Search

Objectives:The National Confidential Enquiry into Patient Outcome and Death presents a detailed survey of practice, encompassing the care pathway for patients with a new tracheostomy formed in hospital, alongside a review of organisational aspects of care.Results:Tracheostomy formation has come to be regarded as a relatively low-risk procedure that can be carried out safely at the bedside, even in high-risk patients. Information on how many procedures are carried out percutaneously has been poor and not captured by existing UK data collection systems.Conclusion:The study reinforces recommendations made by other healthcare groups, and presents new information which can be used as a basis for discussion and future planning to improve patient outcomes. The importance of meticulous ongoing care of a tracheostomy is recognised as important to prevent patient complications. Bedside staff must have the knowledge, competencies and confidence to deal with common and potentially life-threatening emergencies when they occur. [ABSTRACT FROM PUBLISHER]

Background: The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken. Methods: Twenty-five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty-two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview. Results: Median operating time was 225 (range 170–340) min and median hospital stay was 15 (range 8–48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow-up was 22·5 (range 4–114) months. Median 24-h frequency before and after operation was 12 (range 4–20) and 6 (range 3–12) respectively, and median night-time frequency was 4 (range 0–8) and 0·5 (range 0–4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life. Conclusion: Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch–rectal anastomosis should be avoided. [ABSTRACT FROM AUTHOR]

The article focuses on the neoliberalism reform of the veterinary profession in Great Britain. It states that the British government proposed to extend the political ideology known as neoliberalism, wherein professions can engage in farming and in food sectors in terms of public goods and services. Furthermore, the separation on the implementation and creation of policy causes changes to the veterinary profession in terms of animal health.

Potatoes, which had been treated 'in th field' with a commercial formulation of maleic hy azide, were processed into potato crisps and jacket potato crisps on a factory production line using standard manufacturing conditions. Samples were take to strategic points throughout the process and analyzed to determine the degree of carry-through residues. Results demonstrated that ca 56% of the maleic hydrazide residue in a potato could be carried through into the potato crisps, irrespective of which type of crisp was being manufactured. Results from asimilarly constructed study investigating the fate of pesticides applied post-harvest showed that carry-through was less than 10%. This difference is explained in terms of the different modes of action of the two classes qf pesticides being investigated. It is known that, asmaleic hydrazide is a systemic pesticide, it will be located within the flesh of the potato tuber and is therefore likely to be protectedfrom the various stages of the crisping process. However, the post-harvest non-systemic pesticides are applied to the exterior surface ofthe tuber and are therefore not likely to be protected in the same way. The results also showed that due to the concentration effect caused by the loss of moisture during crisp manufacture, the levels of maleic hydrazide residues in crisps (on a mg/kg product basis) were approximately twice those measured in original potatoes. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to compare specific data from the 2020 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report "Balancing the Pressures" with two previous U.K. studies and to examine changes in the pediatric population requiring long-term ventilation (LTV) as well as the types delivered. We believe that the new data presented will facilitate future service planning., Design: A subset of confidential enquiry data derived from a study by a nationally funded quality improvement organization (NCEPOD: www.ncepod.org.uk ) was compared with two previous U.K. datasets., Setting: Healthcare providers across England, Wales, and Northern Ireland-inpatient and community settings., Patients: Children and young people (CAYP) 0-16 years old receiving LTV between April 1, 2016, and March 31, 2018., Interventions: None., Measurements and Main Results: When comparing the NCEPOD data with that last published in the United Kingdom, the number of CAYP requiring LTV more than doubled between 2008 and 2018 (933-2,093). There has also been a particular increase in the proportion of children that were under two when they were commenced on LTV (26-39.2%). Children are now more likely than previously to be receiving LTV to manage upper airway obstruction and CNS conditions. There has also been an approximate doubling of those receiving LTV over the whole 24-hour period (9.4-18.4%)., Conclusions: The increased numbers and changing characteristics of babies and children requiring LTV over the last 3 decades in the United Kingdom have implications for all healthcare sectors but particularly for providers of critical care services., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Assessing how prepared individuals are for a career pathway is essential if job satisfaction and retention are to be considered within an industry. Determining how training prepares registered veterinary nurses (RVNs) will therefore provide employers and educators with valuable information about how education is meeting expectations and demands. A positivist, quantitative approach led to a cross-sectional study via an online questionnaire reaching 141 RVNs. Participants were demographically profiled prior to differences being determined between data sets using the Kruskal-Wallis H and Mann-Whitney U tests. All educational routes and job roles generated different scores for preparedness for the duties carried out; however, the main differences were between degree and diploma routes, with diploma-route students suggesting that they were prepared in more subject areas. A variety of qualification routes are available to a veterinary nurse in the UK, which must be considered when reviewing preparedness and making suggestions for educational reform. Further research is needed to support these findings in relation to the roles of the educator, the employer, and the veterinary nurse to allow for an unbiased understanding of preparedness, which could have links to job satisfaction.

Objectives: The aim of this study was to develop prediction models for the individual-level impacts of cardiovascular events on UK healthcare costs., Methods: In the UK Biobank, people 40-70 years old, recruited in 2006-2010, were followed in linked primary (N = 192,983 individuals) and hospital care (N = 501,807 individuals) datasets. Regression models of annual primary and annual hospital care costs (2020 UK£) associated with individual characteristics and experiences of myocardial infarction (MI), stroke, coronary revascularization, incident diabetes mellitus and cancer, and vascular and nonvascular death are reported., Results: For both people without and with previous cardiovascular disease (CVD), primary care costs were modelled using one-part generalised linear models (GLMs) with identity link and Poisson distribution, and hospital costs with two-part models (part 1: logistic regression models the probability of incurring costs; part 2: GLM with identity link and Poisson distribution models the costs conditional on incurring any). In people without previous CVD, mean annual primary and hospital care costs were £360 and £514, respectively. The excess primary care costs were £190 and £360 following MI and stroke, respectively, whereas excess hospital costs decreased from £4340 and £5590, respectively, in the year of these events, to £190 and £410 two years later. People with previous CVD had more than twice higher annual costs, and incurred higher excess costs for cardiovascular events. Other characteristics associated with higher costs included older age, female sex, south Asian ethnicity, higher socioeconomic deprivation, smoking, lower level of physical activities, unhealthy body mass index, and comorbidities., Conclusions: These individual-level healthcare cost prediction models could inform assessments of the value of health technologies and policies to reduce cardiovascular and other disease risks and healthcare costs. An accompanying Excel calculator is available to facilitate the use of the models., (© 2023. The Author(s).)

An National Confidential Enquiry into Patient Outcome and Death (NCEPOD) study published in June 2014 reviewed the care of more than 2000 patients who had a new tracheostomy formed during an 11-week period in 2013 in the UK, two thirds of which were inserted at the bedside in a critical care unit. Many more patients in hospitals now have a tracheostomy, and this article summarizes the lessons from the report which are particularly important for secondary care clinicians.