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Thomas G.,Royal United Hospital Bath NHS Foundation Trust | Cook T.M.,Royal United Hospital Bath NHS Foundation Trust
Southern African Journal of Anaesthesia and Analgesia | Year: 2016

The Royal College of Anaesthetists’ National Audit Project (NAP) programme has been running in its current form since 2006. Since NAP3 was commissioned the NAPs have examined rare but important complications of anaesthesia and related subspecialties. The topics covered include major complications of central neuraxial block (NAP3), major complications of airway management in hospitals (NAP4) and accidental awareness during general anaesthesia (NAP5). NAP6 is currently studying severe perioperative anaphylaxis. The NAPs have shed new light on the major complications of anaesthesia, providing both quantitative (frequencies, prevalence, incidence, risk factors) and qualitative (themes, patient stories, human factors) knowledge that has led to new learning, recommendations and changes in practice. This article describes the background, nature and processes of the NAPs. © 2016 The Author(s).


Parsons S.R.,Royal United Hospital Bath NHS Foundation Trust | Cornish N.C.,Royal United Hospital Bath NHS Foundation Trust | Martin B.,Royal United Hospital Bath NHS Foundation Trust | Evans S.D.,Royal United Hospital Bath NHS Foundation Trust
Journal of Clinical Urology | Year: 2016

Background: Recurrent urinary tract infections (UTIs) in women are common despite anatomically normal urinary tracts and are frequently referred to secondary care for further assessment. Patients and methods: Clinic letters and pathology reports of 244 women referred to our centre over a 2-year period with uncomplicated recurrent UTIs were reviewed to determine the investigations they underwent in both primary and secondary care. Results: A significant proportion of women do not meet the criteria for recurrent UTIs as their infections are not proven on culture. The majority of women undergo both renal tract ultrasound scan (USS) and flexible cystoscopy. Though USS was found to demonstrate relevant pathology, flexible cystoscopy, however, did not reveal any relevant pathology. Conclusion: Investigation of women with recurrent uncomplicated UTIs should be done with adequate cultures and renal tract USS. © 2016, © British Association of Urological Surgeons 2016.


Pickering G.T.,Royal United Hospital Bath NHS Foundation Trust | Nagata H.,Royal United Hospital Bath NHS Foundation Trust | Giddins G.E.B.,Royal United Hospital Bath NHS Foundation Trust
Journal of Hand Surgery: European Volume | Year: 2014

Assessment of distal radioulnar joint instability is clinically difficult and subjective. The distal radioulnar joint is postulated to 'tighten' in ulnar/radial deviation and pronation/supination. Using a rig, we measured mean distal radioulnar joint translation in neutral forearm rotation and neutral wrist radial and ulnar deviation, as well as extremes of wrist radial and ulnar deviation and forearm rotation. We tested the rig on ten cadaver forearms to validate the measurements we made. We tested 50 normal adults and 50 patients with clinical distal radioulnar joint instability. Distal radioulnar joint stability in men and women and on contralateral sides were comparable. Distal radioulnar joint translation decreased significantly with wrist radial and ulnar deviation and forearm pronation and supination, matching clinical practice and further validating the rig. The data in normal patients is comparable with previous computed tomography-based studies. Translation in all positions was statistically increased within the clinical instability group and did not cross-over with the normal ranges. Distal radioulnar joint translation is a physically measurable phenomenon. Our device appears to be a valid test of distal radioulnar joint translation, establishing normal data in vivo. © The British Society for Surgery of the Hand.


PubMed | Royal United Hospital Bath NHS Foundation Trust
Type: Journal Article | Journal: Primary health care research & development | Year: 2016

Aim To assess and improve the quality of Secondary to Primary Care communication on discharge with a focus on post-surgical wound care.Hospital discharge summaries are the principle means of relaying accurate information back to primary care healthcare providers regarding a patients hospital attendance and any ongoing care that is required. The quality of these summaries can be quiet varied both nationally and local to our Trust. Subsequently the Surgical Directorate were seeing an increased level of additional emergency communication from Primary Care providers especially in relation to post-operative wound care.A survey was distributed to local Primary Care practitioners to assess satisfaction with the General Surgical Department wound care information located on the discharge summary. Using these results, a wound closure information document was developed and distributed to general practice surgeries, and a patient-held wound care card was piloted for two months. The survey was then repeated to determine the success of the intervention. Findings Post discharge communication was on the whole felt to be of poor quality and lacked a large amount of essential and desirable information. There was a particular absence of relevant information regarding surgical wound closure techniques utilised and their ongoing management. Many Primary Care practitioners acknowledge that their knowledge on this subject can be low. A Trust specific information leaflet combined with a dedicated patient held discharge information card can solve a number of these issues improving Primary and Secondary Care satisfaction and reducing the use of emergency resources and appointments.

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