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  1. Article: Promoting the management of acute upper gastrointestinal bleeds among junior doctors: a quality improvement project.

    Saunsbury, Emma / Allison, Emma / Colleypriest, Ben

    BMJ quality improvement reports

    2015  Volume 4, Issue 1

    Abstract: Though they are knowledgeable, foundation year one (FY1) doctors can lack skills and confidence in acute situations due to inexperience. This was witnessed when a new FY1 on call attended an acute upper gastrointestinal bleed (UGIB), a common emergency ... ...

    Abstract Though they are knowledgeable, foundation year one (FY1) doctors can lack skills and confidence in acute situations due to inexperience. This was witnessed when a new FY1 on call attended an acute upper gastrointestinal bleed (UGIB), a common emergency with a 10% in hospital mortality rate. We aimed to improve FY1s' ability to manage these critical patients through simulation based teaching, before and after the introduction of an algorithm summarising current guidelines. After assessing the FY1s' perceived level of confidence in managing UGIBs, they individually attended a simulation session which evaluated specific aspects of their assessment and management plans. Immediate debriefing and subsequent teaching sessions reinforced learning points, with an algorithm instituted as an aide mémoire to improve efficiency. A repeat simulation session assessed improvements in both subjective confidence and objective management targets. All FY1s expressed improved confidence in managing patients with UGIBs. There were improvements across the board in their assessment and management, notably: verbalisation of concern for hypotension increased to 100% (from 60%), two points of intravenous access requested in 100% of cases (from 53%), and a 76 second reduction in time to call for senior support. Collectively, these individual aspects led to improved patient care. Effective management of acute patients is best learnt through exposure, and simulation based teaching provides a safe but powerful modality to aid transition from textbook theory to ward situations. Algorithms can streamline care and hasten the stabilisation of patients. This project reinforces generic competencies that FY1s can translate to their management of not only UGIBs, but many acute presentations, providing a convincing argument for broader simulation use in FY1 teaching.
    Language English
    Publishing date 2015-11-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2677829-4
    ISSN 2050-1315
    ISSN 2050-1315
    DOI 10.1136/bmjquality.u206305.w3502
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity: a discussion paper.

    Cook, Tim / Gupta, Kim / Dyer, Chris / Fackrell, Robin / Wexler, Sarah / Boyes, Heather / Colleypriest, Ben / Graham, Richard / Meehan, Helen / Merritt, Sarah / Robinson, Derek / Marden, Bernie

    Journal of medical ethics

    2020  

    Abstract: Early in the COVID-19 pandemic there was widespread concern that healthcare systems would be overwhelmed, and specifically, that there would be insufficient critical care capacity in terms of beds, ventilators or staff to care for patients. In the UK, ... ...

    Abstract Early in the COVID-19 pandemic there was widespread concern that healthcare systems would be overwhelmed, and specifically, that there would be insufficient critical care capacity in terms of beds, ventilators or staff to care for patients. In the UK, this was avoided by a threefold approach involving widespread, rapid expansion of critical care capacity, reduction of healthcare demand from non-COVID-19 sources by temporarily pausing much of normal healthcare delivery, and by governmental and societal responses that reduced demand through national lockdown. Despite high-level documents designed to help manage limited critical care capacity, none provided sufficient operational direction to enable use at the bedside in situations requiring triage. We present and describe the development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity. The document combines a wide variety of factors known to impact on outcome from critical illness, integrated with broad-based clinical judgement to enable structured, explicit, transparent decision-making founded on robust ethical principles. It aims to improve communication and allocate resources fairly, while avoiding triage decisions based on a single disease, comorbidity, patient age or degree of frailty. It is designed to support and document decision-making. The document has not been needed to date, nor adopted as hospital policy. However, as the pandemic evolves, the resumption of necessary non-COVID-19 healthcare and economic activity mean capacity issues and the potential need for triage may yet return. The document is presented as a starting point for stakeholder feedback and discussion.
    Language English
    Publishing date 2020-11-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 194927-5
    ISSN 1473-4257 ; 0306-6800
    ISSN (online) 1473-4257
    ISSN 0306-6800
    DOI 10.1136/medethics-2020-106771
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1163: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Rates of Bile Acid Diarrhoea After Cholecystectomy: A Multicentre Audit.

    Farrugia, Alexia / Attard, Joseph Anthony / Hanmer, Stuart / Bullock, Stuart / McKay, Siobhan / Al-Azzawi, Marwa / Ali, Roshneen / Bond-Smith, Giles / Colleypriest, Ben / Dyer, Sarah / Masterman, Benjamin / Okocha, Michael / Osborne, Alan / Patel, Rikhilroy / Sallam, Mahmoud / Selveraj, Emmanuel / Shalaby, Samar / Sun, Wenrui / Todd, Fraser /
    Ward, Joel / Windle, Rebecca / Khan, Saboor / Williams, Nigel / Arasaradnam, Ramesh P

    World journal of surgery

    2021  Volume 45, Issue 8, Page(s) 2447–2453

    Abstract: Introduction: Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation, e.g. following cholecystectomy. Post-cholecystectomy diarrhoea has been reported in 2.1-57.2% of patients; however, this is not necessarily due to BAD. ...

    Abstract Introduction: Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation, e.g. following cholecystectomy. Post-cholecystectomy diarrhoea has been reported in 2.1-57.2% of patients; however, this is not necessarily due to BAD. The aim of this study was to determine the rates of bile acid diarrhoea diagnosis after cholecystectomy and to consider investigation practices.
    Methods: A retrospective analysis of electronic databases from five large centres detailing patients who underwent laparoscopic cholecystectomy between 2013 and 2017 was cross-referenced with a list of patients who underwent
    Results: A total of 9439 patients underwent a laparoscopic cholecystectomy between 1 January 2013 and 31 December 2017 in the five centres. In total, 202 patients (2.1%) underwent investigation for diarrhoea via
    Discussion/conclusion: Only a small proportion of patients, post-cholecystectomy, were investigated for diarrhoea with significant time delay to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher, and clinicians need to have an increased awareness of this condition due to its amenability to treatment.
    MeSH term(s) Bile Acids and Salts ; Cholecystectomy/adverse effects ; Diarrhea/epidemiology ; Diarrhea/etiology ; Humans ; Prevalence ; Retrospective Studies
    Chemical Substances Bile Acids and Salts
    Language English
    Publishing date 2021-05-12
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-021-06147-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1336: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article: Understanding why patients die after gastrostomy tube insertion: a retrospective analysis of mortality.

    Longcroft-Wheaton, Gaius / Marden, Peter / Colleypriest, Ben / Gavin, Daniel / Taylor, Gordon / Farrant, Mark

    JPEN. Journal of parenteral and enteral nutrition

    2009  Volume 33, Issue 4, Page(s) 375–379

    Abstract: Objectives: To understand the causes of mortality of inpatients receiving a percutaneous endoscopic gastrostomy (PEG) tube compared with a survival curve predicted from a model proposed by Levine et al (2007).: Design: A retrospective study of ... ...

    Abstract Objectives: To understand the causes of mortality of inpatients receiving a percutaneous endoscopic gastrostomy (PEG) tube compared with a survival curve predicted from a model proposed by Levine et al (2007).
    Design: A retrospective study of patients receiving a PEG over an 18-month period.
    Setting: Royal United Hospital Bath, a district general hospital in the southwest of England.
    Patients: Fifty-five cases, with 44 found eligible for inclusion.
    Interventions: A Levine score was calculated for this cohort. A survival curve after PEG was produced and compared with the Kaplan-Meier curve predicted by the Levine model.
    Main outcome measures: Mortality over a period of 1 year.
    Results: The mortality at 1, 3, 6, and 12 months was 16%, 20%, 25%, and 28%, respectively. This matched the predicted death rate from the Levine model closely (Pearson's rank correlation coefficient = 0.96).
    Conclusions: The authors found that the mortality of patients receiving a PEG followed that predicted for a similar cohort of patients without PEGs in the Levine model. This suggests that the deaths observed were due to underlying comorbidities, can provide a baseline for mortality targets for PEG services, and is useful patient information regarding the risks and benefits of the procedure. The findings demonstrate that PEG does no harm and supports the accepted opinion that nutrition support is associated with a better outcome. Furthermore, they show that most deaths occur within the first month of placement and would support arguments for delaying placement until outcome from the underlying condition is more predictable.
    MeSH term(s) Aged ; Aged, 80 and over ; Cause of Death ; Chi-Square Distribution ; Comorbidity ; Enteral Nutrition/methods ; Enteral Nutrition/mortality ; Female ; Gastroscopy ; Gastrostomy/instrumentation ; Gastrostomy/mortality ; Humans ; Intubation, Gastrointestinal/mortality ; Kaplan-Meier Estimate ; Male ; Retrospective Studies ; Survival Rate
    Language English
    Publishing date 2009-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 800861-9
    ISSN 0148-6071
    ISSN 0148-6071
    DOI 10.1177/0148607108327156
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1524: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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