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Blandford C.M.,ST5 Registrar in Anaesthesia | Gupta B.C.,ST3 Registrar in Anaesthesia | Montgomery J.,Anaesthesia and Critical Care | Stocker M.E.,South Devon Healthcare NHS Foundation Trust
Anaesthesia | Year: 2011

Patients are frequently told new information in the early postoperative period and may retain little of it. Two hundred patients undergoing general anaesthesia for day surgery procedures were randomly allocated into two equal groups, 'Early' and 'Late'. Both groups were asked to undertake a simple memory test either in the early or late postoperative phase of their recovery. A list of five objects was verbally presented and recall of these five objects was tested after 30 min. A control group of 100 patients performed the same test. Patients in the control group received no sedative medications. Statistically significant differences (p < 0.001) in recall ability were demonstrable between each of the three groups. Twenty-three percent of patients in the 'Early' group had total amnesia of any test information given. Only 1% of the 'Late' group were unable to remember any information; a mean interval of 40 min separated the two groups. We recommend that verbal information given postoperatively be delayed until a recovery interval of at least 40 min, and should be supported with written material. You can respond to this article at © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland. Source

Bardhan K.D.,The Rotherham NHS Foundation Trust | Simmonds N.,Luton and Dunstable Hospital NHS Foundation Trust | Royston C.,The Rotherham NHS Foundation Trust | Dhar A.,County Durham and Darlington NHS Foundation Trust | Edwards C.M.,South Devon Healthcare NHS Foundation Trust
Journal of Crohn's and Colitis | Year: 2010

Background: Inflammatory bowel disease (IBD), a paradigm of chronic illness, requires for its safe clinical management ready access to complete information, not always possible using paper records. Aim: To develop an IBD database (DB) for both individual patient management and collating information across centres. Methods: Access® based, with a minimum dataset. Results: Prospectively collected data for 11,432 patients from 21 centres. Profile Diagnosis: Ulcerative colitis (UC) 56%, Crohn's disease (CD) 40%, indeterminate colitis 4%. M:F ratio: UC 1.08:1, CD 0.72:1. Median age at diagnosis: UC 39, CD 30. years. Operated: UC 16%, CD 47%. Thiopurine use: UC 16%, CD 29%. IBD related mortality: 0.74%. Discussion: A snapshot of this large IBD cohort shows the disease profile across the UK is similar to other large series. Unexpected gaps, sometimes large emerged (e.g. data on smoking and immunosuppression) highlighting the need for clear definition, consistency and completeness of data collection. Clinical management is made easier by the 'at a glance' summary, automated clinic letters, and facility for monitoring and audit, but the time required limited its 'real-time' use. Conclusion: Our experience shows it is possible to collect data from centres across the country which truly reflects clinical practice. We have learned as much from the process itself as from the data, principally, information needs to be well defined, validated at entry, and updated at every visit, a time consuming sequence which we had underestimated. Our lessons learned may help inform the development of a national database, and support national IBD standards and audit. © 2010 European Crohn's and Colitis Organisation. Source

Neale J.R.,South Devon Healthcare NHS Foundation Trust | Basford P.J.,Southampton General Hospital
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2015

Higher specialist training in general internal medicine (GIM) and the medical specialties has been subject to many changes and increasing subspecialisation in recent years. The 'Shape of Training' review proposes 'broad-based specialty training', shortening of training by one year, and subspecialisation to be undertaken after the certificate of specialty training is obtained. All higher level gastroenterology trainees based in the UK were invited to complete an online survey between July and September 2012 to assess their experience of gastroenterology and GIM training. Overall, 72.7% of trainees expressed satisfaction with their training in gastroenterology but significantly fewer (43.5%) expressed satisfaction with their training in GIM. Satisfaction with gastroenterology training thus is good, but satisfaction with GIM training is lower and levels of dissatisfaction have increased significantly since 2008. Up to 50% of trainees are not achieving the minimum recommended number of colonoscopy procedures for their stage of training. Experience in GIM is seen as service orientated, with a lack of training opportunities. There is a worrying difficulty in gaining the minimum required experience in endoscopy. If the length of specialist training is shortened and generalised, training in key core specialist skills such as endoscopy may be compromised further. © Royal College of Physicians 2015. All rights reserved. Source

Salmon H.A.,University of Exeter | Chalk D.,University of Exeter | Stein K.,University of Exeter | Frost N.A.,South Devon Healthcare NHS Foundation Trust
Eye (Basingstoke) | Year: 2015

BackgroundKeratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus.MethodsWe constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters.ResultsCollagen crosslinking is cost effective compared with standard management at an incremental cost of £3174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £33 263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness-to-pay threshold of £30 000 per QALY.ConclusionUVA collagen crosslinking is very likely to be cost effective, compared with standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond 5 years is desirable. © 2015 Macmillan Publishers Limited. Source

Reddy V.M.,South Devon Healthcare NHS Foundation Trust
Annals of the Royal College of Surgeons of England | Year: 2013

The gold standard for assessing neck lumps is a one-stop clinic with an on-site cytopathologist who can provide an immediate fine needle aspiration (FNA) report. However, this has considerable resource implications and is not available in all units. In our department, surgeons perform FNAs guided by palpation. The FNA is evaluated for specimen adequacy by an on-site cytotechnician. This study evaluated the impact of the cytotechnician on the adequacy of neck lump FNA. FNA performed between June 2010 and February 2012 was examined. The FNA performed at a neck lump clinic with an assessment of adequacy by an on-site cytotechnician were considered the test group. All other neck lump FNAs from other sources without an assessment of adequacy by an on-site cytotechnician were considered the control group. Of the FNAs, 134 met the inclusion criteria for this study. Of these, 87 FNAs (65%) were analysed for adequacy by the on-site cytotechnician and the remaining 47 (35%) were not. The results demonstrated an FNA inadequacy with and without on-site cytotechnician assessment of 29.9% and 40.4% respectively. This is equivalent to an absolute risk reduction of an inadequate FNA of 10.5%, which equates to a number needed to treat of 9.5, ie the cytotechnician needs to assess 9.5 (ie the cytotechnician [...] specimen). In neck lump clinics where on-site cytopathology is not available, an on-site cytotechnician is a compromise measure that does reduce the number of inadequate FNAs. Source

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