ABSTRACT
Intraoperative bleeding can be difficult to manage and is associated with worse patient outcomes. Good intraoperative haemostasis by the surgeon is a key factor in ensuring a bloodless field and reducing intraoperative blood loss. There is a myriad of mechanical, thermal and energy-based techniques available to use, each of which has their own benefits and drawbacks. The decision of which to use will depend on patient and procedural factors as well as the surgeon's preference. This article reviews techniques commonly used in surgical practice to maintain intraoperative haemostasis.
Subject(s)
Hemostatics , Surgeons , Blood Loss, Surgical/prevention & control , Hemostasis , Hemostatic Techniques , Hemostatics/therapeutic use , HumansABSTRACT
BACKGROUND: A possible association between COVID-19 infection and thrombosis, either as a direct consequence of the virus or as a complication of inflammation, is emerging in the literature. Data on the incidence of venous thromboembolism (VTE) are extremely limited. METHODS: We describe three cases of thromboembolism refractory to heparin treatment, the incidence of VTE in an inpatient cohort, and a case-control study to identify risk factors associated with VTE. RESULTS: We identified 274 confirmed (208) or probable (66) COVID-19 patients. 21 (7.7%) were diagnosed with VTE. D-dimer was elevated in both cases (confirmed VTE) and controls (no confirmed VTE) but higher levels were seen in confirmed VTE cases (4.1 vs 1.2 µg/mL, p<0.001). CONCLUSION: Incidence of VTE is high in patients hospitalised with COVID-19. Urgent clinical trials are needed to evaluate the role of anticoagulation in COVID-19. Monitoring of D-dimer and anti-factor Xa levels may be beneficial in guiding management.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Fibrin Fibrinogen Degradation Products/metabolism , Pneumonia, Viral/complications , Venous Thromboembolism/blood , Venous Thromboembolism/epidemiology , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Biomarkers/blood , COVID-19 , Case-Control Studies , Coronavirus Infections/blood , Female , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Incidence , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Retrospective Studies , Risk Factors , SARS-CoV-2 , Venous Thromboembolism/drug therapy , Venous Thromboembolism/virologyABSTRACT
An evaluation of the patient experience, from referral to first assessment, at an outpatient emergency burns assessment service in a UK burn unit. All patients attending their first appointment were invited to complete a questionnaire, covering patient expectations following referral, their journey to the hospital and an evaluation of the appointment. Process mapping was used to map the patient journey within the department and identify functional bottlenecks and waits. 35 new patients completed the questionnaire over a four-week period in February 2019. 70% of respondents had received no printed information about their condition or the hospital prior to the appointment and 28% of patients did not know what to expect from attending the clinic. Patients incurred high direct and indirect costs in order to attend their appointments. 86% patients felt more confident about looking after their injury following their appointment. The patient journey through the clinic was observed for 19 patients; four functional bottlenecks were identified. The longest waits were for clinical photography and completion of nursing paperwork. A multimodal approach to this quality improvement project has enabled the service to identify process bottlenecks and through consultation with stakeholders, develop staff training and patient information to improve the service.
