Turner R.,Broomfield Hospital |
Nicholson S.,Academic Unit of Community based Medical Education
Medical Education | Year: 2011
Medical Education 2011: 45: 1041-1047 Context UK medical school traditional selection processes are faltering in their ability to distinguish among highly qualified candidates. New methods of selection, including the UK Clinical Aptitude Test (UKCAT), herald a new era in which candidates are selected on aptitude and also aim to widen participation. However, the predictive validity of UKCAT and its role in the selection process are yet to be defined. This paper examines current selection practices and questions the role that such an aptitude test may take. Objective This study is intended to determine whether UKCAT can select suitable candidates for interview. Methods The study was designed to determine whether selectors rejected fewer candidates with high rather than low UKCAT scores using routine selection techniques. Selector rejection rates for 812 candidates with high UKCAT scores and 200 candidates with low UKCAT scores were compared. Additionally, any relationships among UKCAT and subsequent interview performance scores were explored by examining the correlation coefficients between overall and component UKCAT and interview scores for 637 candidates with high UKCAT scores. Results The rejection rate before interview of candidates with low UKCAT scores was 2.7 times that of candidates with high UKCAT scores. However, no relationship between overall UKCAT score and overall interview score existed within a pre-selected cohort of applicants with high UKCAT scores (Kendall's correlation coefficient, tau b=-0.004; p=0.88). Conclusions UKCAT can facilitate the independent selection of appropriate candidates for interview when used as described. However, UKCAT is not predictive of success at interview. The long-term predictive validity of UKCAT is currently under investigation. Therefore, we conclude that UKCAT is best viewed as a useful adjunct to current selection processes. © Blackwell Publishing Ltd 2011.
Jackson J.D.,Manly Hospital |
Hammond T.,Broomfield Hospital
International Journal of Colorectal Disease | Year: 2014
Purpose of review: Acute uncomplicated diverticulitis is traditionally managed by inpatient admission for bowel rest, intravenous fluids and intravenous antibiotics. In recent years, an increasing number of publications have sought to determine whether care might instead be conducted in the community, with earlier enteral feeding and oral antibiotics. This systematic review evaluates the safety and efficacy of such an ambulatory approach. Methods: Medline, Embase and Cochrane Library databases were searched. All peer-reviewed studies that investigated the role of ambulatory treatment protocols for acute uncomplicated diverticulitis, either directly or indirectly, were eligible for inclusion. Results: Nine studies were identified as being suitable for inclusion, including one randomised controlled trial, seven prospective cohort studies and one retrospective cohort study. All, except one, employed imaging as part of their diagnostic criteria. There was inconsistency between studies with regards to whether patients with significant co-morbidities were eligible for ambulatory care and whether bowel rest therapy was employed. Neither of these variables influenced outcome. Across all studies, 403 out of a total of 415 (97 %) participants were successfully treated for an episode of acute uncomplicated diverticulitis using an outpatient-type approach. Cost savings ranged from 35.0 to 83.0 %. Conclusion: Current evidence suggests that a more progressive, ambulatory-based approach to the majority of cases of acute uncomplicated diverticulitis is justified. Based on this evidence, the authors present a possible outpatient-based treatment algorithm. An appropriately powered randomised controlled trial is now required to determine its safety and efficacy compared to traditional inpatient management. © 2014 Springer-Verlag.
Sveinbjornsdottir S.,Broomfield Hospital |
Sveinbjornsdottir S.,University of London
Journal of Neurochemistry | Year: 2016
In this review, the clinical features of Parkinson's disease, both motor and non-motor, are described in the context of the progression of the disease. Also briefly discussed are the major treatment strategies and their complications. (Figure presented.) Parkinson's disease is a slowly progressing neurodegenerative disorder, causing impaired motor function with slow movements, tremor and gait and balance disturbances. A variety of non-motor symptoms are common in Parkinson's disease. They include disturbed autonomic function with orthostatic hypotension, constipation and urinary disturbances, a variety of sleep disorders and a spectrum of neuropsychiatric symptoms. This article describes the different clinical symptoms that may occur and the clinical course of the disease. This article is part of a special issue on Parkinson disease. © 2016 International Society for Neurochemistry
Healy C.,Broomfield Hospital |
Allen R.J.,New York University |
Allen R.J.,Louisiana State University Health Sciences Center
Journal of Reconstructive Microsurgery | Year: 2014
It is over 20 years since the inaugural deep inferior epigastric perforator (DIEP) flap breast reconstruction. We review the type of flap utilized and indications in 2,850 microvascular breast reconstruction over the subsequent 20 years in the senior author's practice (Robert J. Allen). Data were extracted from a personal logbook of all microsurgical free flap breast reconstructions performed between August 1992 and August 2012. Indication for surgery; mastectomy pattern in primary reconstruction; flap type, whether unilateral or bilateral; recipient vessels; and adjunctive procedures were recorded. The DIEP was the most commonly performed flap (66%), followed by the superior gluteal artery perforator flap (12%), superficial inferior epigastric artery perforator flap (9%), inferior gluteal artery perforator flap (6%), profunda artery perforator flap (3%), and transverse upper gracilis flap (3%). Primary reconstruction accounted for 1,430 flaps (50%), secondary 992 (35%), and tertiary 425 (15%). As simultaneous bilateral reconstructions, 59% flaps were performed. With each flap, there typically ensues a period of enthusiasm which translated into surge in flap numbers. However, each flap has its own nuances and characteristics that influence patient and physician choice. Of note, each newly introduced flap, either buttock or thigh, results in a sharp decline in its predecessor. In this practice, the DIEP flap has remained the first choice in autologous breast reconstruction. Copyright © 2014 by Thieme Medical Publishers, Inc.
News Article | February 15, 2017
Best Doctors®, the global health company that solves the unsolvable in health care, today announced the launch of a partnership with UCHealth that will bring Stratus, a high-powered health care data intelligence application, to its care providers and patients. Stratus helps health systems pinpoint where limited resources can make the greatest impact, by focusing in from a population perspective down to a patient view in a matter of seconds. Beyond information, Stratus drives its users toward opportunity and action in support of value-based care, while improving clinical performance and patient satisfaction. “UCHealth’s utilization of Best Doctors’ innovative technology will contribute to better outcomes for patients and improved efficiency among our clinical operations,” said Jean Haynes, UCHealth chief population health officer. “Stratus gives UCHealth the ability to analyze all points of care for patients and share that information with their providers to ensure the highest quality across the continuum of care.” Stratus features a comprehensive integrated dashboard, robust data visualization, dynamic analysis and expansive reporting that produces deep insight in a highly usable format to drive adoption and impact. UCHealth plans to utilize Stratus to support Accountable Care Organizations (ACO), as well as their provider clinical integration strategy. The system is designed to maximize efficiency while containing costs. “UCHealth and Best Doctors are both driven to innovate for improved health outcomes,” said Peter McClennen, chief executive officer at Best Doctors. “Using the broad capabilities of Stratus, UCHealth will help to further ensure that resources are directed appropriately and that patients receive the best possible outcomes.” Based in Aurora, Colo., UCHealth’s network of seven hospitals, more than 100 clinics and over 17,000 employees in Colorado, southern Wyoming and western Nebraska cared for more than 1.2 million unique patients last year. By using high-impact data analytics, UCHealth places itself on the leading edge of population health management. In its highly anticipated study rating population health management providers, KLAS Research rated Best Doctors among the highest ranked for its data tools, service, and overall performance. In addition to its state-of-the-art analytics tools, Best Doctors is world-renowned for its ability to combat medical uncertainty and misdiagnosis. The company, which works with the top 5% of physicians in over 450 subspecialties of medicine, uses a unique process to bring together the brightest minds in medicine, cutting-edge technology and analytics to help members navigate increasingly complex health care systems around the world. With published studies indicating that 15-28% of patients are misdiagnosed – translating into needless suffering and billions of wasted health care dollars annually – Best Doctors innovates to maximize clinical efficiency while dramatically improving patient outcomes. Historically, these clinical-advocacy and second-opinion services have resulted in corrected or refined diagnoses in 37% of Best Doctors U.S.-based cases, while correcting or improving treatment in nearly 75% of cases. About Best Doctors, Inc.: Founded in 1989 by Harvard Medical School physicians, Best Doctors is a medical information services company that connects individuals facing difficult medical treatment decisions with the best doctors, ranked by impartial peer review in over 450 subspecialties of medicine, to review their diagnosis and treatment plans. Best Doctors has grown to over 40 million members worldwide utilizing access to the brightest minds in medicine, analytics and technology to deliver improved health outcomes while reducing costs. For further information, visit Best Doctors at http://www.bestdoctors.com. To schedule an interview with a member of the Best Doctors Executive Team, contact Justin Joseph at Ph: 617.359.5522 or jjoseph(at)bestdoctors(dot)com. About UCHealth UCHealth is an innovative, nonprofit health system that delivers the highest quality medical care with an excellent patient experience. UCHealth combines Memorial Hospital, Poudre Valley Hospital, Medical Center of the Rockies, UCHealth Medical Group, Broomfield Hospital, Grandview Hospital and University of Colorado Hospital into an organization dedicated to health and providing unmatched patient care in the Rocky Mountain West. With more than 100 clinic locations, UCHealth pushes the boundaries of medicine, providing advanced treatments and clinical trials and improving health through innovation. BEST DOCTORS, the STAR-IN-CROSS logo, THE REINVENTION OF RIGHT and CRITICAL CARE INTERCONSULTATION are marks or registered marks of Best Doctors, Inc. Used with permission. # # #
Houshian S.,BrainTree |
Jing S.S.,Broomfield Hospital
Journal of Hand Surgery: European Volume | Year: 2014
We present the outcomes of the delayed management of eight displaced intra-articular fractures of the metacarpal and phalangeal heads treated with capsuloligamentotaxis using the Penning mini-external fixator. Closed anatomical reduction with a 2 mm over-distraction was achieved at the time of operation at an average of 20 days after the initial injury. Excellent outcomes in terms of function and pain were obtained at 6 month's follow-up in all cases. This technique is simple, minimally invasive, and effective, with minimal complications. © 2013 The Author(s).
Touma O.,Broomfield Hospital |
Davies M.,Addenbrookes Hospital
Resuscitation | Year: 2013
Introduction: Cardiac arrest is a common presentation to the emergency care system. The decision to terminate CPR is often challenging to heath care providers. An accurate, early predictor of the outcome of resuscitation is needed. The purpose of this systematic review is to evaluate the prognostic value of ETCO2 during cardiac arrest and to explore whether ETCO2 values could be utilised as a tool to predict the outcome of resuscitation. Method: Literature search was performed using Medline and EMBASE databases to identify studies that evaluated the relationship between ETCO2 during cardiac arrest and outcome. Studies were thoroughly evaluated and appraised. Summary of evidence and conclusions were drawn from this systematic literature review. Results: 23 observational studies were included. The majority of studies showed that ETCO2 values during CPR were significantly higher in patients who later developed ROSC compared to patients who did not. Several studies suggested that initial ETCO2 value of more than 1.33kPa is 100% sensitive for predicting survival making ETCO2 value below 1.33kPa a strong predictor of mortality. These studies however had several limitations and the 100% sensitivity for predicting survival was not consistent among all studies. Conclusion: ETCO2 values during CPR do correlate with the likelihood of ROSC and survival and therefore have prognostic value. Although certain ETCO2 cut-off values appears to be a strong predictor of mortality, the utility of ETCO2 cut-off values during CPR to accurately predict the outcome of resuscitation is not fully established. Therefore, ETCO2 values cannot be used as a mortality predictor in isolation. © 2013 Elsevier Ireland Ltd.
Jayanthi N.V.G.,Broomfield Hospital
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2013
Increasing number of gastrointestinal emergencies are managed laparoscopically. Laparoscopic repair of a perforated peptic ulcer remains contentious. Fashioning an omental patch is a crucial and an essential part of this repair, whether it is performed open or laparoscopically. This article describes a technique to fashion an adequate omental patch over the perforated peptic ulcer. Copyright © 2013 by Lippincott Williams & Wilkins.
Elliot D.,Broomfield Hospital |
Giesen T.,Broomfield Hospital
Hand Clinics | Year: 2013
Repair of the divided flexor tendon to achieve normal, or near normal, function is an unsolved problem, with each result still uncertain. The authors believe the way forward in primary flexor tendon surgery clinically is by use of strengthened but simpler sutures, appropriate venting of the pulley system, and maintaining early rehabilitation. However, there needs also be consideration of patient factors and other aspects. Research needs to continue more widely, in both the laboratory and the clinical environment, to find ways of better modifying adhesions after surgical repair of the tendon. © 2013 Elsevier Inc.
Elliot D.,Broomfield Hospital
Clinics in Plastic Surgery | Year: 2014
This article deals with the classification, assessment, and management of painful nerves of the distal upper limb. The author's preferred surgical and rehabilitation techniques in managing these conditions are discussed in detail and include (1) relocation of end-neuromas to specific sites, (2) division and relocation of painful nerves in continuity (neuromas-in-continuity and scar-tethered nerves) involving small nerves to the same sites, and (3) fascial wrapping of painful nerves in continuity involving larger nerves such as the median and ulnar nerves. The results of these treatments are presented as justification for current use of these techniques. © 2014 Elsevier Inc.