ABSTRACT
A retrospective descriptive study included patients admitted with severe burns over the course of 10 years (2008-2018). Across all patients, there were 39 different species of bacteria, with 23 species being Gram-negative and 16 being Gram-positive bacteria, with also five different species of fungi cultured. Pseudomonas aeruginosa was the most commonly isolated organism, with 57.45% of patients having a positive culture. There was a significant difference in the number of P. aeruginosa isolated from patients that acquired their burns at work, in a garden, inside a vehicle, in a garage or in a public place. In patients that were positive for P. aeruginosa, the number of operations was higher (2.4) and the length of stay was significantly increased (80.1 days). Patients that suffered from substance abuse demonstrated significantly higher numbers of isolated P. aeruginosa (14.8%). Patients that suffered from both mental health illness and substance abuse demonstrated significantly higher numbers of P. aeruginosa isolated (18.5%). In the P. aeruginosa-negative group, there were significantly fewer patients that had been involved in a clothing fire. Furthermore, in the P. aeruginosa-negative patient cohort, the mortality rate was significantly higher (p = 0.002). Since the incidence of P. aeruginosa was also associated with a decreased mortality rate, it may be that patients admitted to hospital for shorter periods of time were less likely to be colonised with P. aeruginosa. This study demonstrates novel factors that may increase the incidence of P. aeruginosa isolated from burn patients.
ABSTRACT
Propranolol is the first-line agent for the treatment of infantile haemangioma (IH). Due to its non-selective beta blockade respiratory adverse events are commonplace. Atenolol is a selective beta-1 antagonist and is a second line for patients with a significant respiratory history or those intolerant of propranolol. Previous studies suggest that the two treatments are equally efficacious; however; the narrow side effect profile and once-daily administration of atenolol makes it an attractive alternative. The aim of this study was to compare the cost-effectiveness of atenolol and propranolol in the treatment of IH. Over a two-year period, five patients with nine IH received the first-line treatment with atenolol. Nine individual lesions from six propranolol patients were matched to these lesions, according to patient demographics and IH characteristics. Treatment response was determined by two independent clinician using both the Visual Analogue Score (VAS) and Haemangioma Activity Score (HAS). A cost-analysis of those treated with atenolol was undertaken and compared to the equivalent costing for standard and maximum dose propranolol. Treatment efficacy of atenolol was comparable to propranolol with mean change in VAS and HAS scores of -7.0 (vs -7.2) and 6.1 (vs 5.7), respectively. The cost analysis revealed atenolol was over 20 times less expensive than standard dose propranolol. In conclusion, the findings of this study suggest that atenolol is significantly less expensive and at least as effective as propranolol. These findings highlight the need for a multicentre randomised controlled trial to further investigate the cost-effectiveness of these two agents in the treatment of IH.
ABSTRACT
BACKGROUND: Operation notes often have omissions and are difficult to locate in patients notes despite clear guidance from the Royal College of Surgeons (RCS) 'Good Surgical Practice' 2014 outlining what should be included in operation notes. Procedure-specific proformas are rarely used by Plastic surgeons despite being utilised by other specialities. With an alarming rise of incidence of skin malignancies there has been an increase in the number of skin lesions referred to Plastic surgeons for excision. The need for reliable, reproducible, accurate and easily accessible operating notes for skin lesion excision is pivotal for continuity of care and treatment planning. This study aimed at comparing the quality of skin lesion operation notes prior-to and after implementation of a procedure-specific proforma in relation to RCS recommendations. METHODS: Fourteen parameters from the recommendations by the RCS 'Good Surgical Practice' 2014 guidelines were used to audit skin lesion operation notes. The study consisted of a retrospective audit of 80 operation notes and a prospective audit of 80 operation notes following the development and implementation of a skin lesion procedure-specific proforma. We assessed and compared the operation notes overall compliance with the RCS guidelines. Statistical analysis highlighting the difference between both groups was performed using the independent sample t-test. RESULTS: After implementation of the skin lesion procedure-specific proforma, the average compliance with the RCS recommendations increased significantly from 87.5% retrospectively to 98.8% prospectively (p-value 0.0414). In 6 of the 14 parameters assessed significant improvements with regards compliance to the guidelines was demonstrated. CONCLUSION: The development and implementation of a skin lesion procedure-specific proforma has demonstrated a significant improvement in the quality of operation notes within a Plastic surgery department which has the potential to minimise omissions and improve continuity of surgical patient care.
