PTH-17 The virtual referral triage clinic – A beneficial change in practice?

Abstract Introduction The international consensus statement on perioperative management of anaemia advises that patients with haemoglobin (Hb) <130 be treated before undergoing elective operations. The advantages include reduced risk of acute kidney injuries, infections and transfusions, and quicker recovery. Methods Data was collected prospectively from 127 consecutive patients undergoing elective arthroplasties at Hinchingbrooke hospital. Baseline compliance with the consensus statement was first assessed in May 2018, and the results presented at a clinical governance meeting. Departmental action plans included early identification of anaemia and treatment to Hb 130, delaying operations where necessary. We then reassessed compliance in May 2019. Results There was a statistically significant change in practice (p = 0.036). The proportion of patients undergoing arthroplasties despite Hb < 130 reduced from 38% to 21%. Those operated with Hb < 120 decreased from 14% to 0%. The proportion of preoperative anaemias that were appropriately investigated during preoperative assessment increased from 11% to 80% (p < 0.001). The increase in attempted treatment of preoperative anaemia prior to surgery however was not significant (7% vs 20%; p = 0.279). Discussion Implementation of departmental action plans resulted in substantial improvements to clinical practice. For those that underwent arthroplasties despite mild preoperative anaemia, it may have been felt that delays in improvement to quality of life for treatment may be unacceptable, or the causes (e.g. chronic disease) difficult to treat. Further action plans should involve even earlier identification of anaemia, involving primary care at the point of referral.

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Centralization of Biliary Atresia: Has Germany Learned Its Lessons?

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1723994 ◽

2021 ◽

Author(s):

Omid Madadi-Sanjani ◽

David Fortmann ◽

Udo Rolle ◽

Burkhard Rodeck ◽

Ekkehard Sturm ◽

...

Keyword(s):

Biliary Atresia ◽

Data Transfer ◽

Previous Analysis ◽

Outcome Data ◽

Free Survival ◽

Change In Practice ◽

Native Liver ◽

Survival With Native Liver ◽

Pediatric Liver Transplant

Abstract Introduction The majority of pediatric surgeons and hepatologists recommend the centralization of biliary atresia (BA) treatment within experienced liver units. We aimed to investigate whether voluntary self-restriction and acceptance of the need for this change in practice changed the BA referral policy in Germany during the last decade. Materials and Methods In cooperation with pediatric surgeons, gastroenterologists or hepatologists, and pediatric liver transplant units, the 2-year follow-up data of infants with BA born in Germany between 2010 and 2014 were collected using www.bard-online.com or pseudonymized data transfer. Results were compared with our previous analysis of the outcome data of infants with BA born between 2001 and 2005 in Germany. Result Overall, 173 infants with BA were identified, of whom 160 underwent Kasai portoenterostomy (KPE; 92.5%) and 13 (7.5%) underwent primary liver transplantation at 21 German centers. At 2-year follow-up, overall survival was 87.7% (vs. 81.9% in 2001–2005 [p = 0.19]), survival with native liver post-KPE was 29.2% (vs. 22.8% in 2001–2005 [p = 0.24]), and jaundice-free survival with native liver post-KPE was 24.0% (vs. 20.1% in 2001–2005 [p = 0.5]). Compared with the 2001–2005 analysis, all criteria showed improvement but the differences are statistically not significant. Conclusion Our observation shows that KPE management requires improvement in Germany. Centralization of BA patients to German reference liver units is not yet mandatory. However, European and national efforts with regard to the centralization of rare diseases support our common endeavor in this direction.

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Changes in the rate of prophylactic vena cava filter insertion at a university hospital

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515592769 ◽

2015 ◽

Vol 31 (6) ◽

pp. 403-408

Author(s):

Andrew Smith ◽

Demetri Adrahtas ◽

Doreen Elitharp ◽

Antonios Gasparis ◽

Nicos Labropoulos ◽

...

Keyword(s):

Vena Cava ◽

Vena Cava Filter ◽

University Hospital ◽

High Rate ◽

Inappropriate Use ◽

Surgical Critical Care ◽

Change In Practice ◽

Filter Insertion ◽

Level I ◽

Second Period

Objective We previously demonstrated a high rate of prophylactic vena cava filter (VCF) insertion at our institution. We have since attempted to restrict the use of VCF to indications supported by Level-I evidence. This study was designed to evaluate the success of our interventions. Methods All patients receiving VCF between 2007–2009 and 2012–2014 at a university hospital were reviewed. After assessing the use of VCF in the first period, a meeting was convened among the Departments of Radiology, Vascular Surgery and Trauma. Policy was implemented to avoid the inappropriate use of VCF. Data were prospectively collected in the second period to assess the effect of our intervention. Results There were 156 VCF placed from 2012 to 2014. VCF was absolutely indicated in 84% of cases, relatively indicated in 9% and prophylactic in 7%. These data contrast our previous experience from 2007 to 2009. In the earlier series, a total of 244 filters were placed, in which 54% of patients had an absolute indication, 14% relative, and 32% prophylactic. There was a significant decrease in filters placed for pure prophylaxis: whereas 76 prophylactic filters were placed between 2007 and 2009, only 11 were placed between 2012 and 2014 ( p < 0.0001). No significant differences existed for relatively indicated filters. The department of trauma and surgical critical care (TSCC) observed the most dramatic change in practice. TSCC placed 61 prophylactic VCF between 2007 and 2009 (57% of all filters placed by the department), and 4 prophylactic VCF from 2012 to 2014 (15% of filters placed by TSCC) ( p < 0.0001). Conclusion These findings demonstrate a significant change in the attitudes regarding prophylactic VCF insertion between the two periods of study. Further investigations must be performed to assess changes in clinical outcomes that may result from the altered practice at our university.

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A Change in Practice Protocol: Preformed Metal Crowns for Treating Non-Infected Carious Primary Molars in a General Practice Setting – A Service Evaluation

Primary Dental Journal ◽

10.1308/205016815816682182 ◽

2015 ◽

Vol 4 (4) ◽

pp. 22-26 ◽

Cited By ~ 5

Author(s):

Greig D Taylor

Keyword(s):

General Practice ◽

Patient Experience ◽

Service Evaluation ◽

Primary Molars ◽

Dental Practice ◽

Practice Setting ◽

Preformed Metal Crowns ◽

General Dental Practitioner ◽

Change In Practice ◽

Caries Management

Restoring non-infected carious primary molars can pose a challenge to the general dental practitioner. This paper aims to assess the effect on primary caries management and patient experience in a general dental practice setting, when restoring non-infected carious primary molars using a Hall preformed metal crown (PMC).

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Improving transfusion practice in transfusion dependent thalassaemia patients

Thalassemia Reports ◽

10.4081/thal.2017.6821 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Chathupa Wickremaarachchi ◽

Elizabeth McGill ◽

Annmarie Bosco ◽

Giselee Kidson-Gerber

Keyword(s):

Blood Cells ◽

Maximum Rate ◽

Fluid Overload ◽

Transfusion Practice ◽

Red Cells ◽

Transfusion Rate ◽

Allergic Reactions ◽

Medical Review ◽

Transfusion Reaction ◽

Change In Practice

The aim of this study was to improve current transfusion practice in transfusiondependent thalassaemia patients by determining whether safe transition from triplewashed red cells (TWRC) to leucodepleted red cells (LDRC), increasing transfusion rates, reducing the use of frusemide and creating uniform practice across patients is possible. In patients receiving regular transfusions (50), triple-washed red blood cells were changed to LDRC, transfusion rates were increased to 5 mL/kg/h (in line with the Cooley’s Foundation guidelines) to a maximum of 300 mL/h and frusemide was ceased. Medical review occurred at completion of the transfusion. Of the 20 patients on TWRC, 18 were transitioned to leucodepleted red cells (90%). Recurrent allergic reactions in 2 patients required re-institution of TWRC. 7 of the 8 patients on regular frusemide ceased this practice with no documented transfusion-related fluid overload. One patient refused. Of the eligible 50 patients, 20 patients (40%) were increased to the maximum transfusion rate of 300 mLs/h; 6 (12%) increased rate but refused to go to the maximum; 9 (18%) refused a change in practice and 15 (30%) were already at the maximum rate. There was only one documented transfusion reaction (palpitations) however this patient was able to tolerate a higher transfusion rate on subsequent transfusions. Thalassemia patients on TWRC were safely transitioned to LDRC. Transfusion rates were safely increased, with a calculated reduction in day-stay bed time of 17.45 h per month. This confirms a guideline of 5 mL/kg/h for transfusion-dependant thalassaemia patients with preserved cardiac function is well tolerated and may be translated to other centres worldwide. 本研究的目的是通过确定是否有可能进行从三洗红细胞（TWRC）到去白细胞红细胞（LDRC）的安全过渡，提高输血速率，减少速尿的使用，并在患者中实施统一规则，从而改进输血依赖型地中海贫血患者中现有的输血实践。在接受定期输血的患者（50例）中，将三洗红细胞改为 LDRC，输血速率提高至5 mL/kg/h（符合库利氏贫血基金会的指引），最高可达到300 mL/h，并停止使用速尿。输血完成后进行体检。在使用TWRC的20例患者中，18例转为去白细胞红细胞（90%）。2例患者产生的复发性过敏反应需要重新输以TWRC。8名定期使用速尿的患者中，7名中止了使用该药物，并且没有输血相关液体超负荷的相关记录。一名病人拒绝。在符合条件的50例患者中，20例（40%）增加至300 mL/h的最大输血速率；6例（12%）输血速率提高但拒绝增加至最大；9例（18%）拒绝做出改变，15例（30%）已经达到了最大速率。只产生一例有记录的输血反应（心悸），但是该患者在随后的输血中能够耐受更高的输血速率。使用TWRC的地中海贫血患者安全转用LDRC。输血速率安全地得到提高，计算出减少的白天卧床时间为每月17.45小时。这证实了5 mL/kg/h的指引在心功能得到保护的输血依赖型地中海贫血患者中有良好的耐受性，可以推广至全球其他中心。

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Women in Probation and Parole, 1974

Crime & Delinquency ◽

10.1177/001112877502100203 ◽

1975 ◽

Vol 21 (2) ◽

pp. 109-115 ◽

Cited By ~ 4

Author(s):

Meyressa H. Schoonmaker ◽

Jennifer S. Brooks

Keyword(s):

Civil Rights ◽

Probation Officers ◽

State Agency ◽

Title Vii ◽

State Agencies ◽

Civil Rights Act ◽

Probation And Parole ◽

Change In Practice ◽

Opposite Sex ◽

Probation And Parole Officers

A 1970 survey of women in probation and parole showed that only 20 states mixed caseloads of parole and probation officers. A survey of state agencies by means of a questionnaire directed. to the director of each state agency in January 1974 showed dramatic changes. The number of states allowing probation and parole officers to supervise clients of the opposite sex jumped to 46, with only four states holding out. The questionnaire results also show, not surprisingly, the low ratio of women employed in probation and parole. Title VII of the Civil Rights Act of 1964, the need for more qualified employees, and the inefficiency of caseload segrega tion have influenced changes in use of personnel. Although the change in practice to integrated caseloads is selective in some states and made with reservations in others, the response of one director of parole operations seems to capture the mood of inevitable change in practice and attitude: Civil Service says that his agency cannot discriminate against women and that a woman can do a "man's job" in all respects.

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Change in practice after the Surfactant, Positive Pressure and Oxygenation Randomised Trial

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2014-306057 ◽

2014 ◽

Vol 99 (5) ◽

pp. F386-F390 ◽

Cited By ~ 5

Author(s):

Jaclyn M LeVan ◽

Luc P Brion ◽

Lisa A Wrage ◽

Marie G Gantz ◽

Myra H Wyckoff ◽

...

Keyword(s):

Randomised Trial ◽

Positive Pressure ◽

Change In Practice

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Psychiatric in-patients, violence and the criminal justice system

The Psychiatrist ◽

10.1192/pb.bp.111.034876 ◽

2012 ◽

Vol 36 (2) ◽

pp. 41-44 ◽

Cited By ~ 9

Author(s):

Simon Wilson ◽

Kevin Murray ◽

Mike Harris ◽

Michael Brown

Keyword(s):

Criminal Justice ◽

Criminal Justice System ◽

Cognitive Abilities ◽

Justice System ◽

Security Management ◽

Management Service ◽

Consultant Psychiatrist ◽

Change In Practice ◽

Violent Offences

SummaryThere is ambivalence about prosecuting psychiatric in-patients for violent offences. This ambivalence is reflected in the Memorandum of Understanding that exists between the Crown Prosecution Service and the NHS Security Management Service. This has led to an unwelcome change in practice when the police ask for information from an individual's consultant psychiatrist, the police requesting information about the individual's cognitive abilities at the time of the alleged offence and using this to make decisions about prosecution. However, there is also guidance on this area from other sources. We describe this and make further suggestions for dealing with these requests.

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