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  1. Article ; Online: Comment on "Pregnancy outcomes after stoma surgery for inflammatory bowel disease: The results of a retrospective multicentre audit".

    Gurbuzer, Fatma Irem / Bethune, Rob

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2023  Volume 25, Issue 4, Page(s) 807–808

    MeSH term(s) Pregnancy ; Female ; Humans ; Pregnancy Outcome ; Surgical Stomas/adverse effects ; Colostomy ; Inflammatory Bowel Diseases/surgery
    Language English
    Publishing date 2023-01-11
    Publishing country England
    Document type Multicenter Study ; Letter ; Comment
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16468
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5799: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Single-shot liposomal bupivacaine in place of rectus sheath catheters to provide non-opiate analgesia after laparotomy: a quality improvement project to reduce the need for ongoing nursing input.

    Matthews, Edward / Ragatha, Pranu / Smart, Neil / Bethune, Rob

    BMJ open quality

    2024  Volume 13, Issue 1

    Abstract: Opioid-sparing pain management is an integral component of enhanced recovery after colonic and rectal surgery. In our hospital, rectus sheath catheters (RSCs) are routinely placed during emergency laparotomy for colorectal procedures to allow a ... ...

    Abstract Opioid-sparing pain management is an integral component of enhanced recovery after colonic and rectal surgery. In our hospital, rectus sheath catheters (RSCs) are routinely placed during emergency laparotomy for colorectal procedures to allow a postoperative compartmental block of the surgical site with repeated doses of bupivacaine. However, RSCs require a significant amount of clinical nursing time to maintain and 'top-up'. We present a quality improvement project in which we administered single-shot liposomal bupivacaine (LB) intraoperatively as an alternative to bolus doses of conventional bupivacaine delivered through RSCs. Having thereby reduced the demands placed on nursing time through a reduction in the use of RSCs, we sought to establish whether there was any associated change in analgesic efficacy. Patient pain scores, use of patient-controlled analgesia (PCA) and length of stay following surgery were analysed before and after the introduction of LB. No disruption in these outcomes was identified using statistical process control analysis. A direct comparison of results for patients who received LB versus those who received bolus dosing of bupivacaine via RSCs found no significant differences, with a median total PCA dose of 270 mg oral morphine equivalents (OME) for patients who received LB versus 396 mg OME for patients who had RSCs (p=0.54). The median length of stay for patients who received LB was 15.5 days versus 16 days for those who had RSCs (p=0.87). We conclude that LB represents a viable alternative to boluses of conventional bupivacaine via RSCs in promoting enhanced recovery after emergency laparotomy and look to extend its use locally.
    MeSH term(s) Humans ; Pain Management ; Pain, Postoperative/drug therapy ; Laparotomy ; Quality Improvement ; Bupivacaine/therapeutic use ; Analgesia ; Catheters
    Chemical Substances Bupivacaine (Y8335394RO)
    Language English
    Publishing date 2024-02-26
    Publishing country England
    Document type Journal Article
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2023-002313
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Repairing disrupted care processes as sources of stability, learning and change in a Finnish hospital: An activity-theoretical study.

    Kajamaa, Anu / Lahtinen, Päivikki / Mattick, Karen / Bethune, Rob

    Medical education

    2024  

    Abstract: Introduction: In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care; 50% of these are preventable. The aim of this study was to deepen our understanding of disruptions of care processes and how ... ...

    Abstract Introduction: In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care; 50% of these are preventable. The aim of this study was to deepen our understanding of disruptions of care processes and how the repairing of disruptions can be sources of stability, learning and change in complex health care settings.
    Methods: The organisational interactions associated with disruptions in the standard care processes of 15 surgical patients were followed in a public sector hospital in Finland. The patients and medical professionals were interviewed in situ during the observation of the care processes. An activity-theoretically informed methodological framework was used to identify and analyse disruptions and the associated repair efforts and repair solutions.
    Results: Disruptions were frequent and found in all 15 care processes. These related to (1) the patient's worsening physiological state, (2) the equipment used in surgical care, (3) the information flow, (4) delays in the care process and (5) the unclear division of labour within the team. The actors carried out three types of repair efforts (technical, cognitive-emotional and extended collaborative) to overcome the disrupted processes, which usually led to repair solutions that restored stability.
    Discussion: The different repair efforts required different kinds of collaboration and learning. Extended collaborative repair was most demanding, providing challenges and opportunities for practice change and expansive learning.
    Language English
    Publishing date 2024-05-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 195274-2
    ISSN 1365-2923 ; 0308-0110
    ISSN (online) 1365-2923
    ISSN 0308-0110
    DOI 10.1111/medu.15407
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    In stock of ZB MED Cologne/Königswinter

    Zs.B 312: Show issues Location:
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    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Transanal total mesorectal excision for abdominoperineal resection is associated with poor oncological outcomes in rectal cancer patients: A word of caution from a multicentric Canadian cohort study.

    May, Vanessa / Bethune, Rob

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2022  Volume 24, Issue 10, Page(s) 1248

    MeSH term(s) Humans ; Cohort Studies ; Canada ; Rectal Neoplasms/surgery ; Proctectomy ; Transanal Endoscopic Surgery ; Rectum/surgery ; Postoperative Complications/surgery ; Laparoscopy ; Treatment Outcome
    Language English
    Publishing date 2022-07-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16236
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5799: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Surgical methods of fistula closure in fistulating perianal Crohn's disease.

    Khalil, Ibraheem / Bethune, Rob

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2022  Volume 25, Issue 3, Page(s) 498

    MeSH term(s) Humans ; Crohn Disease/complications ; Crohn Disease/surgery ; Crohn Disease/drug therapy ; Infliximab/therapeutic use ; Gastrointestinal Agents/therapeutic use ; Fistula/drug therapy ; Rectal Fistula/etiology ; Rectal Fistula/surgery ; Rectal Fistula/drug therapy ; Treatment Outcome
    Chemical Substances Infliximab (B72HH48FLU) ; Gastrointestinal Agents
    Language English
    Publishing date 2022-12-11
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16432
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5799: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Comment on: Decrease in primary but not in secondary abdominal surgery for Crohn's disease: nationwide cohort study, 1990--2014.

    Kantola, Venla / Bethune, Rob

    The British journal of surgery

    2021  Volume 108, Issue 2, Page(s) e97

    MeSH term(s) Cohort Studies ; Colectomy ; Crohn Disease/surgery ; Humans ; Retrospective Studies
    Language English
    Publishing date 2021-03-12
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znaa136
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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.66: Show issues Location:
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  7. Article ; Online: Use of statistical process control in quality improvement projects in abdominal surgery: a PRISMA systematic review.

    Lima de Mendonca, Yara / Sarto, Rubiana / Titeca, Hannes / Bethune, Rob / Salmon, Andrew

    BMJ open quality

    2024  Volume 13, Issue 1

    Abstract: Background: The use of quality improvement methodology has increased in recent years due to a perceived benefit in effectively reducing morbidity, mortality and length of stay. Statistical process control (SPC) is an important tool to evaluate these ... ...

    Abstract Background: The use of quality improvement methodology has increased in recent years due to a perceived benefit in effectively reducing morbidity, mortality and length of stay. Statistical process control (SPC) is an important tool to evaluate these actions, but its use has been limited in abdominal surgery. Previous systematic reviews have examined the use of SPC in healthcare, but relatively few surgery-related articles were found at that time.
    Objective: To perform a systematic review (SR) to evaluate the application of SPC on abdominal surgery specialties between 2004 and 2019.
    Methods: An SR following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram was completed using Embase and Ovid Medline with terms related to abdominal surgery and SPC.
    Results: A total of 20 articles were selected after applying the exclusion criteria. Most of the articles came from North America, Europe and Australia, and half have been published in the last 5 years. The most common outcome studied was surgical complications. Urology, colorectal and paediatric surgery made up most of the articles. Articles show the application of SPC in various outcomes and the use of different types of graphs, demonstrating flexibility in using SPC. However, some studies did not use SPC in a robust way and these studies were of variable quality.
    Conclusion: This study shows that SPCs are being applied increasingly for most surgical specialties; however, it is still less used than in other fields, such as anaesthesia. We identified conceptual errors in several studies, such as issues with the design or incorrect data analysis. SPCs can be used to increase the quality of surgical care; the use should increase, but critically, the analysis needs to improve to prevent erroneous conclusions being drawn.
    MeSH term(s) Child ; Humans ; Quality Improvement ; Delivery of Health Care ; Australia
    Language English
    Publishing date 2024-02-01
    Publishing country England
    Document type Systematic Review ; Journal Article
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2023-002328
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Creation of a Patient Information Video to Improve the Patient Experience of the Surgical Assessment Unit.

    Pringle, Heather / Ragatha, Pranu / Myintmo, Aye Myat / Awarah, Hazel / Chung, Waihim / Bethune, Rob

    Cureus

    2024  Volume 16, Issue 4, Page(s) e57926

    Abstract: Background: Patients who attend emergency surgical services are entering an unfamiliar environment whilst often being unwell and in pain. Patient satisfaction in emergency surgical units is often low due to poor communication with attendees and long ... ...

    Abstract Background: Patients who attend emergency surgical services are entering an unfamiliar environment whilst often being unwell and in pain. Patient satisfaction in emergency surgical units is often low due to poor communication with attendees and long wait times.
    Methods: A pilot patient questionnaire identified areas where patient satisfaction was low during attendance at the surgical assessment unit (SAU). The aim of this intervention was to improve patient satisfaction with their experience whilst attending the SAU. An education video was filmed to address the areas where services were falling short of expectations, and this was played in the waiting room. Further questionnaire results tailored the frequency of the video to achieve maximum impact.
    Results: Data were collected at three time points: firstly, prior to the introduction of the video (n=34); secondly, with the video played hourly (n=15); and finally with the video played every 30 minutes at a higher volume (n=15). Mean satisfaction scores after the final cycle improved to 7.3 from 4.9 (p=0.0009). Additionally, 94% of patients agreed that the video was in keeping with their personal experience of the SAU and agreed that the video improved their understanding of what to expect from the visit.
    Conclusions: Interventions that improve communication with patients and adjust their expectations play an important role in improving patient satisfaction and their overall perception of care. This can be achieved with a simple patient information video.
    Language English
    Publishing date 2024-04-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.57926
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Quality improvement project to improve blood test time to results on the acute surgical unit in North Devon District Hospital.

    Hubbard, Thomas / Nugent, Sam / Bethune, Rob / Beaton, Ceri

    BMJ open quality

    2022  Volume 11, Issue 1

    MeSH term(s) Hematologic Tests ; Hospitals, District ; Humans ; Quality Improvement
    Language English
    Publishing date 2022-01-04
    Publishing country England
    Document type Journal Article
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2021-001650
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Adherence to Post-polypectomy Surveillance Guidelines at a Large District General Hospital.

    Butler, Daniel M / Myintmo, Aye / Flashman, Harriet / Ukoumunne, Obioha C / Bethune, Rob

    Cureus

    2023  Volume 15, Issue 2, Page(s) e35516

    Abstract: Introduction In 2020, the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regarding post-polypectomy surveillance. This ... ...

    Abstract Introduction In 2020, the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regarding post-polypectomy surveillance. This study aimed to establish clinician adherence at the Royal Devon University Healthcare NHS Foundation Trust to the 2020 guidelines compared to the now-retired 2010 guidelines. Materials and Methods Data on 152 patients treated under the 2010 guidelines and 133 patients treated under the 2020 guidelines were collected retrospectively from the hospital's colonoscopy database. Data were analysed to determine whether patients who had a colonoscopy fulfilled BSG/ACPGBI/PHE guidelines for follow-up. Costs were estimated using the price of colonoscopy in the NHS National Schedule. Results Approximately 41.4% (63/152) of patients were adherent to the 2010 guidelines while 66.2% (88/133) of patients were adherent to the 2020 guidelines. The difference in adherence rate was 24.7% (95% confidence interval 13.5% - 35.9%, p<0.0001). Nearly 37% (35/95) of patients who would have been followed up under the 2010 guidelines did not receive any follow-up as a result of the 2020 guidelines. This represents a cost saving of £36,892.28 per year in our hospital. Approximately 47% (28/60) of patients treated under the 2020 guidelines had surveillance colonoscopy planned when the guidelines recommended no follow-up. If every clinician were fully adherent to the 2020 guidelines, then a further £29,513.82 per year would have been saved. Discussion and Conclusion Following the introduction of the 2020 guidelines, adherence to polyp surveillance guidelines increased in our hospital. However, nearly half of the colonoscopies were performed unnecessarily due to non-adherence. Furthermore, our results demonstrate that the 2020 guidelines have decreased the need for follow-up.
    Language English
    Publishing date 2023-02-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.35516
    Database MEDical Literature Analysis and Retrieval System OnLINE

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