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Barnstaple, United Kingdom

Walter R.,Torbay Hospital | Kosy J.D.,Torbay Hospital | Cove R.,North Devon District Hospital
Foot and Ankle Surgery

Background: Measurement of radiological angles can be useful in the planning of the management of patients with hallux valgus. A smartphone application offers an alternative way of measuring these angles in a clinic setting. We compared the reliability (inter- and intra-observer) of this method to the use of PACS. Methods: Radiographs of 30 feet from new patients referred with hallux valgus were examined and angles (HVA, IMA, and DMAA) recorded using the smartphone application and PACS. Results: The smartphone application provided good inter-observer reliability for HVA and IMA (r= 0.93 and r= 0.79 respectively). Intra-observer reliability for HVA and IMA was also found to be good (r= 0.93-0.97 r= 0.82-0.93 respectively). The inter- and intra-observer reliability for using this method to measure DMAA fell below useful levels (r< 0.60 in each case). Conclusions: This smartphone application provides a reliable method to measure HVA and IMA but we would not recommend it to measure DMAA. © 2012 European Foot and Ankle Society. Source

Bunting D.M.,North Devon District Hospital
Journal of the Society of Laparoendoscopic Surgeons

Background: Port-site hernia is a rare but potentially serious complication of laparoscopic cholecystectomy. This study aimed to review the current literature, assess the incidence and causes of port-site hernias, and identify methods to reduce the risk. Methods: A systematic search of the literature published in English from 1995 to 2010 was conducted using PubMed to identify all reports of port-site, trocar-site, or incisional hernia following laparoscopic cholecystectomy. Studies in over 100 patients were identified before the application of defined exclusion criteria. The incidence of port-site hernia was calculated and compared with historical data. Predisposing factors were reviewed. Results: Seven studies met the search criteria, with 99 port-site hernias in 5984 patients. The overall incidence of port-site hernia was 1.7% (range, 0.3% to 5.4). The most important factors were older age, higher body mass index, preexisting hernia, trocar design, trocar diameter, increased duration of surgery, and extension of the port site for gallbladder extraction. Conclusion: The incidence of port-site hernia is low but likely to be underestimated and has not declined over time. Awareness of the predisposing factors and modification of techniques may help to reduce the risk. © 2010 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Source

Dyar O.J.,North Devon District Hospital | Pagani L.,Infectious Diseases Unit | Pulcini C.,Nancy University Hospital Center | Pulcini C.,University of Paris Descartes
Clinical Microbiology and Infection

As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes. © 2014 European Society of Clinical Microbiology and Infectious Diseases. Source

Stephens-Borg K.,North Devon District Hospital
Journal of perioperative practice

We usually display a laid-back approach to medical jargon throughout our theatre work. The word 'perioperative' is built from the Greek word 'peri' (around) and the Latin 'operari' (to work). Latin and Greek became the prefixed language of choice for Leonardo da Vinci, and his research was pivotal in determining the way in which surgical procedures are documented. Ancient manuscripts aided the unfolding of the secrets of anatomy, and Leonardo revealed that art was the key in expressive detailed explanation. Source

Jones A.D.R.,North Devon District Hospital
British Journal of Health Care Management

To display the difficulties in introducing team briefing and debriefing (part of the World Health Organization's (WHO) 5 Steps to Safer Surgery) and to calculate the impact its use has on efficiency in theatre. Twenty-two surgeons, anaesthetists, managers, scrub nurses and operating department practitioners filled in questionnaires asking about attitudes to the pre-existing 'sign in, time out, sign out' surgical safety checklist, attitudes to the introduction of team briefing and debriefing and attitudes to how it was implemented. Orthopaedic theatre efficiency before and after the introduction of team briefing was calculated. There was resistance to the implementation of team briefing and debriefing among some professional groups. Surgeons and anaesthetists were more likely to resist change, citing lack of engagement from management, briefings delaying the start of theatre lists and lack of evidence base for change. The number of operations performed in the three month period after the introduction of briefing and debriefing increased from 4.47 per list to 5.19 per list (p = 0.012). Attitudes to culture change are mixed, with staff more likely to resist change when they have not been consulted beforehand. The use of briefing and debriefing correlates with an increase in efficiency in theatre. Source

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