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Spacer Prescription for Asthma Patients using pMDI at a Primary Care Practice
Full text linkClinical guidelines and the best practice for asthma management recommend all patients and require some sub-groups to use a spacer with pressurised metered-dose inhalers (pMDI). However, little data is available on the rate of spacer prescriptions for asthma patients using pMDI. Therefore, a quality improvement project was conducted to evaluate the practice of spacer prescription in one primary care centre. It was found that spacers were markedly under-prescribed; the prescription rates for regular replacement spacers were especially inadequate. Measures can be implemented in primary care settings to bring the spacer prescription practice closer to guidelines and best practice, and several suggestions were made
How can coding within an electronic patient record (EPR) be improved to provide better care for patients with a diagnosis of domestic abuse?
Full text linkBackground: The aim of this project was to investigate the efficacy of domestic abuse (DA) coding within the electronic patient record, EMIS, used in the general practice the researcher was based and make recommendations on how the process can be improved. There is a significant amount of literature available on the identification of domestic abuse, the recommended interventions and the possible consequences of experiencing domestic abuse. However, the literature on coding within EMIS, in relation to domestic abuse, is very limited, prompting the purpose of this project – to begin bridging this gap in the literature. Thus, the question this project aimed to answer was: How can coding within an electronic patient record be improved to provide better care to patients with a diagnosis of domestic abuse?
Methods: The researcher wanted to explore how the processes coding the witnessing and exposure to domestic abuse can be improved in general practice. However, the limited literature and lack of national standards prevented this from being conducted as a clinical audit. Therefore, it was conducted as a quality improvement project. Ethical approval for the project was obtained from the Medical School ethics committee. Data access was granted by following the National Data Opt-Out Guidance. This project utilised an inductive approach (observation-driven) and represented all of the collected data quantitatively, as frequencies and percentages.
Results: The findings from this project strongly indicated that there were definite improvements to be made to the coding processes within EMIS. Firstly, the process had been overcomplicated by a large quantity of available codes, most of which were not utilised across the sample. Secondly, there were many patients with no record entry of support/intervention after their disclosure of domestic abuse. This could either be because they didn’t receive any, the clinician failed to record it or because external agencies, where primary disclosure occurred, did not inform the GP surgery. Finally, there were many children who were witnesses to episodes of domestic abuse, who were not coded as having a domestic abuse diagnosis. This is important because even when the abuse is not directly affecting a child, they are still considered a victim and are therefore susceptible to a wide and long emerging range of consequences of domestic abuse. The researcher, therefore, recommends that they be coded and supported accordingly.
Conclusions: In conclusion, this project found that there were several improvements that could be made to the coding process, surrounding domestic abuse, to improve the care of these patients and enable better clinical outcomes. This project has added to the limited knowledge base of EPR coding, in relation to domestic abuse in general practice. Further longitudinal research is needed to examine if these recommendations were adopted and whether they would improve administrative and clinical outcomes
To what extent are the mental health services available to asylum seekers and refugees being utilised and what barriers prevent access to these services? A systematic review.
Full text linkBackground: The number of refugees and asylum seekers in the United Kingdom is increasing. With NHS resources already under strain, the effective management of these patients is essential. Asylum seekers and refugees are at increased risk of mental health issues due to their experiences endured in their country of origin and whilst travelling to the UK, as well as stressors associated with settling in the UK. Despite this, ASR patients are less likely to receive mental health support. This systematic review aims to identify the barriers preventing effective mental health support for asylum seekers and refugees in the UK, in order to improve engagement with services and mental health outcomes in this population.
Methods: The researcher followed the PRISMA guidelines to produce this systematic review. 15 papers were identified from searching the databases PubMed, Medline, Embase, Cochrane Library of systematic reviews, PsycINFO, British Nursing Index. Critical appraisal was then carried out on the papers, all of which were deemed high quality and valuable for the study. The researcher used thematic analysis to produce overarching themes presented by the included papers.
Results: The overarching themes identified were: exclusion, healthcare professional factors, culturally sensitive care and practical barriers. 11 identified sub themes were amalgamated to produce these. These wider themes spoke to the significant barriers that prevent access to mental health care for this population. All 15 papers included point to multiple barriers for asylum seekers and refugees.
Conclusions: There are multiple complex barriers for asylum seekers and refugees when accessing mental health support. These complex barriers are evidenced by the wide range of sub themes and the overarching themes identified. The researcher concludes that asylum seeker and refugee engagement with mental health services is low due to significant barriers that prevent access. Mental health services need to build relationships with the asylum seeker and refugee communities in the United Kingdom to enhance engagement in the service. Policy makers need to consider ways to reduce exclusion of this population and consider the impact of current policies on engagement in the service and attitudes towards this patient population
A systematic review of the use of intraoperative surgical drains vs no drains in preventing intra-abdominal abscess post appendicectomy for the treatment of complicated appendicitis.
Full text linkBackground: This systematic review aimed to answer the question of whether surgical drains prevent the incidence of intra-abdominal abscesses in patients undergoing an appendicectomy for complicated appendicitis. Some surgeons leave a surgical drain in situ to remove contaminated intra-abdominal fluids to prevent abscess formation (Abu et al., 2022). However, some studies have shown that the drain itself may act as a foreign body and increase the risk of an intra-abdominal abscess forming (Nazarian, Boardman, Chohda and Shah, 2020).
Methods: This systematic review included eight studies from the past ten years with participants aged 18 and over with complicated appendicitis requiring an appendicectomy. Papers were identified from PubMed and selected using a strict inclusion and exclusion criteria. Narrative synthesis alongside Synthesis Without Meta-analysis (SWiM) guidelines (Campbell et al, 2020) was used to identify common outcomes in these studies and the incidence of intra- abdominal abscess (IAA), Post-operative wound infections (POWI) and Length of Hospital Stay (LOS).
Results: This systematic review collated data from a total of 1,868 patients, 665 in the surgical drain after surgery group (SDS) and 1,203 in the no surgical drain group (NSD). The articles reported no strong evidence of a statistically significant difference between the incidence of IAA or POWI between the SDS and NSD groups. LOS was consistently found to be significantly longer in the SDS groups compared to NSD groups in seven of the eight studies.
Conclusions: The findings of this systematic review do not show a difference in the incidence of intra-abdominal abscess formation with the use of surgical drains in appendectomies. However, the use of surgical drains was found to be associated with a significantly longer hospital stay. There is a possibility a higher LOS may be correlated with a higher incidence of post-operative complications when using a surgical drain, although the exact reasons for this are unclear and require further investigation. Currently there is not strong enough evidence to write guidelines to use or not use drains in appendicectomies for complicated appendicitis and therefore further research is required
Between Two Systems: Reflective insight of private healthcare in India vs the NHS
No full textThis reflective article offers a personal, first-hand perspective and insight into emergency care within a private, low resource Indian hospital, highlighting structural, clinical and ethical contrasts with the National Health Service (NHS). It emphasises the impact of healthcare system design on patient outcomes, contributing to global health understanding and informing culturally competent, equitable and adaptable future medical care
The Golden Thread of Woolmington - A Domestic Yarn That Should Never Have Been Spun
Full text linkThe case of Woolmington v The Director of Public Prosecutions [1935] 1 AC 462 is renowned for Viscount Sankey’s ‘golden thread’ ruling, that the prosecution bears the burden of proof at trial. However, what is frequently overlooked is that this judgment arises from domestic violence. In this commentary, the facts of Woolmington will be investigated, and charted using a domestic abuse risk assessment form (DARA) which is used by police to assess the potential risk to victims after an alleged domestic incident. It will be shown that there were numerous ‘red flags’ in Reginald Woolmington’s behaviour towards Violet, his wife, which indicated that she was at risk of serious physical violence from her husband. The commentary then reflects on the fact that such an important ruling is named after a domestic abuser
The Functional Outcomes of Transoral Robotic Surgery for Head and Neck Cancer Patients at a Kent Based Hospital.
Full text linkBackground: The pathos trial is an ongoing trial to determine optimum adjuvant therapy following transoral robotic surgery (TORS) for treatment of oropharyngeal squamous cell carcinomas. Specifically, the trial investigates how de-escalating adjuvant therapy will affect patient function. There is currently limited literature on functional outcomes of transoral robotic surgery. Current literature measure function based on crude metrics such as the requirement for nasogastric (NG) tubes. With the introduction of questionnaires which can quantify patient function in the follow up after TORS for head and neck cancer treatment, this project aims to develop current knowledge on the functional outcomes following TORS.
Methods: Routine follow up of head and neck cancer patients treated with TORS includes the following questionnaires: MD Anderson Dysphagia Inventory, European Organisation for the Research and Treatment of Cancer (EORTC) C30 questionnaire, EORTC HN35 questionnaire and Voice Handicap Index (VHI). The patients were also asked to rate their daily pain on a scale of 1-10. Patients undergoing TORS for curative treatment of a head and neck cancer at the trust in which the project took place were approached following their surgery to confirm whether they consent their data to be used in the project regarding consent to use their data in the project. The data used includes scores of their questionnaires at the following intervals: preoperative period, immediate postoperative period, 2 weeks after surgery, 1 month after surgery, 3 months after surgery and 6 months after surgery. The gathered data would then be plotted to trend how participant functional burden changed over time following TORS.
Results: At baseline investigation, 86.7% of participants reported a MD Anderson score of 90 – 100, suggesting significant swallowing complications caused by their disease. By the 6-month post TORS investigation, only 20% of participants had maintained a score between 90 – 100. The most abundant intervals at 6 months post TORS were 20 – 29 and 50 – 59, each holding 30% of the recorded sample size. 66.7% of participants reported an EORTC C30 score of 40 – 49 at baseline, which increased to 80% of participants at 6 months. 40% of the sample recorded a score of 30 – 39 on the EORTC HN35 questionnaire at baseline, however, at the 6 month follow up 50% of participants had a HN35 score of between 40 – 49 suggesting a reduction in quality of life when specified to the head and neck region. VHI and pain scores showed an initial surge (deterioration in function) following TORS, however by the 6 month follow up mean VHI scores and mean pain scores had fallen below baseline levels (improvement in function).
Conclusions: The results of the investigation may suggest the functional outcomes following TORS are better than the initial symptomatic burden of cancer. Functional outcomes could have been dramatically influenced by adjuvant therapy regime, so it would be beneficial to stratify future investigations based on adjuvant therapy intensity. Unfortunately, due to numerous factors such as poor patient engagement with follow-up, no significant conclusion can be made from the project and so further investigation is warranted
Feminist Jurisography: Woman's Estate, Australia, 1970
Full text linkThis essay offers some observations on jurisography, an experimental practice named by the author. It draws from Feminist Jurisography: Law, History, Writing (2022) to make an argument about feminist traditions, and how they are inherited. The essay argues that feminist traditions – feminist foundations – are not necessarily forgotten, although they may not always be explicitly acknowledged. It begins with a provocation made by Simone de Beauvoir in The Second Sex (1949): that to respond adequately to one’s situation in time and place as woman requires self-creation of a persona and methodological transformation of disciplinary writing. It then examines how that provocation was adapted in the 1970s by writers in the Women’s Liberation Movement; and describes how popular books, written on the periphery of institutional life, introduced a new public persona: the feminist intellectual. Through a reading of Juliet Mitchell’s Woman’s Estate (1971) and its reception in Australia, the essay argues that regardless of whether one separates from or aligns with a textual inheritance, understanding the methodological innovations of feminist antecedents for projects in the here and now is a political act of acknowledgment
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