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ObjectivesThe National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses.MethodsThe risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer.ResultsOnly 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent.ConclusionThe findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10–15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.
This survey describes current practice in prehospital hypothermia management, comparing the various methods used by different teams, and provides a basis to direct further education and research.
Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.
Objective: To compare early pain relief treatments for trauma patients between a UK and a Chinese hospital and to improve the patient experience of trauma care in Dongguan People's Hospital. Methods:Review and comparison of data of trauma patients from the Emergency Departments of the Royal Sussex County Hospital and Dongguan People's Hospital from April 2016 to June 2016. We compared injury severity, mortality, use of pain medication type and proportion of use, the success of analgesic intervention as measured by the pain score. Data entry and collation used Microsoft Excel 2007, data analysis using IBM SPSS19.0, according to the data types and research purposes using t test, x 2 test or non -parametric test analysis, with p =0.05 as the test level.Results: Analgesia in the UK was given to patients by pre-hospital staff in the UK but not in China. There was no significant difference in ISS score between the two groups. In the UK cohort, patients were older, male and female were equal and more injuries were sustained in body and limbs, while the Chinese Dongguan patients tended to be younger, male and have relatively more head and neck injuries. Brighton and Sussex University Hospital emergency trauma patients were given prehospital analgesia by ambulance staff or pre-hospital doctors. In the UK, commonly used medications were intravenous paracetamol, morphine, ketamine and fentanyl, while Dongguan People's Hospital Emergency Department trauma patients received only in-hospital analgesia, using dezocine, tramadol, Rotundine, celecoxib and Lo Finn Den. After analgesia, pain -scores decreased more significantly in UK patients (5.37 to 2.68) against the decrease in Dongguan Hospital (4.66 to 3.72). We ascertained that Dongguan People's Hospital emergency trauma patients pain did improve but to a lesser degree than for patients in the UK. Conclusion:For patients with trauma, giving analgesia promptly can significantly reduce the pain score of patients, improve the patient's medical experience and lead to more humane patient care.
It has been suggested that a deficit in junior clinicians anatomical knowledge is causing harm to patients, evidenced by a rise in surgical negligence legal claims resulting from a lack of knowledge of underlying anatomy. This study set out to examine the state of anatomy in the UK and Ireland in 2019 and how it has changed over the past two decades. The study used questions previously published by Heylings (2002), with some additions to reflect recent innovations in anatomy teaching. The project was awarded ethical approval (ER/BSMS3867/8) and a survey comprising 53 questions was hosted on the University of Sussex Qualtrics platform. Heads of Anatomy in the UK and Ireland (n=40) were asked to complete the survey and a 100% response rate was obtained. The results showed that anatomy is a defined ‘group’ or department in 62% of institutions. For medical teaching, 38% of institutions follow a systems‐based curriculum and 35% a hybrid curriculum. The number of medical student being taught in a cohort ranged from 71–450. The time dedicated to gross anatomy teaching ranged from 34–145h. Only one institution teaches anatomy by dissection only, 12 using prosection only, and 17 use a combination of the two. Five institutions do not use human cadaveric material. In 2018, five new medical schools were created in the UK, each following an existing institution’s curriculum. At the time of the survey, were yet to enroll students and therefore, were not included in the study. In comparison to data gathered therein 1999 (Heylings, 2002) when 160h was the mean teaching time for traditional regional anatomy courses and 116h for system based courses, the results of the current study reveal a considerable reduction in anatomy teaching hours. Is this reduction responsible for the increase in surgical negligence claims?
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