scholarly journals The Provision of Primary and Revision Elbow Replacement Surgery in the NHS

2018 ◽  
Vol 10 (2_suppl) ◽  
pp. S5-S12 ◽  
Author(s):  
Stuart Hay ◽  
Rohit Kulkarni ◽  
Adam Watts ◽  
David Stanley ◽  
Ian Trail ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Surgical Outcomes ◽  
Surgical Procedure ◽  
Best Practice ◽  
Replacement Surgery ◽  
Practice Recommendations ◽  
Procedure Guidelines ◽  
Elbow Replacement ◽  
First Time ◽  
British Orthopaedic Association

BESS Surgical Procedure Guidelines (SPGs). Optimising Surgical Outcomes for Shoulder and Elbow patients. The British Elbow and Shoulder Society (BESS) SPGs are a series of evidence and consensus Best Practice Recommendations developed by BESS surgeons and physiotherapists to help drive quality improvement and achieve the best possible surgical outcomes for UK patients. This SPG on primary and revision elbow replacement surgery is supported and endorsed by both the British Orthopaedic Association (BOA) and the Getting It Right First Time (GIRFT) Programme.

Consent in elective joint replacement surgery: are we doing enough?

Clinical Risk ◽  
2007 ◽  
Vol 13 (4) ◽  
pp. 131-132
Author(s):  
Atif Waheed ◽  
Kamran Ahmed ◽  
Sameh Ansara ◽  
Shivanand S Geeranavar
Keyword(s):  
Joint Replacement ◽  
Best Practice ◽  
Good Practice ◽  
Limited Extent ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Written Information ◽  
National Guidance ◽  
Valid Consent ◽  
British Orthopaedic Association

A substantial number of clinical negligence claims arise from a failure to adequately advise patients prior to surgery. It is important for surgeons at all levels to maintain good practice in obtaining consent and to recognize that the standards against which they are judged in litigation have changed in recent years. Consent is a process rather than an event and evidence of valid consent includes the surgeon's letters, oral and written information given to the patient and, to a limited extent, the consent form. We retrospectively audited the documentation relating to consent in the case notes of 50 patients undergoing elective joint replacement surgery between August 2004 and March 2005, and found that documentation was generally inadequate. We recommend that there should be national guidance on complications for standard elective joint replacement procedures. This could be incorporated into the best practice guidance on joint replacement surgery published by the British Orthopaedic Association.

scholarly journals A rapid improvement program. How to standardise a joint replacement pathway across 10 hospitals in 6 months.

2020 ◽  
Author(s):  
Thomas Wainwright ◽  
Robert Middleton ◽  
Mark J. Ferreira
Keyword(s):  
Quality Improvement ◽  
Knee Replacement ◽  
Significant Variation ◽  
Best Practice ◽  
Enhanced Recovery ◽  
Clinical Pathways ◽  
Length Of Hospital Stay ◽  
Rapid Improvement ◽  
Improvement Program ◽  
Replacement Surgery

Introduction There is strong evidence for implementing standardised enhanced recovery pathways after hip and knee replacement surgery. However, many units still do not use defined clinical pathways. A project was therefore undertaken to introduce a standard clinical pathway across a group of private hospitals. Background BMI Healthcare identified that there was significant variation across their 60 hospitals in regard to length of stay following hip and knee replacement. Diagnostic investigations into this variation revealed significant variation in the care processes and procedures used at individual hospitals and across units. Therefore, ten hospitals were chosen as sentinel sites, and a standardised pathway was introduced. In each hospital the entire multi- disciplinary team was involved in the project. Intervention A 6-month rapid improvement program was undertaken. The first step identified best practice for the provision of hip and knee replacement pathways. An evaluation of current clinical pathways against the gold standard established from the scoping exercise was then completed in each unit. A central improvement team in each hospital were trained in quality improvement techniques and they facilitated the changes in each hospital. The pathway was introduced along with improved documentation and performance measures. This was followed by an evaluation of the new pathway.Regular monitoring was completed centrally via email and telephone, as well as monthly site visits where the hospital team presented their progress, and difficulties with implementation were addressed. Effects of changes The new pathway was successfully implemented by all 10 hospitals. This is evidenced by full compliance to the new pathway, which was measured in each unit using variance analysis and process controlmeasures. The new pathway resulted in a 14% reduction to length of hospital stay across the nine sites, excellent clinical outcomes, and high patient and staff satisfaction. Message for others Facilitating change in ten separate hospitals concurrently is possible if sound quality improvement methodology is used, along with regular monitoring, and the involvement of the whole MDT team in each hospital. The role of ongoing monitoring from external experts and monthly performance reports for each hospital was a very powerful method for making change happen.

Conference report: innovation, interaction … and a lot of data: first time reflections on Internet Librarian International, UK 2018

2019 ◽  
Vol 36 (2) ◽  
pp. 21-22
Author(s):  
Ray Harper
Keyword(s):  
Best Practice ◽  
New Technologies ◽  
Conference Report ◽  
Library Services ◽  
New Techniques ◽  
Content Type ◽  
Making A Difference ◽  
Analyse Data ◽  
Physical Spaces ◽  
First Time

Purpose The purpose of this paper is to summarise a number of presentations at Day 1 of the Internet Librarian International conference, London, UK (16 October 2018). This was the 20th conference in the series, and the three key themes included were the next-gen library and librarian; understanding users, usage and user experience; and inclusion and inspiration: libraries making a difference. Design/methodology/approach This paper reports from the viewpoint of a first-time attendee of the conference. This summarises the main issues raised by each presentation and draws out the key learning points for practical situations. Findings The conference covered a variety of practical ways in which libraries can use technology to support users and make decisions about services. These include developing interactive physical spaces which include augmented reality; introducing “chat-bots” to support users; using new techniques to analyse data; and piloting new ways to engage users (such as coding clubs). A key theme was how we use and harness data in a way that is ethical, effective and relevant to library services. Originality/value This conference focussed on practical examples of how library and information services across sectors and countries are innovating in a period of huge change. The conference gave delegates numerous useful ideas and examples of best practice and demonstrated the strength of the profession in adapting to new technologies and developments.

Illuminating the decision-making strategies of anesthesia providers in challenging cases

2020 ◽  
Vol 64 (1) ◽  
pp. 653-657
Author(s):  
Joshua Biro ◽  
David M. Neyens ◽  
Candace Jaruzel ◽  
Catherine D. Tobin ◽  
Myrtede Alfred ◽  
...  
Keyword(s):  
Decision Making ◽  
Work Environment ◽  
Medication Errors ◽  
Information Seeking ◽  
Best Practice ◽  
Practice Recommendations ◽  
Medication Delivery ◽  
Anesthesia Providers ◽  
Healthcare Work ◽  
Realistic View

Medication errors and error-related scenarios in anesthesia remain an important area of research. Interventions and best practice recommendations in anesthesia are often based in the work-as-imagined healthcare system, remaining under-used due to a range of unforeseen complexities in healthcare work-as- done. In order to design adaptable anesthesia medication delivery systems, a better understanding of clinical cognition within the context of anesthesia work is needed. Fourteen interviews probing anesthesia providers’ decision making were performed. The results revealed three overarching themes: (1) anesthesia providers find cases challenging when they have incomplete information, (2) decision-making begins with information seeking, and (3) attributes such as expertise, experience, and work environment influence anesthesia providers’ information seeking and synthesis of tasks. These themes and the context within this data help create a more realistic view of work-as-done and generate insights into what potential medication error reducing interventions should look to avoid and what they could help facilitate.

scholarly journals The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Endocrines ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 241-250
Author(s):  
Marta Araujo-Castro ◽  
Eider Pascual-Corrales ◽  
Héctor Pian ◽  
Ignacio Ruz-Caracuel ◽  
Alberto Acitores Cancela ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Somatostatin Analogues ◽  
Beneficial Effects ◽  
Key Factor ◽  
Long Acting ◽  
First Time ◽  
Endocrine Complications

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

Counseling during Real Ear Measurements: The Clients' Perspective

2021 ◽  
Author(s):  
Angela Ryall ◽  
Lorienne M. Jenstad ◽  
John Pumford ◽  
Tami Howe ◽  
Garnet Grosjean
Keyword(s):  
Focus Groups ◽  
Hearing Aids ◽  
Visual Information ◽  
Best Practice ◽  
Qualitative Content Analysis ◽  
Hearing Aid ◽  
Added Value ◽  
Centered Care ◽  
Prior Literature ◽  
First Time

Abstract Background When dispensing hearing aids, audiologists must follow validated fitting and verification procedures to ensure that the hearing aids are properly fitted to the client's hearing. Real ear measurements (REMs) are best practice for verifying hearing aids. Prior literature regarding REMs has mainly focused on the clinicians' perspective. Purpose This study investigated informational counseling throughout REMs by gathering perspectives of first-time hearing aid users regarding the content and format of counseling. Research Design The study used an interpretive description approach with focus groups. Study Sample There were 16 adult participants (4 males, 12 females) who were first-time hearing aid users and who all had memory of REMs occurring during their own hearing aid verification. Intervention We investigated the addition of informational counseling during REM verification. Data Collection and Analysis Four focus groups were conducted to elicit feedback on a demonstration of informational counseling during REM hearing aid verification. The data from the focus groups were transcribed verbatim and analyzed using qualitative content analysis. Results Analysis revealed positive aspects, negative aspects, and suggested changes in relation to the verbal and visual information presented during the REM verification demonstration. These data fell into two broad categories: the interaction and transaction of informational counseling. Conclusion Most clients were interested in learning more about REMs if the information was accessible. Results provide recommendations for clinical audiologists and REM system manufacturers to make the information presented during informational counseling more client-friendly and individualized for client-centered care. To continue exploring this new inquiry, further experimental research is required to determine if there is any added value of incorporating informational counseling during REMs.

scholarly journals Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020

2021 ◽  
pp. 1-69
Author(s):  
David J. Gladstone ◽  
M. Patrice Lindsay ◽  
James Douketis ◽  
Eric E Smith ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Best Practice ◽  
Practice Recommendations
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