scholarly journals Prescribing, Supplying, and Administering Medicines. A Contemporary Review of Podiatric Surgery in the United Kingdom

2021 ◽  
Author(s):  
Anthony John Maher ◽  
Alan Borthwick
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Local Anaesthetic ◽  
Narrow Range ◽  
Independent Prescribing ◽  
The United Kingdom ◽  
Controlled Drugs ◽  
Post Operative Pain ◽  
Anaesthetic Block ◽  
Podiatric Surgery

Abstract Background. In the United Kingdom (UK) podiatrists are able to access ‘prescription only’ medicines via a specific but narrow range of legally mandated mechanisms. Data on access is also recorded by many podiatrists, especially podiatric surgeons, via a tailored data base developed within the College of Podiatry, known as PASCOM 10.Methods. The PASCOM 10 system was accessed to generate reports for the 2019 calendar year relating to podiatric surgery. The following reports were requested; Procedures, Fixations, Anaesthesia, Demographics, Medications, Post Treatment Sequalae, Patient Satisfaction (PSQ-10), Manchester Oxford Foot/Ankle Questionnaire (MOXFQ), Providers, and Referrals.Results. In 2019 there were 11,189 admissions for podiatric surgery in England recorded on the PASCOM 10 database. 103 surgery centres contributed data resulting in 18,497 procedures. Care was primarily offered in NHS settings accounting for 91% of activity, 94% of these procedures were performed under a local anaesthetic block. 18,576 medicines were supplied, administered, or prescribed from a list of 70 individual items. 29% of all medicines were prescribed by a podiatrist. Controlled drugs (CD) accounted for 28.7 percent of all recorded medicines. Conclusions. Using the PASCOM 10 database, it has been possible to identify an emerging trend in the methods of access to POM medicines by podiatrists, which appears to signal a shift in favour of independent prescribing and with that, a need for better access to controlled drugs to manage acute post-operative pain.

scholarly journals Early adopters of paramedic prescribing: a qualitative study

2019 ◽  
Vol 4 (3) ◽  
pp. 57-57 ◽  
Author(s):  
Karen Stenner ◽  
Suzanne van Even ◽  
Andy Collen
Keyword(s):  
Primary Care ◽  
United Kingdom ◽  
Qualitative Study ◽  
Public Consultation ◽  
Urgent Care ◽  
Early Adopters ◽  
Healthcare Settings ◽  
Independent Prescribing ◽  
The United Kingdom ◽  
Controlled Drugs

Aims: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the United Kingdom.Methods: Following a public consultation by NHS England in 2015, the decision was made in March 2018 to amend legislation to enable advanced paramedics to independently prescribe medicine in UK settings. Capturing the experience of these ‘early adopters’ will help to identify where paramedic prescribing can produce optimum benefits in healthcare systems, as well as enabling early scoping out of challenges to implementation and strategies for resolving challenges. This exploratory qualitative study involved interviews with 17 paramedics who have undertaken the independent prescribing programme in the United Kingdom. Participants were recruited via social media and regional paramedic networks between May and July 2019. Interviews were conducted by telephone or video call and explored use/anticipated use of prescribing, benefits and challenges to prescribing and support for the prescribing role. Thematic analysis was conducted to identify key themes.Results: Of the 17 participants, six were currently prescribing and the remainder were awaiting annotation. Participants worked in a range of settings, including: primary care, emergency departments, urgent care, walk in centres and rapid response services. Key benefits to prescribing were similar to those reported by other non-doctor prescribers and included: streamlining care for patients, improving safety, improving efficiency and facilitating new advanced clinical practice roles. Key challenges included: administrative IT issues, lack of ability to prescribe controlled drugs and managing patient/colleague expectations around paramedic prescribing. In general, participants felt supported in their prescribing role, both by doctors and other non-doctor prescribers, and felt confident to prescribe following the prescribing course. Concerns were raised about potential isolation in some settings, lack of parity in prescribing legislation across different professions and the way this is taught in prescribing programmes.Conclusion: Indications are that paramedic prescribing is rolling out successfully in line with expectations. Barriers and facilitators are similar to those reported by other non-doctor prescribers and independent prescribing is already an essential component to advanced practitioner roles in settings such as primary care. Findings highlight a need for greater alignment of prescribing legislation across non-doctor prescribers from different professions undertaking advanced roles.

scholarly journals Open Appendicectomy under Spinal Anesthesia—A Valuable Alternative during COVID-19

2021 ◽  
Vol 07 (02) ◽  
pp. e69-e72
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Stated Preference ◽  
Case Series ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department ◽  
The United Kingdom

Abstract Introduction Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from March 25th, 2020 until the surgical department reverted to the laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (four-sevenths) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) postoperative events. Two patients suffered minor postoperative complications. Two experienced intraoperative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days, respectively. Although four stated preference in hindsight for GA, the majority (five-sevenths) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe and feasible in the United Kingdom. The technique could be a valuable contingency for COVID-suspected cases and patients with high-risk respiratory disease.

The Act of State Doctrine of the United Kingdom: An Analysis, With Comparisons to United States Practice

1981 ◽  
Vol 75 (2) ◽  
pp. 283-323 ◽  
Author(s):  
Michael Singer
Keyword(s):  
United States ◽  
International Trade ◽  
United Kingdom ◽  
Natural Resources ◽  
Narrow Range ◽  
The United States ◽  
Considerable Importance ◽  
The United Kingdom ◽  
Underlying Causes ◽  
Contractual Rights

Until quite recently the doctrine of act of state had long occupied a quiet backwater of English jurisprudence. Some cases of the last few years, however, have indicated that this doctrine may assume considerable importance in the future. In this respect the English experience is similar to that of the United States, where act of state cases were relatively rare and received little attention for many years before Sabbatino. This coincidence should cause little surprise for, as the cases in both nations make clear, there are common underlying causes. Act of state doctrine developed in an era when governments confined themselves to a narrow range of activities. Nowadays, however, the doctrine is being strained to cope with the activities of states whose governments own and develop natural resources, and engage in international trade, while maintaining an approach to property and contractual rights vastly different from that of the United Kingdom and the United States.

scholarly journals SURG-13. DAY-CASE IMAGE-GUIDED BIOPSY FOR BRAIN TUMOURS: A DECADE OF EXPERIENCE FROM A SINGLE NEUROSURGICAL UNIT IN THE UNITED KINGDOM

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi242-vi242
Author(s):  
Victoria Wykes ◽  
Simon McElligott ◽  
Joy Roach ◽  
Jonathan Duffill ◽  
Crispin Weidmann ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Brain Tumour ◽  
Brain Tumours ◽  
Enhanced Recovery ◽  
Day Case ◽  
Tissue Samples ◽  
Image Guided ◽  
The United Kingdom ◽  
Guided Biopsy

Abstract In the United Kingdom widespread adoption of day-case image-guided biopsy (DIB) for brain tumour has yet to develop. We review a decade of experience of DIB for suspected supra-tentorial brain tumour and recommend discharge criteria for patients post-operatively. 30-day complications, post-operative admissions into hospital and patient satisfaction are examined. METHODS Published protocols and procedures for DIB of brain tumours were used. Tissue samples were sent for fixed histological preparation without intraoperative neuropathological assessment. All patients undergoing an image-guided biopsy for tumour were retrospectively identified from operative logbooks (01/10/2006–30/09/2016), and information recorded from online records. Patients completed satisfaction questionnaires. RESULTS 706 image-guided biopsies for supratentorial tumour were performed of which approximately 60% were identified pre-operatively as candidates for DIB. 92% of DIB patients were successfully discharged 6 hours postoperatively. 4.5% of DIB patients were admitted directly from the day-case unit following identification of a postoperative haematoma >2 cm diameter on CT head performed at 4 hours. 3/401 DIB patients (< 1%) required surgical evacuation for the haematoma, all made a full recovery, with no delay to commencing their oncological management. A diagnostic accuracy of 98% was achieved. Overall 90% of patients were satisfied about the timing of their discharge from hospital and 92.5 % felt they had enough medical support following discharge. DISCUSSION Conscious sedation with enhanced recovery techniques, lack of intra-operative neuropathological analysis and a stream lined service with robust communication between patients, carers/families and the oncology allied medical professionals has ensured that DIB for diagnosis of tumour is safe, reliable and feasible for most patients and is not associated with increased morbidity or mortality. The procedure is well tolerated with good patient satisfaction. We recommend that patients with a good pre-operative functional baseline, requiring a supra-tentorial biopsy are offered day-case surgery in a dedicated unit specialising in this procedure.

scholarly journals 524 Anaesthetic Use and Packing in Subcutaneous Abscess Management: A Retrospective Before and After Analysis Within A Two-Cycle Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Elkadi ◽  
E Dodd ◽  
W Bolton ◽  
T Poulton ◽  
J Burke ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Local Anaesthesia ◽  
Future Research ◽  
Incision And Drainage ◽  
The United Kingdom ◽  
Guidance Intervention ◽  
Change In Practice ◽  
Before And After

Abstract Introduction In the United Kingdom, there are no widely used guidelines within the management of subcutaneous abscesses by incision and drainage (I&D) to direct the use of local anaesthesia (LA) vs genal anaesthesia (GA); or the use of wound packing vs no packing. Method Two cohorts of patients undergoing I&D procedures were retrospectively identified from attendance records over a 3.5-month period. The first cohort was between 16th October 2018 to 31st January 2019. The second cohort of patients was during the COVID-19 pandemic following the introduction of new RCS guidance (intervention) between 29th March 2020 and 15th June 2020. Results Seventy-one patients before and 63 after the intervention were included. There were significantly more procedures performed under LA after the introduction of the intervention (n = 52; 82.5%) vs before (n = 4; 5.6%) p &lt; 0.0001. The incidence of wound packing decreased after the intervention (n = 43; 68.3% vs n = 62; 87.3%) p = 0.00452. Conclusions The results demonstrate that during the pandemic, change in practice resulted in more subcutaneous abscesses being treated with LA. The majority of abscesses were packed in both cohorts although the incidence declined after the intervention. Future research should explore the patient satisfaction regarding pain management and the abscess recurrence rate.

Patient satisfaction with gender identity clinic services in the United Kingdom

2013 ◽  
Vol 28 (4) ◽  
pp. 400-418 ◽  
Author(s):  
Andrew Davies ◽  
Walter Pierre Bouman ◽  
Christina Richards ◽  
James Barrett ◽  
Sheraz Ahmad ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Gender Identity ◽  
The United Kingdom

The ethics of gender reassignment surgery

2021 ◽  
pp. 1573-1576
Author(s):  
Oliver Fenton
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Gender Dysphoria ◽  
Gender Reassignment Surgery ◽  
The United Kingdom ◽  
Gender Reassignment ◽  
And Gender

Transgender issues are very much in the news at present. There has been discussion about both gender dysphoria in general but, more specifically, the practical, psychological, and financial implications of carrying out gender reassignment surgery. In the United Kingdom, this extends to a debate on whether it is justifiable to carry out these procedures within an already hard-pressed National Health Service. This chapter discusses the nature, history, and background of both gender dysphoria and gender reassignment surgery and whether such procedures are justifiable in terms of outcomes and patient satisfaction; and also whether these are legitimate procedures to carry out within the National Health Service.

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