Evaluation of Nationwide Referral Pathways, Investigation and Treatment of Suspected Cauda Equina Syndrome in the United Kingdom (ENTICE)

Neurosurgery ◽  
2019 ◽  
Vol 84 (5) ◽  
pp. E271-E271 ◽  
Author(s):  
Dillon Vyas ◽  
Keyword(s):  
United Kingdom ◽  
Cauda Equina Syndrome ◽  
Clinical Symptoms ◽  
Cauda Equina ◽  
National Guidelines ◽  
Time Intervals ◽  
Mri Scan ◽  
Out Of Hours ◽  
The United Kingdom ◽  
The Uk

Abstract INTRODUCTION Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery, if required, should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. METHODS A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 mo between 1st October 2016 and 31st March 2017. RESULTS A total of 28 UK spinal units submitted data on 4441 referrals. Over half of the referrals were made without any previous imaging (n = 2572, 57.9%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%), of which 2.9% (n = 45/1529) underwent surgical decompression. Patient location and prereferral imaging were not significantly associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced significantly longer time intervals from presentation and from referral to undergoing the MRI scan. CONCLUSION This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Cases not transferred experienced delays if undergoing an MRI scan outside of the spinal unit.

scholarly journals The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

2008 ◽  
Vol 90 (6) ◽  
pp. 513-516 ◽  
Author(s):  
M Crocker ◽  
G Fraser ◽  
E Boyd ◽  
J Wilson ◽  
BP Chitnavis ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Pain Syndrome ◽  
Working Hours ◽  
Out Of Hours ◽  
Interhospital Transfer ◽  
Mri Scans ◽  
Prolapsed Intervertebral Disc ◽  
Magnetic Resonance Imaging Mri ◽  
The Uk

INTRODUCTION The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. PATIENTS AND METHODS We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. RESULTS A total of 76 patients were transferred for assessment and ‘on-call’ MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing – from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. CONCLUSIONS These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

Evaluation of nationwide referral pathways, investigation and treatment of suspected cauda equina syndrome in the United Kingdom

2019 ◽  
Vol 33 (6) ◽  
pp. 624-634
Author(s):  
Daniel M. Fountain ◽  
Simon C. L. Davies ◽  
Julie Woodfield ◽  
Mohammed Kamel ◽  
Paulina Majewska ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
The United Kingdom

British Reception of Periodicity

2015 ◽  
Author(s):  
Gordon Woods
Keyword(s):  
United Kingdom ◽  
Periodic Table ◽  
English Language ◽  
Periodic Acid ◽  
Time Intervals ◽  
The United Kingdom ◽  
Advanced Search ◽  
Periodic Law ◽  
Google Books ◽  
The Uk

The discovery of periodicity in the properties of the elements and its connection to their atomic weights is one of the most important advances in nineteenth-century chemistry. This chapter will consider the tables of John Newlands (1837–1898) and William Odling (1829–1921), which preceded that of Dmitrii Ivanovich Mendeleev (1834–1907). Mendeleev’s table was published in 1869, prior to his being aware of the UK precedents of his tabulation. The major portion of this chapter will extend the ideas advanced by Stephen Brush in The Reception of Mendeleev’s Periodic Law in America and Britain but will restrict itself to the dissemination of the periodicity concept within the United Kingdom. This will be monitored by recording its appearances in textbooks and examination papers, and in a wider context, by extracting data from Google Books. The periodic table has a rich history since its inception. It has evolved into many shapes, and indeed dimensions, yet retaining its essential periodic underpinning. In the United Kingdom it is seen as a “table,” whereas the French prefer “classification” and the Germans and Russians “system.” Mendeleev himself referred to his periodic law in his Faraday Lecture and never used the term “table,” thus it is ironic that his fame is linked to words that he appears never to have uttered. The arrangement of the elements in rows and columns is seen as a table, but why label it periodic? A related, more familiar word to non-chemists is periodical, normally referring to a magazine that appears at regular time intervals. Google Books is a powerful modern tool for investigating the usage of selected words or phrases over selected time intervals. The writer chose to use its advanced search for books in the English language. This meant that sources other than British, notably North American, are also included but the observed patterns are probably true for British books. The data compare the number of times the terms periodic table, periodic law, periodic classification, and periodic acid occurred in five-year intervals between 1870 and 1919.

scholarly journals Situation of HIV infections and STIs in the United Kingdom in 2007

2008 ◽  
Vol 13 (49) ◽  
Author(s):  
S Lattimore ◽  
Z Yin ◽  
L Logan ◽  
B Rice ◽  
A Thornton ◽  
...  
Keyword(s):  
United Kingdom ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Newly Diagnosed ◽  
National Guidelines ◽  
Sexually Transmitted ◽  
The United Kingdom ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
The Uk

In the United Kingdom (UK) in 2007, an estimated 77,400 persons were living with human immunodeficiency virus (HIV) of whom 28% are unaware of their infection. A total of 7,734 persons were newly diagnosed with HIV infection in 2007, of which 31% were diagnosed late. This highlights the need for wider HIV testing, especially in those areas with a high diagnosed prevalence, as recommended in recent national guidelines. Among newly diagnosed cases of HIV in 2007, 41% acquired their infection through sex between men (four in five of whom acquired their infection in the UK) and 55% through heterosexual contact (four in five of whom acquired their infection abroad, mainly in sub-Saharan Africa). Young persons aged 16 to 24 years are disproportionally affected by sexually transmitted diseases (STIs) accounting for 65% of genital chlamydia infections, 50% of cases of genital warts and 50% of cases of gonorrhoea that were diagnosed in 2007.

TBE in United Kingdom

2020 ◽  
Keyword(s):  
United Kingdom ◽  
Clinical Disease ◽  
England And Wales ◽  
Probable Case ◽  
The United Kingdom ◽  
South West ◽  
Louping Ill ◽  
The Uk ◽  
North And South ◽  
South West England

Until 2019, TBE was considered only to be an imported disease to the United Kingdom. In that year, evidence became available that the TBEV is likely circulating in the country1,2 and a first “probable case” of TBE originating in the UK was reported.3 In addition to TBEV, louping ill virus (LIV), a member of the TBEV-serocomplex, is also endemic in parts of the UK. Reports of clinical disease caused by LIV in livestock are mainly from Scotland, parts of North and South West England and Wales.4

Risk Transferin Public Private Partnership/Private Finance Initiative Procurement Documents:The Differencebetween The United Kingdom and Malaysia

2016 ◽  
Vol 4 (4) ◽  
pp. 30
Author(s):  
Nooriha Abdullah ◽  
Darinka Asenova ◽  
Stephen J. Bailey
Keyword(s):  
United Kingdom ◽  
Public Procurement ◽  
Research Question ◽  
Public Private Partnership ◽  
Private Finance Initiative ◽  
Private Partnership ◽  
Risk Transfer ◽  
Private Finance ◽  
The United Kingdom ◽  
The Uk

The aim of this paper is to analyse the risk transfer issue in Public Private Partnership/Private Finance Initiative (PPP/PFI) procurement documents in the United Kingdom (UK) and Malaysia. It utilises qualitative research methods using documentation and interviews for data collection. The UK documents (guidelines and contracts) identify the risks related to this form of public procurement of services and makeexplicittheappropriateallocation of those risks between the public and the private sector PPP/PFI partners and so the types of risks each party should bear. However, in Malaysia, such allocation of risks was not mentioned in PPP/PFI guidelines. Hence, a question arises regarding whether risk transfer exists in Malaysian PPP/PFI projects, whether in contracts or by other means. This research question is the rationale for the comparative analysis ofdocumentsand practicesrelatingtorisk transfer in the PPP/PFI procurements in both countries. The results clarify risk-related issues that arise in implementing PPP/PFI procurement in Malaysia, in particular how risk is conceptualised, recognised and allocated (whether explicitly or implicitly), whether or not that allocation is intended to achieve optimum risk transfer, and so the implications forachievement ofvalue for moneyor other such objectivesinPPP/PFI.

HIV and other STIs in the United Kingdom: further increases

2003 ◽  
Vol 7 (48) ◽  
Author(s):  
◽  
Keyword(s):  
United Kingdom ◽  
Disease Surveillance ◽  
Communicable Disease ◽  
People Living With Hiv ◽  
Health Protection Agency ◽  
Protection Agency ◽  
England And Wales ◽  
The United Kingdom ◽  
The Uk ◽  
Living With Hiv

The Health Protection Agency Communicable Disease Surveillance Centre for England and Wales and others have reported that the number of people living with HIV in the UK has increased

Research Applications

1989 ◽  
Vol 21 (6-7) ◽  
pp. 709-715
Author(s):  
M. J. Rouse
Keyword(s):  
United Kingdom ◽  
Water Utilities ◽  
Practical Application ◽  
Research Results ◽  
Contract Research ◽  
The United Kingdom ◽  
New Knowledge ◽  
The Uk

This paper covers the approach taken by WRc to the practical application of research results. WRc works on an annual programme of research paid for collectively by the UK water utilities totalling ₤15m. In addition contract research is carried out for government largely on environmental matters and for utilities and others on a confidential basis. The approach to the implementation described here deals with the application of results across the whole of the United Kingdom where there are a large number of users of the results but with varying degrees of interest in any particular topic. The requirement is to inform all of the outcome of the work and then to provide the facility of rapid implementation for those who have an immediate requirement to apply the new knowledge and technology.

Volunteering in hospice and palliative care in the United Kingdom

2018 ◽  
Author(s):  
Ros Scott
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Care Services ◽  
The United Kingdom ◽  
Strategic Direction ◽  
Palliative Care Services ◽  
History Of ◽  
The Uk ◽  
Hospice And Palliative Care ◽  
Changing Role

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.

scholarly journals A Free-Market Environmentalist Transition toward Renewable Energy: The Cases of Germany, Denmark, and the United Kingdom

Energies ◽  
2021 ◽  
Vol 14 (15) ◽  
pp. 4659
Author(s):  
William Hongsong Wang ◽  
Vicente Moreno-Casas ◽  
Jesús Huerta de Soto
Keyword(s):  
United Kingdom ◽  
Renewable Energy ◽  
Private Property ◽  
Free Market ◽  
State Intervention ◽  
Tax Rate ◽  
Reform Agenda ◽  
The United Kingdom ◽  
Market Environmentalism ◽  
The Uk

Renewable energy (RE) is one of the most popular public policy orientations worldwide. Compared to some other countries and continents, Europe has gained an early awareness of energy and environmental problems in general. At the theoretical level, free-market environmentalism indicates that based on the principle of private property rights, with fewer state interventionist and regulation policies, entrepreneurs, as the driving force of the market economy, can provide better services to meet the necessity of offering RE to protect the environment more effectively. Previous studies have revealed that Germany, Denmark, and the United Kingdom have made some progress in using the market to develop RE. However, this research did not analyze the three countries’ RE conditions from the perspective of free-market environmentalism. Based on our review of the principles of free-market environmentalism, this paper originally provides an empirical study of how Germany, Denmark, and the United Kingdom have partly conducted free-market-oriented policies to successfully achieve their policy goal of RE since the 1990s on a practical level. In particular, compared with Germany and Denmark, the UK has maintained a relatively low energy tax rate and opted for more pro-market measures since the Hayekian-Thatcherism free-market reform of 1979. The paper also discovers that Fredrich A. Hayek’s theories have strongly impacted its energy liberalization reform agenda since then. Low taxes on the energy industry and electricity have alleviated the burden on the electricity enterprises and consumers in the UK. Moreover, the empirical results above show that the energy enterprises play essential roles in providing better and more affordable RE for household and industrial users in the three sampled countries. Based on the above results, the paper also warns that state intervention policies such as taxation, state subsidies, and industrial access restrictions can impede these three countries’ RE targets. Additionally, our research provides reform agendas and policy suggestions to policymakers on the importance of implementing free-market environmentalism to provide more efficient RE in the post-COVID-19 era.

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