SummaryThis study compares the speed of onset of effective analgesia in two randomly assigned groups of patients requesting analgesia in labour. Patients in the combined spinal-epidural group (n ¼ 69) were given a subarachnoid injection of 1.5 ml containing bupivacaine 2.5 mg and fentanyl 25 mg for initiation of analgesia. Patients in the epidural group (n ¼ 73) were given an epidural injection of 10 ml containing bupivacaine 12.5 mg and fentanyl 50 mg. Mean (SD) onset times to the first pain-free contraction were 10.0 (5.7) min in the combined spinal-epidural group and 12.1 (6.5) min in the epidural group (p ¼ 0.054). Patients in the combined spinal-epidural group suffered a higher incidence of motor weakness and proprioceptive deficit than those in the epidural group (p ¼ 0.01). The incidence of technique failure and side-effects was similar in the two groups. It is our contention that the statistically nonsignificant difference in onset times does not justify the additional potential for side-effects and the extra cost of the equipment involved in the combined spinal-epidural technique.
The aim of our study was to compare dilation forceps tracheostomy and sequential dilator tracheostomy in anaesthetized live adult sheep with respect to the characteristics of the stoma formed and the associated injury. We performed percutaneous tracheostomy on adult sheep randomly allocated to receive either dilation forceps or sequential dilators. Sheep were sacrificed immediately after insertion of the percutaneous tracheostomy and the tracheas dissected. Specimens were examined for site, shape and size of stoma, mucosal lacerations, and posterior wall trauma. Ten sheep had dilation forceps tracheostomy and ten had sequential dilator tracheostomy. All of the specimens were found to have cephalo-caudal mucosal tears, usually crossing tracheal rings. The dilation forceps technique was found to have a larger stoma (28.8 mm vs 24.0 mm, P=0.023). The incidence of posterior needle trauma and mucosal lacerations were common (35% and 50% respectively), but they were not statistically different between the two groups. The role of the mucosal tears in the development of tracheal stenosis is reviewed in the discussion.
Introduction
Symptomatic presentations account for the majority of invasive breast cancer diagnoses. While the National Health Service Breast Screening Programme is subjected to strict quality control, no such system for performance monitoring exists in the symptomatic clinic. We assess the sensitivity of cancer detection and missed cancer rate for symptomatic breast patients to benchmark future outcome measures.
Methods
A retrospective cohort study of patients attending the symptomatic breast clinic between October 2013 and October 2018 was performed. Patients with new cancer diagnoses were identified and screened for those who had presented to the department within the 3 years prior to their diagnosis. From this, the sensitivity and missed cancer rate were calculated.
Results
About 40 323 patients were seen over the 5‐year study period. About 2155 new cancers were diagnosed, with 2033 identified at their initial clinic attendance. A further 122 patients had cancer diagnosed on a subsequent appointment, of which 23 patients were considered to have had a delay in diagnosis. The sensitivity of the one‐stop symptomatic breast clinic was therefore 99.0%, and the missed cancer rate was 0.06% over 5 years.
Conclusion
The missed cancer rate reported in this study is favorable compared to the outcomes reported in the National Health Service Breast Screening Programme and superior to the only other study reporting outcomes on a much smaller cohort. The unit in question therefore is performing exceptionally against current standards and sets a benchmark against which future performance can be measured.
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