scholarly journals EP.FRI.472Building the ‘LIEGS’ way – Establishing an ambulatory Rapid Access Theatre Service for those patients with acute surgical pathology requiring operative management

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nasira Amtul ◽  
Aman Ahmad ◽  
Lindsay Mutyavaviri ◽  
Adam Peckham-Cooper ◽  
Giles Toogood ◽  
...  
Keyword(s):  
Wait Time ◽  
Database Systems ◽  
Operative Management ◽  
Day Case ◽  
Rapid Access ◽  
Early Results ◽  
Patient Database ◽  
Biliary Pathology ◽  
Operating List ◽  
The Uk

Abstract Aim LTHT is the largest acute surgical unit in the UK and has seen an annual 11% increase in attendances with often 90 patients assessed daily. 40% patients present with acute biliary pathology but despite this there has been no dedicated operating list for this cohort of patients. Rapid Access Theatre (RAT) lists were created to manage these patients. We report our early results. Method In October 2020 the trust appointed four EGS Consultants forming a dedicated acute general surgical service. Emphasis was placed on creating ambulatory pathways and those patients safe to be managed at home but requiring surgical intervention are placed on a day case RAT list. COVID-19 has restricted the broad use of this service for all emergency admissions but biliary pathology continues to be amenable to these pathways. Data was collected retrospectively using in-house coding and electronic patient database systems.   Results 34 day case laparoscopic cholecystectomies were performed in the first 10 weeks. Mean age was 44(17-67) with a male:female ratio of 1:1. Mean wait time from clinical review to theatre was 11(3-23) days. 1 patient required overnight admission but there were no readmissions and no reported complications at 30 days.   Conclusion Despite isolation restrictions resulting from COVID-19, the service has allowed patients to be assessed and treated in a timely, safe fashion. The new service has resulted in significant reductions in bed stays and improved patient experiences. Financial savings have been clearly delineated and as such expansion of the model is underway.

SP3.1.9 Building the ‘LIEGS’ way – The development and delivery of ambulatory surgical services in the busiest acute surgical unit in the UK

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adam Peckham-Cooper ◽  
Andrea Giorga ◽  
Nasira Amtul ◽  
Aman Ahmad ◽  
Giles Toogood ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Surgical Care ◽  
Day Case ◽  
Emergency General Surgery ◽  
Alternative Pathways ◽  
Rapid Access ◽  
Acute Surgery ◽  
Patient Pathways ◽  
The Uk

Abstract Background Managing unplanned surgical care presents enormous challenges to trusts and continues to be resource intensive. Significant patient numbers can be managed in novel ways preventing admission with effective triage to alternative flow streams using outpatient/ambulatory models. Leeds Institute of Emergency General Surgery (LIEGS) reports its early experience. Methods Patients requiring assessment or admission from primary care are triaged directly by a consultant. GP’s are offered advice or patients are directed to appropriate assessment/triage pathways. A number of alternative pathways exist depending on pathology and patient demographics. Prospective data for all patients referred are captured and retrospective analysis of outcomes collected. We report our experience from October-November 2020. Results Consultant triage and early senior decision-making has streamlined patient pathways and flow. 51%(237) of all GP referrals(465) were assessed primarily in ASC, 8%(36) required advice only and 10%(44) were directed to other specialities. 30%(139) were seen on the Surgical Assessment Unit ward representing a reduction of 70% compared to the previous year. Outcomes from those patients seen in ASC were discharge after imaging (87,18.7%), discharge without imaging (74,15.9%), hospital admission (65,14%), acute operation (63,13.5%), referral to other specialty (64,13.8%) and Rapid Access Theatre for day case operation (32,6.9%). Conclusion 71.7% of all acute surgery primary care referrals were managed on in an ambulatory fashion providing an invaluable resource. Early senior decision making, a one-stop clinic for investigations and day case Rapid Access Theatre (RAT) lists can significantly improve the patient pathways and experience.

scholarly journals Diagnostic amyloid proteomics: experience of the UK National Amyloidosis Centre

2020 ◽  
Vol 58 (6) ◽  
pp. 948-957 ◽  
Author(s):  
Diana Canetti ◽  
Nigel B. Rendell ◽  
Janet A. Gilbertson ◽  
Nicola Botcher ◽  
Paola Nocerino ◽  
...  
Keyword(s):  
Simple Algorithm ◽  
Enzymatic Digestion ◽  
The Body ◽  
Clinical Samples ◽  
Correct Identification ◽  
Pathogenic Variants ◽  
Amyloidogenic Protein ◽  
Patient Database ◽  
Serious Disease ◽  
The Uk

AbstractSystemic amyloidosis is a serious disease which is caused when normal circulating proteins misfold and aggregate extracellularly as insoluble fibrillary deposits throughout the body. This commonly results in cardiac, renal and neurological damage. The tissue target, progression and outcome of the disease depends on the type of protein forming the fibril deposit, and its correct identification is central to determining therapy. Proteomics is now used routinely in our centre to type amyloid; over the past 7 years we have examined over 2000 clinical samples. Proteomics results are linked directly to our patient database using a simple algorithm to automatically highlight the most likely amyloidogenic protein. Whilst the approach has proved very successful, we have encountered a number of challenges, including poor sample recovery, limited enzymatic digestion, the presence of multiple amyloidogenic proteins and the identification of pathogenic variants. Our proteomics procedures and approaches to resolving difficult issues are outlined.

scholarly journals Day case laparoscopic cholecystectomy: Identifying patients for a ‘COVID-Cold’ isolated day-case unit during the pandemic

2021 ◽  
pp. 175045892097741
Author(s):  
Zoe Hinchcliffe ◽  
Imran Mohamed ◽  
Anil Lala
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Hospital ◽  
Univariate Analysis ◽  
District General Hospital ◽  
Day Case ◽  
Patient Factors ◽  
Surgical Services ◽  
North Wales ◽  
Selection For ◽  
The Uk

Background The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as ‘COVID-cold’ operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Method Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. Results The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p = 0.004), BMI ( p = 0.01), ASA Score ( p = 0.006), previous ERCP ( p = 0.05), imaging suggesting cholecystitis ( p = 0.003) and thick-walled gallbladder ( p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05–3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72–11.38; p = 0.002) and previous ERCP (5.25, 1.53–18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35–39.9kg/m2. Conclusions Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35–39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.

scholarly journals Is there a need for early post-operative x-rays in primary total knee replacements? Experience of a centre in the UK

2012 ◽  
Vol 94 (3) ◽  
pp. 199-200 ◽  
Author(s):  
S Hassan ◽  
A Wall ◽  
B Ayyawamy ◽  
S Rogers ◽  
SP Mills ◽  
...  
Keyword(s):  
Tibial Fracture ◽  
Operative Management ◽  
X Rays ◽  
Inferior Pole ◽  
Total Knee Replacements ◽  
Knee Replacements ◽  
Total Knee ◽  
The Uk ◽  
Primary Total Knee

INTRODUCTION Early post-operative x-rays are often taken in total knee replacements (TKRs). Patient mobilisation may be delayed until these x-rays are obtained and this may prolong discharge. The aim of this study was to assess the value of such early x-rays and whether they influenced the early post-operative management of these patients. METHODS A total of 624 consecutive TKRs performed at the Blackpool Victoria Hospital over a 34-month period were evaluated. Plain anteroposterior and lateral x-rays were examined. RESULTS Two patients were found to have significant abnormalities: an undisplaced peri prosthetic tibial fracture and a partial inferior pole patellar avulsion. Neither of these required further treatment or influenced mobility. No other complications were noted that changed routine post-operative management. CONCLUSIONS These results question the need for immediate x-rays in primary TKRs.

scholarly journals Demographic and clinical characteristics of traumatic shoulder dislocations in an eastern Anatolian city in Turkey: A retrospective single-centre analysis of 181 patients

2021 ◽  
Vol 8 (5) ◽  
pp. 298-305
Author(s):  
Ömer Cengiz ◽  
Ferdi Dırvar
Keyword(s):  
Emergency Department ◽  
Shoulder Dislocation ◽  
Clinical Characteristics ◽  
Sports Injuries ◽  
Age Distribution ◽  
Mechanism Of Injury ◽  
Single Centre ◽  
Patient Database ◽  
The Usa ◽  
The Uk

Objective: This study aims to investigate demographic and clinical characteristics of traumatic shoulder dislocations in an Eastern Anatolian city (Muş) in Turkey. Material and Methods: Digital patient database was reviewed to identify the glenohumeral shoulder dislocations admitted to the emergency department between January 2017 and December 2018. Incidence, demographics, recurrence, associated injuries, and mechanism of injury were evaluated. Results: One hundred and eighty-one patients (140 males, 41 females; mean age: 39.98±20.41 years) experienced traumatic shoulder dislocation during the study period. The incidence was 18,9 per 100,000 person-years. Age distribution peaked between 21 and 30 (94.5% male) and between 61 and 70 years. Primary shoulder dislocation occurred in 153, recurrent dislocations in 28, and anterior dislocations in 177 patients. The mechanism of injury included falls in 144 and sports injuries in 18 cases. The reduction was achieved in 154 patients in the emergency department. Conclusion: The incidence of traumatic shoulder dislocations in Muş was higher than the study conducted in Turkey but similar to those in Europe, the UK, and the USA. Risk factors included young age (21-40) and participation in sports in men but fall and being in the 6th decade in women.

scholarly journals Concurrency Control in Database Systems

2019 ◽  
Vol 1 (2) ◽  
pp. 26-40
Author(s):  
Dardina Tasmere ◽  
Md. Nazmus Salehin
Keyword(s):  
Concurrency Control ◽  
Phase Locking ◽  
Wait Time ◽  
Arrival Rate ◽  
Database Systems ◽  
Control Algorithms ◽  
Control Mechanisms ◽  
Time Stamp ◽  
System Behavior ◽  
Two Phase

Concurrency control mechanisms including the wait, time-stamp and rollback mechanisms have been briefly discussed. The concepts of validation in optimistic approach are summarized in a detailed view. Various algorithms have been discussed regarding the degree of concurrency and classes of serializability. Practical questions relating arrival rate of transactions have been presented. Performance evaluation of concurrency control algorithms including degree of concurrency and system behavior have been briefly conceptualized. At last, ideas like multidimensional timestamps, relaxation of two-phase locking, system defined prewrites, flexible transactions and adaptability for increasing concurrency have been summarized.

scholarly journals 1018 Did COVID Compromise the Care of Closed Paediatric Hand Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Dbeis ◽  
G Yim ◽  
A Watts
Keyword(s):  
Health Informatics ◽  
Operative Management ◽  
National Standards ◽  
Post Injury ◽  
Rapid Access ◽  
Hand Fractures ◽  
National Guidance ◽  
A Prospective Study ◽  
Surgery Department ◽  
Mean Time

Abstract Aim To assess the effect of a ‘rapid-access’ musculoskeletal unit, established in March 2020, as part of the Royal Devon & Exeter hospital COVID response, with direct assessment of hand trauma by the Plastic Surgery department staff, on treatment timelines and national guidance compliance for closed paediatric hand fractures. Method This was a retrospective review from 1st January to 31st December 2019 and a prospective study from the 1st April to 15th June 2020. The retrospective cases were collated by health informatics. The prospective data was recorded on the department’s database. Exclusion criteria: nail bed injuries with tuft fractures, ligament injuries only, open fractures and patients aged 18 at time of surgery. Results In 2019 the majority (73%) of patients (n = 26) were referred within 48hrs but waited a median of 5 days to be seen in clinic by a hand surgeon resulting in significant delays in treatment. After service reconfiguration in 2020, all patients (n = 6) were operated on within 72 hours of the decision to operate - mean time to surgery 1.5 days (range 0-3 days). The mean time from referral to clinic was 1.33 days (range 0-6 days). 4 patients were operated on within 7 days of injury. Of the 2 patients operated on &gt; 7 days, 1 was referred 32 days post injury and 1 failed conservative management. Conclusions The introduction of a ‘rapid-access’ musculoskeletal unit with early senior review and a dedicated theatre has created ‘gold-standard’ compliance with national standards for the operative management of closed paediatric fractures.

Burns first aid

2019 ◽  
pp. 59-66
Author(s):  
Jorge Leon-Villapolas
Keyword(s):  
Operative Management ◽  
First Aid ◽  
Burn Injuries ◽  
Tissue Preservation ◽  
Common Occurrence ◽  
Conflicting Information ◽  
History Of ◽  
The Common ◽  
The Uk ◽  
The Way

In the UK alone there are approximately 175,000 acute burn injuries /year. There is a great variation in the way these injuries are managed. Advances in our understanding of the pathophysiology and natural history of burn injuries have highlighted the importance of early intervention in minimizing later functional and cosmetic morbidity. Differences in beliefs and ethnic background have a large impact on the way that burns are initially dealt with, as we know that only a minority of patients presenting with burns are optimally managed pre-hospital. Lack of education and conflicting information about burns first aid is believed to be a major factor in the common occurrence of burnt patients presenting with a variety of domestic remedies being applied to their burns as first aid. Judicious application of simple burns first aid is the first step for soft tissue preservation, improvement of outcomes and a decrease in the need for operative management.

scholarly journals Ear, Nose and Throat Day-Case Surgery at a District General Hospital

2009 ◽  
Vol 91 (2) ◽  
pp. 147-151 ◽  
Author(s):  
T Pézier ◽  
P Stimpson ◽  
RG Kanegaonkar ◽  
DA Bowdler
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Information Management System ◽  
Day Case ◽  
Common Procedure ◽  
Admission Rates ◽  
Ent Surgery ◽  
Proxy Measure ◽  
South East England ◽  
The Uk

INTRODUCTION In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. PATIENTS AND METHODS Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. RESULTS Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. DISCUSSION ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.

scholarly journals Structure and Functions of Computer Database Systems

1988 ◽  
Vol 13 (4) ◽  
pp. 37-44
Author(s):  
Attahir Yusuf ◽  
Godson Nnadi
Keyword(s):  
Computer System ◽  
System Development ◽  
Database Systems ◽  
Rapid Access ◽  
Effectiveness And Efficiency ◽  
The Creation ◽  
Commercial Organizations ◽  
Structure And Functions

The effectiveness and efficiency with which commercial organizations process large quantities of data they generate is becoming a key competitive weapon. Computer system development in recent years has led to the creation of databases—easily updated filing systems that provide easy and rapid access to a number of users with diverse needs. Yusuf and Nnadi explain what database systems are, their functions, trends in their structures, and how they should be evaluated.

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