Objectives: The TWR system was introduced in July 2000. The purpose of this study was to investigate whether patients below the age of 50 years with colorectal cancer (CRC) are experiencing delays in ...treatment. Methods: The CRC database was searched for all newly diagnosed colorectal cancers between January 2001 and December 2005 in patients who were aged less than 50 years. Results: There were 911 patients with CRC during the study period. Of these, 41 patients (4.5%) were aged under 50. Thirty-eight case notes were retrieved and reviewed; the median age was 47 years. Fourteen (37%) presented as an emergency, 9 (24%) via the TWR, 8 (21%) were non-TWR referrals to outpatients and the remainder were referred via miscellaneous routes. The median time from referral to initial consultation was 11 days (range 8–14 days) in the TWR group, 24 days (range 14–135 days) in the surgical outpatients group and 44 days (range 11–93 days) in the miscellaneous (direct endoscopy, in-hospital physician's referral) group. The median time from referral to initiation of treatment was 51 days (range 15–116 days) in the TWR group, 103 days (range 43–174 days) in the outpatient group and 96 days (range 27–270 days) in the miscellaneous group. Excluding age as a factor, 73% of the non-TWR referrals met the TWR criteria. Conclusion: Patients with symptoms of CRC below the age of 50 years may face referral and diagnostic delay if not referred via the TWR system; many of these would be eligible if age was not a deciding factor.
Introduction Transitioning through levels of surgical training is highly stressful and these periods can be error prone. The Severn School of Surgery runs transitional training "bootcamps" for core ...and specialty level surgical trainees. There are no free training courses available nationally that provide human factors and non-technical skills training for surgeons making the transition between registrar and consultant. We present the structure, learning objectives and impact on trainee confidence levels of a course developed that aims to to aid this transition. Methods The course was split over two days and delivered by an expert multidisciplinary faculty: the first day focused on human factors training with seminars and immersive simulation scenarios, the second day introduced wider relevant topics such as medico-legal perspectives, NHS culture, how to deal with complaints, bullying and harassment as well as a workshop on leadership and management. Confidence questionnaires pre- and post- bootcamp were provided with a 1-10 likert scale. Feedback forms for each session were completed with agreement ratings 1(strongly disagree)-5 (strongly agree). Data were analysed using t-tests with level of significance set at p<0.05. Agreement data were reported as the weighted average score for each question. Results Twenty delegates attended the 'bootcamp' over two days. There were delegate representatives from the surgical specialities of colorectal, breast, upper gastro-intestinal, hepatobiliary, trauma and orthopaedics, ophthalmology, ENT and cardiothoracics. There were significant increases in candidate's confidence levels performing as a consultant with regard to: overall confidence (p=0.008), non-technical skills (p=0.042), leadership (p=0.045), conflict communication (p=0.012), NHS structure (p=0.01) and NHS management (p=0.002). Feedback was overwhelmingly positive: candidates agreed strongly with the relevance of the chosen curriculum (4.51), felt strongly that they had knowledge acquisition (4.52), felt more prepared to be a consultant (4.53) and enjoyed the course (4.56). Discussion This course, free for delegates and available to multiple surgical specialties within the South West, aims to aid the transition between registrar and consultant life. Positive feedback was achieved during this first year. Confidence levels amongst candidates significantly improved over the duration of the course especially in the domains of conflict resolution, NHS structure and NHS management.
IntroductionTransitioning through levels of surgical training is highly stressful and these periods can be error prone. The Severn School of Surgery runs transitional training ”bootcamps” for core ...and specialty level surgical trainees. There are no free training courses available nationally that provide human factors and non-technical skills training for surgeons making the transition between registrar and consultant. We present the structure, learning objectives and impact on trainee confidence levels of a course developed that aims to to aid this transition.MethodsThe course was split over two days and delivered by an expert multidisciplinary faculty: the first day focused on human factors training with seminars and immersive simulation scenarios, the second day introduced wider relevant topics such as medico-legal perspectives, NHS culture, how to deal with complaints, bullying and harassment as well as a workshop on leadership and management. Confidence questionnaires pre- and post- bootcamp were provided with a 1–10 likert scale. Feedback forms for each session were completed with agreement ratings 1(strongly disagree)−5 (strongly agree). Data were analysed using t-tests with level of significance set at p<0.05. Agreement data were reported as the weighted average score for each question.ResultsTwenty delegates attended the ‘bootcamp’ over two days. There were delegate representatives from the surgical specialities of colorectal, breast, upper gastro-intestinal, hepatobiliary, trauma and orthopaedics, ophthalmology, ENT and cardiothoracics. There were significant increases in candidate’s confidence levels performing as a consultant with regard to: overall confidence (p=0.008), non-technical skills (p=0.042), leadership (p=0.045), conflict communication (p=0.012), NHS structure (p=0.01) and NHS management (p=0.002). Feedback was overwhelmingly positive: candidates agreed strongly with the relevance of the chosen curriculum (4.51), felt strongly that they had knowledge acquisition (4.52), felt more prepared to be a consultant (4.53) and enjoyed the course (4.56).DiscussionThis course, free for delegates and available to multiple surgical specialties within the South West, aims to aid the transition between registrar and consultant life. Positive feedback was achieved during this first year. Confidence levels amongst candidates significantly improved over the duration of the course especially in the domains of conflict resolution, NHS structure and NHS management.
Surgery has been the gold standard in the treatment of adult pyloric stenosis (APS). The introduction of proton pump inhibitors (PPIs) in 1989 revolutionised the treatment of peptic ulcer disease and ...its complications.
We carried out a prospective study to evaluate the effectiveness of PPIs as an alternative to surgery for treatment of APS. Six consecutive patients admitted with a diagnosis of adult peptic pyloric stenosis between November 1999 and August 2002 were studied. The diagnosis was confirmed with endoscopy. All patients were commenced on a twice-daily dose of intravenous PPI. This was changed to oral treatment after 2 days. Main outcome measures evaluated were resolution of symptoms on PPIs and failure of medical therapy.
There were five females and one male. Median age at diagnosis was 72 years (range, 30-90 years). Median duration of symptoms was 2 weeks (range, 1-5 weeks). Of the patients, five had a history of peptic ulcer disease. Complete resolution was achieved in 5 patients (83%). Median duration for resolution of symptoms was 9 days (range, 5-14 days). All patients were changed to oral PPIs after 2 days. One patient did not respond to oral therapy and required surgical intervention (pyloroplasty). Median follow-up was 26 months (range, 6-48 months). There was no recurrence of symptoms. All patients were discharged on low-dose PPI.
This study supports the view that proton pump inhibitors are a safe and feasible alternative to surgery in adult pyloric stenosis secondary to peptic ulcer disease.
For estimating the finite population mean $ \bar Y $ of the study variable y, we propose a ratio‐type estimator which gives an improvement over estimators given by Upadhyaya and Singh (1999), Sisodia ...and Dwivedi (1981), and Singh and Kakran (1993). These estimators are compared by observing the bias and mean square error (MSE). In this empirical study, the suggested estimator under the optimal condition is found to be more efficient than the estimators mentioned above.
The role of Low molecular weight heparins (LMWH) in day case/short-stay surgery is unknown.
To characterise the current national use of LMWH prophylaxis in specific day and short stay surgeries.
A ...standardised anonymous postal questionnaire was sent to all consultant general surgeons in Ireland. The operations selected were herniorraphy, anorectal, varicose vein and laparoscopic cholecystectomy.
Questionnaires were sent to 82 surgeons in 2003. There was a response rate of 68.3% (56). Fifty-four per cent of respondents said there was a protocol in place for administration of LMWH in day case surgery. Of these 41% were not confident that their protocols were being adhered. Fifty-nine per cent of all respondents said they stratified patients according to individual risk. Thirteen per cent reported occurrence of VTE post day case surgery
This study demonstrates a heterogeneous pattern of administration of LMWH. In the absence of published validated protocols, the authors suggest a consensus day case protocol.
Sousa, Shabbir, Corte-Real, and Gupta (2010) and Gupta, Shabbir, Sousa, and Corte-Real (2012) have presented ratio and regression estimators for the finite population mean of a sensitive study ...variable utilizing nonsensitive auxiliary information. We improve the results further by using optional scrambling. In the process, we also estimate the sensitivity level of the underlying sensitive question. We compare the proposed method with Sousa et al. (2010) and Gupta et al. (2012) estimators.
In the Republic of Ireland there are no paediatric surgeons outside Dublin. Most paediatric trauma is managed in general hospitals by general or orthopaedic surgeons.
In this study we audited our ...experience with paediatric trauma in a regional setting.
We carried out a retrospective review of all non-orthopaedic paediatric trauma patients admitted to our institution over a two-year period.The method of injury, management and outcome were recorded and the TRISS (revised trauma injury severity score) method was used to calculate the probability of survival.
One hundred and fifty four paediatric patients were admitted following trauma. Falls, RTAs and burns were the commonest reasons for admission. Twenty nine of these patients (19%) required surgical procedures. There were no unexpected deaths.
The majority of paediatric trauma admissions were for minor injuries. A number of seriously injured children were successfully treated with no unexpected deaths.
Background and Aims: Hickman catheters have been shown to provide safe long-term venous access for patients with malignant diseases. In many centres, catheters are placed using fluoroscopic guidance. ...We hypothesised that ultrasound-assisted catheter placement by surgeons in the operating theatre would be a simple, safe and effective alternative technique with reduced infective complication rates. Methods: Hickman catheter insertions between May 1998 and March 2002 were studied. The data were collected from the Hospital Inpatient Enquiry database and the case notes of all patients were reviewed. Percutaneous catheter placement with tunnelling was performed in the operating theatre after scanning the internal jugular vein (IJV) for position, size and patency, using a Pie 100LC Scanner (Pie Medical, Maastricht). A standard chest radiograph confirmed catheter position at the end of the procedure. Results: Fifty-eight patients (30males and 28 females) had 65 Hickman catheters inserted. The median age was 60 years (range 32–82 years). Catheter placement was achieved in all patients, 59 in the right IJV and six in the left. Ultrasound scanning demonstrated that the right IJV was thrombosed in six patients (10%), thus avoiding unnecessary attempts at cannulation. The Hickman catheters remained in situ for a combined total of 5857 days (median, 89 days, range 4–485 days). Immediate complications occurred in two patients (pneumothorax in both). One patient required a chest drain. The overall sepsis rate was 3.92 per 1000 catheter days. Systemic sepsis was slightly higher (2.21per 1000 catheter days) than superficial sepsis (1.71 per 1000 catheter days). In all the patients who developed systemic sepsis the catheter had to be removed (n=13). All the superficial infections were treated successfully with antibiotics (n= 10 patients). Two catheters developed thrombosis. Conclusion: We conclude that ultrasound-assisted percutaneous placement of Hickman catheters in the operating suite is a simple, safe and effective technique and may help to reduce infective complications
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