SP1.1.4The Walking Thread – What happens to fistula-in-ano patients who are lost to follow up? A Service Improvement Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ellen Murgitroyd ◽  
Blair Wilson ◽  
Darja Kremel ◽  
David Anderson
Keyword(s):  
Current Practice ◽  
Single Point ◽  
Perianal Abscess ◽  
Service Improvement ◽  
Fistula In Ano ◽  
Best Management ◽  
Retrospective Audit ◽  
Lost To Follow Up

Abstract Aims Management of perianal abscess and resultant fistula-in-ano remains controversial. Studies suggest that 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Our current practice is to incise and drain primary abscesses and for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic (EUA) at 6-12 weeks. Does this result in best management or do they become “elective emergencies”? Methods A retrospective audit of management of fistula-in-ano over 4 years was conducted, utilising precollected data of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes. Patients lost to follow up were analysed including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients underwent operations for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up despite documented follow up plans for 32. Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up. Conclusions The various presentations (emergency, elective, clinic) and waiting lists mean these patients are presenting as emergencies whilst awaiting follow-up. Many are simply lost to follow up, with Setons in-situ.   We propose a fortnightly hot-clinic system, run by second on-call registrars to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow-up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

scholarly journals 1703 The Walking Thread – What Happens to Fistula-In-Ano Patients Who Are Lost to Follow Up? A Service Improvement Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Ellen ◽  
B Wilson ◽  
D Anderson
Keyword(s):  
Single Point ◽  
Safety Net ◽  
Day Surgery ◽  
Service Improvement ◽  
Data Set ◽  
Fistula In Ano ◽  
Best Management ◽  
Retrospective Audit ◽  
Lost To Follow Up

Abstract Aim 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Current practice is to incise and drain primary abscesses and safety net for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic at 6-12 weeks.Is this best management or do they become “elective emergencies”? Method We performed a retrospective audit of management of fistula-in-ano over 4 years. We used a precollected data set of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes and collected data for patients lost to follow up, including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients were operated on for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up. 32 had documented follow up plans, that were not fulfilled (eg elective theatre not booked). Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up Conclusions The various presentations (emergency, elective, clinic or day surgery) and long waiting lists mean many of these patients are presenting as emergencies still awaiting follow up. Many are lost to follow-up, with Setons in situ. We propose a fortnightly hot-clinic system, registrar led to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

scholarly journals Cryoablation of Small Renal Tumors in Patients with Solitary Kidneys: Initial Experience

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Ravi Munver ◽  
Grant I. S. Disick ◽  
Salvatore A. Lombardo ◽  
Vladislav G. Bargman ◽  
Ihor S. Sawczuk
Keyword(s):  
Tumor Location ◽  
Renal Tumors ◽  
Minimal Risk ◽  
Contralateral Kidney ◽  
Nephron Sparing ◽  
Feasible Alternative ◽  
Lost To Follow Up

Introduction. The purpose of this study was to evaluate the role of renal cryoablation in patients with solitary kidneys with the goals of tumor destruction and maximal renal parenchymal preservation.Methods. Eleven patients with single tumors were treated with cryoablation, of which 10 patients had solitary kidneys and 1 had a nonfunctioning contralateral kidney. All procedures were performed via an open extraperitoneal approach; ten tumors were treated with in-situ cryoablation and 1 tumor was treated with cryo-assisted partial nephrectomy.Results. Cryoablation was successfully performed without any preoperative complications. Mean patient age was 62.4 years (range 49–79), tumor location included: 6 (upper pole), 2 (mid-kidney), 3 (lower pole). The mean and median tumor size was 2.6 cm and 2.8 cm (range 1.2–4.3 cm), mean operative time 205 minutes (range 180–270 minutes), blood loss 98.5 ml (range 40–250 ml), and hospitalization 4.6 days (range 3–8 days). Creatinine values included: preoperative 1.43 mg/dL (range 1.2–1.9), postoperative 1.67 mg/dL (range 1.5–2.5), and nadir 1.57 mg/dL (range 1.3–2.1). All patients were followed postoperatively with magnetic resonance imaging for surveillance. At a median follow-up of 43 months, 9 patients had no evidence of recurrence, 1 patient has an enhancing indeterminate area, and 1 patient was lost to follow-up.Conclusion. Intermediate-term results suggest that renal cryoablation offers a feasible alternative for patients that require a maximal nephron-sparing effort with preservation of renal function and minimal risk of tumor recurrence.

scholarly journals 1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Wong ◽  
R Sehgal ◽  
A Goyal ◽  
D Allen
Keyword(s):  
Discharge Summary ◽  
Sufficient Information ◽  
Health Seeking ◽  
Post Intervention ◽  
Discharge Letter ◽  
Red Flag ◽  
Considerable Morbidity ◽  
Lost To Follow Up

Abstract Introduction Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents. Method A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up. Results Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%. Conclusions Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.

Cancer Incidence in Epic-Italy at First Follow-Up

2003 ◽  
Vol 89 (6) ◽  
pp. 656-664 ◽  
Author(s):  
Rosario Tumino ◽  
Graziella Frasca ◽  
Domenico Palli ◽  
Giovanna Masala ◽  
Giovanna Tagliabue ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Uterine Cancer ◽  
Descriptive Analysis ◽  
Cancer Registries ◽  
Pooled Data ◽  
Cancer Occurrence ◽  
Starting Point ◽  
Lost To Follow Up

A descriptive analysis was performed in order to evaluate the completeness of follow-up and to explore the occurrence of malignancy in the Italian section of the European Prospective Investigation into Cancer and Nutrition (EPIC-Italy) at the first follow-up for cancer incidence. The EPIC-Italy cohort consisted of 47,749 subjects, aged 35-65 years, who voluntarily accepted to participate in the project from 1992-1997. Tabulations of the enrolled subjects are presented by sex, age groups, population at risk and person-years as calculated at the first follow-up in 1998; alive, lost to follow-up and dead subjects were tabulated by sex and centers. Cancer occurrence is described by quality indexes of data collected and the lapse of time between the date of recruitment and date of diagnosis. External comparisons for each center and pooled data were carried out by calculation of standard incidence ratios (SIRs) using the rates of the population-based cancer registries covering the areas of EPIC Italian centers. Similarly, an internal comparison was also performed using as the reference population the EPIC-Italy center with the lowest crude cancer incidence rates. A total of 148,968 person-years (43,568 men and 105,400 women) was calculated as the denominator; the percentages of lost to follow-up were 1.34% for men and 0.9% for women. We found 781 malignancies (216 in males and 565 in females), 17 in situ breast cancers and 8 in situ cervical cancers. In men 65 malignant cases (30.1%) and in women 186 malignancies (32.9%) occurred in the first year following enrollment. The proportion of microscopically verified cancers was 93.1%. In pooled data for men, statistically significant SIRs of less than 1 were calculated for all cancer sites combined (SIR = 0.81), lung (SIR = 0.49) and bladder (SIR = 0.62), whereas statistically significant excesses of observed cases were found for melanoma and cancers of ill-defined sites within respiratory system and intrathoracic organs (ICD-0-2 = C39). In pooled data for women, none of the SIRs were statistically significant. For men, SIRs disaggregated by center showed statistically significant excesses of cases only in Florence for the thyroid (SIR = 5.01). For women, statistically significant excesses of observed cases were computed in Florence and Varese for breast cancer (SIRs, 1.36 and 1.27, respectively), Florence for uterine cancer NOS (SIR = 20.3) and Varese for kidney (SIR 2.24). Internal comparisons showed some evidence of an excess of cases in northern compared to southern centers. In conclusion, after an average follow-up of 3 years, nearly 99% of the enrolled individuals were traced and checked for their vital status. Cancer occurrence in women was not far from that expected in comparison to the local general population, whereas in men significantly fewer cases than expected were observed. This preliminary descriptive analysis will be used as a starting point for monitoring the validity of EPIC-Italy over time.

scholarly journals Challenges to primary healthcare services in the management of non-communicable diseases in marginalised populations on the Thailand–Myanmar border: a pilot survey

2018 ◽  
Vol 48 (4) ◽  
pp. 273-277 ◽  
Author(s):  
Makoto Saito ◽  
Arunrot Keereevijit ◽  
Thi Dar San ◽  
Yin Yin Thein ◽  
Mary Ellen Gilder ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Low Cost ◽  
Healthcare Services ◽  
Communicable Diseases ◽  
Retention Rates ◽  
Non Communicable Diseases ◽  
Pilot Survey ◽  
Retrospective Audit ◽  
Lost To Follow Up

Non-communicable diseases (NCDs) are emerging rapidly. This manuscript reports on a pilot survey of NCDs at a primary healthcare level in a marginalised migrant population on the Thailand–Myanmar border in the face of declining rates of malaria. A retrospective audit of routine clinic (2004–2016) and NCD patient survey data (2014–2016) was conducted. The length of follow-up was assessed by Kaplan–Meier analysis. From July 2014 to July 2016, 238 migrant patients were on the NCD register. Hypertension (n = 80) and diabetes mellitus (n = 51) were the most common diagnoses. After the first consultation, 41% (95% confidence interval = 35–47%) were lost to follow-up by 30 days. NCD retention rates were low: 50% of registered patients were lost to follow-up by 80 (95% CI = 49–132) days. After this survey, a novel low-cost insurance scheme for the migrant community has been launched in this area. Development of new schemes involving patients, healthcare providers and funding support are required for improved and sustainable NCD care for marginalised populations.

scholarly journals The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX©Catheter

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jason Reinglas ◽  
Kayvan Amjadi ◽  
Bill Petrcich ◽  
Franco Momoli ◽  
Thomas Shaw-Stiffel
Keyword(s):  
High Risk ◽  
Patency Rate ◽  
Spontaneous Bacterial Peritonitis ◽  
Treatment Options ◽  
Technical Success ◽  
Bacterial Peritonitis ◽  
Large Volume Paracentesis ◽  
Lost To Follow Up

Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA.Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic.Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP) from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics.Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

scholarly journals P007 Service evaluation of the nurse-led telephone advice line in the wake of COVID-19: a report of audit and staff satisfaction

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Julia Day ◽  
Janet Ball ◽  
Jayne Down ◽  
Raj Sengupta
Keyword(s):  
Service Use ◽  
Single Point ◽  
Working Hours ◽  
Work Load ◽  
Service Evaluation ◽  
Service Improvement ◽  
Staff Satisfaction ◽  
Telephone Advice ◽  
Staff Workload

Abstract Background/Aims  The Rheumatology nurse advice line (NAL) at the Royal National Hospital for Rheumatic Diseases (RNHRD, Bath) provides a vital service for direct patient access to specialist advice via a designated voicemail system. Increasing numbers and difficulty connecting call returns have increased staff workload, reduced efficiency and impacted on staff satisfaction. An audit was therefore undertaken to evaluate service use and efficiency, paired with formal assessment of staff satisfaction in order to identify areas for improvement. Methods  The total number of monthly calls through the NAL during 2020 were counted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call being logged, returned and concluded. The number of clinicians and attempts required to contact the patient was noted. An anonymised staff satisfaction questionnaire was completed by NAL nurses and administrators. Data was analysed using Excel. Results  An average 653 calls per month (range 340-894) came through the NAL between January and September 2020. 97 consecutive patient contacts were audited from August 2020. Multiple attempts were required to successfully return the call in 19.6% of cases (n = 19/97). Of those, 68.4% (n = 13/19) of calls needed ≥ 2 nurses to contact the patient. In general, the first attempt to return the call was prompt (average 7.6 hours, range 0.1-27.7). However, the time to conclude the call from the patient’s first call log ranged from 0.1 - 142.6 hours (average 12.7 hours) with increased time associated with difficulties contacting the patient or when further advice was required from a Rheumatology doctor (18.5%, n = 18/97). Staff surveys revealed 67% of staff felt that the NAL is a good service to offer patients. However, 67% of staff did not feel the NAL in its current format was easy to manage. Specific comments included that the lack of rota'd responsibility, unpredictable workload and time inefficiencies were barriers to managing the service. Conclusion  From this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns is inefficient and contributes to staff dissatisfaction. This data has driven change for service improvement. To improve efficiency, calls will be answered live by an administrator during working hours and patients given a call-back time. A doctor will be named as a single point of contact for the nurses to seek additional advice and a nurse rota will designate responsibility for NAL calls to reduce work-load uncertainty. Follow up service evaluation will include staff and patient satisfaction questionnaires, and repeat audit, with consideration of ways to support frequent service users. Disclosure  J. Day: None. J. Ball: None. J. Down: None. R. Sengupta: None. V. Flower: None.

scholarly journals Retained plastic biliary stent presenting with obstructive jaundice: a case report

2021 ◽  
Vol 8 (9) ◽  
pp. 2792
Author(s):  
Gayatri Muley ◽  
Waqar Ansari ◽  
Atish Parikh ◽  
Dhiraj Kachare ◽  
Urvashi Jain ◽  
...  
Keyword(s):  
Case Report ◽  
Obstructive Jaundice ◽  
Biliary Obstruction ◽  
Biliary Stent ◽  
Plastic Stent ◽  
History Of ◽  
Lost To Follow Up ◽  
Cbd Exploration

Forgotten stents may lead to serious complications. We present a case report of a forgotten common bile duct (CBD) fully covered plastic stent presenting with Obstructive Jaundice. A 66 years-old female patient presented with features of obstructive jaundice. Further enquiry revealed a history of ERCP guided biliary stent placement 12 years ago, after which she was lost to follow up. An endoscopic attempt to retrieve the old stent and relieve biliary obstruction was unsuccessful, and a fresh stent was placed across the CBD following a sphincterotomy. CT showed evidence of a stent in situ, alongside calcified fragments of the previous stent and multiple CBD stones. Patient was taken up for surgery and Roux-en-y hepaticojejunostomy was performed following CBD exploration and retrieval of the stent-stone complex.

Shimodaira-Taniguchi Conization Method: Its Utility and Reliability

2010 ◽  
Vol 20 (6) ◽  
pp. 1025-1030 ◽  
Author(s):  
Maki Matsumura ◽  
Tsuyoshi Ota ◽  
Nobuhiro Takeshima ◽  
Ken Takizawa
Keyword(s):  
Operation Time ◽  
Intraepithelial Neoplasia ◽  
Adenocarcinoma In Situ ◽  
Secondary Hemorrhage ◽  
Stage Ia ◽  
Cancer Of The Cervix ◽  
Lost To Follow Up ◽  
Frequency Current

Introduction:Introduced in 1992, the Shimodaira-Taniguchi conization procedure addresses the disadvantages of the loop electrosurgical excision procedure by relying on a high frequency current of 150 W and a triangular probe with a 0.25-mm linear excision electrode to extract a single informative specimen. We conducted a retrospective study to evaluate Shimodaira-Taniguchi conization as a conservative therapy for cervical intraepithelial neoplasia (CIN) and microinvasive cancer of the cervix.Methods:Subjects were 455 patients who underwent Shimodaira-Taniguchi conization for CIN, carcinoma in situ, adenocarcinoma in situ, or stage IA microinvasive cervical carcinoma at our hospital from January 2005 to December 2008. Patient follow-up ranged from 13 to 60 months. Clinical data were obtained and evaluated.Results:Mean operation time was 11 minutes, and average blood loss was 9.9 mL. Margins were positive in 178 (39.1%) cases. Postsurgical complications occurred in 61 patients, with secondary hemorrhage occurring in 46 patients. None required transfusion. None were lost to follow-up, and there was no disease-related death. Disease recurred in 6 (1.3%) patients: 4 with a positive excision margin and 2 with a negative margin. Cervical stenosis occurred in 15 (3.3%) patients, 3 of whom suffered cervical obstruction, including 1 with dysmenorrhea who underwent hysterectomy. In most cases (n = 357, 78%), a single adequate specimen was extracted.Conclusions:As a conservative treatment for CIN and microinvasive cervical cancer, Shimodaira-Taniguchi conization is useful. It is easy, provides adequate histologic specimens (often singular), and results in few postoperative complications.

TP3-9 Assessment of seizures in over 75-year olds: a clinical audit

2019 ◽  
Vol 90 (3) ◽  
pp. e20.3-e21
Author(s):  
ZT Ahmed ◽  
A Rather
Keyword(s):  
Current Practice ◽  
Clinical Audit ◽  
Data Entry ◽  
Integrated Approach ◽  
Initial Assessment ◽  
National Audit ◽  
Retrospective Audit ◽  
Specialist Referral ◽  
Nice Guidance

ObjectivesThis audit evaluates the assessment of first seizures in over 75-year-olds within our centre using NICE guidance (CG137) as our standard. This is in response to the National Audit of Seizure management in Hospitals which revealed significant deficits in current practice.DesignA retrospective audit design was used.SubjectsWe reviewed patient records of 74 patients over the age of 75 who presented to A+E with their first seizure between 1 st January and 30th April 2017.MethodsData entry took place between 14th November and 22nd January when follow-up information should have been available. A proforma based on current NICE guidance was used to evaluate initial assessment, investigations and specialist review.Results38 females and 36 males were assessed with an average age of 83 years (range 76–95). NICE recommends that all patients are seen by a specialist within 2 weeks, however only 38% of our patients met this standard. Only 65% of patients indicated for an EEG had one and 34% waited longer than the recommended 4 weeks. Neuroimaging was optimal with 95% of patients receiving an MRI within 4 weeks. In contrast, blood glucose was only measured in 47% of patients and only 51% had a 12-lead ECG despite recommendations that these investigations should be performed routinely.ConclusionsThere is a lack of comprehensive A+E assessments and specialist referral for older people both within our centre and nationally. A more thorough and integrated approach is needed to improve outcomes and optimise care.

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