Role of the accident and emergency review clinic in UK service provision.
Ontology highlight
ABSTRACT:
SUBMITTER: Dasan S
PROVIDER: S-EPMC1725995 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Endoscopic ultrasound (EUS) is a standard procedure that plays an important role in the management of both malignant and benign disease. The development of EUS services in the UK has been haphazard and training inconsistent. The British Society of Gastroenterology has charged a working group with the task of laying down a national framework for how such services might be commissioned, structured and regulated; with particular attention to defining how endoscopist skills might be acquired, assessed and maintained. This report lays out a map for this process and its future revision.
| S-EPMC5517224 | biostudies-other
Project description:To determine the location and use of small bowel endoscopy services in the UK and to analyse training uptake to assess future demand and shape discussions about training and service delivery.Surveys of British Society of Gastroenterology (BSG) members by web-based and personal contact were conducted to ascertain capsule endoscopy practice and numbers of procedures performed. This was compared with expected numbers of procedures calculated using BSG guidelines, hospital episode statistics and published data of capsule endoscopy in routine practice. Analysis of data from two national training courses provided information about training.45% of UK gastroenterology services offered in-house capsule endoscopy. 91.3% of survey responders referred patients for capsule endoscopy; 67.7% felt that local availability would increase referrals. Suspected small bowel bleeding and Crohn's disease were considered appropriate indications by the majority. Demand is increasing in spite of restricted use in 21.6% of centres. Only two regions performed more than the minimum estimate of need of 45 procedures per 250 000 population. Eight centres perform regular device-assisted enteroscopy; 14 services are in development. 74% of trainees were interested in training and of those training in image interpretation, 67% are doctors and 28% are nurses.Capsule endoscopy is used by the majority of UK gastroenterologists but appears to be underused. Current demand for device-assisted enteroscopy seems likely to be matched if new services become established. Future demand is likely to increase, however, suggesting the need to formalise training and accreditation for both doctors and nurses.
| S-EPMC5517256 | biostudies-other
Project description:Endoscopic retrograde cholangiopancreatography (ERCP) in the UK has been historically performed under conscious sedation. However, given the increasing complexity of cases, the role of propofol-assisted ERCP (propERCP) is increasing. We describe our experience of propERCP and highlight the importance of this service.Our prospective ERCP database was interrogated between January 2013 and January 2014. Data collection included procedural information, patient demographics, American Association of Anaesthesiologists (ASA) status, Cotton grade of endoscopic difficulty and endoscopic and anaesthetic complications. Comparison was made with patients undergoing conscious sedation ERCP (sedERCP).744 ERCPs were performed in 629 patients (53% male). 161 ERCPs were performed under propofol. PropERCP patients were younger compared with the sedERCP group (54 vs 66 years, p<0.0001) but ASA grade 1-2 status was similar (84% vs 78%, p=0.6). An increased number of Cotton grade 3-4 ERCPs were performed in the propERCP group (64% vs 34%, p<0.0001). Indications for propERCP included sphincter of Oddi manometry (27%), previously poorly tolerated sedERCP (26%), cholangioscopy (21%) and patient request (8%). 77% of cases were elective, 12% were urgent day-case transfers and 11% were urgent inpatients. 59% of cases were tertiary referrals. ERCP was completed successfully in 95% of cases. Anaesthetic and endoscopic complications were comparable between the two groups (5% and 7% vs 3% and 5%). Where sedERCP had been unsuccessful due to patient intolerance, the procedure was completed successfully using propofol.PropERCP is safe and is associated with high endoscopic success. The need for propERCP is likely to increase given patient preference and the high proportion of complex procedures being undertaken. All endoscopy units should look to incorporate propofol-assisted endoscopy into aspects of their services.
| S-EPMC5369549 | biostudies-other
Project description:BackgroundAcute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay.ObjectiveThe aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions.MethodsProspective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed.ResultsIn 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40-60).ConclusionThis first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.
| S-EPMC7592923 | biostudies-literature
Project description:OBJECTIVE:To investigate the quantity and quality of orthotic service provision within the UK. DESIGN:Cross-sectional survey obtained through freedom of information request in 2017. SETTING:National Health Service (NHS) Trusts/Health Boards (HBs) across the UK. MAIN OUTCOME MEASURES:Descriptive statistics of survey results, including information related to finance, volume of appointments, patients and orthotic products, waiting times, staffing, complaints, outcome measures and key performance indicators. RESULTS:Responses were received from 61% (119/196) of contacted Trusts/HBs; 86% response rate from Scotland (12/14) and Wales (6/7), 60% (3/5) from Northern Ireland and 58% (98/170) from England. An inhouse service was provided by 32% (35/110) of responses and 68% (74/110) were funded by a block contract. Long waiting times for appointments and lead times for footwear/orthoses, and large variations in patient entitlements for orthotic products across Trusts/HBs were evident. Variations in the length of appointment times were also evident between regions of the UK and between contracted and inhouse services, with all appointment times relatively short. There was evidence of improvements in service provision; ability for direct general practitioner referral and orthotic services included within multidisciplinary clinics. However, this was not found in all Trusts/HBs. CONCLUSIONS:The aim to provide a complete UK picture of orthotic service provision was hindered by the low response rate and limited information provided in some responses, with greater ability of Trusts/HBs to answer questions related to quantity of service than those that reflect quality. However, results highlight the large discrepancies in service provision between Trusts/HBs, the gaps in data capture and the need for the UK NHS to establish appropriate processes to record the quantity and quality of orthotic service provision. In addition to standardising appointment times across the NHS, guidelines on product entitlements for patients and their lead times should be prescribed to promote equity.
| S-EPMC6830620 | biostudies-literature
Project description:BackgroundAchieving global targets of adherence to treatment, retention in care, and treatment success remains a challenge. Health system investment to make antiretroviral therapy services more responsive to patients' needs and values could address these impediments. Appropriate resource allocation to implement differentiated HIV treatment services demands research evidence. This study aimed to provide an overview of the patients' preferences for antiretroviral therapy service delivery features.MethodsElectronic databases (PubMed, Web of Science, Embase, and CINAHL) and search engines (Google and Google Scholar) were searched. This review has followed a convergent segregated approach to synthesis and integration. Data from the included studies were systematically extracted, tabulated, and summarised in a narrative review. Studies that analysed preferences for antiretroviral therapy regardless of the method used and published in the English language in any year across the world and HIV positive clients who were 15 years and above on 4th February 2021 were included for this review. The quality of the included studies was assessed using the mixed methods appraisal tool. A thematic synthesis of the data from the findings section of the main body of the qualitative study was undertaken. ATLAS.ti software version 7 was used for qualitative synthesis.ResultsFrom the 1054 retrieved studies, only 23 studies (16 quantitative, three qualitative, and four mixed-methods) fulfilled the inclusion criteria. The median number of attributes used in all included quantitative studies was 6 (Inter Quartile Range 3). In this review, no study has fulfilled the respective criteria in the methodological quality assessment. In the quantitative synthesis, the majority of participants more valued the outcome, whereas, in the qualitative synthesis, participants preferred more the structure aspect of antiretroviral therapy service. The thematic analysis produced 17 themes, of which ten themes were related to structure, three to process, and four to outcome dimension of Donabedian's quality of care model. The findings from individual quantitative and qualitative syntheses complement each other.ConclusionsIn this review, participants' value for antiretroviral therapy service characteristics varied across included studies. Priorities and values of people living with HIV should be incorporated in the policy, practice, research, and development efforts to improve the quality of antiretroviral therapy service hence avoid poor patient outcomes.
| S-EPMC8404280 | biostudies-literature
Project description:Emergency dental care is a vital service that new graduates should be prepared to offer. There are few published data relating to emergency dental care education. To assess this, and to gain a profile of accident and emergency departments (A&E) in dental schools, an online survey was sent to all of the dental schools in the Republic of Ireland and the UK.The survey addressed the school's A&E curriculum, teaching methods, undergraduate exposure and departmental details.The majority of A&E departments operated during normal working hours with a minority offering an out-of-hours service. Teaching of A&E topics, and undergraduate experience, vary significantly between schools. A&E departments were diversely named and exhibited significant regional variation. Approximately half employed a triage system. It is unclear what represents an adequate level of undergraduate exposure, and more research is required in this area.Assessment of undergraduates following time in clinic is an important component of any A&E module. We consider a reflective portfolio to represent a suitable form of assessment, and would recommend their introduction. In addition, we recommend that dental hospitals consider a nurse-led triage system.
| S-EPMC4496797 | biostudies-other
Project description:ObjectiveTo synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions.DesignSystematic review (PROSPERO# CRD42021231625).Eligibility criteriaWe included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs.Data sourcesWe searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020.Risk of biasFor trials, we used Cochrane Collaboration's tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool.Data extraction and synthesisWe summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data.ResultsWe included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs.ConclusionOTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP's impacts on user costs, among key subgroups and in low-resource settings.
| S-EPMC8921871 | biostudies-literature
Project description:ObjectiveTo determine the perspectives of Scottish accident and emergency (A&E) trainees and trainers on current training in the speciality, in order to help develop a simulator based training programme to complement existing training.MethodsQuestionnaires were sent to all Scottish A&E trainees and consultants responsible for training. They were presented with various clinical challenges. Trainees were asked to rate their confidence, experience, knowledge, and training on a Likert scale of 1 to 5. Trainers were asked to identify those areas where they felt trainees' performance consistently failed to meet a desired standard, and whether this was the result of lack of training, lack of exposure, or both.ResultsTrainees' response rate was 75%; consultants' was 59.4%. Overall trainees gave scores of 4/5 for confidence and knowledge, 3/5 for experience, and 2/5 for training. The highest scores were for medical, anaesthetics, and interpersonal skills. Consultants attributed lack of exposure to underperformance more frequently than lack of training.ConclusionsTrainees and trainers agree on the level of exposure to various clinical challenges, but disagree on training. Trainees' levels of confidence and knowledge outweigh their experience and training, suggesting that trainees associate knowledge with clinical competence.
| S-EPMC2579540 | biostudies-literature
Project description: Not available
| S-EPMC1120668 | biostudies-literature