The European Society of Anaesthesiology (ESA) is to launch a safety starter kit containing a wide variety of essential resources to help raise safety standards in anaesthesiology across Europe. The kit will be distributed on a memory stick at this year
People who receive primary care from free clinics are less likely to use the emergency department for minor issues, according to a team of medical researchers.
Nationally, the number of emergency departments (EDs) has decreased yet the number of ED visits has gone up, the team reported. Therefore, it is important to figure out how to reduce unnecessary ED visits.
According to the National Association of Free and Charitable Clinics, there are more than 1,200 free clinics nationwide. Many of these clinics work in co-operation with one of their local hospitals.
Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine, and his colleagues analysed records of uninsured patients from five hospitals and four free clinics across neighbouring Virginia communities.
Over three years, 52,010 individual uninsured patients visited at least one of the hospitals’ five emergency departments a total of 99,576 times. The researchers found that approximately 10 percent of those ED visits were by patients who had been treated at free clinics associated with the hospitals in the first two years studied
Hwang compared the diagnoses at the time of admittance to the emergency department between the free clinic patients and the non-free clinic patients. The five most common diagnoses were identical for both groups — sprains and strains, disorders of teeth and jaw, superficial injury or contusion, abdominal pain and back problems. The secondary diagnoses were not as similar for the two groups, but the researchers found mental health and substance abuse to be the most common underlying condition for both groups of uninsured patients.
‘Emergency department visits by free clinic patients were less likely to require the lowest levels of care, suggesting uninsured free clinic users were less likely to use the emergency department as their primary care provider,’ the researchers wrote.
The researchers determined that half of the ED visits in this study were avoidable, using the measurements the hospitals themselves use. By providing primary care for the uninsured, free clinics are able to help reduce non-emergency visits to the ED.
‘The emergency department is an extremely expensive and inefficient way to handle many problems that show up there,’ said Hwang. ‘If hospitals support local free clinics, the ED will be less crowded and therefore have less need for expensive expansions. Free clinics are the cheaper solution.’ Penn State University
Tufts University School of Engineering researchers have demonstrated silk-based implantable optics that offer significant improvement in tissue imaging while simultaneously enabling photo thermal therapy, administering drugs and monitoring drug delivery. The devices also lend themselves to a variety of other biomedical functions.
Biodegradable and biocompatible, these tiny mirror-like devices dissolve harmlessly at predetermined rates and require no surgery to remove them.
The technology is the brainchild of a research team led by Fiorenzo Omenetto, Frank C. Doble Professor of Engineering at Tufts. For several years, Omenetto; David L. Kaplan, Stern Family Professor of Biomedical Engineering and Biomedical Engineering chair, and their colleagues have been exploring ways to leverage silk’s optical capabilities with its capacity as a resilient, biofriendly material that can stabilise materials while maintaining their biochemical functionality.
‘This work showcases the potential of silk to bring together form and function. In this case an implantable optical form — the mirror — can go beyond imaging to serve multiple biomedical functions,’ Omenetto says.
To create the optical devices, the Tufts bioengineers poured a purified silk protein solution into moulds of multiple micro-sized prism reflectors, or microprism arrays (MPAs). They pre-determined the rates at which the devices would dissolve in the body by regulating the water content of the solution during processing. The cast solution was then air dried to form solid silk films in the form of the mould. The resulting silk sheets were much like the reflective tape found on safety garments or on traffic signs.
When implanted, these MPAs reflected back photons that are ordinarily lost with reflection-based imaging technologies, thereby enhancing imaging, even in deep tissue.
The researchers tested the devices using solid and liquid ‘phantoms’ (materials that mimic the scattering that occurs when light passes through human tissue). The tiny mirror-like devices reflected substantially stronger optical signals than implanted silk films that had not been formed as MPAs.
The Tufts researchers also demonstrated the silk mirrors
Nurses have been warned about wearing nail extensions and using nail polish after a poll suggested infection control was being put at risk by fashion-conscious NHS staff.
Guidance states that fingernails should be short and free of varnish. But an online poll of nearly 500 student nurses found lapses were commonplace with 60% reporting nail extensions and polish being used.
The Royal College of Nursing said the findings were ‘worrying’.
The survey was carried out by Cardiff University and London’s City University. Overall each of the 488 students who took part reported seeing at least one breach in infection control rules by health staff once other problems, such as a failure to wash hands as well as breaches of nail care were taken into account.
The researchers said the survey showed lapses were widespread.
Tom Sandford, of the RCN, added: ‘Fingernails should be short and free of nail varnish. False nails should not be worn. Nail varnish and extensions harbour bacteria and prevent good hand hygiene. Health organisations should uphold clear local policies on uniforms and work-wear and their implications for infection control and health and safety.’
BBC
The introduction of CT pulmonary angiography has been associated with an 80% rise in the detection of pulmonary emboli in the US, but with little change in death rates.
Professor Renda Soylemez Wiener and colleagues argue this is evidence of over-diagnosis. They say some patients are helped, but many are harmed by the adverse effects of unnecessary treatment.
This article is the first of a series looking at the risks and harms of over-diagnosis in a range of common conditions. The series, together with the Preventing Overdiagnosis conference in September, are part of the BMJ’s Too Much Medicine campaign to help tackle the threat to health and the waste of money caused by unnecessary care.
Pulmonary embolism has been described as one of the most commonly missed deadly diagnoses. Until recently, ventilation-perfusion (VQ) scanning was the first line test, but a new technology introduced in 1998
Stroke patients at risk of blood clots and death could be helped by a compression device that wraps around the legs. Researchers have shown for the first time that by gently squeezing the legs, the risk of dying after stroke is reduced.
It is thought that the compression reduces the risk of clots in the veins of the legs by increasing blood flow.
The results of the trial reveal that thigh-length intermittent pneumatic compression (IPC) reduces the risk of deep vein thrombosis (DVT), which commonly affects stroke patients. Until now, no treatment has been available that safely reduces the risk of the blood clots in the legs and the risk of dying.
More than 2800 stroke patients across the UK were involved in the randomised trial, which took place between 2008 and 2012. Hundreds of researchers from more than 100 hospitals took part.
The IPC sleeves, which cost the NHS as little as
The small size and abnormal anatomy of children born with heart defects often force doctors to place lifesaving defibrillators entirely outside the heart, rather than partly inside
For patients with advanced gastric cancer, treatment with chemotherapy after surgery can reduce the risk of cancer related death by 34% over five years compared to surgery alone.
Prof Sung Hoon Noh, a gastric surgeon from Yonsei University College of Medicine, Korea, presented 5-year follow-up from the phase III CLASSIC trial, which added combination chemotherapy to a standard surgical procedure called D2 gastrectomy. The chemotherapy regimen studied in the trial is called XELOX, which is a combination of the drugs capecitabine and oxaliplatin.
CLASSIC was a multinational open-label randomised phase III trial performed in South Korea, China and Taiwan. Patients with stage II
Nearly 20 percent of kidneys that are recovered from deceased donors in the U.S. are refused for transplant due to factors ranging from scarring in small blood vessels of the kidney
Prothrombin complex concentrates (PCCs) are faster and more effective than fresh frozen plasma at reversing hemorrhage caused by the anti-coagulant warfarin, despite plasma being the most commonly used therapy. A literature review suggests that physicians in the United States should join those around the world in following recommendations of multiple specialty organisations to use PCCs as the first line of defence in this common and life-threatening emergency (
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