual aspects of the combination of theory and practice in the teaching of discipline «clinical laboratory diagnostics»

2019 ◽  
Vol 23 (1 (89)) ◽  
pp. 140-144 ◽  
Author(s):  
G. I. Kshanovska ◽  
L. D. Boreyko ◽  
I. A. Plesh ◽  
S. Yu. Karatieieva ◽  
N. А. Slyvka
Keyword(s):  
Clinical Laboratory ◽  
Theory And Practice ◽  
Laboratory Diagnostics

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

scholarly journals Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort and validation study

2020 ◽  
Vol 79 ◽  
pp. 257-264 ◽  
Author(s):  
Koen Gelpke ◽  
Jenneke T.H. Hamminga ◽  
James J. van Bastelaar ◽  
Bart de Vos ◽  
Maarten E. Bodegom ◽  
...  
Keyword(s):  
Validation Study ◽  
Prospective Cohort ◽  
Negative Appendectomy ◽  
Negative Appendectomy Rate ◽  
Appendicitis Score ◽  
Multicenter Prospective Cohort

The Application of Lean Six Sigma Methodology in Execution Process, Management and Attribution of Maintenance Activities

2014 ◽  
Author(s):  
Robson Ferreira de Souza ◽  
Luciane G. Tomaz ◽  
Vicente J. C. Real ◽  
Tatiana Malafaia Cardoso
Keyword(s):  
Natural Gas ◽  
Cultural Change ◽  
Six Sigma ◽  
Process Management ◽  
Action Plan ◽  
Lean Six Sigma ◽  
Workforce Training ◽  
Improvement Project ◽  
Six Sigma Methodology ◽  
Market Solutions

One of any company’s major assets is information and there is no information without data. In this regard, there are numerous market solutions for maintenance data records. At times, data quality is not satisfactory and this prevents obtaining information, thus jeopardizing reliability of the assets, affecting efficacy of a company’s management decisions and causing serious problems. This article aims to explain the use of the six sigma methodology to improve quality in maintenance records in the Natural Gas Department of Transpetro. To this end, the Maintenance Record Improvement Project was created, which involved plotting the execution process and maintenance records, development of portable tools for field records, redefining execution and management of routine maintenance processes, workforce training and cultural change. The article demonstrates how improvement opportunities were identified, mapping and measuring gaps, analysis of needs jointly with ways for treating them and preparing the action plan to prioritize the correction of deviations. In order to control the process, an indicator was developed to monitor progress in the quality of completing the records in the diverse Work Centers in the Transpetro Natural Gas Department (DGN) maintenance area.

Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan.

2020 ◽  
pp. 1-17
Author(s):  
Mohammad Ashraf ◽  
Syed Shahzad Hussain ◽  
Usman Ahmad Kamboh ◽  
Mehreen Mehboob ◽  
Saman Shahid ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit Quality ◽  
Wound Care ◽  
International Standards ◽  
Neurosurgical Department ◽  
Post Intervention ◽  
Improvement Project ◽  
Audit Cycle ◽  
Patient Note ◽  
Operative Notes

Abstract Objective: To identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. Methods: The prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 219 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patient-notes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. Results: Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care: monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in ‘use of antibiotic prophylaxes’. Conclusion: Regular audits are needed to monitor and improve, Continuous..

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