scholarly journals P-EGS01 Cholecystectomy after gall stone pancreatitis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ahmed Ammar ◽  
Ahmed Elsayed ◽  
Mohammad Mohsin ◽  
Hossam Shaaban
Keyword(s):  
Gall Stone ◽  
Significant Risk ◽  
Admission Rate ◽  
Index Admission ◽  
British Society ◽  
Gallstone Pancreatitis ◽  
Delayed Cholecystectomy ◽  
Total Percentage ◽  
Unfit Patients ◽  
The Uk

Abstract Background According to the UK guidelines for the management of acute pancreatitis commissioned by the British Society of Gastroenterology, All patients presenting with gallstone pancreatitis should be considered for cholecystectomy when they are well enough to undergo surgery. In cases of mild biliary pancreatitis, cholecystectomy should ideally be performed during the index admission or within 2 weeks of discharge as interval cholecystectomy is associated with a significant risk of readmission for recurrent biliary events. In cases of severe gallstone pancreatitis, cholecystectomy may need to be delayed until collections have improved, unless the patient is well enough for surgery and the gallbladder is some distance from the collection Methods Methods Inclusion Criteria Exclusion Criteria Results 80 patients were collected during the study period, 96 % of them were classified as mild pancreatitis Cholecystectomy rate Total percentage of cholecystectomies performed for mild gall stone pancreatitis during index admission or within 2 weeks from discharge : 37% Percentage of early cholecystectomies for eligible patients (i.e.after ruling out unfit patients, patients declining treatment, previous cholecystectomy..etc) : 54% Re-admission rate Re-admission rate for early cholecystectomy patients : 7.4% Re-admission rate for delayed cholecystectomy patients : 20.7% Conclusions

scholarly journals P-BN57 The impact of COVID-19 pandemic on management of patients with acute uncomplicated gallstone pancreatitis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Aleksandra Staniszewska ◽  
Rebekah McCready ◽  
Christopher Grocock ◽  
Rohan Gunasekera ◽  
Mark Hartley ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Index Admission ◽  
British Society ◽  
Categorical Variables ◽  
Gallstone Pancreatitis ◽  
Continuous Variables ◽  
Post Discharge ◽  
Baseline Characteristics ◽  
The Impact ◽  
Biliary Imaging

Abstract Background Current British Society of Gastroenterology guidelines suggest that patients presenting with acute uncomplicated gallstone pancreatitis should ideally undergo laparoscopic cholecystectomy during the index admission or within two weeks of discharge from hospital. COVID-19 pandemic had a significant impact on the delivery of elective and semi-elective surgical services in the National Health Service (NHS) due to limited availability of theatre resources. The aim of this study was to evaluate compliance with the BSG guidelines during the COVID-19 pandemic and the impact of the newly introduced `Hot’ lists at our centre. Methods Patients admitted with first presentation of acute uncomplicated gallstone pancreatitis between 01/03/19 and 25/02/21 were identified from electronic records. Pregnancy and lack of fitness for surgery were the exclusion criteria. Patients admitted between 01/03/19 and 31/12/19 were defined as the pre-COVID cohort. Those admitted between 23/03/20 and 25/02/21 formed the COVID cohort and had access to urgent gallbladder lists. Baseline characteristics, choice of imaging and timing of laparoscopic cholecystectomy were compared between the two cohorts using STATA software. Continuous variables were compared with Mann Whitney test and categorical variables were compared with Pearson’s Chi-Squared test. Results 53 patients were identified in the total cohort with 27 being hospitalised prior to COVID-19 outbreak and 26 presenting after the national lockdown. Baseline characteristics did not differ significantly between the two groups.  Biliary imaging pathway was similar between the two cohorts and importantly there appeared to be no delays in radiological tests during the lockdown. The overall proportion of patients undergoing cholecystectomies remained similar between the two groups and percentage of patients having it during the index admission did not differ. However, patients undergoing cholecystectomy post discharge had a significantly shorter waiting time during the lockdown (p = 0.021) as they were prioritised on the ‘Hot lists’ created to meet the demands of reduced planned theatre service. Conclusions During the 2020 COVID pandemic our service for patients with uncomplicated gallstone pancreatitis continued to be delivered. Despite clinical pressures, there were no notable delays in biliary imaging. The introduction of the urgent operating lists has significantly reduced the time to laparoscopic cholecystectomy following admission for patients with acute uncomplicated gallstone pancreatitis during this period.

scholarly journals Unplanned General Surgical Re-Admissions – How Many, Which Patients and Why?

2007 ◽  
Vol 89 (4) ◽  
pp. 363-367 ◽  
Author(s):  
Dayo Adeyemo ◽  
Simon Radley
Keyword(s):  
Postoperative Complications ◽  
Performance Indicator ◽  
Admission Rate ◽  
Index Admission ◽  
Admission Rates ◽  
Department Of Health ◽  
Retrospective Audit ◽  
Admission Data ◽  
The Uk ◽  
Patient Administration System

INTRODUCTION The unplanned re-admission rate is a national key performance indicator employed by the UK Department of Health. An adjusted figure, based on admission information data on the hospital electronic Patient Administration System (PAS), but adjusted to take account of case mix is compared with a calculated ‘expected’. While previous studies have investigated unplanned re-admission rates in age-, procedure- or process-specific conditions, ‘all-cause’ general surgical re-admission rate is yet to be studied. The aim of this study was to assess the accuracy of hospital unplanned re-admission data, and identify patterns or possible causes of unplanned general surgical re-admissions. PATIENTS AND METHODS Retrospective audit of case note records of all patients identified from the hospital electronic PAS as unplanned, general surgical re-admissions over a period of 4 consecutive months. RESULTS Of all 161 re-admissions in this study, 46 (29%) were unrelated to the index admission, planned or involved patient self-discharge during the index admission. Of the ‘genuine’, unplanned re-admissions, 80 (78%) followed an emergency index admission, 58 (56%) had chronic or recurrent symptoms, for which 26 (25%) were on waiting lists. Fourteen (14%) were multiple admissions of 4 patients, while 8 (8%) re-admissions required further surgery for significant postoperative complications. CONCLUSIONS Unplanned. general surgical re-admission rates collated from hospital PAS systems may be inaccurate. Nearly half of ‘genuine’, unplanned re-admissions involved patients with chronic and/or recurrent symptoms, which are predictable and may be preventable. Significant postoperative complications accounted for few re-admissions in this study.

Cardiovascular Risk Prediction using JBS3 Tool: A Kerala based Study

2020 ◽  
Vol 16 ◽  
Author(s):  
Paulin Paul ◽  
Noel George ◽  
B. Priestly Shan
Keyword(s):  
Logistic Regression ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Goodness Of Fit ◽  
Significant Risk ◽  
Lifetime Risk ◽  
British Society ◽  
Cvd Risk ◽  
South Indian ◽  
Cardiovascular Risk Prediction

Background: The accuracy of Joint British Society calculator3 (JBS3) cardiovascular risk prediction may vary within Indian population, and is not yet studied using south Indian Kerala based population data. Objectives: To evaluate the cardiovascular disease (CV) risk estimation using the traditional CVD risk factors (TRF) in Kerala based population. Methods: This cross sectional study has 977 subjects aged between 30 and 80 years. The traditional CVD risk markers are recorded from the medical archives of clinical locations at Ernakulum district, in Kerala The 10 year risk categories used are low (<7.5%), intermediate (≥7.5% and <20%), and high (≥20%). The lifetime classifications low lifetime (≤39%) and high lifetime (≥40%) are used. The study was evaluated using statistical analysis. Chi-square test was done for dependent and categorical CVD risk variable comparison. Multivariate ordinal logistic regression for 10-year risk model and odds logistic regression analysis for lifetime model was used to identify significant risk variables. Results: The mean age of the study population is 52.56±11.43 years. The risk predictions has 39.1% in low, 25.0% in intermediate, and 35.9% had high 10-year risk. The low lifetime risk had 41.1% and 58.9% is high lifetime risk. Reclassifications to high lifetime are higher from intermediate 10-year risk category. The Hosmer-Lemeshow goodness-of-fit statistics indicates a good model fit. Conclusion: The risk prediction and timely intervention with appropriate therapeutic and lifestyle modification is useful in primary prevention. Avoiding short-term incidences and reclassifications to high lifetime can reduce the CVD mortality rates.

scholarly journals Bedside tracer gas technique accurately predicts outcome in aspiration of spontaneous pneumothorax

Thorax ◽  
2001 ◽  
Vol 56 (8) ◽  
pp. 617-621
Author(s):  
D G Kiely ◽  
S Ansari ◽  
W A Davey ◽  
V Mahadevan ◽  
G J Taylor ◽  
...  
Keyword(s):  
Chest Radiograph ◽  
Spontaneous Pneumothorax ◽  
Significant Risk ◽  
Admission Rate ◽  
Primary Spontaneous Pneumothorax ◽  
Tracer Gas ◽  
Secondary Spontaneous Pneumothorax ◽  
Poor Predictor ◽  
Bedside Test ◽  
Simple Bedside

BACKGROUNDThere is no technique in general use that reliably predicts the outcome of manual aspiration of spontaneous pneumothorax. We have hypothesised that the absence of a pleural leak at the time of aspiration will identify a group of patients in whom immediate discharge is unlikely to be complicated by early lung re-collapse and have tested this hypothesis by using a simple bedside tracer gas technique.METHODSEighty four episodes of primary spontaneous pneumothorax and 35 episodes of secondary spontaneous pneumothorax were studied prospectively. Patients breathed air containing a tracer (propellant gas from a pressurised metered dose inhaler) while the pneumothorax was aspirated percutaneously. Tracer gas in the aspirate was detected at the bedside using a portable flame ioniser and episodes were categorised as tracer gas positive (>1 part per million of tracer gas) or negative. The presence of tracer gas was taken to imply a persistent pleural leak. Failure of manual aspiration and the need for a further intervention was based on chest radiographic appearances showing either failure of the lung to re-expand or re-collapse following initial re-expansion.RESULTSA negative tracer gas test alone implied that manual aspiration would be successful in the treatment of 93% of episodes of primary spontaneous pneumothorax (p<0.001) and in 86% of episodes of secondary spontaneous pneumothorax (p=0.01). A positive test implied that manual aspiration would either fail to re-expand the lung or that early re-collapse would occur despite initial re-expansion in 66% of episodes of primary spontaneous pneumothorax and 71% of episodes of secondary spontaneous pneumothorax. Lung re-inflation on the chest radiograph taken immediately after aspiration was a poor predictor of successful aspiration, with lung re-collapse occurring in 34% of episodes by the following day such that a further intervention was required.CONCLUSIONSNational guidelines currently recommend immediate discharge of patients with primary spontaneous pneumothorax based primarily on the outcome of the post-aspiration chest radiograph which we have shown to be a poor predictor of early lung re-collapse. Using a simple bedside test in combination with the post-aspiration chest radiograph, we can predict with high accuracy the success of aspiration in achieving sustained lung re-inflation, thereby identifying patients with primary spontaneous pneumothorax who can be safely and immediately discharged home and those who should be observed overnight because of a significant risk of re-collapse, with an estimated re-admission rate of 1%.

scholarly journals New Labour, New Policies: Constructing a Discourse of Citizenship

1998 ◽  
Vol 3 (2) ◽  
pp. 101-114
Author(s):  
Keith Crawford
Keyword(s):  
Citizenship Education ◽  
New Labour ◽  
Political Context ◽  
British Society ◽  
Contemporary Society ◽  
Legitimation Crisis ◽  
New Policies ◽  
The Uk ◽  
The Impact

The purpose of this paper is examine the development of citizenship education as a curriculum priority within the UK. Employing Habermas' theory of legitimation crisis, the paper places the contemporary enthusiasm for citizenship education within a socioeconomic, cultural and political context. The paper argues that current preoccupations with citizenship education contained in Education for Citizenship and the Teaching of Democracy in Schools (Dfee, 1999), stem from the impact of Neo-Liberal concerns with individualism, economic and technological globalisation and the potential fragmentation of contemporary society. The paper explores the principles of education for citizenship and the teaching of democracy in schools and suggests that, as part of New Labour's developing conception of British society, citizenship education asks some fundamental questions of that society.

Peer Review of Paediatric Endocrine Services in the UK: A Template for Quality and Service Improvement

2021 ◽  
pp. 1-6
Author(s):  
John Schulga ◽  
Heather Mitchell ◽  
S. Faisal Ahmed ◽  
Assunta Albanese ◽  
Justin Warner ◽  
...  
Keyword(s):  
Peer Review ◽  
National Level ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
British Society ◽  
Service Improvement ◽  
Paediatric Endocrinology ◽  
Test Feasibility ◽  
Specialist Nurses ◽  
The Uk

<b><i>Background:</i></b> Independent peer review of healthcare services can complement existing internal-, institutional-, and national-level regulatory mechanisms aimed at improving quality of healthcare. However, this has not been reported for paediatric endocrinology services in the UK. We aimed to test feasibility and acceptability through a first cycle of a national peer review of paediatric endocrine services. <b><i>Methods:</i></b> Tertiary centres in paediatric endocrinology across the UK were assessed against 54 quality standards, developed by the British Society for Paediatric Endocrinology and Diabetes (BSPED) in five domains of healthcare by a team comprising paediatric endocrinologists and specialist nurses. The evaluation was supported by a self-assessment. A post-peer-review questionnaire was used as feedback. <b><i>Results:</i></b> All 22 centres in the UK underwent independent peer review between 2011 and 2017. Each served a median population of 2.6 million (range 1–8 million) and offered 1,872 (range 779–6,738) outpatient consultations annually. A total of 43 (range 30–49) standards were met in combined evaluation of all centres. Variance of adherence for essential standards ranged from 52 to 97% at individual centres with 90% adherence demonstrated by 32% of centres. Post-review feedback showed 20/22 (95%) validating the utility of the peer review. <b><i>Conclusions:</i></b> The BSPED peer review of all UK centres providing paediatric endocrine services is shown to be feasible and provides a quality benchmark for replication by national services.

Survey of the Use of Diffusion-Weighted Imaging for Cholesteatoma in the United Kingdom

ORL ◽  
2021 ◽  
pp. 1-7
Author(s):  
Sunil Dutt Sharma ◽  
Ahmad Hariri ◽  
Ravi Kumar Lingam ◽  
Arvind Singh
Keyword(s):  
United Kingdom ◽  
British Society ◽  
Petrous Apex ◽  
The United Kingdom ◽  
Diffusion Weighted ◽  
Clinical Scenarios ◽  
Head And Neck Imaging ◽  
The Mean ◽  
The Uk

<b><i>Background:</i></b> Non-echoplanar diffusion-weighted MRI (DWMRI) has a role in the surgical planning for cholesteatoma. <b><i>Aims/Objectives:</i></b> The aim of the study was to assess the use of DWMRI in the management of cholesteatoma across the UK, and measure clinicians’ confidence in the use of DWMRI. <b><i>Materials and Methods:</i></b> Telephone survey in 139 Otolaryngology Departments in the United Kingdom between March 2017 and July 2017, and asking radiology delegates at the British Society of Head and Neck Imaging 2017 meeting. <b><i>Results:</i></b> The response rate was 101 out of 139 Trusts (73%). Of those respondents who did have DWMRI available, 68/88 respondents (77%) use it for cholesteatoma. The mean confidence (±standard deviation) of the respondents with DWMRI in identifying cholesteatoma presence was 7.3 ± 2.1, in identifying volume of cholesteatoma was 6.8 ± 1.8, and in identifying subsites of cholesteatoma was 4.6 ± 2.1. <b><i>Conclusions and Significance:</i></b> DWMRI has a well-defined role in the follow-up of patients after cholesteatoma surgery, and those primary cases of cholesteatoma where the diagnosis is in question. The use of DWMRI for cholesteatoma is variable across the UK, but there are certain clinical scenarios where there is not enough awareness regarding the benefits of imaging (such as petrous apex cases of cholesteatoma).

scholarly journals Re-Admissions Following Hip Fracture Surgery

2009 ◽  
Vol 91 (7) ◽  
pp. 591-595 ◽  
Author(s):  
James Hahnel ◽  
Hannah Burdekin ◽  
Sanjeev Anand
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
The Elderly ◽  
Index Admission ◽  
Study Cohort ◽  
Rehabilitation Care ◽  
Hip Fracture Surgery ◽  
Fatal Adverse Events ◽  
The Uk ◽  
Fracture Surgery

INTRODUCTION Hip fractures in the elderly are a growing problem with a predicted incidence of 117,000 cases per year by 2016. Re-admission following a healthcare episode is an important outcome measure, which reflects non-fatal adverse events and indicates the natural history of disease. The purpose of this observational, multicentre audit was to examine rates and reasons for re-admission following hip fracture, to identify areas in the index admission and rehabilitation care that could be improved to prevent re-admission. PATIENTS AND METHODS A total of 535 patients (> 65 years old) in two district general hospitals in the UK who underwent hip fracture surgery were recruited into the study. RESULTS Of the study cohort, 72 patients (13.5%) died during their index admission and 88 (19.0%) of 463 patients were re-admitted once within 3 months. Causes of re-admission were attributed to medical (54.8%), failure to rehabilitate (23.8%), orthopaedic (19.0%) and surgical (2.4%) reasons. Infection was the most common (31.0%) reason for re-admission and arguably the most treatable. During the 3-month postoperative period, the mortality rate was 21.3%, increasing in those re-admitted to 35.1% representing the frailty of this group of patients. CONCLUSIONS High rates of re-admission are seen following discharge in elderly patients with hip fractures. Re-admitted patients have high mortality rates. Understanding causes of re-admission may help to reduce this burden.

scholarly journals Goals, Objectives and Content of Professional Training for International Communication Specialists in The UK

2019 ◽  
Vol 9 (1) ◽  
pp. 88-96
Author(s):  
Olena Moshenets
Keyword(s):  
Professional Training ◽  
International Communication ◽  
British Society ◽  
Information Culture ◽  
Managerial Skills ◽  
Self Study ◽  
Competency Based ◽  
The Uk ◽  
High Level ◽  
Uk Higher Education

Abstract The article analyzes the goals, objectives and content of professional training for international communication specialists in the UK universities. It is found that professional training of international communication specialists aims to prepare a competent and competitive expert under the rapidly changing requirements of British society and the international labour market. They are expected to have the relevant basic professional knowledge, practical abilities and skills (leadership and managerial skills, high-level political and information culture, active social position, high responsibility, willingness and capacity for self-study). It is indicated that British degree programmes mainly seek to train specialists based on interdisciplinary and competency-based principles, focusing on learning outcomes. Upon the successful completion of the degree programme, the graduate must possess not only theoretical knowledge but also special and general abilities and skills, which are necessary for effective functioning in various contexts of public life. It is specified that in the context of competency-based approach, the UK higher education aims to develop future specialists’ ability to independently acquire new knowledge throughout life, identify and realize their own intellectual and creative potential, strive for self-determination, social integration and self-development, which creates relevant conditions for acquiring high-level professional competency in general and nurture professional culture in particular. It is concluded that British degree programmes in international communication consist of compulsory and optional modules. Each university is entitled to choose the number and content of compulsory and optional modules in accordance with the directions of scientific research of the department and scientific interests of students and lecturers.

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