Introduction: We implemented an acute care urology (ACU) model at a large Canadian community hospital to determine the impacts on safe and timely care of patients with renal colic. The model includes a dedicated ACU surgeon, a clinic for emergency department (ED) referrals, and additional daytime operating room blocks for urgent cases. Methods: We conducted a chart review of 579 patients presenting to the ED with renal colic. Data was collected before (pre-intervention, September to November 2015) and after (postintervention, September to November 2016) implementation of the ACU model. Secondary methods of evaluation included surveying patients and 20 ED physicians to capture subjective feedback. Results: Of the 579 patients presenting with renal colic,194 were diagnosed with an obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p<0.001). Furthermore, the ACU clinic resulted in significantly more patients being referred for outpatient care (p=0.0004). There was also higher likelihood that patients would successfully obtain an appointment post-referral (p=0.0242). The number of after-hours and weekend surgeries decreased significantly after dedicated ACU daytime operating room (OR) blocks were added in Sep 2015 (p<0.0001). All surveyed patients rated the care as either “excellent” or “very good,” and all physicians believed the ACU model has improved patient care. Conclusions: The ACU model has shown benefit in ensuring timely followup for ED patients, reducing use of after-hour OR time, and improving patient and physician satisfaction.
An 8-week study was conducted to evaluate the influence of molasses treated cassava peel meal (MTCPM) based diet as substitute for maize on haemato-biochemical parameters of broiler chickens. Five experimental diets were formulated to meet nutrient requirement standards of broilers. Diet 1 (0 % MTCPM) served as the control while diets 2, 3, 4 and 5 contained 25, 50, 75 and 100 % MTCPM respectively replacing maize in the diets of birds. A total of one hundred and fifty (150) day-old broiler chicks were randomly allotted into five treatment groups with three replicates of ten birds each. Each group was assigned to the five experimental diets in completely randomized design (CRD). Throughout the experimental period, feed and water were provided ad libitum for all treatment groups. There were no significant differences (P>0.05) in all the haematological parameters measured. The values obtained for packed cell volume (36.21- 38.19 %), white blood cell (4.18 - 4.20 x 103/ml), red blood cell (4.48 - 4.86 x 106/ml), haemoglobin (11.96-12.68 g/dl) were similar regardless of MTCPM level in the diet. The results of the serum biochemical indices of broiler chickens fed MTCPM based diet revealed that the serum protein (2.01 – 2.43 mg/dl) level increased (P<0.05) among birds fed 50 % MTCPM based diet compared to others. The dietary inclusion of MTCPM did not significantly (P>0.05) influence the cholesterol (0.92-1.19 mmol/l), glucose (6.40-6.91 mmol/l), and urea (0.69-0.80 mg/dl) compositions of the broilers fed the experimental diets. It was concluded that MTCPM has a high potential as feed ingredient in poultry diets and could be included in the diet of broiler birds without any deleterious effect on health status of the birds.
Introduction: Renal colic is one of the most common presentations to the emergency department (ED), and often requires complex interdisciplinary collaboration between emergency physicians and urology surgeons. Previous literature has shown that adoption of interdisciplinary rapid referral clinics can improve both timeliness of care and patient outcomes. However, these Acute Care Surgery models have not yet been commonly adopted for urology care in the ED. Methods: In July 2016, we adopted the intervention of an Acute Care Urology (ACU) model through the creation of a rapid referral clinic dedicated to ED patient referrals, the addition of an ACU surgeon, and enhanced use of daytime OR blocks. We conducted a manual chart review of 579 patients presenting to the ED with a complaint of renal colic. Patient data was collected in two separate time periods to analyze trends before implementation of the ACU model (pre-intervention, September - November 2015), to examine the model's impact (post-intervention, September - November 2016). Secondary methods of evaluation included a survey of 20 ED physicians to capture subjective feedback through Likert scale data. Results: Of the evaluated 579 patients with a complaint of renal colic,194 patients were discharged from ED with an diagnosis of obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p <0.001). The mean time to clinic was 15.76 days (SD = 15.47, range 1-93) pre-intervention versus 4.17 days (SD = 2.33, range = 1-12) post-intervention. Furthermore, the ACU clinic allowed significantly more patients to be referred for outpatient care (p = 0.0004). There was also higher likelihood that patients would successfully obtain an appointment following referral (p = 0.0055). Decreasing trends were shown in mean ED wait time, in addition to time from assessment to procedure. Results of the qualitative survey were overwhelmingly positive. All 20 surveyed ED physicians were more confident that outpatients would be seen in a timely manner (85% strongly agree, 15% agree). Qualitative feedback included the belief that follow-up is more accessible, that ED physicians are less likely to page the on-call urologist, and that they are able to discharge patients sooner. Conclusion: The ACU model for patients with renal colic may be beneficial in reducing ED-to-clinic time, ensuring proper follow-up after ED diagnosis, and improving patient care within the ED.
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