Post-operative CRP is an accurate negative predictive test for the development of AL following oesophago-gastric surgery. It may help to discriminate between patients with a high risk of leak and those in which AL is unlikely to occur.
In health care, record keeping of doctor-patient encounters is vital for quality patient care and medico-legal reasons. We audited the documentation of post-acute consultant ward round (PACWR) in our department before and six months after an introduction of a proforma (standard form).The clinical notes of all patients admitted acutely under General Surgery over a period of one week before and one week after the introduction of a proforma were reviewed to note whether time and date, signature, impression and dietary plan were documented after PACWR. The nurses were also surveyed on the day of the PACWR for their certainty regarding the dietary plan of their patients and whether they had to contact the surgical team for clarification.There were 108 and 103 patients eligible for the first and second study periods respectively. After the introduction of the proforma, there was a statistically significant improvement in the documentation of time and date (37% vs. 72%, p-value < 0.01) and impression (40% vs. 61%, p-value < 0.01). Improvement in the documentation of the dietary plan reached statistical significant only when the analysis was restricted to the cases where a proforma was filled out (78 out of 103 patients). Introduction of the proforma had no statistically significant impact on the nurses’ certainty regarding their patients’ dietary plan and the number of times they had to contact the surgical teams.In conclusion, PACWR proforma improves overall documentation. This will help in avoiding adverse effects on patient care and medico-legal ramifications.
The worrisome increase in invasive group A streptococcal disease means that presentations of primary group A streptococcal peritonitis are likely to become more common. The challenge for the treating surgeon is to consider the possibility of this diagnosis. In the current era of multi-detector CT technology, secondary peritonitis from an intra-abdominal source may be excluded reliably using abdominal CT. Exploratory laparotomy is not mandated, and paracentesis is sufficient to confirm the diagnosis and avoid operative morbidity in patients with localized intra-peritoneal fluid collections. Laparoscopic peritoneal lavage should be reserved for patients with widespread intra-peritoneal free fluid or whose condition deteriorates despite antibiotic therapy.
Background: Poor documentation of medical notes and plans not only adversely affects patient management but also has medico-legal implications. A standardized ward round checklist (adhesive proforma sticker, PFS) was introduced at our institu-
Gall bladder polyps, which are common and are usually benign in the general population, are often malignant in PSC. Regardless of size, any PLG in a patient with PSC should be considered for cholecystectomy.
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