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Surgical Services (surgical + services)
Selected AbstractsThe emergence of mucormycosis as an important opportunistic fungal infection: five cases presenting to a tertiary referral center for mycologyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2007Mahreen Ameen MRCP Background, Mucormycosis, a rare opportunistic fungal infection, is re-emerging in importance with the increase in prevalence of immunosuppressive states, both as a result of therapy and disease. Methods, We report five cases of mucormycosis diagnosed by the Dermatology Department and managed jointly with the Medical and Surgical Services of "Dr Manuel Gea Gonzalez" General Hospital in Mexico City, a tertiary referral center for mycology. We also review the current literature including recent advances in medical therapy. Results, Four of the five cases were of the rhino-orbital-cerebral variant, commonly associated with significant mortality, and one of these patients died despite early diagnosis and aggressive management. The fifth case was primary cutaneous mucormycosis and this patient survived infection without relapse. Diabetic ketoacidosis predisposed to infection in four cases and the other was associated with advanced human immunodeficiency virus infection. Radiologic imaging was important in cases of facial involvement in order to evaluate the extent of disease and possible intracranial involvement. All cases were managed with systemic antifungals and surgical debridement, together with the treatment of predisposing factors. Conclusions, These cases illustrate the need for early clinical recognition and prompt therapy, as well as the requirement for tissue biopsy in order to demonstrate the characteristic morphologic features of this fungal agent in the absence of positive mycology culture results. This report also highlights that, although rhino-orbital-cerebral mucormycosis requires effective multidisciplinary management, the disease not uncommonly presents to dermatologists for diagnosis. [source] Surgical workforce in New Zealand: characteristics, activities and limitationsANZ JOURNAL OF SURGERY, Issue 4 2009Antony Raymont Planning the future surgical workforce is a vitally important activity in which the Royal Australasian College of Surgeons is actively engaged. This paper reports on a survey, undertaken in late 2005, of all vocationally registered New Zealand surgeons. It describes their age and gender distribution, their workload, the distribution of their work hours and limitations on their activities. It is hoped that this will contribute to planning of surgical services for the future. Of surgeons surveyed, 452 (73%) responded. Their mean age was 51 years and 7% were female. Recruitment has been stable at approximately 20 per year since 1990. New Zealand surgeons worked, on average, 48 h per week and could accommodate additional work. Seventy-seven per cent of surgeons took after-hours calls and reported a 55% chance of returning to the hospital each week (30% in the main population centres and 70% in other districts). Overall, surgeons spent 50% of their clinical time in private practice. Most surgeons experienced significant resource constraints in providing surgical care. The current workload of surgeons in New Zealand is acceptable but after-hours duties, especially in secondary hospitals, may be unattractive. Surgical services are currently limited by institutional resources. If there is a substantial increase in the need for surgery in the future, surgical recruitment, which has been stable, should be increased. [source] The History of Dermatologic Surgical ReconstructionDERMATOLOGIC SURGERY, Issue 11 2000Daniel E. Zelac MD Over the last 40,50 years, reconstructive surgery in dermatology has undergone expansive growth and development. As dermatologists began to provide a greater array of surgical services during this period, it became apparent that new skills and techniques in the area of reconstruction would be required. Initially many of the procedures and concepts were adopted from other specialties, however, in the years since, significant contributions have been made by dermatologists which in turn have benefited other specialties as well. This review attempts to summarize some of the significant historical events and innovations that have established and supported dermatologic surgical reconstruction. [source] Striving for a better operative outcome: 101 PancreaticoduodenectomiesHPB, Issue 6 2008A.W.C. Kow Abstract Pancreaticoduodenectomy (PD), once carried high morbidity and mortality, is now a routine operation performed for lesions arising from the pancreatico-duodenal complex. This study reviews the outcome of 101 pancreaticoduodenectomies performed after formalization of HepatoPancreatoBiliary (HPB) unit in the Department of Surgery. A prospective database comprising of patients who underwent PD was set up in 1999. Retrospective data for patients operated between 1996 and 1999 was included. One hundred and one cases accrued over 10 years from 1996 to 2006 were analysed using SPSS (Version 12.0). The mean age of our cohort of patients was 61±12 years with male to female ratio of 2:1. The commonest clinical presentations were obstructive jaundice (64%) and abdominal pain (47%). Majority had malignant lesions (86%) with invasive adenocarcinoma of the head of pancreas being the predominant histopathology (41%). Median operative time was 315 (180,945) minutes. Two-third of our patients had pancreaticojejunostomy (PJ) while the rest had pancreaticogastrostomy (PG). There were five patients with pancreatico-enteric anastomotic leak (5%), three of whom (3%) were from PJ anastomosis. Overall, in-hospital and 30-day mortality were both 3%. The median post-operative length of stay (LOS) was 15 days. Using logistic regressions, the post-operative morbidity predicts LOS following operation (p<0.005). The strategy in improving the morbidity and mortality rates of pancreaticoduodenectomies lies in the subspecialization of surgical services with regionalization of such complex surgeries to high volume centers. The key success lies in the dedication of staffs who continues to refine the clinical care pathway and standardize management protocol. [source] Coding diagnoses and procedures using a high-quality clinical database instead of a medical record reviewJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2001Carl van Walraven MSc MD FRCPC Abstract A discharge abstract must be completed for each hospitalization. The most time-consuming component of this task is a complete review of the doctors' progress notes to identify and code all diagnoses and procedures. We have developed a clinical database that creates hospital discharge summaries. To compare diagnostic and procedural coding from a clinical database vs. the standard chart review by health records analysts (HRA). All patients admitted and discharged from general medical and surgical services at a teaching hospital in Ontario, Canada. Diagnostic and procedural codes were identified by reviewing discharge summaries generated from a clinical database. Independently, codes were identified by hospital health records analysts using chart review alone. Codes were compared with a gold standard case review conducted by a health records analyst and a doctor. Coding accuracy (percentage of codes in gold standard review) and completeness (percentage of gold standard codes identified). The study included 124 patients (mean length of stay 5.5 days; 66.4% medical patients). The accuracy of the most responsible diagnosis was 68.5% and 62.9% for the database (D) and chart review (C), respectively (P = 0.18). Overall, the database significantly improved the accuracy (D = 78.9% vs. C = 74.5%; P = 0.02) and completeness (D = 63.9% vs. C = 36.7%; P < 0.0001) of diagnostic coding. Although completeness of procedural coding was similar (D = 5.4% vs. C = 64.2%; P = NS), accuracy decreased with the database (D = 70.3% vs. C = 92.2%; P < 0.0001). Mean resource intensity weightings calculated from the codes (D = 1.3 vs. C = 1.4; P = NS) were similar. Coding from a clinical database may circumvent the need for HRAs to review doctors' progress notes, while maintaining the quality of coding in the discharge abstract. [source] Regulating hospital use: length of stay, beds and whiteboardsNURSING INQUIRY, Issue 1 2005Marie Heartfield This paper presents part of a larger study of contemporary nursing practice and the rationalisation of hospital length of stay. Informed by Michel Foucault's work on governmentality, length of hospital stay and the re-engineering of surgical services are examined, not in terms of numerical representations of hospital use, but as part of social and political processes through which certain concepts are made susceptible to measurement and practices are organised. Using data generated through fieldwork in a hospital surgical division this analysis offers understandings of how social practices around length of hospital stay are translated and how they pattern contemporary hospital nursing practice. Nursing practice is explored through the reconstitution of hospital beds and the demands of local administration of hospital length of stay. [source] Safety on an inpatient pediatric otolaryngology service: Many small errors, few adverse eventsTHE LARYNGOSCOPE, Issue 5 2009Rahul K. Shah MD Abstract Objectives: Studies of medical error demonstrate that errors and adverse events (AEs) are common in hospitals. There are little data of errors on pediatric surgical services. Methods: We retrospectively reviewed 50 randomly selected inpatient admissions to the otolaryngology service at a tertiary care children's hospital. We used a "zero-defect" paradigm, recording any error or adverse event,from minor errors such as illegible notes to more significant errors such as mismanagement resulting in a bleeding emergency. Results: A total of 553 errors/AEs were identified in 50 admissions. Most (449) were charting or record-keeping deficiencies. Minor AEs (n = 26) and moderate AEs (n = 8) were present in 38% of admissions; there were no major AEs or permanent morbidity. Medication-related errors occurred in 22% of admissions, but only two resulted in minor AEs. There was a positive correlation between minor errors and AEs; however, this was not statistically significant. Conclusions: Multiple errors occurred in every inpatient pediatric otolaryngology admission; however, only 26 minor and eight moderate AEs were identified. The rate of errors per 1,000 hospital days (6,356 per 1,000 days) is higher than previously reported in voluntary reporting studies, possibly due to our methodology of physician review with a "zero-defect" standard. Trends in the data suggest that the presence of small errors may be associated with the risk of adverse events. Although labor-intensive, physician chart review is a valuable tool for identifying areas for improvement. Although small errors were common, there were few harms and no major morbidity. Laryngoscope, 2009 [source] Role of an acute assessment and review area for general surgical patientsANZ JOURNAL OF SURGERY, Issue 6 2010Ellen Perry Abstract Background:, Increasing demand for acute surgical services is one of the major challenges facing modern health systems. The aim of this study was to assess the impact of implementing a dedicated surgical assessment and review area (SARA) on patient flow for acute general surgical patients at a major teaching hospital in New Zealand. Methods:, A specific area within inpatient surgical beds was redeveloped and staffed by a dedicated surgical team. Prospective data pertaining to patient flow and outcomes were collected (10-month period) and compared with historical controls (preceding 14 months prior to implementation). Results:, During the 24-month period 9182 acute general surgical patients were admitted (3836 [41.1%] post implementation of SARA). Subsequent to the introduction of SARA, 865 (22.5%) patients were referred directly from their general practitioner. Length of stay was reduced in all patients from 2.58 to 2.04 days (P < 0.001) and in those who did not require surgery from 2.56 to 1.96 days (P < 0.001). However, the number of days in which the department of surgery had outlying patients increased significantly from 76.7% to 86.3%, P < 0.001. Conclusions:, The introduction of a dedicated SARA significantly reduced hospital stay and improved efficiencies of the emergency department. [source] Making sense of emergency surgery in New South Wales: a position statementANZ JOURNAL OF SURGERY, Issue 3 2010Stephen A. Deane Abstract Background:, Emergency surgery is a major component of the provision of surgical services and makes up a substantial volume of the workload of surgeons in many hospitals. It is often more complex and surgically challenging than elective surgery. However, little attention has been concentrated on the management or resource requirements of emergency surgery. Method:, This article identifies principles for models of emergency surgery care and describes how they can be incorporated into a redesign of emergency surgery. They have been developed and are endorsed by experienced surgical staff routinely coping with the challenges of emergency surgery. Results:, The benefits of redesigning emergency surgery will be realized by an active partnership between managers, surgeons and surgical teams. The anticipated clinical benefits include improved patient outcomes, enhanced patient and surgical team satisfaction, and increased trainee supervision in emergency surgery. Significant management benefits will ensue from high rates of emergency operating theatre utilization, reduced patient cancellations and reduction in after-hours costs. This unplanned but predictable workload will be managed in a planned and predictable fashion. Conclusion:, Reform of emergency surgery services is a necessity and not a choice. The development of the emergency surgery guidelines for New South Wales is a step in the right direction. The principles identified in the guidelines should be adapted and implemented across Australia if sustainable, safe and efficient emergency surgery services are to be provided. Patients will expect nothing less. [source] Surgical workforce in New Zealand: characteristics, activities and limitationsANZ JOURNAL OF SURGERY, Issue 4 2009Antony Raymont Planning the future surgical workforce is a vitally important activity in which the Royal Australasian College of Surgeons is actively engaged. This paper reports on a survey, undertaken in late 2005, of all vocationally registered New Zealand surgeons. It describes their age and gender distribution, their workload, the distribution of their work hours and limitations on their activities. It is hoped that this will contribute to planning of surgical services for the future. Of surgeons surveyed, 452 (73%) responded. Their mean age was 51 years and 7% were female. Recruitment has been stable at approximately 20 per year since 1990. New Zealand surgeons worked, on average, 48 h per week and could accommodate additional work. Seventy-seven per cent of surgeons took after-hours calls and reported a 55% chance of returning to the hospital each week (30% in the main population centres and 70% in other districts). Overall, surgeons spent 50% of their clinical time in private practice. Most surgeons experienced significant resource constraints in providing surgical care. The current workload of surgeons in New Zealand is acceptable but after-hours duties, especially in secondary hospitals, may be unattractive. Surgical services are currently limited by institutional resources. If there is a substantial increase in the need for surgery in the future, surgical recruitment, which has been stable, should be increased. [source] Acute-care surgical services: a personal perspectiveANZ JOURNAL OF SURGERY, Issue 1-2 2009FRCSC, Stephen A. Deane FRACS No abstract is available for this article. [source] Trauma teams in Australia: a national surveyANZ JOURNAL OF SURGERY, Issue 10 2003Kenneth Wong Background: Trauma teams have been associated with improved trauma patient outcomes. The present study seeks to estimate the use of trauma teams in Australian hospitals and describe their medical composition, leadership and criteria for activation. Methods: Australian public hospitals with more than 100 beds, an emergency department and offering surgical services were identified. A survey assessing the presence, composition and means of activation of a trauma team was mailed to the ,Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. Results: Questionnaires were distributed to 130 hospitals. After exclusion of hospitals that did not receive patients with traumatic injuries, and dedicated paediatric tertiary referral centres, 111 hospitals remained for analysis. Of these, 56% had an established trauma team, while 71% of hospitals without a trauma team claimed to have insufficient doctors to form one team. Ninety-five per cent of trauma teams were potentially activated by prehospital paramedic data (field triage). For 92% of trauma teams a combination of anatomical, physiological and mechanistic criteria were required for activation. The most common methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (31%) or by paging trauma team members individually (31%). Fifty-eight per cent of trauma team leaders were emergency medicine specialists/registrars, while 8% of trauma teams were led by surgeons/registrars. Consultant surgeons were members of 23% of trauma teams and 74% of trauma teams consisted of more junior members after hours. Some form of trauma audit was engaged in by 64% of hospitals. Conclusions: Trauma teams are yet to be utilized by many Australian hospitals that provide trauma care. Australian surgeons presently have limited leadership roles and membership in trauma teams. Trauma audit can be more widely adopted in Australian hospitals. [source] Costs of accessing surgical specialists by rural and remote residentsANZ JOURNAL OF SURGERY, Issue 9 2001Sarah L. Rankin Introduction: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. Methods: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. Results: An estimated saving of AU$1077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. Conclusion: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available. [source] | ||||||||||||||||||||||