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Ystrad Mynach, United Kingdom

Jones R.K.,University of Cardiff | Hampton D.,Deparmtent of Clinical Biochemistry | O'Sullivan D.J.,Aneurin Bevan Health Board | Phillips A.O.,University of Cardiff
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2013

Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Of those followed in nephrology, 70% showed no evidence of progressive renal dysfunction. The nephrology cohort were significantly younger that those seen by primary care physicians or diabetologists. Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD. © Royal College of Physicians, 2013. All rights reserved.

Mowbray N.,Aneurin Bevan Health Board | Ansell J.,Welsh Institute of Minimal Access Therapy WIMAT | Warren N.,Welsh Institute of Minimal Access Therapy WIMAT | Wall P.,Isca Healthcare Research | Torkington J.,University of Wales
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: Smoke is generated by energy-based surgical instruments. The airborne byproducts may have potential health implications. This study aimed to evaluate the properties of surgical smoke and the evidence for the harmful effects to the theater staff. Methods: Cochrane Database, MEDLINE, PubMed, Embase classic and Embase, and the metaRegister of Controlled Trials were searched for studies reporting the constituents found in the smoke plume created during surgical procedures, the methods used to analyze the smoke, the implications of exposure, and the type of surgical instrument that generated the smoke. Studies were excluded if they were animal based, preclinical experimental work, or opinion-based reports. The common end points were particle size and characteristics, infection risk, malignant spread, and mutagenesis. Results: The inclusion criteria were fulfilled by 20 studies. In terms of particle size, 5 (25 %) of the 20 studies showed that diathermy and laser can produce ultrafine particles (UFP) that are respirable in size. With regard to particle characterization, 7 (35 %) of the 20 studies demonstrated that a variety of volatile hydrocarbons are present in diathermy-, ultrasonic-, and laser-derived surgical smoke. These are potentially carcinogenic, but no evidence exists to support a cause-effect relationship for those exposed. In terms of infection risk, 6 (30 %) of the 20 studies assessed surgical smoke for the presence of viruses, with only 1 study (5 %) positively identifying viral DNA in laser-derived smoke. One study (5 %) demonstrated bacterial cell culture (Staphylococcus aureus) from a laser plume after surgery. Regarding mutagenesis and malignant spread, one study (5 %) reported the mutagenic effect of smoke, and one study (5 %) showed the presence of malignant cells in the smoke of a patient undergoing procedures for carcinomatosis. Conclusions: The potentially carcinogenic components of surgical smoke are sufficiently small to be respirable. Infective and malignant cells are found in the smoke plume, but the full risk of this to the theater staff is unproven. Future work could focus on the long-term consequences of smoke exposure. © 2013 Springer Science+Business Media New York.

Thomas S.,Aneurin Bevan Health Board
Nursing children and young people | Year: 2012

To evaluate the experience of nursing respite care in families caring for children with complex health needs. Seven mothers took part in semi-structured, in-depth interviews, which were taped, transcribed and coded. Results were categorised thematically. Families described a positive impact on all aspects of life, the high value of respite care and the preference for more information, flexibility, choice and co-ordination of the different services. Respite care is highly beneficial to family life, but there need to be clearer communication lines and a stable, flexible and adequately resourced workforce. Families value a single point of contact and would prefer more respite care to be available.

Rai P.R.,Aneurin Bevan Health Board | Kerr M.,Welsh Center for Learning Disability
Psychiatrist | Year: 2010

Aims and method: To study the use of antidepressants in adults with intellectual disability, focusing on medication type, indication, retention and clinical outcome. Case notes of all service users in a learning disability service were hand-searched to identify antidepressant usage, and those who had been treated with antidepressants and in whom at least 1 year of follow-up was possible were included in the study. Results: A total of 241 treatment episodes were identified. The rates of positive outcome in terms of clinical improvement at 6 weeks, 6 months and 12 months were 49.4%, 48.1% and 49% respectively, and only 29 (12%) episodes of side-effects had been noted. Clinical implications: Antidepressants are commonly prescribed in adults with intellectual disability. Approximately half did well in terms of clinical improvement.

Evans E.,Aneurin Bevan Health Board | Aiking H.,VU University Amsterdam | Edwards A.,University of Cardiff
Quality in Primary Care | Year: 2011

Background General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. Aim To use peer review with consultant engagement to influence GPs to improve the quality and effectiveness of their referrals. Design Service development project. Setting Ten out of 13 GP practices in Torfaen, Gwent; consultants from seven specialties in Gwent Healthcare NHS Trust; project designed and managed within Torfaen Local Health Board between 2008 and 2009. Methods GPs discussed the appropriateness of referrals in selected specialties, including referral information and compatibility with local guidelines, usually on a weekly basis and were provided with regular feedback of 'benchmarked' referral rates. Six-weekly 'cluster groups', involving GPs, hospital specialists and community health practitioners discussed referral pathways and appropriate management in community based services. Results Overall there was a reduction in variation in individual GP referral rates (from 2.6-7.7 to 3.0-6.5 per 1000 patients per quarter) and a related reduction in overall referral rate (from 5.5 to 4.3 per 1000 patients per quarter). Both reductions appeared sustainable whilst the intervention continued, and referral rates rose in keeping with local trends once the intervention finished. Conclusion This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies. © 2011 Radcliffe Publishing.

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