scholarly journals EP.FRI.700 NCEPOD Acute Bowel Obstruction Report 2019:  A pilot study for review of quality of care provided to patients with acute bowel obstruction in a Surgical Emergency Unit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Abhishek Dey ◽  
Antons Rudzats ◽  
Jeffrey Gilmour
Keyword(s):  
Bowel Obstruction ◽  
Retrospective Case ◽  
X Ray ◽  
Surgical Emergencies ◽  
The Mean ◽  
Pathway Of Care ◽  
In Transit ◽  
Mean Time ◽  
Larger Sample

Abstract Aims Acute bowel obstruction is one of the commonest surgical emergencies posing various diagnostic and therapeutic challenges. A review of care titled ‘Delay in Transit’ by NCEPOD delineated inadequacies in the pathway of care for patients with acute bowel obstruction nationwide, highlighting areas of improvement. This audit aims to assess key elements of management pathway in our centre and compare it to national statistics.  Methods A retrospective case note analysis was conducted for 24 randomly selected patients, aged above 15 years, admitted with a clinical diagnosis of acute bowel obstruction between December, 2018-December, 2019. Results Summary of some of NCEPOD recommendations, national and local performance The mean time to diagnosis was 8.5±6.6 hours, which was delayed if abdominal X-ray preceded the CT. Poor consultant review times may reflect failure to capture on records. Conclusion The management pathway, although faring well in some criteria, has scope for further improvement. Plans for an audit with a larger sample size will be implemented along with an enhanced pathway.

scholarly journals 1700 Using Intra-Operative Imaging as A Tool to Provide Peer Review, Scoring, Feedback and Education for Hand and Wrist Trauma Cases - A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Smith ◽  
A Thompson ◽  
P Stanier ◽  
J Rooker ◽  
I Lowdon
Keyword(s):  
Final Report ◽  
X Rays ◽  
Improvement Project ◽  
X Ray ◽  
Constructive Feedback ◽  
Wrist Trauma ◽  
Specific Feedback ◽  
The Mean ◽  
Mean Time

Abstract Aim To improve the efficiency of intraoperative hand trauma x-ray review, introduce a scoring system for quality of fixation achieved and use this as an education and feedback tool for trainees. Method A large QI project in 2019 demonstrated that intra-operative images taken using the mini C-arm were not being reviewed. In March 2020 the first QI cycle introduced an Access database to ensure that as cases were removed from the trauma board, they were added to a review list. Each x-ray was also scored in the trauma meeting (good, acceptable, poor) to assess the radiographic quality of fixation. The second QI cycle identified the named surgeon for each case, allowing surgeon specific feedback. Finally, we trained all qualified users of the mini C-arm to upload their own images after each case, reducing the mean time to upload. Results This QI project has improved the review rate of mini C-arm images from 30% to 100% and every x-ray is scored. The mean time to review images has reduced from 4 days to less than 24 hours. All trainees can access their scores for imaged hand and wrist trauma and receive written constructive feedback. Conclusions This project ensures appropriate and prompt review of all hand and wrist trauma cases allowing early identification of any concerns. All x-rays are scored, and this process acts as an educational prompt in the trauma meeting. A final report can be printed for each trainee which can be uploaded to their portfolio to document their surgical progress.

Quality of febrile neutropenia management in a regional cancer center emergency department.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 104-104
Author(s):  
Priyanka Kapil ◽  
Katherine Enright
Keyword(s):  
Emergency Department ◽  
Febrile Neutropenia ◽  
Antibiotic Therapy ◽  
Cancer Site ◽  
Cancer Center ◽  
Time To Initiation ◽  
The Mean ◽  
The Impact ◽  
Mean Time

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.

scholarly journals Epidemiología de la atención prehospitalaria de las luxaciones de hombro en montaña (Epidemiology of prehospital care of shoulder dislocation in the mountain)

2019 ◽  
Vol 0 (Avance Online) ◽  
Author(s):  
Eva Sierra Quintana ◽  
Francisco Benjumea Fernández ◽  
María de la Vieja Soriano
Keyword(s):  
Shoulder Dislocation ◽  
Prehospital Care ◽  
Descriptive Study ◽  
X Ray ◽  
Approach Method ◽  
The Mean ◽  
Extremity Injuries ◽  
Epidemiological Characteristics ◽  
Mean Time ◽  
Accident Site

RESUMEN Objetivo: Describir las características clínico-epidemiológicas de los pacientes rescatados que presentaban luxación de hombro, así como el abordaje terapéutico. Método: Estudio descriptivo retrospectivo de los pacientes atendidos durante el periodo julio 2010-diciembre 2016 que presentaban una luxación de hombro. Resultados: Se analizan 57 pacientes. Las luxaciones de hombro suponen un 42.5% de las lesiones en extremidades superiores y un 2.7% del total de rescates. La edad media es 40.7±11.9 años; 96.4% varones. El senderismo, barranquismo y esquí de montaña son las actividades con más luxaciones. El 98.2% eran tipo glenohumeral anterior. La reducción fue exitosa en 80.9%, siendo la maniobra de Kocher la más empleada. El tiempo medio hasta el primer intento de reducción cuando maniobra fue exitosa fue de 87 minutos y 142 minutos cuando fracasa. Conclusiones: Se observa un aumento en las luxaciones de hombro, siendo la mayoría reducidas en el lugar del accidente, sin existir una maniobra de elección, y mayor éxito cuanto menor tiempo hasta maniobra. Reducir sin radiografía es seguro y eficaz. ABSTRACT Objective: To describe the clinical-epidemiological characteristics of the rescued patients with shoulder dislocation, as well as the therapeutic approach. Method: A retrospective descriptive study of the patients treated during the period July 2010-December 2016, who presented with a shoulder dislocation. Results: A total of 57 patients were analysed. Shoulder dislocations account for 42.5% of upper extremity injuries and 2.7% of total rescues. The mean age being 40.7±11.9 years; 96.4% were male. Hiking, canyoning and mountain skiing are the activities in which most of the dislocations occur. 98.2% of the dislocations were anterior glenohumeral type. The reduction was successful in 80.9%, with the Kocher manoeuvre being the most used. The mean time until the first reduction attempt was successful was 87 minutes and 142 minutes when the manoeuvre failed. Conclusions: An increase in the number of shoulder dislocation was observed, most of them reduced at the accident site, there is no evidence of a single most successful manoeuvre over another. The quicker the reduction is attempted the more success is achieved. A reduction without performing an X-ray is safe and efficient. RESUMO Objetivo: Descrever as características clínico-epidemiológicas e abordagem terapêutica em pacientes resgatados com luxação do ombro. Método: Estudo descritivo retrospectivo dos pacientes que apresentaram luxação de ombro, atendidos no período de julho de 2010 a dezembro de 2016. Resultados: Um total de 57 pacientes foram analisados. Luxações do ombro representam 42.5% das lesões da extremidade superior e 2.7% do total de resgates. A médiade idade foi de 40.7 ± 11.9 anos; 96.4% eram do sexo masculino. Caminhadas, canyoning e esqui de montanha são as atividades nas quais a mayoría das luxações ocorre. 98.2% das luxações foram do tipo glenoumeral anterior. A redução foi bem sucedida em 80.9%, sendo a manobra de Kocher a mais utilizada. O tempo médio até a primeira tentativa de redução foi de 87 minutos e 142 minutos quando a manobra falhou. Conclusões: Um aumento no número de luxações do ombro foi observado e a maioria delas reduzidas no local do acidente. Não há evidência de uma única manobra de maior sucesso em detrimento de outra. Quanto mais rápidaa redução é realizada, maior é o sucesso alcançado. Uma redução sem a realização de um raio X é segura e eficiente.

scholarly journals Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

2018 ◽  
Vol 44 (6) ◽  
pp. E15 ◽  
Author(s):  
Malte Mohme ◽  
Friederike S. Fritzsche ◽  
Klaus C. Mende ◽  
Jakob Matschke ◽  
Ulrike Löbel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Course ◽  
Case Series ◽  
Diffuse Astrocytoma ◽  
The Mean ◽  
Mean Time ◽  
Tectal Glioma ◽  
Astrocytoma Grade

OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

scholarly journals The impact of angling experience on the efficiency of float fishing using different hook types

2019 ◽  
Vol 27 (1) ◽  
pp. 41-46
Author(s):  
Tomasz K. Czarkowski ◽  
Andrzej Kapusta
Keyword(s):  
The Mean ◽  
Catch Rates ◽  
Time Required ◽  
The Impact ◽  
Mean Time

Abstract The aim of the study was to compare the catch efficiency of novice and experienced anglers float fishing with different hook types. The mortality of fish that were caught and released was determined based on the experience of the angler and the type of hook used. The mean catch rates of the experienced angler was 46.7 fish per hour, while that of the novice angler was 33.7 fish per hour. The landing efficiency of fish using hooks with micro-barbs was higher than that with barbless hooks. Angling experience had a significant impact on the mean time required to unhook caught fish and also on the mortality of the fish released. The lowest mortality was noted in fish caught by experienced anglers fishing with barbless hooks. The results of the study suggest that angling experience does not have a great impact on parameters characterizing the quality of angling catches. The efficiency of float fishing performed by novice and experienced anglers was similar. Differences were noted in the time required to unhook the fish and in the mortality of the fish released.

scholarly journals Navigation with laparoscopic ultrasound during fundus-first laparoscopic cholecystectomy-a single-centre retrospective case control study

2020 ◽  
Author(s):  
Maciej Sebastian ◽  
Agata Sebastian ◽  
Jerzy Rudnicki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Statistical Significance ◽  
Laparoscopic Ultrasound ◽  
Retrospective Case ◽  
Exact Test ◽  
Critical View ◽  
Critical View Of Safety ◽  
The Mean ◽  
Mean Time ◽  
Bail Out

Abstract Background Laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystolithiasis. The critical view of safety is a generally accepted technique of intraoperative visualization but during inflammation and fibrosis in the region of Calot’s triangle it may fail. Fundus-first laparoscopic cholecystectomy with laparoscopic ultrasound navigation may be an attractive bail-out option when the intraoperative conditions are difficult. Methods The study group consisted of 900 patients with symptomatic cholecystolithiasis which was divided into two subgroups. The first subgroup where the only method of intraoperative identification was the critical view of safety consisted of 402 patients, the second subgroup where the critical view of safety and laparoscopic ultrasound were used consisted of 498 patients. In the first subgroup fundus-first laparoscopic cholecystectomy was performed in 13 patients, in the second subgroup in 42 patients. Statistical analysis included the Mann-Whitney U test for continuous and Fisher’s exact test for binary variables. The level of statistical significance was set at 95% (p < 0.05). Results Fundus-first technique was significantly more often in the subgroup with laparoscopic ultrasound and the hospitalization time of fundus-first laparoscopic cholecystectomies was significantly shorter than in converted cases. The mean time of laparoscopic cholecystectomy and the mean time to obtain the transection level between the gallbladder and the hepatoduodenal ligament were significantly shorter and the conversion rate was significantly lower in the fundus-first and laparoscopic ultrasound group. Conclusions Fundus-first technique with laparoscopic ultrasound navigation may be a very efficient bail-out option during laparoscopic cholecystectomy due to a more precisely and significantly faster defined plane of dissection what enables safe performance of laparoscopic cholecystectomy with significantly lower rate of conversions.

scholarly journals Evaluation of Youtube Video Content About Developmental Dysplasia of the Hip

2020 ◽  
Author(s):  
Ahmet Oztermeli ◽  
Nazım Karahan
Keyword(s):  
Peer Review Process ◽  
International Health ◽  
Poor Quality ◽  
Developmental Dysplasia ◽  
Global Quality ◽  
Youtube Videos ◽  
The Mean ◽  
Mean Time ◽  
Dysplasia Of The Hip

Abstract Background: The purpose of this study is to investigate the quality and reliability of YouTube videos regarding developmental dysplasia of the hip (DDH).YouTube is one of the most popular websites used as a source of information, but the variety in authorship and lack of a peer-review process are problems.Methods: The search string “developmental dysplasia of the hip” was inputted to the YouTube search engine, and the first 52 videos returned as a response were assessed. The Video Power Index (VPI) (like ratio*view ratio/100) was used to assess the popularity of the videos. Global Quality Score (GQS) and developmental dysplasia of the hip scores (DDHS) were used to evaluate the quality and educational quality of the videos, and The Journal of the American Medical Association Score (JAMAS) was used to evaluate the accuracy of the source of information.Results: According to our research, the mean duration time of the videos was 526 s (SD: 813), and the average view count of the videos was 34,644. The mean time since upload was 1907 days (SD: 1137). On average, the videos received 10.9 comments, 210.3 likes, and 6.8 dislikes. The mean like ratio and VPI were 92.9 (SD: 19.57) and 25.8 (SD: 53.43), respectively. The mean JAMAS, GQS, and DDHS of all videos evaluated were 1.37 (SD: 0.7), 2.46 (SD: 1.09), and 4.63 (SD: 5.00), respectively. The DDHS and GQS were positively correlated (p:0.001 r: 65.8%). The GQS and the DDHS were higher in the academic group than in the commercial group (p:0.01). (p:0.037).Conclusions: The videos regarding DDH on YouTube generally had poor quality. As a result, to maintain an optimal parent–physician or patient–physician relationship, we suggest that international health societies make their own educational videos for parents, patients, and fellow physicians.

Cancer diagnosis and adverse financial events: Evidence from credit reports.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6504-6504
Author(s):  
Veena Shankaran ◽  
Li Li ◽  
Catherine R. Fedorenko ◽  
Hayley Sanchez ◽  
Yuxian Du ◽  
...  
Keyword(s):  
Financial Data ◽  
Retrospective Case ◽  
Financial Status ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Matched Case ◽  
Western Washington ◽  
The Mean ◽  
Financial Events

6504 Background: Increasing evidence shows that cancer patients (pts) experience financial hardships after diagnosis. Few studies, however, have used objective financial data to estimate the relative risk of adverse financial events (AFEs) in cancer pts versus individuals without cancer. Using a retrospective case-control design, we investigated whether cancer pts are at increased risk of new AFEs, as measured by their credit reports. Methods: Western Washington Surveillance Epidemiology and End Results (SEER) cancer registry (cases) and voter registry (controls) records from 2013 to 2018 were linked to quarterly credit records from TransUnion (2012-2020), one of the 3 largest national credit agencies. Controls were age and sex matched to cases and assigned an index date corresponding to the diagnosis (dx) date of the matched case. Individuals with evidence of any AFE in the credit report closest to index/dx date or did not survive to 24 months were excluded. Cases and controls experiencing any of the following AFEs within 24 months were compared, using two-sample z tests: severe (3rd party collections, charge-offs), more severe (tax liens, delinquent mortgage payments), and most severe (foreclosures, repossessions). Multivariate logistic regression models were used to evaluate the association between cancer dx and AFE, adjusting for age, sex, dx year, and available credit 6 months before the index/dx date. Results: A total of 332,825 individuals (84,185 cases and 248,640 controls, mean age 66 (SD 13), 52.7% female) were included. The mean available line of credit in the year before index/dx date was $12,303. AFEs were more common in cases versus controls (Table). After adjusting for age, sex, available credit above or below $12,303, and dx year, cancer dx was significantly associated with any AFE (OR 1.77, 95% CI 1.7-1.85, p<0.0001), severe AFEs (OR 1.94, 95% CI 1.85-2.03, p<0.0001), more severe AFEs (OR 1.23, 95% CI 1.12-1.36, p<0.0001), and most severe AFEs (OR 1.46, 95% CI 1.16-1.86, p=0.0016). Age >65 and higher available baseline credit were associated with decreased risk of any and each category of AFE. Conclusions: Within 24 months from dx, significantly higher proportions of cancer pts experienced AFEs relative to controls. Such events on credit reports have serious and long-lasting consequences on financial status. Studies that link clinical and financial data to investigate the impacts of these events on treatment decisions, quality of life, and clinical outcomes are needed.[Table: see text]

scholarly journals The Journey of Cultures Taken During Revision Joint Arthroplasty: Preanalytical Phase

2019 ◽  
Vol 4 (3) ◽  
pp. 120-125 ◽  
Author(s):  
Kier M. Blevins ◽  
Karan Goswami ◽  
Javad Parvizi
Keyword(s):  
Laboratory Culture ◽  
Joint Arthroplasty ◽  
Idle Time ◽  
Pathogen Identification ◽  
Preanalytical Phase ◽  
Hip And Knee Arthroplasty ◽  
The Mean ◽  
Initial Sampling ◽  
In Transit ◽  
Mean Time

Abstract. Background: Microbiological culture has been considered the standard for pathogen identification for decades. However, culture is a laborious, time consuming, imperfect and outdated process. This study aims to inform the orthopedic community of the steps and timing of routine culture processing.Methods: We prospectively tracked 103 cultures from 33 revision hip and knee arthroplasty patients between September 2017-February 2018. Times were recorded at intraoperative collection; time of pick up from OR, transportation time; arrival at the laboratory; culture processing and plating time; and time to final result reporting.Results: Of the 103 cultures, 45.6% were processed and incubated in less than two hours, and 54.4% greater than or equal to two hours. The mean time spent in the OR, during transport, and within the laboratory prior to incubation was 0:53, 0:06 and 1:12. The range of time that samples remained at each stage varied considerably in the OR (0:03-3:33), in transit(0:04-0:16), and in the lab prior to incubation(0:26-3:01). The proportion of the total time to incubation attributed to idle time samples spent in the OR after initial sampling was 40.0%. In contrast, transport to the laboratory represented 5.1% of the total time. Idle time in the laboratory represented the greatest share at 54.9%.Conclusion: There is significant variability in the time to transport, process and incubate culture samples. Almost half of the specimens were processed outside the 2-hour recommended window. Surgeons should be aware of idle time during processing and seek to optimize their institutional pathways to maximize culture yield.

scholarly journals CP3 Stars in Open Clusters

1993 ◽  
Vol 138 ◽  
pp. 639-643
Author(s):  
H. Schneider
Keyword(s):  
Rotational Velocity ◽  
Open Clusters ◽  
Age Dependence ◽  
Open Clusters And Associations ◽  
Peculiar Stars ◽  
The Mean ◽  
Mean Time ◽  
Larger Sample

AbstractAbt published in 1979 frequencies of peculiar stars in open clusters based on published classifications for 661 stars in 14 open clusters and associations. Among others he discussed an age dependence of the frequencies of CP3 stars and found them increasing with age. Furthermore, he suggested a possible age dependence of the rotational velocity of these stars.But the sample he used was rather small: he found eight CP3 stars in 5 open clusters. In the mean time the number of cluster CP3 stars was more than double. Therefore, the findings of Abt shall be examined on the basis of the larger sample.

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