BackgroundAcute gallstone disease is a high‐volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance.MethodsPatients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole‐QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods.ResultsOf 13 sites invited to join Chole‐QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole‐QuIC sites showed a significant improvement (P < 0·050), with four sites increasing their 8‐day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals.ConclusionA surgeon‐led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy.
Objective:To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy.Methods:This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A (Haemorrhoidectomy by Ligasure) and group B (Milligan Morgan Haemorrhoiectomy). Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day.Results:Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 – 60 years. Third degree Heamorrhoids were present in 37 (67.3%) of patients while remaining 18 (32.7%) had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6± 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34±25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method.Conclusion:The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups.
Background: Intracranial atherosclerosis is an important etiology of stroke in the USA, but its prevalence in the general population remains unknown. This study was performed to determine the feasibility of transcranial Doppler ultrasound (TCD) for general population screening and to estimate the prevalence of intracranial stenosis in the USA. Methods: We used a public database to randomly select 99 subjects aged 65–84 years residing in a well-defined geographic area. For all subjects clinical history was reviewed, blood pressure was recorded and TCD examination was performed to identify intracranial stenosis. Results: The mean age of subjects was 72 years, 42 were men, and 17 were African-Americans. All acoustic windows were present in 77 subjects. After multivariate adjustment, the odds of absence of a bone window were higher in African-Americans [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.8–2.0], nonsmokers (OR 3.1, 95% CI 1.0–9) and those with a high BMI (9% higher odds per index point). Among 77 subjects who had all acoustic windows present, intracranial stenosis of >50% was identified in 6.5%, and intracranial stenosis of any severity was identified in 16% of the persons. Intracranial stenosis was most prevalent in the middle cerebral artery (6%). Conclusion: Presence of acoustic windows is associated with vascular risk factors. Based on the high prevalence of significant intracranial stenosis in the US elderly population, it is feasible and important to perform a large-scale population-based study for this disease entity.
No clear difference was observed between compliant and noncompliant balloons for therapeutic angioplasty in preventing angiographic recurrence or the need for repeat angioplasty in patients with subarachnoid hemorrhage-related cerebral vasospasm. An immediate normal or supranormal vessel diameter after the first-time angioplasty resulted in a significant reduction in the need for repeat angioplasty.
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