Research has consistently demonstrated that preventive cardiology programs have limited success, and healthy practices among high-risk individuals remain suboptimal. Furthermore, there are no current programmes in Malta that offer support to first-degree relatives of patients with premature coronary heart disease. This internal pilot study will determine the feasibility, acceptability, and potential effectiveness of a preventative intervention.
Many essential interventions are required to ensure in-patients receive safe and effective care with a good experience. In addition, healthcare organisations are assessed on numerous performance indicators, including the aforementioned interventions, where underperformance can lead to lower publicly reported ratings, loss of income and reputational damage. Most importantly, underperformance can lead to compromised patient experience and outcomes. We created a prompt card as a service improvement tool to be used on the daily ward rounds at the bedside of every patient, entitled 'every patient, every day' to improve documentation, antibiotic prescribing, venous thromboembolism (VTE) prophylaxis, coding and patient communication.Preimplementation data around these interventions and patient experience factors were collected by shadowing ward rounds. The 'every patient, every day' tool was then implemented. The ward rounds were shadowed by the same individual to collect post-implementation data. Effect of implementation was assessed via Poisson regression models conducted on the documentation, antibiotics and VTE measures, and logistic regression models conducted on the communication and coding measures.The corresponding rate ratios for the effect of the implementation of the service improvement tool were found to be 1.53 (95% CI 1.38 to 1.69) for improved documentation. Antibiotics prescribing improved by 1.44 (95% CI 1.06 to 1.94). VTE prescribing and documentation improved by a rate ratio 1.25 (95% 1.04 to 1.50). For communication, the effect of the implementation was significant at the 5% significance level (p<0.001), with an OR of 18.6 (95% CI 8.41 to 41.09). Coding effect was non-significant at the 5% significance level (p=0.113) but was substantive. Implementation of the tool resulted in substantive improvements in all outcomes and shows corrected significance with the documentation and communication outcomes.The 'every patient, every day' ward round prompt card is an extraordinarily simple tool shown to increase compliance with a number of safety and quality indicators to improve an organisation's performance, and hopefully be a facet contributing to enhanced patient experience and outcomes.
Though uncommon, imposed upper airways obstruction (IUAO) is important as a differential diagnosis of infantile epilepsy. It is also extremely dangerous. Because most cases eventually involve the police and legal arguments and because consent for publication can rarely be obtained, IUAO is a difficult subject to write about and those making such a diagnosis may be persecuted [1]. That makes it difficult for the clinician to find convincing published evidence to help in making the diagnosis of IUAO. This discussion should be read in the light of these caveats. IUAO usually means intentional suffocation or smothering of an infant by the mother in the context of what Professor Roy Meadow [1] called Munchausen syndrome by proxy and I called ‘active’ Meadow syndrome [2]. The presentation is as unexplained seizures or syncopes or severe cyanotic attacks or apparently life-threatening events. Although as shown in Table 1 the clinical and monitoring features should make it easy to distinguish IUAO from the better understood alternative diagnoses, doctors still have great difficulty, perhaps because of fears of personal consequences [1]. In my opinion, the features in Table 1 make it unnecessary to undertake covert video surveillance [3] but Courts of law are daunting places of argument.
Background: Hospital in-patients need sleep so that restorative process and healing can take place. However, over one third of in-patients experience sleep disturbance, often caused by noise. This can compromise patients’ perceptions of care quality and cause physical and psychological ill health. Aims: To assess 1) in-patients sleep quality, quantity, reported sources of sleep disturbance and their suggestions for improvement 2) objectively measure decibel levels recorded at night. Methods: This descriptive study conducted in a Medical Assessment Unit used multi-methods; a semi-structured ‘sleep experience’ questionnaire administered to a purposive sample of in-patients; recording of night-time noise levels, on 52 consecutive nights, using two calibrated Casella sound level meters. Results: Patient ratings of ‘in-hospital’ sleep quantity (3.25; 2.72 SD) and quality (2.91; 2.56 SD) was poorer compared to ‘home’ sleep quantity (5.07; 2.81 SD) and quality (5.52; 2.79 SD). The difference in sleep quality (p<0.001) and quantity (p<0.001) ratings whilst in hospital, compared to at home, was statistically significant. Care processes, noise from other patients and the built environment were common sources of sleep disturbance. Participants’ suggestions for improvement were similar to interventions identified in current research. The constant noise level ranged from 38-57 decibels (equivalent to an office environment), whilst peak levels reached a maximum of 116 decibels, (equivalent to banging a car door one metre away). Conclusion: The self-rated patient sleep experience was significantly poorer in hospital, compared to home. Noise at night contributed to sleep disturbance. Decibel levels were equivalent to those reported in other international studies. Data informed the development of a ‘Sleep Smart’ toolkit designed to improve the in-patient sleep experience.
Purpose: As advances are made in smaller-gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25- and 23-gauge (G) vitrectomy is known, but no studies exist looking at the incidence in 27G vitrectomy with an attached posterior hyaloid face (PHF). This study set out to characterize the incidence. Methods: A retrospective, consecutive, observational study of patients undergoing 27G transconjunctival sutureless vitrectomy for macular pathology or floaters was conducted. This was a single-surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, United Kingdom. Inclusion criteria included only those with an attached PHF at the disc, identified intraoperatively. Results: Data were collected and analyzed in 94 patients. Preoperative diagnosis frequency was as follows: epiretinal membrane 24 (25.5%), macular hole 47 (50.0%), vitreomacular traction 11 (11.7%), and floaters 12 (12.8%). In 82 out of 94 patients (89.1%), 27G vitrectomy was combined with 2.2 mm microincisional phacoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27G PPV was 17% (16 cases). Conclusions: This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27G vitrectomy. Our single-surgeon case series of 27G PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no postoperative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with outcome (incidence of retinal tear).
This paper discusses recent developments in research support for ambulance trusts in England and Wales and how this could be designed to lead to better implementation, collaboration in and initiation of high-quality research to support a truly evidence-based service.
Method
The National Ambulance Research Steering Group was set up in 2007 to establish the strategic direction for involvement of regional ambulance services in developing relevant and well-designed research for improving the quality of services to patients.
Results
Ambulance services have been working together and with academic partners to implement research and to participate, collaborate and lead the design of research that is relevant for patients and ambulance services.
Conclusion
New structures to support the strategic development of ambulance and prehospital research will help address gaps in the evidence for health interventions and service delivery in prehospital and ambulance care and ensure that ambulance services can increase their capacity and capability for high-quality research.
Vaccination has been one of the most successful and cost-effective healthinterventions ever employed. One disease (smallpox) has been eradicated, another(poliomyelitis) should disappear early in the new millennium and a third (measles)should follow shortly after. Conventional vaccines usually depend on one of threedevelopment processes, attenuation of virulent organisms (by passage in cell cultureand(slash)or experimental animals), killing of virulent organisms (by chemical inactivation) or the purification of immunogenic molecules (either proteins or carbohydrates) from wholeorganisms. These traditional processes, although serendipitous and poorly understood, have produced effectivepharmaceutical products which give excellent protection against diseases such as smallpox, rabies, measles,yellow fever, tetanus and diphtheria. In spite of these successes however, the application of these protocolshave failed to produce safe and efficacious vaccines against other infectious diseases which kill or maim tens ofmillions of people every year. The most important of these are malaria, AIDS, herpes, dengue fever and someforms of viral hepatitis. Consequently, fundamentally new technologies are required to tackle these important infections. One of themost promising has been the development of genetically modified viruses. This process normally involvestaking a proven safe and efficacious vaccine virus, such as vaccinia or adenovirus, and modifying its genometo include genes coding for immunogenic proteins from other viruses such as HIV or measles. This reviewwill describe the generation of such novel vaccine vectors and compare their advantages and shortcomings. In addition the literature describing their use as experimental vaccines will also be reviewed. Keywords: Genetically Modified Viruses, Vaccines, Vaccination, Rabies, Poliomyelitis, Measles, Yellow fever, Tetanus, Diphtheria, Smallpox
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