Critical Care Admissions following Total Laryngectomy: Is It Time to Change Our Practice?

Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality.

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Role of oral sildenafil in neonates with persistent pulmonary hypertension of newborn

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20193757 ◽

2019 ◽

Vol 6 (5) ◽

pp. 2222

Author(s):

Arohi Gupta ◽

Mala Kumar ◽

Tarun Anand

Keyword(s):

Pulmonary Hypertension ◽

Average Length ◽

Case Series ◽

Phosphodiesterase Inhibitors ◽

Persistent Pulmonary Hypertension ◽

Treatment Modalities ◽

Retrospective Case ◽

Average Length Of Stay ◽

Resource Limited

Persistent pulmonary hypertension of newborn is a devastating condition and leads to morbidity and mortality. Even after the increasing use of NO, ECMO and HFO many patients succumb to death. About 50% of the patients either have rebound hypertension or do not respond to the treatment. Hence the role of phosphodiesterase inhibitors (sildenafil) need to be evaluated. Methods is authors report a retrospective case series of 24 patients with PPHN admitted in NICU and treated with oral sildenafil. Results sildenafil was started on all patients on a mean of 1.46 days and stopped on mean of 3.8 days. Initial fio2 was 100%, which after starting sildenafil decreased gradually to 50% on mean of 10 days. Average length of stay in NICU was 20 days. 17(70.8%) patients survived whereas 7 (29%) expired No improvement in oxygen Index after 48 hours (p<0.05) was the independent predicting risk factor for PPHN related mortality in the expired patients.Conclusion are oral sildenafil can be a used in conjunction with other treatment modalities for PPHN especially in resource limited settings.

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Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

Journal of the Intensive Care Society ◽

10.1177/17511437211012151 ◽

2021 ◽

pp. 175114372110121

Author(s):

Stephen A Spencer ◽

Joanna S Gumley ◽

Marcin Pachucki

Keyword(s):

Critical Care ◽

Intensive Care ◽

Intensive Care Units ◽

Case Series ◽

Critically Ill Children ◽

Single Centre ◽

Retrospective Case ◽

Retrospective Case Series ◽

Paediatric Critical Care ◽

Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

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Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211026432 ◽

2021 ◽

pp. 194338752110264

Author(s):

Sean A. Knudson ◽

Kristopher M. Day ◽

Patrick Kelley ◽

Pablo Padilla ◽

Ian X. Collier ◽

...

Keyword(s):

Systematic Review ◽

Surgical Planning ◽

Average Length ◽

Case Series ◽

Retrospective Case ◽

Oral Nutrition ◽

Microsurgical Reconstruction ◽

Virtual Surgical Planning ◽

And Function ◽

Ballistic Trauma

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.

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Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

Ocular Oncology and Pathology ◽

10.1159/000512030 ◽

2021 ◽

pp. 1-9

Author(s):

Biljana Kuzmanović Elabjer ◽

Mladen Bušić ◽

Andrej Pleše ◽

Mirjana Bjeloš ◽

Daliborka Miletić ◽

...

Keyword(s):

Uveal Melanoma ◽

Tumor Regression ◽

Corneal Thickness ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Close Monitoring ◽

Single Institution ◽

Retrospective Case ◽

Caucasian Patients

Introduction: Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). Objective: Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. Methods: This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. Results: The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. Conclusion: The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

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A team approach to the introduction of safe early mobilisation in an adult critical care unit

BMJ Open Quality ◽

10.1136/bmjoq-2018-000339 ◽

2018 ◽

Vol 7 (4) ◽

pp. e000339 ◽

Cited By ~ 4

Author(s):

Sanjiv Chohan ◽

Sara Ash ◽

Lorraine Senior

Keyword(s):

Critical Care ◽

Intensive Care ◽

Staff Development ◽

Critical Care Unit ◽

Average Length ◽

Team Approach ◽

Early Mobilisation ◽

Long Term Outcomes ◽

Average Length Of Stay

Delirium and intensive care unit acquired weakness are common in patients requiring critical care and associated with higher mortality and poor long-term outcomes. Early mobilisation has been shown to reduce the duration of both conditions and is recommended as part of a strategy of rehabilitation of critically ill patients starting during their stay in intensive care. Our aim was to achieve 95% reliability with a standardised mobilisation process. Multidisciplinary involvement through the use of regular focus groups lead to the development of a standardised process of sitting a ventilated or non-ventilated patient at the side of the bed for a set period of time, which was called the daily dangle. Team learning from Plan, Do, Study, Act (PDSA)cycles, as well as feedback from both staff and patients, allowed us to develop the process and achieve a median 87% reliability. Delirium rates fell from 54.1% to 28.8%. There was no change in average length of stay, and no adverse events. Ownership by the staff, development of the process by staff, iterative testing and learning, and designs for reliability were the factors behind the successful adoption of a new and challenging process. Particular changes which drove reliability were standardisation of the criteria for a dangle, standardisation of the dangle itself and a reminder included on the daily goals checklist.

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Effectiveness and Safety of Sitagliptin in Patients with Beta-thalassaemia Major and Diabetes Mellitus: A Case Series

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2017.004 ◽

2016 ◽

Vol 9 (1) ◽

pp. e2017004 ◽

Cited By ~ 2

Author(s):

Shahrzad Zonoozi

Keyword(s):

Diabetes Mellitus ◽

Case Series ◽

Close Monitoring ◽

Thalassaemia Major ◽

Efficacy And Safety ◽

Antidiabetic Agent ◽

Retrospective Case ◽

Beta Thalassaemia ◽

Equivalent Reduction

Sitagliptin, a modern antidiabetic agent which is weight neutral and associated with low rate of hypoglycaemias, is being increasingly used in type 2 diabetes mellitus (DM). However there is paucity of data about its efficacy and safety in beta-thalassaemia major (β-TM).This retrospective case series of five patients (mean age of 45 years) is the first study evaluating the use of sitagliptin in patients with β-TM and DM.Four patients responded well to sitagliptin, as evidenced by decrease in fructosamine by 77 and 96µmol/L (equivalent reduction in HbA1c of 1.5% and 1.9%) observed in two patients and reduction in the frequency of hypoglycaemia without worsening glycaemic control in two others. One patient did not respond to sitagliptin. No patients reported significant side effects.This study provides evidence that sitagliptin may be considered, with caution, for use in patients with β-TM and DM, under the close monitoring of a Diabetologist.

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Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.6812 ◽

2015 ◽

Vol 9 (12) ◽

pp. 1323-1330 ◽

Cited By ~ 7

Author(s):

Basima Abdalla Almomani ◽

Amanda McCullough ◽

Rawan Gharaibeh ◽

Shaher Samrah ◽

Fatimah Mahasneh

Keyword(s):

Critical Care ◽

Acinetobacter Baumannii ◽

Case Series ◽

Positive Culture ◽

Multidrug Resistant ◽

Ventilator Associated Pneumonia ◽

Retrospective Case ◽

Critical Care Units ◽

Susceptibility Data ◽

Case Series Study

Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017–0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028–0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.

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SP6.1.10 Can gallbladder polyp surveillance be justified? Experience of a large DGH

British Journal of Surgery ◽

10.1093/bjs/znab361.137 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Nicholas Bradley ◽

Michael Wilson ◽

Christopher Shearer ◽

Timothy Heron ◽

Katie Robertson ◽

...

Keyword(s):

Incidental Finding ◽

Case Series ◽

District General Hospital ◽

Pathological Examination ◽

Histopathological Analysis ◽

Low Grade ◽

Retrospective Case ◽

Gallbladder Polyps ◽

Abnormal Pathology ◽

Gallbladder Malignancy

Abstract Aims Gallbladder polyps are typically an incidental finding on sonographic or pathological examination with an estimated prevalence of 0.3 – 9.5%. Their role as a precursor to gallbladder malignancy is disputed. The 2017 European Joint Society Guidelines (ESGAR/EAES/EFISDS/ESGE) aim to standardise management of gallbladder polyps detected prior to cholecystectomy. We aim to describe our experience in the management of gallbladder polyps in a district general hospital. Methods This single centre retrospective case series included consecutive cholecystectomies over an 8-year period, identified through pathology records. Medical records were interrogated to identify the presence of gallbladder polyps identified pre-operatively and at subsequent histopathological analysis. Results 3835 cases were included. Four cases (0.1%) had an adenocarcinoma identified; none of these had pre-operatively identified polyps. Two cases (0.05%) were found to have lesions with high-grade dysplasia, 1 of which had a 17mm polyp preoperatively. One case (0.03%) had cellular atypia, without a pre-operative polyp. Forty six cases (1.2%) were found to have low-grade dysplasia; 1 (2.2%) of these had adenomyomatosis pre-operatively but none had pre-operative polyps. Overall, 53 patients (1.4%) had abnormal pathology with only 1 (1.9%) of these having a pre-operative polyp identified. Conclusions Our results suggest that in the real-world setting, intensive surveillance of gallbladder polyps has limited utility in identifying cases of gallbladder malignancy. The burden on services produced by adherence to strict surveillance guidelines is difficult to justify and a less arduous approach is unlikely to significantly influence the management or outcome in patients with gallbladder malignancy.

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Penetrating Orbital-Cranial Injuries Management in a Limited Resource Hospital in Latin America

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0035-1546813 ◽

2015 ◽

Vol 8 (4) ◽

pp. 356-362 ◽

Cited By ~ 6

Author(s):

Glyn Estebanez ◽

Diana Garavito ◽

Laura López ◽

JuanCarlos Ortiz ◽

Andrés M. Rubiano

Keyword(s):

Ct Angiography ◽

Case Series ◽

Limited Resource ◽

University Hospital ◽

Retrospective Case ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Occipital Lobes ◽

Difficult Cases

Penetrating orbital-cranial injuries (POCIs) are difficult cases especially in hospitals in low-middle-income countries (LMIC) where resources are limited. We present a case series of POCI managed in a university hospital in such scenario. A retrospective case series was conducted including patients with POCI in 2011. Mechanism of injury, Glasgow Coma Scale score, imaging, medical and surgical management, complications, and Glasgow Outcome Scale (GOS) score were analyzed. A total of 30 patients with penetrating orbital injuries were admitted from March 2011 to December 2011. Of this group, only four patients were diagnosed with cranial penetration. Computed tomography (CT) angiography revealed orbital fractures and injury to frontal, temporal, or occipital lobes. Urgent craniotomy with isolation of ipsilateral carotid artery was performed. GOS score at discharge was 5 in three patients and 4 in one patient. POCIs are not uncommon in hospitals of LMIC. In such scenarios, a standard approach with CT angiography and early neurosurgical intervention results in good outcome.

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937 Is the Dog Still Man's Best Friend?

British Journal of Surgery ◽

10.1093/bjs/znab134.335 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Ashraf ◽

M Waseem

Keyword(s):

Average Length ◽

Financial Burden ◽

District General Hospital ◽

The Elderly ◽

Operative Management ◽

Search Term ◽

Patient Demographics ◽

Best Friend ◽

Average Length Of Stay ◽

The Impact

Abstract Introduction It is colloquially known that dogs are man’s best friend. However, animal attacks cause a large number of injuries and deaths worldwide, with 70% of injuries being caused by pets. This study highlights the impact of dog related injuries. Method Data was collected retrospectively over 1 year in a small district general hospital. The search term “dog” was used to find patients who had attended A&E or fracture clinic. This data was analysed for patient demographics, injury type and severity, management, and cost to the NHS. Results The majority (77%) of patients were female and elderly, with the modal age group being 70-79. Of the 38% of patients requiring admission, average length of stay was 6.7 days. Fractures made up the majority of injuries (56%) and 17% of patients required operative management. A further 2% suffered from post-operative complications. The average cost to the NHS was £1,695 per patient. Conclusions Dog related injuries disproportionately affected women and the elderly, with a large portion requiring operative management. Some patients developed further complications. As well as health burden there was also a financial burden associated with these injuries. These health and financial detriments are not often considered when deciding on pet ownership.

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