ABSTRACT
Since 2005, Acute National Health Service (NHS) Trusts have been funded using a system called Payment by Results. This provides a national or regionally set tariff per patient treated, according to a health resource group code. Health resource group codes vary according to diagnosis or procedures carried out and patient co-morbidities. This only funds trusts admitting patients rather than those advising remotely, as neurosurgical centres do for the majority of emergency referrals. Numbers of referrals and emergency admissions to our unit were analysed for the last 4 years in addition to consultant and secretarial time devoted to these cases. This demonstrated an increase in the number of referrals and time spent advising. For the trust hosting the neurosurgical department, this represents a funding deficit for services offered. In our region, this has been remedied by charging neighbouring trusts a fee for emergency neurosurgical referral advice. However, this is difficult to administrate and would be better served as a service-level agreement with our commissioners. Only when this has been achieved, can neurosurgical centres provide a comprehensive consultant-led emergency service without it being to the detriment of the host trust.
Subject(s)
After-Hours Care/economics , Delivery of Health Care/economics , Emergency Medical Services/economics , Neurosurgical Procedures/economics , After-Hours Care/statistics & numerical data , Costs and Cost Analysis , Delivery of Health Care/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Financing, Organized , Hospital Charges , Humans , Neurosurgical Procedures/statistics & numerical data , Referral and Consultation/economics , Referral and Consultation/statistics & numerical data , State Medicine/economics , United KingdomABSTRACT
The 2001 Report of the National Confidential Enquiry into Perioperative Deaths recommended that an echocardiogram should be performed on patients with aortic stenosis prior to anaesthesia. In this study we present the patient details, management and outcome of the 272 hip fracture patients with a previously undiagnosed murmur and echocardiographically proven aortic stenosis admitted from 2001-2005 in our hospital. The patients with aortic stenosis were significantly older, and had significantly lower Abbreviated Mental Test Scores, than the control group of 3698 hip fracture patients without aortic stenosis. There were significant trends toward general anaesthesia over spinal anaesthesia, and use of invasive monitoring of blood pressure, as the severity of the aortic stenosis increased. There were no significant trends towards higher 30-day or 1-year mortality rates as the severity of the aortic stenosis increased. Resources for rapid pre-operative echocardiograms should be made available for hip fracture patients as the results have significant implications for their subsequent anaesthetic management.
Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Hip Fractures/surgery , Age Factors , Aged , Aged, 80 and over , Anesthesia, General , Anesthesia, Spinal , Aortic Valve Stenosis/complications , Female , Heart Murmurs/etiology , Hip Fractures/complications , Humans , Incidental Findings , Male , Middle Aged , Nerve Block/methods , Preoperative Care/methods , Prognosis , Psychometrics , Severity of Illness Index , Survival Analysis , UltrasonographyABSTRACT
Cystadenocarcinoma is a rare salivary neoplasm. It occurs in major and minor salivary glands and usually has a good prognosis. Mandibular involvement by salivary gland tumors at presentation is exceptionally rare. We present the first case, to our knowledge, of salivary gland cystadenocarcinoma appearing as a cystic lesion in the mandible.
Subject(s)
Cystadenocarcinoma/pathology , Mandibular Neoplasms/pathology , Salivary Gland Neoplasms/pathology , Salivary Glands, Minor/pathology , Aged , Diagnosis, Differential , Female , Humans , Jaw Cysts/diagnosisABSTRACT
The case presented is that of a 5-year-old female with Wolf-Hirschhorn syndrome. Dental findings were severe hypodontia, late dental development, taurodontism of the primary molars, microdontia, and spacing. Hypodontia has previously been reported and therefore this case adds to the evidence that hypodontia may be a common feature of this syndrome. It also suggests that other dental anomalies could occur in children with Wolf-Hirschhorn syndrome.
Subject(s)
Abnormalities, Multiple , Anodontia , Craniofacial Abnormalities , Molar/abnormalities , Child , Chromosome Deletion , Chromosomes, Human, Pair 4 , Facies , Female , Heart Septal Defects, Atrial , Humans , Learning Disabilities , Syndrome , Tooth Crown/abnormalities , Tooth, Deciduous/abnormalitiesABSTRACT
To identify individuals who could be at high risk of developing vCJD, a sensitive immunohistochemical technique was used to detect prion protein in a retrospective series of over 3000 tonsil and appendix specimens. No positives were detected but further studies are required to help reduce uncertainties about possible future numbers of vCJD cases in the UK.
Subject(s)
Appendix/pathology , Creutzfeldt-Jakob Syndrome/pathology , Palatine Tonsil/pathology , Prions/analysis , Creutzfeldt-Jakob Syndrome/epidemiology , Cross-Sectional Studies , Humans , Incidence , Retrospective Studies , United Kingdom/epidemiologyABSTRACT
Of a total of 147 erythromycin-resistant Streptococcus pneumoniae isolates, 64 (43.5%) were resistant to erythromycin, clindamycin, and streptogramin B (MLSB phenotype), 57 of which possessed the ermB gene. Eighty-two (55.8%) were resistant to erythromycin alone (M phenotype), 81 of which possessed the mefE gene. One was erythromycin and streptogramin B resistant but susceptible to clindamycin (MS phenotype) and possessed neither the erm gene nor the mefE gene.
