scholarly journals SP4.2.5 Did COVID-19 change the way we treat appendicitis?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Libor Hurt ◽  
Nicholas Mowbray ◽  
Anna Powell-Chandler ◽  
Nicola Reeves ◽  
Susan Chandler ◽  
...  
Keyword(s):  
Computed Tomography ◽  
United Kingdom ◽  
Acute Appendicitis ◽  
Conservative Approach ◽  
Prospective Audit ◽  
Radiological Findings ◽  
The United Kingdom ◽  
South Wales ◽  
Radiological Data ◽  
Operation Rate

Abstract Intro/aims In repsonse to the COVID-19 pandemic, the United Kingdom (UK) commenced a national lockdown in March 2020. Initial guidance advocated the avoidance of aerosol generating procedures and hence we hypothesised there would be a decrease in the use of surgery to treat acute appendicitis. Methods A prospective audit was undertaken across 4 hospitals in South Wales, UK, during April 2020. Patients over 18 years of age with suspected or confirmed appendicitis were identified and data was collected including their history, radiological findings, management, and re-admission. Comparison was made with theatre and radiological data from April 2018 and 2019. Results A total of 254 patients were treated over the 3-year period; 95 patients in 2018, 95 in 2019 and 64 in 2020. During the lockdown, the use of Computed Tomography (CT) increased from 36.3% to 85.9% (p < 0.001). An antibiotic only approach to treat appendicits rose from 6.2% to 40.6% (p < 0.001). Four patients in the lockdown cohort failed the conservative approach and required an appendicectomy. The overall rate of laparoscopic appendicectomy was reduced from 85.3% to 17.2% (p < 0.001). A malignancy was identified in 3% of cases. Conclusions Whilst less patients presented with acute appendicitis compared to previous years, there was still a significant reduction in the operation rate. The data aligns with the literature confirming the antibiotic-only approach to be safe with a low failure rate. It is essential however that patients are fully consented for this approach including the risk of a missed malignancy.

scholarly journals Investigation of an outbreak of ciprofloxacin-resistant Neisseria gonorrhoeae using a simplified opa-typing method

2001 ◽  
Vol 126 (2) ◽  
pp. 219-224 ◽  
Author(s):  
H. M. PALMER ◽  
J. P. LEEMING ◽  
A. TURNER
Keyword(s):  
United Kingdom ◽  
Neisseria Gonorrhoeae ◽  
Significant Problem ◽  
Resistant Clone ◽  
Typing Method ◽  
Antibiotic Resistant ◽  
The North ◽  
The United Kingdom ◽  
South Wales ◽  
Pcr Rflp

Ciprofloxacin-resistant gonococci have been isolated from patients in the United Kingdom since 1993. Until recently, evidence has suggested that the majority of infections are not endemic but have been acquired abroad. In October 1999, increasing numbers of ciprofloxacin resistant isolates of the non-requiring auxotype were reported in Oldham and Rochdale (Northwest England). These and similar isolates from elsewhere in England and Wales were genetically characterized using a simplified opa-typing method (a non-radioactive PCR–RFLP method targeting the opa family of genes). Of 73 isolates studied, 24 had unique opa-types (10 from infections acquired abroad), whilst the remaining 49 were indistinguishable (none were known to be acquired abroad). This cluster included 31 isolates from Oldham and Rochdale, 16 from elsewhere in the north of England, and 2 from Southern England and South Wales with known epidemiological links to cases from Manchester and Rochdale respectively. This study illustrates the potential for spread of an antibiotic resistant clone of N. gonorrhoeae both locally and nationally and demonstrates that endemic acquisition of ciprofloxacin-resistant gonococci is now a significant problem in the United Kingdom.

scholarly journals Availability of computed tomography of the brain in the United Kingdom.

BMJ ◽  
1989 ◽  
Vol 298 (6682) ◽  
pp. 1219-1220 ◽  
Author(s):  
R. L. Hewer ◽  
V. A. Wood
Keyword(s):  
Computed Tomography ◽  
United Kingdom ◽  
The United Kingdom ◽  
The Brain

scholarly journals Notes on the Geology of Cleveland

The Geologist ◽  
1861 ◽  
Vol 4 (3) ◽  
pp. 81-95 ◽  
Author(s):  
Charles Peatt
Keyword(s):  
United Kingdom ◽  
The North ◽  
The United Kingdom ◽  
South Wales ◽  
Geological Features ◽  
Future Position

The district of which it is the object of the present paper to describe the principal geological features, has within the last few years attracted an extraordinary amount of interest and attention, as well from scientific observers as from those who are always seeking some fresh outlet for the investment of their capital. Until a period so recent as little more than twelve years ago, it was only for its fertile meadows and picturesque scenery of hill and dale, that Cleveland had gained any celebrity; but a metamorphosis so truly marvellous has since that time taken place, that it is already entitled to be associated with the most productive iron-making districts in the United Kingdom, and what, in all probability, will be its future position in that respect I shall not now venture to predict, although present circumstances would seem to indicate that, at no very distant day, the great iron-fields of South Staffordshire and South Wales must give place to their youthful opponent in the north.The discovery, or more properly speaking, the development of the great ironstone deposits of Cleveland in 1848 has given such a stimulus to the iron manufacture of the district, and indeed, of the country, as has seldom been experienced by any other branch of trade. The present flourishing town of Middlesburgh, which, with its new environs, has a population of nearly twenty thousand, for the most part dependent on the iron trade, was, forty years ago, represented by one solitary farmstead, with a census of five inhabitants: and in like manner have all the surrounding villages in the neighbourhood of the new works and mines multiplied their former dimensions with amazing rapidity.

Planning and development control in an area susceptible to landslides

1987 ◽  
Vol 4 (1) ◽  
pp. 247-253 ◽  
Author(s):  
H. J. Siddle ◽  
H. R. Payne ◽  
M. J. Flynn
Keyword(s):  
United Kingdom ◽  
Planning Process ◽  
Research Project ◽  
Development Control ◽  
The United Kingdom ◽  
Pilot Scheme ◽  
Adequate Information ◽  
South Wales ◽  
The World ◽  
Geological Constraints

AbstractThere is an increasing desire amongst those concerned in the planning process for the availability of adequate information on potential geological constraints to development. The potential for landsliding is a hazard of relevance to many areas of the United Kingdom, including South Wales, where the Department of the Environment and the Welsh Office have sponsored a research project to produce a methodology for the preparation of ‘Landslip Potential Planning Maps’. This paper describes the methodologies used to reduce hazards through planning in various parts of the world and outlines the proposed implementation of the pilot scheme in the Rhondda Valleys.

scholarly journals Climbing to freedom on an impossible staircase: Exploring the emancipatory potential of becoming an entrepreneur-employer

2020 ◽  
pp. 026624262096761
Author(s):  
Helen C Williams ◽  
Katrina Pritchard ◽  
Maggie C Miller ◽  
Cara Reed
Keyword(s):  
United Kingdom ◽  
Women Entrepreneurs ◽  
Interpretative Phenomenological Analysis ◽  
Phenomenological Analysis ◽  
Men And Women ◽  
Visual Method ◽  
The United Kingdom ◽  
South Wales ◽  
Catch 22 ◽  
Perceived Constraints

This article contributes to critical discussions questioning the emancipatory potential of entrepreneurship by examining the experiences of men and women entrepreneurs who have recently become employers in South Wales, the United Kingdom. Our research uses a co-creative visual method based in interpretative phenomenological analysis (IPA) to explore transitions from entrepreneur to entrepreneur-employer in everyday contexts. Findings demonstrate how initial emancipatory experiences become increasingly bounded when becoming an entrepreneur-employer. This exposes a Catch-22 of entrepreneuring-as-emancipation as a symptom of neoliberal entrepreneurial discourses that constrain what entrepreneurs are encouraged to do: grow. We find a plurality of particular emancipations, but conclude that within a developed context entrepreneurship, and more specifically, becoming an entrepreneur-employer is a relational step through which perceived constraints become more readily experienced and emancipation never fully realised.

scholarly journals A giant testicular mixed germ cell tumour

2016 ◽  
Vol 98 (8) ◽  
pp. e171-e172 ◽  
Author(s):  
A Reekhaye ◽  
A Harris ◽  
S Nagarajan ◽  
D Chadwick
Keyword(s):  
Computed Tomography ◽  
United Kingdom ◽  
Germ Cell ◽  
Germ Cell Tumour ◽  
Testicular Tumour ◽  
Medical Attention ◽  
The United Kingdom ◽  
Scrotal Swelling ◽  
Germ Cell Testicular Tumour ◽  
Active Disease

We present a case that we believe to be the largest mixed germ cell testicular tumour reported in the United Kingdom. A 23-year-old male was admitted to our urology department with a large scrotal swelling. The patient was found to have a giant left testicular tumour and a solitary lung metastasis at presentation. He underwent an emergency radical orchidectomy and subsequently received four cycles of bleomycin, etoposide and cisplatin chemotherapy. Four months after starting treatment, the tumour markers had normalised and a repeat staging computed tomography showed no active disease. The tumour reached that size because of the patient’s failure to seek medical attention due to fear and embarrassment.

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