A Surgical Care Practitioners’ Pilot Programme in Wales

2005 ◽  
Vol 15 (4) ◽  
pp. 176-179 ◽  
Author(s):  
Alun Morgan ◽  
Paul Ward
Keyword(s):  
Surgical Care ◽  
Preliminary Evidence ◽  
Surgical Patients ◽  
Preliminary Evaluation ◽  
Pilot Programme ◽  
Significant Difference

The Surgical Care Practitioner Pilot Programme, funded by the Welsh Assembly Government, commenced in October 2003. Preliminary evidence suggests that the pilot is making a significant difference to the care of surgical patients in those NHS trusts involved. The authors describe why the programme was initiated and what it was designed to deliver, together with the preliminary evaluation.

Zwischenevaluation des Wald-Wild-Management-Instruments (WWMI) im Pilotprogramm effor2 «Wald und Wild» | Preliminary evaluation of the Game-Forest-Management-Tool (GFMT) in the effor2 pilot programme «Game and Forest»

2003 ◽  
Vol 154 (8) ◽  
pp. 305-313 ◽  
Author(s):  
Roman Eyholzer ◽  
Martin Baumann ◽  
Rolf Manser
Keyword(s):  
Forest Management ◽  
Management Practice ◽  
Management Tool ◽  
Preliminary Evaluation ◽  
Optimal Contract ◽  
Technical Tool ◽  
Entire Study ◽  
Pilot Programme ◽  
Complex Problems ◽  
Entire Study Area

Faced with the challenging task of balancing forest interests and wildlife, the Swiss Forest Agency initiated the pilot programme«Game and Forest», which is committed to a philosophy of goal-oriented management practice and a redesign of forestry subsidizing. Within this programme the diverse goals of forestry and hunting have been amalgamated to a superimposed goal and set out in a corresponding contract. The Game-Forest-Management-Tool (GFMT) has been divised to simulate the effect of various strategies to deal with the complex problems of forest-wildlife. Optimal contract-fulfilling procedures can be simulated on a PC using this technical tool. The efficiency of the measures suggested by simulations that were carried out are being tested in a study area within the pilot programme, «Game and Forest». Half way through this trial, after two years, we can say that there has been no significant increase of non-browsed areas. In 2004, after the collection of data for the entire study area, we will be able to tell whether applying this computer simulated strategy truly leads to an augmentation of non-browsed area and a decrease in bark-peeled forests in the pilot area.

scholarly journals Comparison of Simulation-Based versus Cadaveric-Tissue-Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Corneal Laceration Model

2021 ◽  
Vol 13 (01) ◽  
pp. e57-e65
Author(s):  
Boonkit Purt ◽  
Timothy Ducey ◽  
Sean Sykes ◽  
Joseph F. Pasternak ◽  
Denise S. Ryan ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Wound Closure ◽  
Ocular Trauma ◽  
Controlled Trial ◽  
Preliminary Evaluation ◽  
Skills Acquisition ◽  
Visual Axis ◽  
Significant Difference ◽  
Skills Laboratory ◽  
Corneal Laceration

Abstract Purpose The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition. Design Prospective randomized controlled trial. Participants Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD). Methods Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for “refresher” training. Main Outcome Measures Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists. Results No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p = 0.009; length, p = 0.003; and tension, p = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills. Conclusions For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

scholarly journals Preliminary Evidence of Children’s Weight Gain From 5 Months of Home Quarantine During the COVID-19 Pandemic

2021 ◽  
pp. 155982762110066
Author(s):  
Keith Brazendale ◽  
Jeanette Garcia ◽  
Ethan T. Hunt ◽  
Michael Blankenship ◽  
Daniel Eisenstein ◽  
...  
Keyword(s):  
Weight Status ◽  
Preventive Measures ◽  
Preliminary Evidence ◽  
Normal Weight ◽  
Preventative Measures ◽  
Significant Difference ◽  
The Impact ◽  
Weight Data ◽  
Overweight Or Obesity

Purpose. Preventive measures to curtail the spread of the Coronavirus Disease 2019 (COVID-19)—such as home quarantine, closure of schools/programs—are necessary, yet the impact of these restrictions on children’s weight status is unknown. The purpose of this case report was to investigate changes in children’s body mass index (BMI) and zBMI during COVID-19 quarantine. Methods. Children had their heights and weights recorded early March 2020 (pre-COVID-19) and 5 months later (early August 2020). Paired sample t tests examined changes in BMI and zBMI from baseline to follow-up. Results. Twenty-nine children (62% female; mean age 9.3 years; 27.5% with overweight or obesity) provided height and weight data at both time points. There was a significant difference in pre-COVID-19 BMI (mean [M] = 20.1, standard deviation [SD] = 6.0) and follow-up BMI (M = 20.7, SD = 6.4); t(57) = −3.8, P < .001, and pre-COVID-19 zBMI (M = 0.8, SD = 0.9) and follow-up zBMI (M = 0.9, SD = 0.9); t(57) = -3.1, P = .003. Five of the 29 children moved from normal weight to overweight (n = 4) or obese (n = 1) during 5 months of quarantine. Conclusions. Preliminary evidence shows most children increased their BMI and zBMI values from pre-COVID-19 assessment to the follow-up assessment, 5 months later. These initial findings identify potential incidental negative health consequences of children as a result of COVID-19 preventative measures such as home quarantine.

scholarly journals Assessment of the quality of life of orthodontic and surgical patients. Analysis of the factors that motivate the initiation of treatment within the masticatory system

2021 ◽  
Vol 11 (6) ◽  
pp. 120-136
Author(s):  
Justyna Oliwia Szpyt ◽  
Magdalena Gębska
Keyword(s):  
Quality Of Life ◽  
Open Bite ◽  
Surgical Patients ◽  
Control Group ◽  
Self Confidence ◽  
Lower Canine ◽  
Significant Difference ◽  
The Face ◽  
Masticatory System

IntroductionAccording to Angle's classification, a correct bite should have, inter alia, the following regularities: the median line of the face should coincide with the line between the central incisors of the upper and lower arches, the lower incisors should be overlapped by the incisal edges of the upper incisors, the top of the canine in the upper arch is inserted between the lower canine and the tangent premolar, each tooth is in contact with two opposing teeth, adjacent teeth both in the upper and lower arch are in contact with each other. Any deviation from these rules may indicate the presence of a malocclusion. We can distinguish here, for example: posteroclusion, open bite, retrusive occlusion, protrusive occlusion, supraclusion bite. They seem to be important not only in terms of functionality, but also psychology. Research shows that the correction of mandibular prognathism increases the level of self-confidence and self-acceptance, which may improve the quality of life of patients.Purpose of researchThe aim of the study was to check the quality of life of orthodontic and surgical patients as well as what factors motivate these people to start treatment in the area of the masticatory system.Material and methods208 people aged 18 to 55 participated in the survey. They were both people with malocclusion and no malocclusion, who constituted the control group. The questionnaire was created on the basis of standardized OQLQ and OHIP-14 questionnaires. It also included questions about the factors that motivate to start treatment in the masticatory system.ResultsThe most common malocclusion among the respondents was progenia (58.8%), followed by retrogenia (34.3%), then open bite (4%) and posteroclusion (2.9%). According to the OHIP-14 form, statistically significant (p <.0001) higher quality of life was seen in people without a masticatory organ defect, compared to people with the malocclusion. A statistically significant difference (p <.0001) between people with present or recent malocclusion (M = 54.29, SD = 16.71) and people without malocclusion (M = 31.93, SD = 18.31) was also visible in the study with using the OQLQ questionnaire.ConclusionsA malocclusion worsens the comfort and quality of life.Incorrect bite, face and smile aesthetics as well as psychological aspects are the most important factors motivating to undertake surgical and orthodontic treatment.Bruxism and facial pain are not factors prompting the initiation of treatment of malocclusion.

scholarly journals Medical Diseases in Surgical Patients in Hong Kong

1984 ◽  
Vol 12 (1) ◽  
pp. 33-40
Author(s):  
M. L. Yeung
Keyword(s):  
Internal Medicine ◽  
Respiratory Diseases ◽  
Airway Disease ◽  
Anaesthetic Management ◽  
Outpatient Clinics ◽  
Surgical Patients ◽  
Chronic Obstructive ◽  
Chronic Obstructive Airway Disease ◽  
Significant Difference ◽  
Using Data

The incidence of medical diseases in surgical patients was assessed using data gathered from 5944 consecutive anaesthetics. Medical disease which might affect anaesthetic management was present in 23.2% of patients. The commonest diseases were hypertension, anaemia, chronic obstructive airway disease, diabetes mellitus, and pulmonary tuberculosis. No significant difference was detected in sex incidence for ischaemic heart disease and cerebrovascular disease. There was a disproportionate preponderance of males with respiratory diseases. It is suggested that anaesthetics should be administered only by qualified anaesthetists, that the establishment of anaesthetic outpatient clinics is desirable, and that internal medicine should be included in anaesthetic training.

Current Surgical Guidelines

2009 ◽  
Author(s):  
Abdullah Jibawi ◽  
David Cade
Keyword(s):  
Breast Cancer ◽  
Diverticular Disease ◽  
Critically Ill ◽  
Selection Criteria ◽  
Surgical Care ◽  
Surgical Patients ◽  
Surgical Guidelines ◽  
Current Guidelines ◽  
Critically Ill Surgical Patients ◽  
Risk Decision

Current Surgical Guidelines covers the main conditions requiring surgical care, such as breast cancer, critically ill surgical patients, and diverticular disease, and focuses on the evidence and selection criteria which determine the best action to take. Recommendations are graded according to relevant current guidelines and all benefits/risk decision recommendations are supported by easy-to-digest facts and figures.

Randomized cooperative study of perioperative chemotherapy in breast cancer.

1995 ◽  
Vol 13 (11) ◽  
pp. 2712-2721 ◽  
Author(s):  
M R Sertoli ◽  
P Bruzzi ◽  
P Pronzato ◽  
P Queirolo ◽  
D Amoroso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Preliminary Evidence ◽  
Breast Cancer Patients ◽  
Free Survival ◽  
Node Negative ◽  
Significant Survival ◽  
Significant Difference ◽  
Estrogen Receptor Negative

PURPOSE The aim of this multicentric randomized trial was to determine whether reducing the interval between surgery and chemotherapy improves the outcome of breast cancer patients. PATIENTS AND METHODS Between June 1985 and July 1992, 600 breast cancer patients, clinical stages T1-3A,N0-2,M0 were randomly assigned to a perioperative cycle (PC) of cyclophosphamide 600 mg/m2, epidoxorubicin 60 mg/m2, and fluorouracil 600 mg/m2 (CEF). Node-negative (N-) patients did not receive any further treatment. Node positive (N+) patients received 11 cycles if previously given PC, or 12 cycles of CEF alternated with cyclophosphamide 600 mg/m2, methotrexate 40 mg/m2, and fluorouracil 600 mg/m2 (CMF). In addition, N+ patients received concomitant or sequential 5-year tamoxifen therapy. RESULTS At a median follow-up duration of 5.7 years, no significant difference in survival (88% v 84%, P = .3) between the two treatment arms was seen. However, a difference of borderline significance in relapse-free survival (RFS; 76% v 70%, P = .053) was evident. A significant survival advantage for the PC arm was detected only in the estrogen receptor-negative (ER-) patients (P = .003). RFS was significantly improved in N- patients, postmenopausal patients, and ER- patients. Multivariate analyses show that pathologic tumor size, nodal status, receptor status, and treatment (only in ER- patients) are significantly correlated with survival and RFS. PC toxicity did not influence wound healing. CONCLUSION This study provides preliminary evidence that PC positively affects relapse rate and survival in some subgroups, namely, ER- patients.

scholarly journals Clinical agreement and interchangeability of TEG5000 and TEG6s during cardiac surgery

2020 ◽  
Vol 48 (1) ◽  
pp. 43-52
Author(s):  
Qi Wong ◽  
Kelly P Byrne ◽  
Scott C Robinson
Keyword(s):  
Cardiac Surgery ◽  
Reaction Time ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Surgical Patients ◽  
Treatment Recommendation ◽  
New Device ◽  
Management Algorithm ◽  
Arterial Blood ◽  
Significant Difference

TEG6s® is a new device introduced by the Haemonetics Corporation and designed to provide the same information as TEG® 5000 (Haemonetics Corporation, Braintree, MA, USA) but with much greater ease of use. We tested whether using citrated TEG6s gave reaction time, maximum amplitude and percentage of clot that had lysed at 30 minutes values similar to a non-citrated TEG5000, to allow clinical interchangeability using our current thrombelastography management algorithm for cardiac surgery. We also examined the agreement between the alpha-angle and functional fibrinogen maximum amplitude in our cardiac surgical patients.  In total, 243 paired arterial blood samples in 99 patients were tested, using TEG5000 (non-citrated) and TEG6s (citrated) after induction of anaesthesia (prior to heparin administration), following protamine administration at the end of the cardiac bypass and whenever a TEG5000 was requested after this by the attending anaesthetist. Bland–Altman plots and Lin’s concordance coefficient were used to compare agreement whereas modified Bland–Altman plots and McNemar’s test were used to illustrate the differences in management recommendations between the two thrombelastography devices.  All 243 samples were compared for reaction time and alpha-angle; 239 samples were compared for maximum amplitude; 136 samples were compared for the percentage of clot that had lysed at 30 minutes; 16 samples were compared for functional fibrinogen maximum amplitude. Lin’s concordance coefficient for these parameters was: reaction time 0.63, alpha-angle 0.39, maximum amplitude 0.5, percentage of clot that had lysed at 30 minutes 0.09 and functional fibrinogen maximum amplitude 0.31. Differences between the two devices became more marked at more abnormal values. Significant differences in median values, suggesting a fixed bias, were found for maximum amplitude and functional fibrinogen maximum amplitude. Differences in treatment recommendation could only be calculated for reaction time and maximum amplitude. Maximum amplitude was found to have a significant difference in treatment recommendation between the two devices using our current thrombelastography management algorithm for cardiac surgery with TEG6s recommending treatment in 11.5% more patients than TEG5000.  Using the TEG6s with our current TEG5000–based thrombelastography management algorithm for cardiac surgery would result in a change in treatment recommendation in at least 10% of our cardiac surgical patients. Agreement between the two thrombelastography devices appears to decrease with increasing patient coagulopathy. New algorithms will need to be developed and tested to validate TEG6s for cardiac surgical patients in our institution.

Article Commentary: Optimizing Surgical Care: A Contemporary Assessment of Temperature, Oxygen, and Glucose

2010 ◽  
Vol 76 (6) ◽  
pp. 571-577 ◽  
Author(s):  
Ashley Dickinson ◽  
Motaz Qadan ◽  
Hiram C. Polk
Keyword(s):  
Immune Response ◽  
Quality Of Care ◽  
Innate Immune Response ◽  
Surgical Care ◽  
Innate Immune ◽  
Surgical Patients ◽  
Evidence Based

Factors such as temperature, oxygen, and glucose have recently been implicated in the development of surgical sepsis by either promoting or attenuating protective components of the innate immune response. Reducing infective sequelae and the improvement of the quality of care of surgical patients is a top practice priority today. These factors and their associated effects are discussed through the examination of recent clinical and scientific studies to provide an up-to-date evidence-based review.

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