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Guy H.,East and North Herts NHS Trust | Guy H.,University of Hertfordshire | Gilroy P.,West Hertfordshire Hospitals NHS Trust | Downie F.,Papworth Hospital NHS Foundation Trust | Downie F.,Anglia Ruskin University
Wounds UK | Year: 2013

The current attention on pressure ulcer (PU) prevention has been welcomed by tissue viability nurses in the UK. However, it has also created a need for clarity and a deeper understanding around what is, and what is not, a PU as well as a need to define when PU development may be unavoidable. Two areas in PU development that remain difficult to prevent and classify as avoidable or unavoidable are suspected deep tissue injuries (SDTIs), and device-related pressure ulcers (DRPUs). The aim of this article is to provoke debate around these two complex areas of skin damage. In terms of serious incident reporting, and associated financial penalties or reimbursements, it is important to distinguish correctly if SDTIs and DRPUs are PUs, or something quite different. Therefore, it is imperative to investigate, define, and classify these lesion types correctly, based on robust evidence.

Downie F.,Papworth Hospital NHS Foundation Trust | Downie F.,Anglia Ruskin University | Guy H.,East and North Herts NHS Trust | Guy H.,University of Hertfordshire | And 3 more authors.
Wounds UK | Year: 2013

In 1987, 1988, and 1998, Hibbs asserted her hypothesis that 95% of pressure ulcers (PUs) are preventable. But until recently, few UK healthcare organisations have collected data on PU incidence - or the avoidability or otherwise of the damage. In 2012, NHS Midlands and East launched a campaign to eliminate avoidable grade 2-4 PUs by year end. Five hospitals within NHS Midlands and East pooled data collected between April 2012 and March 2013 on hospital-acquired grade 3-4 PUs and found the percentage of avoidable PUs to be less than half Hibbs' figure of 95%.

Lamb B.W.,Imperial College London | Lamb B.W.,University of London | Taylor C.,Kings College London | Lamb J.N.,East and North Herts NHS Trust | And 4 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Multidisciplinary teams (MDTs) are the standard means of making clinical decisions in surgical oncology. The aim of this study was to explore the views of MDT members regarding contribution to the MDT, representation of patients' views, and dealing with disagreements in MDT meetings - issues that affect clinical decision making, but have not previously been addressed. Methods: Responses to open questions from a 2009 national survey of MDT members about effective MDT working in the United Kingdom were analyzed for content. Emergent themes were identified and tabulated, and verbatim quotes were extracted to validate and illustrate themes. Results: Free-text responses from 1,636 MDT members were analyzed. Key themes were: (1) the importance of nontechnical skills, organizational support, and good relationships between team members for effective teamworking; (2) recording of disagreements (potentially sharing them with patients) and the importance of patient-centered information in relation to team decision making; (3) the central role of clinical nurse specialists as the patient's advocates, complementing the role of physicians in relation to patient centeredness. Conclusions: Developing team members' nontechnical skills and providing organizational support are necessary to help ensure that MDTs are delivering high-quality, patient-centered care. Recording dissent in decision making within the MDT is an important element, which should be defined further. The question of how best to represent the patient in MDT meetings also requires further exploration. © 2012 Society of Surgical Oncology.

Sherman J.,A+ Network | Kouchard J.,East and North Herts NHS Trust
British Journal of Oral and Maxillofacial Surgery | Year: 2013

Over a three-year period we devised, developed, and implemented a simple proforma, validated by a previous audit, to improve the accuracy of data collected on maxillofacial trauma. It covers both sides of an A4 sheet and functions as an aide-memoire for junior staff and prompts the comprehensive recording of all necessary medicolegal details should further documentation be required by the police, judiciary, or compensatory body. © 2012 The British Association of Oral and MaxilloFacial Surgeons. All rights reserved.

Vijendren A.,East and North Herts NHS Trust
BMJ case reports | Year: 2013

A young girl presented to the ENT acute clinic with a persistent cough and a bulge in the left oropharynx. As there were no clinical signs suggestive of a quinsy, an MRI was performed that showed a large mass extending from the base of the skull to the epiglottis medialising the lateral and posterior pharyngeal walls. The patient subsequently underwent an excision biopsy which demonstrated a ganglioneuroma, however developed a left-sided Horner's syndrome and mild vocal cord palsy after.

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