RESUMEN
BACKGROUND: Clinical handover is an essential step in the surgical patient's hospital journey, but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team. METHODS: We designed a pre-post study examining the quality of pre-operative cardiothoracic patient handovers before and after the introduction of an intra-departmentally designed "Cardiothoracic Clinical Handover Tool" based on the Royal College of Surgeons of England's guidelines for "Safe Handover". RESULTS: Forty clinical handovers were assessed in each arm of the study. Handover quality improved from a score of 63.75% to 88.57% (p = < 0.001). This prolonged handover duration from a mean of 72.1 to 102.4 seconds per case (p = 0.003). Interruptions occurred in 27.5% of pre- and 25% of post-intervention handovers. Interruptions resulted in increased handover duration in both pre- and post-intervention groups (114.6 vs 77.7 seconds, p = 0.012) and poorer quality handovers in the pre-intervention group (51.28% vs 68.42%, p = 0.03) but failed to impact handover quality in the post-intervention group (88.57% vs 88.57%, p = 1). CONCLUSIONS: Clinical handover tools have the potential to enhance the quality of pre-operative handover and protect against poor handover practices such as interruptions, safe-guarding patient welfare. We provide the first cardiothoracic specific pre-operative handover tool based on the RCSE guidelines.
RESUMEN
Lymphoma of a dural genesis is a distinct variant of primary central nervous system lymphoma and is rare. It putatively has a more benign clinical course. Cranial primary dural lymphoma is more often marginal zone B-cell lymphoma, whereas spinal primary dural lymphoma is most commonly diffuse large B-cell lymphoma.We report a male patient who presented with subacute progressive radiculopathy due to a compressive infiltrative lumbosacral spinal lesion. This was determined to be primary dural diffuse large B-cell lymphoma. The radiology, therapeutic considerations and differentiating biological characteristics of primary dural lymphoma, differ from other primary central nervous system lymphomas.Primary dural lymphoma is under-represented in the medical literature. It has unique clinical characteristics. The optimal treatment algorithm remains undefined, but there is some evidence suggesting a benefit of surgical cytoreductive therapy in the first instance, and low-dose radiotherapy may be an effective adjuvant therapy in addition to chemotherapeutic and immunotherapeutic agents.
