scholarly journals Reduction in Varicose Vein Services: Impact on Operative Training

2007 ◽  
Vol 89 (8) ◽  
pp. 789-791 ◽  
Author(s):  
A Bajwa ◽  
TR Magee ◽  
RB Galland
Keyword(s):  
Varicose Vein ◽  
Primary Care Trust ◽  
District General Hospital ◽  
Work Load ◽  
Middle Grade ◽  
Case Load ◽  
Before And After ◽  
Local Primary Care ◽  
The Impact ◽  
Surgical Unit

INTRODUCTION This study examines the impact of rationing varicose vein operations on operative training on a general surgical unit with a vascular interest. PATIENTS AND METHODS Log-books of middle-grade surgeons were analysed for 3-month periods before and after a decision by the local Primary Care Trust to ration varicose vein referrals. Number, intermediate equivalents and type of operations were recorded, whether they were general or vascular cases and whether the trainee had carried out or assisted with the operation. RESULTS There was a slight fall in the total number of operations in which the middle-grade surgeons were involved (208 to 186). There was a significant increase in general surgical cases with the fall in number of varicose vein operations (P < 0.0001).The fall in case-load and work-load operative training in vascular surgery was compensated by an increase in general surgical cases (P = 0.0003). This was largely due to increased number of hernia repairs (P = 0.0035). CONCLUSIONS From the point of operative training, a vascular unit in a district general hospital would not be sustainable following withdrawal of varicose vein services. However, this can be off-set by increasing general surgical case-load to fill the gap created.

scholarly journals Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

2016 ◽  
Vol 98 (2) ◽  
pp. 107-115 ◽  
Author(s):  
S Bokhari ◽  
U Walsh ◽  
K Qurashi ◽  
L Liasis ◽  
J Watfah ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Best Practice ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Early Laparoscopic Cholecystectomy ◽  
Before And After ◽  
One Year ◽  
The Impact ◽  
Surgical Unit

Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to ‘surgeon preference/skill’, was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. Conclusions A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

scholarly journals Vascular Surgery within General Surgery: An Analysis of Workload 1989–2005

2007 ◽  
Vol 89 (7) ◽  
pp. 682-684 ◽  
Author(s):  
SQ Ashraf ◽  
A Bajwa ◽  
TR Magee ◽  
RB Galland
Keyword(s):  
Primary Care ◽  
Vascular Surgery ◽  
General Hospital ◽  
General Surgery ◽  
Varicose Vein ◽  
Primary Care Trust ◽  
District General Hospital ◽  
Considerable Debate ◽  
General Surgeons ◽  
Surgical Unit

INTRODUCTION There is considerable debate as to whether vascular surgery should be a subspecialty separate from general surgery. This study examines the changing relationship between general and vascular surgery in a district general surgical unit over 16 years. PATIENTS AND METHODS A detailed survey of referrals, admissions and operations to one unit was carried out over 3 months in 003. This was compared with similar surveys in 1989, 1990 and 1995. In addition a 3-month audit of operations performed was carried out in 2005 following a decision by the Primary Care Trust (PCT) to reduce varicose vein referrals. RESULTS There was a significant increase in the number of varicose vein and arterial referrals 1989–2003 (P = 0.0001 and P < 0.0001, respectively). This was reflected in increased number of vascular admissions (P < 0.0001). In 1989, 14% of the arterial cases were admitted as emergencies. This figure rose to 52% in 2003 (P < 0.0001). There was a significant increase in the number of arterial operations performed between 1989 and 1995; however, from 1995 to 2003 this number fell P < 0.0001). The number of varicose vein procedures increased significantly 1989–2003 (P < 0.0001), with a significant fall after the PCT decision (P < 0.0001). However, the number of operations carried out in 2005 increased slightly with the proportion of general surgical cases, mostly hernia repairs and laparoscopic cholecystectomies, increasing. CONCLUSIONS With increasing specialisation comes the risk that reduction in any aspect of a particular specialty may result in that unit becoming unsustainable. In vascular surgery this will inevitably lead to centralisation of services. In a large district general hospital having two general surgeons with a vascular interest, the general surgical component has maintained the workload of the unit following reduction in varicose vein referrals.

scholarly journals Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis

2015 ◽  
Vol 97 (4) ◽  
pp. 308-314 ◽  
Author(s):  
S Bokhari ◽  
M Kulendran ◽  
L Liasis ◽  
K Qurashi ◽  
M Sen ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
District General Hospital ◽  
British Society ◽  
Gallstone Pancreatitis ◽  
Before And After ◽  
The Mean ◽  
Comparative Audit ◽  
The Impact ◽  
Surgical Unit ◽  
Definitive Management

Introduction Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP). Methods A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed. Results Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001). Conclusions A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP.

The Impact of an Automated Dispensing System for Supplying Narcotics in a Surgical Unit: The Experience of the National Cancer Institute Foundation of Milan

2018 ◽  
Vol 54 (5) ◽  
pp. 335-342 ◽  
Author(s):  
Giulia Portelli ◽  
Michela Canobbio ◽  
Rossella Bitonti ◽  
Chiara Della Costanza ◽  
Roberto Langella ◽  
...  
Keyword(s):  
National Cancer Institute ◽  
Hospital Costs ◽  
Added Value ◽  
Staff Time ◽  
Economic Saving ◽  
Before And After ◽  
Average Operating ◽  
The Impact ◽  
Surgical Unit ◽  
Narcotic Drugs

Objective: An automated dispensing system for narcotic drugs was introduced in a surgical unit to be compliant with the Italian narcotic drugs regulation. The aim of this study was to evaluate the impact of this automated dispensing system on the incidence of registry errors and corrections and on staff time and hospital costs. Methods: In 2014, Pyxis MedStation 3500 was introduced in a surgical unit of the National Cancer Institute of Milan, to improve the effectiveness of narcotics dispensing and avoid potential errors. Two different time periods of 8 months were compared, respectively, before and after the introduction of the automated dispensing system. In the pre-Pyxis period, drug movements were recorded through paper registries, while in the post-Pyxis period, electronic reports were automatically created from the system. For each period, the number of load/unload registry entries and corrections, the number of registry errors, the staff time dedicated to dispensing and registry activities, and stock and expired drug quantities were recorded. Results: Load and unload errors were reduced by 100% from the pre-Pyxis period to the post-Pyxis period, while registry corrections were lowered by 95%. Time dedicated from nurses to dispensing registration activities was reduced from 36 to 2 hours/month, while pharmacist time lowered from 9 to 1 hours/month. These time savings correspond to an economic saving of ~€4,120 and ~€3,730, respectively. In the post-Pyxis period, average operating room stock quantities were reduced versus the pre-Pyxis period, with wastage being 100% avoided. The reduction in stock drug quantities could correspond to an economic saving of ~€22,300 over the examined 8-month period, while the impact of drug wastage avoidance is modest (~€650). Conclusion: The overall economic impact of Pyxis use, over the 8-month time horizon in analysis, was around €31,000 saved or possibly converted into resource cost dedicated to other added value activities.

WED 028 One person can make a difference: our experience in a busy london dgh

2018 ◽  
Vol 89 (10) ◽  
pp. A5.1-A5
Author(s):  
Aadila Lalloo ◽  
Bazo Raheem ◽  
Giovanni Cocco ◽  
Ana Guzman ◽  
Michael Rose ◽  
...  
Keyword(s):  
Significant Proportion ◽  
District General Hospital ◽  
Full Time ◽  
Consultation Service ◽  
Number Of Patients ◽  
Before And After ◽  
Specialist Nurses ◽  
Working Day ◽  
Junior Colleague ◽  
The Impact

Our Neurology unit is in a busy district general hospital; serving a deprived inner London community, providing a ward consultation service 5 days a week. The unit consists of 5 consultant Neurologists, a consultant Neuroradiologist and 2 specialist nurses. In 2016, a junior doctor was appointed. By analysing data from 10 months in 2015 and 2017; we assessed the impact on the delivery of Neurological care, before and after the appointment. The unit saw a 157% increase in number of patients seen, including a significant proportion now seen in ED and ambulatory care. This is equivalent to a minimum of 2 more patients each working day (n=872 vs. 1317). The percentage of patients seen on same day of referral (<12 hours) increased from 47% to 77%. The proportion of inpatients reviewed who were then followed up on the ward during their stay, increased from 13.9% to 35.5%, representing increased availability of continuing Neurology advice. The percentage of patients who waited more than 24 hours for Neurology input decreased from 14.9% to 5.83%. Our results support the appointment of a full time junior colleague to allow rapid, safe and ongoing Neurological input to patients and to support ED and admitting colleagues.

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

ANALISIS PENGARUH PEMBANGUNAN JALAN LAYANG JANTI TERHADAP PERKEMBANGAN TATA RUANG KAWASAN JANTI STUDI KASUS : KAWASAN JANTI, DESA CATURTUNGGAL, KABUPATEN SLEMAN, D. I. YOGYAKARTA

2017 ◽  
Vol 11 (3) ◽  
pp. 255
Author(s):  
Jeky El Boru
Keyword(s):  
Road Network ◽  
Open Space ◽  
Qualitative Description ◽  
Analysis Method ◽  
Open Spaces ◽  
The Road ◽  
Before And After ◽  
Linkage Method ◽  
The Impact ◽  
Parking Place

Abstract: This research aims to analyze the impact of Janti Flyover Construction toward the growth of layout at Janti Urban Area, including structured space, open space, and linkage. Method used for data collecting are observation, air photograph monitoring, and interview, whereas the analysis method is qualitative description, which is the superimposed method of two layers, that are the layout condition before and after flyover construction. The result shows that the impact of Janti Flyover construction can be seen on building mass (solid), the increasing number of open spaces, including the road network, parking place, and park, whereas the relation between spaces, visually and structurally, can be seen on the growth of buildings which have new shapes and styles, therefore the performance of the overall building does not have a proportional shape. Considering Janti Street at the collective relation, its role is getting stronger as the main frame road network.Keywords: Flyover construction, layout changing, Janti AreaAbstrak: Penelitian ini bertujuan untuk menganalisis pengaruh pembangunan Jalan Layang Janti terhadap perkembangan tata ruang Kawasan Janti, meliputi ruang terbangun, ruang terbuka, serta hubungan antar ruang (“linkage”). Metode pengumpulan data dilakukan melalui observasi, pengamatan foto udara, dan wawancara; sedangkan metode analisis melalui deskripsi secara kualitatif yang berupa “superimposed method” dari dua lapisan kondisi lahan, yakni kondisi tata ruang sebelum dan sesudah pembangunan jalan layang. Hasil penelitian menunjukkan bahwa pengaruh pembangunan Jalan Layang Janti terdapat pada massa bangunan (“solid”), pertambahan ruang terbuka yang berupa jaringan jalan, parkir, dan taman; sedangkan pada hubungan antar ruang ̶ secara visual dan struktural ̶ yakni tumbuhnya bangunan dengan bentuk dan gaya baru, sehingga bentuk tampilan bangunan secara keseluruhan tidak proporsional. Pada hubungan kolektif, Jalan Janti semakin kuat perannya sebagai kerangka utama jaringan jalan.Kata kunci : Pembangunan jalan layang, tata ruang, Kawasan Janti

Impact of merger on efficiency and productivity : a case study of commercial banks in Malaysia

1970 ◽  
Vol 5 (1) ◽  
pp. 77
Author(s):  
Mahadzir Ismail ◽  
Saliza Sulaiman ◽  
Hasni Abdul Rahim ◽  
Nordiana Nordin
Keyword(s):  
Efficiency Score ◽  
Malmquist Productivity Index ◽  
Productivity Index ◽  
Data Envelopment ◽  
Master Plan ◽  
Before And After ◽  
Domestic Banks ◽  
The Impact ◽  
Efficiency And Productivity

The Financial Master Plan (2001- 2010) aims to enhance the capacity of banking industry so that higher effic iency and productivity can be reaped in the future. This study seeks to determine the impact of merger on the efficiency and productivity ofcommercial banks in Malaysia for the period 1995 until 2005. The study uses a non-parametric approach, nam ely DEA (data envelopment analysis?) to estimate the efficiency scores and to construct the Malmquist productivity index. To enable this estimation, three bank inputs and outputs are used. Amongst the findings are those banks exhibit higher efficiency score after the merger and thefo reign banks are more efficient than the local banks. Productivity of the banks is calculated in both periods, before and after the merger: The results show that, it is the local banks that have improved the most after the merger. The main source of productivity is technical change or innovation. The findings support the existing policy of having larger domestic banks in term of size.

THE EFFECT OF METACOGNITIVE INSTRUCTION ON MAXIMIZING EFL LEARNERS’ METACOGNITIVE AWARENESS IN LISTENING

2018 ◽  
Vol 7 (1) ◽  
pp. 8-17
Author(s):  
Mahsa Assadi
Keyword(s):  
Experimental Research ◽  
Listening Comprehension ◽  
Intervention Program ◽  
Metacognitive Awareness ◽  
Listening Test ◽  
Efl Learners ◽  
Metacognitive Instruction ◽  
Before And After ◽  
Comprehension Ability ◽  
The Impact

This study reports a pre-experimental research on the impact of metacognitive instruction on EFL learners’ metacognitive awareness and their listening performance. To obtain the goal of the study, a group of 30 Iranian intermediate EFL learners, including 14 males and 16 females, were selected randomly. Their ages range from 20 to 24. The participants took part in 16 weeks’ intervention program based on metacognitive pedagogical sequence consisted of five stages. The metacognitive awareness listening questionnaire (MALQ), and a listening test were also used to find changes in metacognitive awareness and listening performance before and after the treatment. The results of comparing pre and posttests scores revealed that metacognitive instruction raised the learners’ metacognitive awareness and helped them improve their listening comprehension ability.

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