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Scott B.,Royal Surrey County Hospital NHS Foundation Trust
Journal of perioperative practice

Some patients recovered in the post anaesthetic care unit (PACU) will require airway management and close monitoring to prevent any post operative complications. Ineffective airway management will lead rapidly to hypoxaemia, and will ultimately compromise patient care. This article discusses physiological principles and monitoring of airway management in the PACU, an understanding of which is essential when providing appropriate care for patients emerging from anaesthesia. Source

Murphy J.A.,Nightingale | Milner T.D.,Royal Surrey County Hospital NHS Foundation Trust | O'Donoghue J.M.,Royal Infirmary
The Lancet Oncology

Recent studies have shown that the number of women undergoing risk-reducing mastectomy has increased rapidly in the USA in the past 15 years. Although a small rise in the number of bilateral risk-reducing procedures has been noted in high-risk gene mutation carriers who have never had breast cancer, this number does not account for the overall increase in procedures undertaken. In patients who have been treated for a primary cancer and are judged to be at high risk of a contralateral breast cancer, contralateral risk-reducing mastectomy is often, but not universally, indicated. However, many patients undergoing contralateral risk-reducing mastectomy might not be categorised as high risk and therefore any potential benefit from this procedure is unproven. At a time when breast-conserving surgery has become more widely used, this sharp increase in contralateral risk-reducing mastectomy is surprising. We have reviewed the literature in an attempt to establish what is driving the increase in this procedure in moderate-to-low-risk populations and to assess its justification in terms of risk-benefit analysis. © 2013 Elsevier Ltd. Source

Kelliher L.,Royal Surrey County Hospital NHS Foundation Trust
Journal of perioperative practice

The concept of 'enhanced recovery' following elective surgery is becoming increasingly prominent in the world of perioperative practice. Enhanced recovery pathways (ERP) are being implemented in more and more trusts throughout the UK, and in multiple different surgical specialties. But what does enhanced recovery actually mean and how does it impact upon both patients and healthcare professionals? Our unit has been using an ERP in colorectal surgery since 2007 and we are currently in the process of implementing a pathway for both our orthopaedic and gynaecological patients. This article comprises some background information on the evolution of enhanced recovery, a summary of its key elements and a review of the evidence, including a look at our unit's experience. Source

Stebbing J.F.,Royal Surrey County Hospital NHS Foundation Trust
Best Practice and Research: Clinical Gastroenterology

This chapter reflects on how England has led the world in service development and quality assurance of endoscopy. It draws out themes of leadership, strategic vision and organisational culture. It emphasises the pivotal importance of focussing service improvement on enhancing the quality of a patient's experience of endoscopy. It describes the processes used here for quality assurance of endoscopy units and how these have dovetailed with other strands of work in transforming the English endoscopy service. The chapter presents discussion of the responses to accreditation processes and how the design of the JAG Accreditation process maximises its effectiveness. © 2011 Elsevier Ltd. All rights reserved. Source

Davies A.,Royal Surrey County Hospital NHS Foundation Trust
European Oncology and Haematology

Cancer pain presents a significant clinical challenge. Even when background pain is effectively controlled, patients often experience episodes of breakthrough cancer pain (BTcP), which typically reach maximum intensity in 10 minutes and last for 60 minutes. Immediate-release opioids are often used to treat BTcP, but only produce analgesia after 20-30 minutes and their full analgesic effect after 60-90 minutes, so transmucosal formulations of fentanyl citrate have been developed that produce analgesia more rapidly. A new sublingual transmucosal formulation (the FE tablet) utilises a unique three-layer structure and is available in dosages from 67 μg to 800 μg. This review summarises available data on the new formulation. In phase I trials, it has demonstrated dose proportionality, absolute bioavailability of approximately 70 % and higher plasma fentanyl concentrations than an oral transmucosal fentanyl citrate lozenge. In a prospective, randomised, double-blind, crossover study to evaluate efficacy and safety, pain relief was recorded from 6 minutes after administration onwards and lasted for up to 60 minutes. © Touch medical media 2014. Source

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