scholarly journals Antibiotics prescription in the elderly across different clinical areas; A real-life clinical audit

2021 ◽  
Vol 2 (4) ◽  
pp. 53-58
Author(s):  
Khaled Madi ◽  
Joyce Luk ◽  
Seline Sutton ◽  
Amr Elkammash ◽  
Sathyabama Loganathan
Keyword(s):  
Antibiotic Prescription ◽  
Compliance Rate ◽  
National Health System ◽  
Real Life ◽  
Working Hours ◽  
The Elderly ◽  
Out Of Hours ◽  
The Uk ◽  
Hospital Wards ◽  
Selection Of

Ageing of the population represents a great challenge to the national health system (NHS) in the UK. Patients in this age group have multiple comorbidities and use polypharmacy. They also have alterations in the absorption, metabolism and excretion of drugs. These factors make them susceptible to developing side effects and drug interactions on using antibiotics.Our team audited the safety of antibiotic prescription in elderly patients (above 85 years of age) in regards to the selection of the appropriate antibiotics, and the documentation of the indication and duration of them. We also compared the prescription process during working hours and out of hours. We recruited 20 patients from each of the three departments involved in their care: The Old people admission unit (OPAU), the geriatric wards and other hospital wards. Our minimum compliance rate was 95% in each of the studied parameters. We spotted a significant compromise in the antibiotic prescription on non-geriatric wards and out of hours. This goes with the concerns raised by other studies. We recommend continuous education and the setting up of campaigns to increase the awareness of the medical staff on this aspect.

scholarly journals Supply and Demand in Liver Transplantation Surgery: Implications for Training in the UK

2013 ◽  
Vol 95 (8) ◽  
pp. 1-5
Author(s):  
SJ McNally ◽  
RW Parks ◽  
SJ Wigmore
Keyword(s):  
Liver Transplantation ◽  
Supply And Demand ◽  
Significant Proportion ◽  
Working Hours ◽  
Working Time ◽  
Out Of Hours ◽  
Medical Graduates ◽  
Transplantation Surgery ◽  
European Working ◽  
The Uk

At the end of the 1990s there was a perceived crisis in the recruitment of transplant surgeons in the UK. transplantation surgery is a demanding specialty, requiring a significant proportion of time to be spent in out-of-hours work performing prolonged and technically demanding surgery. Other factors, such as reduced working hours associated with the implementation of the european Working time regulations and the changing expectations of new medical graduates, are thought to have contributed to making training in liver transplantation surgery an unattractive option.

scholarly journals S.VA.M.Di.: a new opportunity for the National Health System

2016 ◽  
Vol 10 (3) ◽  
Author(s):  
Simona De Simoni ◽  
Cecilia Arriga ◽  
Silvia Dari ◽  
Giuseppe Cimarello
Keyword(s):  
Home Care ◽  
Health Professionals ◽  
National Health System ◽  
Working Hours ◽  
Integrated Approach ◽  
The Elderly ◽  
Decision Processes ◽  
Social Dimensions ◽  
Multidimensional Evaluation ◽  
Dimensional Assessment

Multi-dimensional assessment is still evolving today. Object of our study is not only the transition from the S.Va.M.A form («Scheda per la valutazione multidimensionale dell’anziano» – Questionnaire for multidimensional evaluation of the elderly) to the S.Va.M.Di form («Scheda di valutazione multidimensionale del disabile» – Questionnaire for the multidimensional assessment of disabled individuals), but the administration of S.VA.M.Di to subjects included in a «PAI» («Piano assistenziale individuale» – Individual Assistance Plan). This integration is designed to facilitate the access of patients to home care, integrated home care and residential and semi-residential care.During 2015 the S.VA.M.Di questionnaire was administered on an experimental basis within the Adult Disability Service of ASL Viterbo to a random mode selected sample of 108 residents of the Viterbo province with a diagnosis of mental retardation (mild, moderate, moderate/severe and severe).S.VA.M.Di is an anamnestic, diagnostic, evaluative and prescriptive tool, useful for an integrated approach in the patient’s care in the health, social health and / or social dimensions; it is a tool that describes the decision processes and allows statistical and epidemiological analysis.The analysis of the results showed that the S.VA.M.Di is certainly a very complex questionnaire to be completed, in terms of working hours devoted to the writing and the complexity in processing. However, it has considerable advantages as regards the completeness and accuracy of the data collected. Essential for its implementation and adoption is the adequate training of health professionals involved.

Lessons learnt from setting up a UK urgent dental care centre during the COVID-19 pandemic

2021 ◽  
Vol 12 (2) ◽  
pp. 64-71
Author(s):  
Abisola Asuni ◽  
Emily Carter ◽  
Jenna Trainor ◽  
Alex Daly ◽  
Kelly Gillan ◽  
...  
Keyword(s):  
Dental Care ◽  
Working Hours ◽  
Protective Equipment ◽  
Out Of Hours ◽  
Dental Hospital ◽  
Dental Practices ◽  
The Uk ◽  
Staff Wellbeing ◽  
Staffing Requirements ◽  
Dental Conditions

When the COVID-19 pandemic led to the closure of general dental practices throughout the UK on 23 March 2020, Newcastle Dental Hospital became a regional in-hours urgent dental care hub treating ‘hot’ (COVID-19 positive, self-isolating), ‘warm’ (shielding, vulnerable) and ‘cold’ (other) patients. It provided urgent dental care to over 3,000 patients in the first 6 weeks. With no other urgent dental care centres being operational until 15 April, the hospital was the sole care provider (both during normal working hours and out of hours) to a population of over 3 million for more than 3 weeks. Consideration of staffing requirements, logistics, staff wellbeing, personal protective equipment, referral pathways, clinic setup and management of urgent dental conditions during the COVID-19 pandemic are discussed along with the challenges faced.

scholarly journals The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

2008 ◽  
Vol 90 (6) ◽  
pp. 513-516 ◽  
Author(s):  
M Crocker ◽  
G Fraser ◽  
E Boyd ◽  
J Wilson ◽  
BP Chitnavis ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Pain Syndrome ◽  
Working Hours ◽  
Out Of Hours ◽  
Interhospital Transfer ◽  
Mri Scans ◽  
Prolapsed Intervertebral Disc ◽  
Magnetic Resonance Imaging Mri ◽  
The Uk

INTRODUCTION The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. PATIENTS AND METHODS We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. RESULTS A total of 76 patients were transferred for assessment and ‘on-call’ MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing – from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. CONCLUSIONS These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

scholarly journals Behaviour of occupational health services during the COVID-19 pandemic

2020 ◽  
Vol 70 (5) ◽  
pp. 359-363 ◽  
Author(s):  
S Ranka ◽  
J Quigley ◽  
T Hussain
Keyword(s):  
Occupational Health ◽  
Health Services ◽  
Business Model ◽  
Online Survey ◽  
Working Hours ◽  
Occupational Health Services ◽  
Telephone Line ◽  
Out Of Hours ◽  
The Uk ◽  
Different Parts

Abstract Background Disasters, crises and pandemics are emergencies which impact on businesses severely. The COVID-19 pandemic reached its peak in mid-April 2020 in the UK. During this period, NHS Occupational Health Services (OHS) were stretched to their limit along with other health services. OHS may have had to change their pattern of operation, operating times, services offered, etc. to cope with the pandemic. Data about business model modifications, services offered by the OHS businesses during the pandemic could help in better utilization of OHS resources in the future. Aims To understand the behaviour of OHS in different parts of the country during the COVID-19 pandemic. Methods An online survey link was sent to both accredited and unaccredited UK Occupational Health Physicians (OHPs). Results Sixty-two OHPs responded to the survey. In the current pandemic, 51% of the OHS (95% CI 0.38–0.62) offered weekend or out-of-hours (OOH) services, 21% had to employ extra staff (95% CI 0.13–0.33) and 54% had to change their working hours (95% CI 0.41–0.65). Ninety per cent of the OHS (95% CI 0.78–0.94) continued to offer routine services; however, there was a decline in offering vaccination services. Fifty-six per cent of the OHS (95% CI 0.42–0.67) offered a dedicated telephone line and 46% of the OHS (95% CI 0.32–0.56) started a dedicated COVID-19 queries inbox. Conclusions There was a change in the behaviour of the OHS to cope with the pandemic. Having a dedicated helpline to manage the crisis situation seemed a logical step whilst offering routine services.

scholarly journals Factors influencing the decisions of senior UK doctors to retire or remain in medicine: national surveys of the UK-trained medical graduates of 1974 and 1977

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017650 ◽  
Author(s):  
Fay Smith ◽  
Shelly Lachish ◽  
Michael J Goldacre ◽  
Trevor W Lambert
Keyword(s):  
Response Rate ◽  
Working Hours ◽  
Retirement Plans ◽  
Out Of Hours ◽  
National Surveys ◽  
Work Related ◽  
Medical Graduates ◽  
Retention Policy ◽  
Factors Influencing ◽  
The Uk

ObjectiveTo report attitudes to retirement of late-career doctors.DesignQuestionnaires sent in 2014 to all UK medical graduates of 1974 and 1977.SettingUnited Kingdom.Participants3695 medical graduates.Main outcome measuresFactors which influenced doctors’ decisions to retire and factors which encouraged doctors to remain in work.ResultsThe response rate was 85% (3695/4369). 55% of respondents overall were still working in medicine (whether they had not retired or had retired and returned; 61% of men, 43% of women). Of the retirees, 67% retired when they had originally planned to, and 28% had changed their retirement plans. Fifty per cent of retired doctors cited ‘increased time for leisure/other interests’ as a reason; 43% cited ‘pressure of work’. Women (21%) were more likely than men (11%) to retire for family reasons. Women (27%) were more likely than men (9%) to retire because of the retirement of their spouse. General practitioners (GPs) were more likely than doctors in other specialties to cite ‘pressure of work’. Anaesthetists and GPs were more likely than doctors in other specialties to cite the ‘possibility of deteriorating skill/competence’. Radiologists, surgeons, obstetricians and gynaecologists, and anaesthetists were most likely to cite ‘not wanting to do out-of-hours work’.Doctors who were still working were asked what would encourage them to stay in medicine for longer. Factors cited most frequently were ‘reduced impact of work-related bureaucracy’ (cited by 45%) and ‘workload reduction/shorter hours’ (42%). Men (30%) were more motivated than women (20%) by ‘financial incentivisation’. Surgeons were most motivated by ‘reduction of on-call or emergency commitments’.ConclusionsRetention policy should address ways of optimising the clinical contribution of senior doctors while offering reduced workloads in the areas of bureaucracy and working hours, particularly in respect of emergency commitments.

A Court of Specialists

2020 ◽  
Author(s):  
Chris Hanretty
Keyword(s):  
Family Law ◽  
Public Law ◽  
Tax Law ◽  
Decision Making Process ◽  
Main Argument ◽  
Political Differences ◽  
Uk Supreme Court ◽  
The Uk ◽  
Initial Selection ◽  
Selection Of

This book explains how judges on the UK Supreme Court behave. It looks at different stages in the court's decision-making process—from the initial selection of cases, to the choice of judges to sit on panels, to the final outcome. The main argument of the book is that judges' behavior is strongly affected by their specialism in different areas of law. Cases in tax law (or family law, or public law) are more likely to be heard by specialists in that area, and those specialists are more likely to write the court's decision—or disagree with the decision when there is dissent. Legal factors like specialization in areas of law explains more of the court's work than do political differences between judges.

scholarly journals Hybridization of ring theory-based evolutionary algorithm and particle swarm optimization to solve class imbalance problem

2021 ◽  
Author(s):  
Sayan Surya Shaw ◽  
Shameem Ahmed ◽  
Samir Malakar ◽  
Laura Garcia-Hernandez ◽  
Ajith Abraham ◽  
...  
Keyword(s):  
Particle Swarm Optimization ◽  
Real Life ◽  
Class Imbalance ◽  
Ring Theory ◽  
Class Imbalance Problem ◽  
Minority Class ◽  
Swarm Optimization ◽  
Imbalance Problem ◽  
Representative Samples ◽  
Selection Of

AbstractMany real-life datasets are imbalanced in nature, which implies that the number of samples present in one class (minority class) is exceptionally less compared to the number of samples found in the other class (majority class). Hence, if we directly fit these datasets to a standard classifier for training, then it often overlooks the minority class samples while estimating class separating hyperplane(s) and as a result of that it missclassifies the minority class samples. To solve this problem, over the years, many researchers have followed different approaches. However the selection of the true representative samples from the majority class is still considered as an open research problem. A better solution for this problem would be helpful in many applications like fraud detection, disease prediction and text classification. Also, the recent studies show that it needs not only analyzing disproportion between classes, but also other difficulties rooted in the nature of different data and thereby it needs more flexible, self-adaptable, computationally efficient and real-time method for selection of majority class samples without loosing much of important data from it. Keeping this fact in mind, we have proposed a hybrid model constituting Particle Swarm Optimization (PSO), a popular swarm intelligence-based meta-heuristic algorithm, and Ring Theory (RT)-based Evolutionary Algorithm (RTEA), a recently proposed physics-based meta-heuristic algorithm. We have named the algorithm as RT-based PSO or in short RTPSO. RTPSO can select the most representative samples from the majority class as it takes advantage of the efficient exploration and the exploitation phases of its parent algorithms for strengthening the search process. We have used AdaBoost classifier to observe the final classification results of our model. The effectiveness of our proposed method has been evaluated on 15 standard real-life datasets having low to extreme imbalance ratio. The performance of the RTPSO has been compared with PSO, RTEA and other standard undersampling methods. The obtained results demonstrate the superiority of RTPSO over state-of-the-art class imbalance problem-solvers considered here for comparison. The source code of this work is available in https://github.com/Sayansurya/RTPSO_Class_imbalance.

scholarly journals NCOG-36. FIRST HEALTH UTILITIES OF GLIOBLASTOMA PATIENTS USING TTFIELDS TREATMENT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii137-ii137
Author(s):  
Gordon Chavez ◽  
Christina Proescholdt
Keyword(s):  
Population Sample ◽  
National Health System ◽  
Medical Decision ◽  
Economic Evaluations ◽  
Health State ◽  
High Quality ◽  
Health States ◽  
Tumor Treating Fields ◽  
Health State Utilities ◽  
The Uk

Abstract BACKGROUND Despite the importance of Health State Utilities for health policy and medical decision making, there are no publications that provide high quality utility values estimated from glioblastoma multiforme (GBM) patients. Published health economic evaluations for GBM treatments rely on utilities determined by Garside et al. (2007), which used the standard gamble method in healthy panel members of the UK National Health System. There are no published utilities for GBM estimated from a general population sample, and there are no utility estimates whatsoever for Tumor Treating Fields (TTFields) users. METHODS We designed a study to remedy this major deficit by eliciting utilities directly from GBM patients using the EuroQol 5-Dimension (EQ-5D) survey. The EQ-5D is a widely used and NICE-recommended tool for the estimation of health state utilities. The survey is composed of a questionnaire that asks patients to specify their health state along 5 dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Statistical models provided by EuroQol’s network of researchers convert this data into health state utility estimates. RESULTS The EQ-5D questionnaire is administered to active patients using TTFields treatment during the study duration, allowing the elicitation of health preference measures for different glioblastoma health states based on: progression status (progressed vs. non-progressed), current treatments (TTFields only vs. TTFields + others) and time-from-diagnosis (0-12 months vs. > 12 months) CONCLUSION These results are important for understanding the patient preferences using TTFields treatment and communicating these preferences to decision makers. This study is the first to provide direct, high quality utility measures in glioblastoma patients using TTFields treatment.

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