THE IMPACT OF AN EPILEPSY-CARE BUNDLE ON THE MANAGEMENT OF ACUTE SEIZURES IN A LARGE LONDON-BASED DISTRICT GENERAL HOSPITAL

2015 ◽  
Vol 86 (11) ◽  
pp. e4.107-e4
Author(s):  
Aravindhan Baheerathan ◽  
Kohilan Gananandan ◽  
Orlando Swayne
Keyword(s):  
District General Hospital ◽  
Business Case ◽  
Medical Emergency ◽  
Initial Assessment ◽  
Care Bundle ◽  
Staff Turnover ◽  
Acute Seizures ◽  
Neuro Imaging ◽  
The Impact

IntroductionSeizures account for 2–3% of presentations to the Accident & Emergency department. The National Audit of Seizure management in Hospitals (NASH) has demonstrated significant variances with regards to initial assessment and subsequent management. Standardised management protocols are crucial in optimising the care of this commonly encountered medical emergency.MethodsThe care of 30 patients admitted with seizures over a 1–month period was retrospectively reviewed. Following this a trust-wide seizure bundle was implemented and another 30 patients were reviewed. Data collection specifically assessed: ▸ Demographics of patients admitted, ▸ Immediate assessment & initial investigations, ▸ Consequent neuro-imaging & specialist investigations, ▸ Referral pathway.ResultsThe results showed poor uptake of the bundle and consequently management was broadly unchanged. The most significant results were:▸ 24% of cases did not have a senior review▸ 70% of cases were not discussed with neurology▸ 36% of cases did not have any follow up arrangedConclusionThe implementation of a seizure bundle can be challenging in the context of a unit that has a rapid staff turnover and is heavily staffed by locum physicians. Repeated staff education is required. This evidence is being used in a business case to employ an epilepsy nurse at Northwick Park. (Aravindhan Baheerathan and Kohilan Gananandan will both be presenting authors and contributed equally to this abstract).

scholarly journals The Impact of Depression on Patient Outcomes in Hip Arthroscopic Surgery

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880649 ◽  
Author(s):  
RobRoy L. Martin ◽  
John J. Christoforetti ◽  
Ryan McGovern ◽  
Benjamin R. Kivlan ◽  
Andrew B. Wolff ◽  
...  
Keyword(s):  
Rating Scale ◽  
Arthroscopic Surgery ◽  
Severe Depression ◽  
Outcome Data ◽  
Labral Repair ◽  
Initial Assessment ◽  
Symptoms Of Depression ◽  
Number Of Patients ◽  
The Impact

Background: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement. Hypothesis: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and 12-item Short-Form Health Survey (SF-12) when consenting for surgery. At 2-year follow-up, patients were emailed the iHOT, the VAS, and a rating scale of surgical satisfaction. Initial SF-12 mental component summary (MCS) scores <46.5 and ≤36 were used to qualify symptoms of depression and severe depression, respectively, as previously described and validated. Repeated-measures analysis of variance was performed to compare preoperative and 2-year postoperative iHOT-12, VAS, and satisfaction scores between those with and without symptoms of depression. Results: A total of 781 patients achieved the approximate 2-year milestone (mean follow-up, 735 ± 68 days), with 651 (83%) having 2-year outcome data available. There were 434 (67%) female and 217 (33%) male patients, with a mean age of 35.8 ± 13.0 years and a mean body mass index of 25.4 ± 8.8 kg/m2. The most common procedures were femoroplasty (83%), followed by synovectomy (80%), labral repair (76%), acetabuloplasty (58%), acetabular chondroplasty (56%), femoral chondroplasty (23%), and labral reconstruction (19%). The mean initial SF-12 MCS score was 51.5 ± 10.3, with cutoff scores indicating symptoms of depression and severe depression in 181 (28%) and 71 (11%) patients, respectively. Patients with symptoms of depression scored significantly ( P < .05) lower on the initial iHOT-12 and VAS and 2-year follow-up iHOT-12, VAS, and rating scale of surgical satisfaction. Conclusion: A large number of patients who underwent hip arthroscopic surgery presented with symptoms of depression, which negatively affected self-reported function, pain levels, and satisfaction on initial assessment and at 2-year follow-up. Surgeons who perform hip arthroscopic surgery may need to identify the symptoms of depression and be aware of the impact that depression can have on surgical outcomes.

scholarly journals EP.FRI.271 The impact of Surgical Assessment Unit on emergency and ambulatory surgical care in a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Aloka Suwanna Danwaththa Liyanage ◽  
Philip Apter ◽  
Gemma Causer ◽  
Krishnan Gokul ◽  
Paul Ainsworth
Keyword(s):  
Care Delivery ◽  
Surgical Care ◽  
District General Hospital ◽  
Direct Access ◽  
Post Discharge ◽  
Similar Time ◽  
Assessment Unit ◽  
Audit Period ◽  
The Impact

Abstract Aims There has been a paradigm shift in the delivery of emergency and ambulatory surgical care necessitated by paucity of beds, improved expedited diagnostics and delayed transit in Emergency departments. The objective of a surgical assessment unit (SAU) is to reduce the number of semi-urgent admissions, provide direct access to urgent surgical admissions bypassing the ED, expeditious assessment by senior clinicians and to reduce the number of OPD follow up. In our setting, the SAU came into existence on all 5 working days at 12-hour daily schedule and its impact was evaluated retrospectively.  Methods Prospectively maintained data base over a 2-month period was examined. Pre and post SAU figures were compared to judge any quantitative improvement in surgical services.  Results During the audit period of 2 months there were 156 emergency patients and 190 ward attenders for follow up care. Majority of these patients were assessed within 4 hours and discharged or ambulated. Numbers being admitted overnight purely to facilitate investigations showed a decrease of 44.6% post SAU establishment. There was a reduction in post discharge outpatients appointments when compared to a similar time period pre SAU (14% difference).   Conclusion The SAU, although initially conceived and designed purely to cope with increased admissions and to minimise breaching of emergency department targets, has shown quantitative and qualitative improvement in emergency and ambulatory surgical care delivery. 

MOTOR PROGRAMMING PREDICTS THE FUNCTIONAL RECOVERY GAIN IN PATIENTS WITH RIGHT HEMISPHERIC FRONTAL STROKE

2020 ◽  
Vol 18 (3) ◽  
pp. 339-345
Author(s):  
Constantinos Kormas ◽  
Eleni Vidali ◽  
Evangelos Lymperopoulos
Keyword(s):  
Executive Functioning ◽  
Functional Recovery ◽  
Motor Programming ◽  
Initial Assessment ◽  
Stroke Patients ◽  
Functional Rehabilitation ◽  
Global Status ◽  
The Difference ◽  
The Impact

Executive functioning significantly affects the functional rehabilitation progress in stroke patients. The current study are aimed to examine the impact of executive functions on functional recovery gain in a sample of right hemispheric (RH) frontal stroke patients. A total of 50 inpatients admitted to the Theseus Rehabilitation Center and diagnosed with RH frontal stroke were included in this study. The initial assessment of executive functioning was conducted using the Frontal Assessment Battery (FAB). Functional recovery of basic activities of daily living (ADLs) was computed by the difference between follow-up and baseline Barthel Index (BI) scores. Pearson’s analysis revealed that the FAB global scores significantly correlated with the BI gain scores. Additionally, multiple regression analysis showed a significant contribution of only motor programming to the basic ADLs recovery gain. The global status of executive function was found to be significantly associated with functional recovery gain, and motor programming was the strongest predictor in RH frontal stroke patients. These findings are discussed for the treatment rehabilitation prognosis.

A Pre-Post Comparison of a Multidimensional Treatment Program for Acutely Suicidal Borderline Patients

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Ohlendorf ◽  
T. Di Clemente ◽  
D. Gaudry-Maire ◽  
Y. Burnand
Keyword(s):  
Catchment Area ◽  
Direct Costs ◽  
Borderline Personality ◽  
Psychiatric Services ◽  
Medical Emergency ◽  
Service Research ◽  
Borderline Patients ◽  
The Impact ◽  
Improved Outcome

Over the last few years, a new comprehensive program for acutely suicidal borderline patients has been developed in the Geneva area (careful description is provided in a distinct section of this workshop). The present work will report the results of a service research oriented study aimed at evaluating the impact of the implementation of such multidimensional intervention on a system of psychiatric services in a 500.000 inhabitant catchment area. Specifically, a pre-post design has been utilized to compare two distinct patient cohorts meeting criteria for borderline personality disorder who had bee referred to medical emergency room with suicidal attempt. Both cohorts had follow-up at 3-month and 1 year to assess treatment failure, repetition, hospitalization and direct costs. The results indicate that the program is feasible and may be associated with improved outcome and substantial costs savings among acutely suicidal borderline patients.

IMPACT OF A CLINICAL PATHWAY ON THE MANAGEMENT OF FIRST SEIZURES AT A DISTRICT GENERAL HOSPITAL

2015 ◽  
Vol 86 (11) ◽  
pp. e4.149-e4
Author(s):  
Zoya Georgieva ◽  
Harith Altemimi
Keyword(s):  
Cultural Change ◽  
Clinical Pathway ◽  
District General Hospital ◽  
Blood Glucose Measurement ◽  
Glucose Measurement ◽  
Junior Doctors ◽  
Neurology Clinic ◽  
Drug History ◽  
The Impact

Diagnostic confidence and management of first seizures can be challenging, particularly for junior doctors. This audit evaluates the impact of a clinical pathway based on recommendations by the College of Emergency Medicine, which intended to improve the management of such patients at a UK DGH.A systematic search identified cases spanning 3 months either side of the date of introduction of the pathway. 23 pre- and 25 post-pathway cases presenting to A&E or as inpatients were randomly selected, excluding cases with a known seizure-related diagnosis.The pathway was only utilised in 16% of cases. Referral to neurology clinic increased from 30% to 52%, but attending within the recommended 2 weeks of ictus remained infrequent (8%). Clinical assessment worsened in several categories, including documenting a drug history, obtaining an ECG, and blood glucose measurement. Documenting discussions about driving decreased from 43% to 36%.Findings confirm suboptimal investigation and follow-up of first seizures, with a surprising deterioration after introduction of a local clinical guideline. This audit demonstrates the importance of cultural change in addition to the availability of a structured guideline. We propose this can be achieved by dedicated junior doctor training sessions and development of a patient information leaflet.

scholarly journals Review of the Multidisciplinary Voice Clinic in a District General Hospital of the United Kingdom

2016 ◽  
Vol 24 (3) ◽  
pp. 154-156
Author(s):  
Louise Marie Evans ◽  
Parry Haf Beca ◽  
Helen Patterson ◽  
Alagar Chandra Mohan
Keyword(s):  
Patient Satisfaction ◽  
District General Hospital ◽  
Language Therapy ◽  
Patient Demographics ◽  
The United Kingdom ◽  
Pre Treatment ◽  
The Impact ◽  
The Voice

Introduction The Voice Clinic is a multidisciplinary specialist voice clinic. Our aim is to review patient demographics, subjective symptoms both at presentation and 16 months post clinic and patient satisfaction.   Methods A retrospective review of all pre treatment voice clinic questionnaires for all new patients who attended the voice clinic over a 3-month period. A telephone interview was conducted 16 months after first presentation to determine patient satisfaction and whether patient’s symptoms had improved.    Results A total of 25 patients who had completed a pre clinic questionnaire were identified, 17/25 completed the follow up interview. 88% of patients reported symptoms of ≥ 6 months duration. 41% underwent Speech and Language Therapy (SALT), 24% had medical management, 6% surgery, and 30% were given advice only. On a severity scale of 1- 10 (10 most severe) 40% rated their voice severity to be ≥5/10 at presentation, 16 months later this was 11% of patients.  56% rated the impact of their voice on their life to be ≥ 5/10 at presentation, 16 months later this was 6%.   Conclusion   Although limited the review shows that for the majority of patients their symptoms and quality of life improved after review at the multidisciplinary clinic.

scholarly journals Improved outcomes following the implementation of a decompensated cirrhosis discharge bundle

2021 ◽  
pp. flgastro-2021-102021
Author(s):  
Katherine Smethurst ◽  
Jennifer Gallacher ◽  
Laura Jopson ◽  
Titilope Majiyagbe ◽  
Amy Johnson ◽  
...  
Keyword(s):  
Liver Disease ◽  
Electronic Version ◽  
Decompensated Cirrhosis ◽  
Care Bundle ◽  
Paper Version ◽  
Medical Needs ◽  
Avoidable Readmission ◽  
The Uk ◽  
The Impact

IntroductionMortality from liver disease is increasing and management of decompensated cirrhosis (DC) is inconsistent across the UK. Patients with DC have complex medical needs when discharged from hospital and early readmissions are common. Our aims were: (1) to develop a Decompensated Cirrhosis Discharge Bundle (DCDB) to optimise ongoing care and (2) evaluate the impact of the DCDB.MethodsA baseline review of the management of patients with DC was conducted in Newcastle in 2017. The DCCB was developed and implemented in 2018. Impact of the DCDB was evaluated in two cycles, first a paper version (November 2018–October 2019) and then an electronic version (November 2020–March 2021). Key clinical data were collected from the time of discharge.ResultsOverall, 192 patients (62% male; median age 55; median model for end-stage liver disease 17; 72% alcohol related) were reviewed in three cycles. At baseline, management was suboptimal, particularly ascites/diuretic management and provision of follow-up for alcohol misuse and 12% of patients had a potentially avoidable readmission within 30 days. After DCDB introduction, care improved across most domains, particularly electrolyte monitoring (p=0.012) and provision of community alcohol follow-up (p=0.026). Potentially preventable readmissions fell to 5% (p=0.055).ConclusionsUse of a care bundle for patients with DC can standardise care and improve patient management. If used more widely this could improve outcomes and reduce variability in care for patients with DC.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Coexistent Osteoarthritis and Parkinson’s Disease: Data from the Parkinson’s Foundation Outcomes Project

2020 ◽  
Vol 10 (4) ◽  
pp. 1601-1610
Author(s):  
Jaimie A. Roper ◽  
Abigail C. Schmitt ◽  
Hanzhi Gao ◽  
Ying He ◽  
Samuel Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Study Data ◽  
Functional Mobility ◽  
Quality Improvement Initiative ◽  
Timed Up And Go ◽  
Mobility Performance ◽  
Risk Of Mortality ◽  
The Impact

Background: The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson’s disease is unknown. Objective: We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson’s disease. Methods: In a retrospective observational longitudinal study, data from the Parkinson’s Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson’s disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. Results: More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson’s disease seem to additively increase the risk of mortality (p = 0.007). Conclusion: Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson’s disease.

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