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Weston-super-Mare, United Kingdom

Kodumuri P.,University of Nottingham | Geutjens G.,Royal Derby Hospitals | Kerr H.-L.,Weston General Hospital
International Orthopaedics | Year: 2012

Purpose Septic arthritis is a life-threatening emergency with high mortality of up to 11 %. We investigated if delay of arthroscopic lavage of infected major joints would have a bearing on the mortality and morbidity such as admission to an intensive care unit (ICU). Methods We retrospectively reviewed patients presenting with septic arthritis to two regional hospitals over a period of seven years from 1 January 2005 to 31 December 2011. We divided our sample of 82 patients into four groups based on the time delay between clinical diagnosis and arthroscopic lavage ranging from less than six hours to more than 24 hours. Results We determined that 35.4 % of patients had prosthetic joints. Knee joints were predominantly involved (74.4 %). Staphylococcus aureus was the most commonly isolated pathogen (41.5 %). There were ten (12.2 %) deaths and the same number of admissions to an ICU. Our study revealed there was no statistical significance between the time delay and mortality (P=0.25) or ICU admission (P=0.74) or the number of washouts (P=0.08) in all four groups. Conclusions Up to 48 hours delayed arthroscopic lavage for septic arthritis does not increase the risk of mortality. Further prospective large sample studies are recommended to investigate this and the risk of long-term morbidity. © Springer-Verlag 2012. Source

Spencer R.F.,Weston General Hospital
Journal of Bone and Joint Surgery - Series A | Year: 2011

The concepts of surface replacement of the hip and metal-on-metal articulation date back to the 1930s, and recent hip resurfacing designs have been more successful than their predecessors. Experience with the Cormet device followed initial collaboration with Mr. Derek McMinn. Both hybrid implants (a cementless cup and a cemented head) and entirely cementless implants, inserted with use of a variety of surgical approaches, yielded good results, with the cementless option increasing in popularity. The indications for hip resurfacing have become better understood, with the procedure considered most suitable for young and middle-aged males with a high activity profile. In addition, revision surgery, if necessary, has been associated in most cases with bone and soft-tissue conservation. Caution should be exercised when treating small individuals (especially females) and individuals with accompanying diagnoses other than osteoarthritis (such as hip dysplasia), for whom other bone-conserving options may be more appropriate to avoid an adverse reaction to metal debris. Correct implant placement during hip resurfacing is of critical importance. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated. Source

Oglesby K.J.,Weston General Hospital | Durham L.,Care Network | Welch J.,University College London | Subbe C.P.,Wrexham Maelor Hospital
Critical Care | Year: 2011

Introduction: Rapid Response Systems were created to minimise delays in recognition and treatment of deteriorating patients on general wards. Physiological 'track and trigger' systems are used to alert a team with critical care skills to stabilise patients and expedite admission to intensive care units. No benchmarking tool exists to facilitate comparison for quality assurance. This study was designed to create and test a tool to analyse the efficiency of intensive care admission processes.Methods: We conducted a pilot multicentre service evaluation of patients admitted to 17 intensive care units from the United Kingdom, Ireland, Denmark, United States of America and Australia. Physiological abnormalities were recorded via a standardised track and trigger score (VitalPAC™ Early Warning Score). The period between the time of initial physiological abnormality (Score) and admission to intensive care (Door) was recorded as 'Score to Door Time'. Participants subsequently suggested causes for admission delays.Results: Score to Door Time for 177 admissions was a median of 4:10 hours (interquartile range (IQR) 1:49 to 9:10). Time from physiological trigger to activation of a Rapid Response System was a median 0:47 hours (IQR 0:00 to 2:15). Time from call-out to intensive care admission was a median of 2:45 hours (IQR 1:19 to 6:32). A total of 127 (71%) admissions were deemed to have been delayed. Stepwise linear regression analysis yielded three significant predictors of longer Score to Door Time: being treated in a British centre, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and increasing age. Binary regression analysis demonstrated a significant association (P < 0.045) of APACHE II scores >20 with Score to Door Times greater than the median 4:10 hours.Conclusions: Score to Door Time seemed to be largely independent of illness severity and, when combined with qualitative feedback from centres, suggests that admission delays could be due to organisational issues, rather than patient factors. Score to Door Time could act as a suitable benchmarking tool for Rapid Response Systems and helps to delineate avoidable organisational delays in the care of patients at risk of catastrophic deterioration. © 2011 Oglesby et al.; licensee BioMed Central Ltd. Source

Carlino W.,Weston General Hospital
European Journal of Orthopaedic Surgery and Traumatology | Year: 2014

Trauma is a global disease that affects patients across the socio-economic spectrum. Uncontrolled major haemorrhage occurs from both blunt and penetrating trauma which may lead to hypovolaemic shock and ultimately death. In polytrauma patients that require urgent resuscitation secondary to major haemorrhage, high volume fluid infusions followed by definitive surgical care have been superseded by damage control resuscitation. DCR is a systematic approach to major trauma that integrates the principles of haemostatic resuscitation, permissive hypotension and damage control surgery (DCS). The aim of DCR is to aggressively minimise hypovolaemic shock and limit the development of coagulopathy, hypothermia and acidosis known as the lethal triad. Besides increased volumes of scientific knowledge to underpin modern trauma resuscitation techniques upon, patient survival is also dependent upon effective teamwork and leadership. In conclusion, successful resuscitation from major haemorrhage depends upon a variety of factors distilled into a trauma team with effective leadership, excellent technical and non-technical team skills as well as the early initiation of DCR. © 2013 Springer-Verlag France. Source

Malhotra R.,Weston General Hospital | Kelly S.,Coventry University
Local and Regional Anesthesia | Year: 2010

Purpose: Infective complications of lumbar puncture are not common, but are a significant source of mortality. Causative pathogens have been traced to the oropharynx of the operator, and it is likely that wearing facemasks will minimize the risk of iatrogenic meningitis. The aim of this survey was to assess whether doctors currently wear facemasks when performing lumbar punctures. Methods: We constructed an anonymous survey asking about the use of a facemask when performing lumbar punctures. This was distributed to trainee doctors in medical specialties at the West Midlands and Severn Deaneries in the UK. Results: The response rate was 72% (72/100). Responders had performed, on average, a total of 15 (range 3-22) lumbar punctures. Only 27 of the doctors (37.5%) wore a facemask when performing lumbar punctures. CT 1-2 doctors were five times more likely than registrars to wear a facemask (53% versus 10%). Similarly, the likelihood of wearing a facemask decreased with the number of times the procedure had been performed. Discussion: There are varying practices regarding the use of facemasks for lumbar punctures amongst doctors, with significant differences according to grade and level of experience. Facemasks should be used as part of a "maximal sterile precautions" approach to reduce the risk of infective complications. © 2010 Malhotra and Kelly. Source

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