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Hudson M, Luo R, Reese G, Koizia L, Fertleman M, Sritharan G. TU6.3 Limited geriatrician input is better than none: Geriatrician led team meetings improve understanding of frailty and medical management of older general surgical patients, meeting NELA standards of care. Br J Surg 2022. [DOI: 10.1093/bjs/znac248.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aims
General surgical teams are treating an increasing number of frail, older patients.1 Geriatrician involvement has shown improvement in length of stay.2
We sought to demonstrate that even with limited geriatrician involvement we could meet NELA targets of completing frailty scores, increasing frequency of geriatrician reviews and improving team education.
Methods
We introduced twice-weekly geriatrician-led team meetings followed by selected patient reviews to best optimise the care of older patients. Surgical trainees, nurses and allied health staff attended each meeting. The team was educated by the geriatrician about geriatric medicine and the importance of recognising frailty. They were also supported in performing independent frailty assessments.
We measured frequency of frailty score recorded and geriatrician involvement pre- and post-set up of this limited service. We also conducted semi structured interviews of staff pre- and post-intervention related to educational impact.
Results
94% (29/31) of patients aged over 65 had a clinical frailty score recorded post intervention compared to 9% (3/35) originally. All 31 had geriatrician involvement. Comments from the surgical team included: ‘pro-active approach to identifying frailty’, ‘early identification of barriers to discharging complex patients' and ‘improvement in understanding of geriatric giants’.
Conclusions
The Emergency Laparotomy and Frailty (ELF) study recognised that frailer individuals were vulnerable to adverse outcomes and longer hospital stays.3 Our limited geriatrician-led service supported surgical doctors and the MDT in understanding frailty and considering its impact. Within a short space of time we aligned with NELA recommendations, improved patient outcomes and improved MDT understanding of geriatric medicine.
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Affiliation(s)
| | - Rong Luo
- Imperial College Healthcare NHS Trust , London
| | | | - Louis Koizia
- Cutrale Perioperative and Ageing Group, Imperial College , London
| | | | - Ganan Sritharan
- Cutrale Perioperative and Ageing Group, Imperial College , London
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2
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Luo R, Hudson M, Cepeda V, Reese G, Sritharan G, Peck G, Morgan C, Koizia L, Fertleman M. 1029 EVEN LIMITED GERIATRICIAN INVOLVEMENT REDUCES LENGTH OF STAY FOR ALL-AGE ACUTE GENERAL SURGERY PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
More than half of patients undergoing emergency general surgery are older than 651. The Emergency Laparotomy and Frailty (ELF) study identified that frail patients (CFS ≥5) were vulnerable to adverse outcomes and longer hospital stays and should be reviewed by a geriatrician2. The 2021 National Emergency Laparotomy Audit (NELA) found that only 27% were reviewed by a geriatrician1. Local problem A local hospital had no routine geriatrician input to perioperative care of older people admitted under the care of general surgeons.
Method/Intervention
In one month prior to intervention, we noted CFS recorded once and a geriatrician involved in only 3 patients over the age of 65 (n = 35). We introduced a service comprising twice-weekly geriatrician-led multi-disciplinary team (MDT) meetings of all-age patients followed by selected patient ward rounds. This equated to 2.5 Programmed Activity’s (PA) per week. After another month we measured the number of patients having CFS recorded, those who had geriatrician involvement and length of stay. We also surveyed members of the MDT.
Results
All 31 patients aged over 65 received geriatrician input with 93.5% having a CFS recorded. Length of stay of all-age patients (n = 75) was reduced from 12.8 to 8.8 days, with the most significant reduction of 6.5 days in over 65’s (16.7 to 10.2); >200 bed days saved for older people. The MDT comments included: ‘improved MDT communication’, ‘early identification of discharge barriers’ and ‘pro-active approach’.
Conclusion
NELA highlights that consistent geriatrician input remains generally poor. Even a limited geriatrician-led service can be highly effective at guaranteeing review of appropriate patients in line with recommendations from NELA. Alongside targeted patient review geriatricians can support and lead decision making of all-age patients. This cost-effective strategy can reduce length of stay for young and old alike and gained excellent feedback from the MDT.
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Affiliation(s)
- R Luo
- Imperial College Healthcare NHS Trust , London
| | - M Hudson
- Imperial College Healthcare NHS Trust , London
| | - V Cepeda
- Imperial College Healthcare NHS Trust , London
| | - G Reese
- Imperial College Healthcare NHS Trust , London
| | - G Sritharan
- Cutrale Perioperative and Ageing group, Imperial College London
| | - G Peck
- Cutrale Perioperative and Ageing group, Imperial College London
| | - C Morgan
- Cutrale Perioperative and Ageing group, Imperial College London
| | - L Koizia
- Cutrale Perioperative and Ageing group, Imperial College London
| | - M Fertleman
- Cutrale Perioperative and Ageing group, Imperial College London
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3
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Hudson MAJ, Atkin J, Lumley G, Singh S, Varma S, Shenoy D, Morgan C, Peck G, Fertleman M, Koizia L. 694 IMPROVING OPIATE PRESCRIBING IN OLDER ADULTS WITH HIP FRACTURES TO COMBAT THE IATROGENIC FALLOUT. Age Ageing 2022. [DOI: 10.1093/ageing/afac034.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The number of opioid prescriptions in older patients has increased dramatically and it is recognised that opioids are the fourth most likely drug to cause preventable hospital admissions. The adverse effects of opioids occur more frequently in the geriatric population. Little is known about the impact of postoperative pain in older adults. NICE recommends paracetamol with additional opioids if there is insufficient postoperative pain relief. Multidisciplinary management with early and then daily physiotherapy is critical. We have assessed pre-morbid, immediate and prolonged use of opioids in patients following hip fracture. Local problem Pre-intervention analysis identified 79% (57/72) of all patients being discharged on opiates. At 4-months, 37% (17/46) of those were still using them. This represents 28% (17/61) of all patients.
Methods
Analysis of all patients (excluding poly-trauma) with hip fractures over the age of 60 years admitted to St Mary’s Hospital. Interventions Development of local guideline on analgesia prescribing; particularly focusing senior geriatrician led decision making. Prescribing oxycodone for first 72-hours and initially using nerve block. Avoidance of transdermal preparations and withdrawing stronger opioids prior to discharge. Clear instructions for GP’s on a stop date and need for community review. Patient information leaflet dispensed with all discharge opioid prescriptions.
Results
Post-intervention cycle; 17% (11/63) of patients were taking prescribed opioids prior to admission (similar to the pre-cohort). 52% (33/63) were discharged on opiates, down from 79%. At 4-months, of those discharged on opioids, 30% (9/30) were still using them; lower than in the first cycle (37%). Overall reduction from 28% to 16% of patients on opioids at 4-months.
Conclusion
The use of specific hip fracture analgesia guideline, senior geriatrician decision-making and support to community colleagues can reduce in-patient and community opiate prescribing, and stem the growing problem of opioid addiction, misuse and iatrogenic re-admission.
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Affiliation(s)
- M A J Hudson
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - J Atkin
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - G Lumley
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - S Singh
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - S Varma
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - D Shenoy
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - C Morgan
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - G Peck
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - M Fertleman
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - L Koizia
- Orthogeriatric and Surgical Liaison Department, Imperial College Healthcare NHS Trust, St Mary's Hospital, London
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Chauhan D, Kilic Y, Segal JP, Patel N, Koizia L. An Unusual Cause of Gastrointestinal Perforation in an Adolescent Patient With Beta-Thalassemia on Deferasirox and SARS-CoV-2 Infection. J Hematol 2021; 10:76-79. [PMID: 34007369 PMCID: PMC8110227 DOI: 10.14740/jh815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
Chelation therapy is recognized as a safe and effective treatment option in patients with beta-thalassemia with iron overload. We report an 18-year-old male with acute abdomen and gastrointestinal bleeding with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection secondary to gastric perforation due to chelation therapy. This patient had a prolonged intensive care stay with complications of SARS-CoV-2 and a small bowel obstruction post-surgery that resolved after conservative management. Given the acute presentation, chelation therapy use and concomitant SARS-CoV-2 infection, clinicians should keep an open mind on the differential diagnosis of acute abdomen in patients with beta-thalassemia.
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Affiliation(s)
- Devkishan Chauhan
- The Hillingdon Hospital, London, UK.,These authors contributed equally and are joint first authors
| | - Yakup Kilic
- The Hillingdon Hospital, London, UK.,These authors contributed equally and are joint first authors
| | | | | | - Louis Koizia
- Cutrale Perioperative and Ageing Group, Imperial College, London, UK
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van der Kruk E, Silverman AK, Koizia L, Reilly P, Fertleman M, Bull AMJ. Age-related compensation: Neuromusculoskeletal capacity, reserve & movement objectives. J Biomech 2021; 122:110385. [PMID: 33910081 DOI: 10.1016/j.jbiomech.2021.110385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
The prevention, mitigation and treatment of movement impairments, ideally, requires early diagnosis or identification. As the human movement system has physiological and functional redundancy, movement limitations do not promptly arise at the onset of physical decline. A such, prediction of movement limitations is complex: it is unclear how much decline can be tolerated before movement limitations start. Currently, the term 'homeostatic reserve' or 'physiological reserve' is used to refer to the redundancy of the human biological system, but these terms do not describe the redundancy in the muscle architecture of the human body. The result of functional redundancy is compensation. Although compensation is an early predictor of movement limitations, clear definitions are lacking and the topic is underexposed in literature. The aim of this article is to provide a definition of compensation and emphasize its importance. Compensation is defined as an alteration in the movement trajectory and/or altering muscle recruitment to complete a movement task. Compensation for capacity is the result of a lack in neuromusculoskeletal reserve, where reserve is defined as the difference between the capacity (physiological abilities of the neuromusculoskeletal system) and the task demand. Compensation for movement objectives is a result of a shift in weighting of movement objectives, reflecting changing priorities. Studying compensation in biomechanics requires altered protocols in experimental set-ups, musculoskeletal models that are not reliant on prescribed movement, and inclusion of alternative movement objectives in optimal control theory.
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Affiliation(s)
- Eline van der Kruk
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Bioengineering, Imperial College London, London, UK.
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, USA.
| | - Louis Koizia
- Department of Medicine, Imperial College Healthcare, London, UK.
| | - Peter Reilly
- Department of Orthopaedics, Imperial College Healthcare, London, UK.
| | | | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK.
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6
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Martin G, Koizia L, Kooner A, Cafferkey J, Ross C, Purkayastha S, Sivananthan A, Tanna A, Pratt P, Kinross J. Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation. J Med Internet Res 2020; 22:e21486. [PMID: 32730222 PMCID: PMC7431236 DOI: 10.2196/21486] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility to and quality of care, and to protect staff. Mixed-reality (MR) technology is the latest iteration of telemedicine innovation; it is a logical next step in the move toward the provision of digitally supported clinical care and medical education. This technology has the potential to revolutionize care both during and after the COVID-19 pandemic. OBJECTIVE This pilot project sought to deploy the HoloLens2 MR device to support the delivery of remote care in COVID-19 hospital environments. METHODS A prospective, observational, nested cohort evaluation of the HoloLens2 was undertaken across three distinct clinical clusters in a teaching hospital in the United Kingdom. Data pertaining to staff exposure to high-risk COVID-19 environments and personal protective equipment (PPE) use by clinical staff (N=28) were collected, and assessments of acceptability and feasibility were conducted. RESULTS The deployment of the HoloLens2 led to a 51.5% reduction in time exposed to harm for staff looking after COVID-19 patients (3.32 vs 1.63 hours/day/staff member; P=.002), and an 83.1% reduction in the amount of PPE used (178 vs 30 items/round/day; P=.02). This represents 222.98 hours of reduced staff exposure to COVID-19, and 3100 fewer PPE items used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. In total, 89.3% (25/28) of users felt that their clinical team was safer when using the HoloLens2. CONCLUSIONS New technologies have a role in minimizing exposure to nosocomial infection, optimizing the use of PPE, and enhancing aspects of care. Deploying such technologies at pace requires context-specific information security, infection control, user experience, and workflow integration to be addressed at the outset and led by clinical end-users. The deployment of new telemedicine technology must be supported with objective evidence for its safety and effectiveness to ensure maximum impact.
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Affiliation(s)
- Guy Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louis Koizia
- Cutrale Perioperative and Ageing Group, Imperial College London, London, United Kingdom
| | - Angad Kooner
- Division of Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John Cafferkey
- Division of Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Clare Ross
- Division of Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Arun Sivananthan
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Anisha Tanna
- West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Philip Pratt
- The Helix Centre, Imperial College London, London, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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7
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Lee A, Koizia L, Dani M, Fertleman M. Corrigendum: 'Nipples to knees' in the 'Me Too' era. Clin Med (Lond) 2020; 20:379. [PMID: 32532708 DOI: 10.7861/clinmed.corr.20.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Louis Koizia
- Imperial College Healthcare NHS Trust, London, UK
| | - Melanie Dani
- Imperial College Healthcare NHS Trust, London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
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8
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Abstract
We live in an era of increased societal awareness of sexual harassment and frequent reporting by patients of inappropriate conduct. In this article, we reflect on traditional teaching of physical examination involving full exposure and intimate examinations, and whether this is still necessary, or appropriate, in clinical practice today. We discuss the balance between appropriate physical examination and inappropriate patient exposure resulting in perceived or actual harassment. We argue that ethical values and societal values change with time, and there is an onus on medical educators to reflect societal sensitivities in their teaching.
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Affiliation(s)
| | - Louis Koizia
- Imperial College Healthcare NHS Trust, London, UK
| | - Melanie Dani
- Imperial College Healthcare NHS Trust, London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
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Abstract
Introduction The prevalence of major trauma in the elderly is increasing with ageing western societies. Frailty is now a well-recognised predictor of poor outcome after injury; however, few studies have focused on the progression of frailty and patients’ perceptions of their injuries after discharge. Aim We hypothesised that the number of elderly patients that survive major trauma is low and, of those that do, frailty post injury worsens with overall negative views about quality of life. To investigate this, we examined mortality, frailty and patient experience for elderly major trauma admissions to a level 1 trauma centre at one year after admission. Method All consecutive patients > 75 with an injury severity score of > 15 were included in the study. Patients were invited to participate in a structured telephone interview to assess change in frailty status as well as assess patient experience after injury. Results A total of 79 patients met inclusion criteria; 34 patients had died and 17 were uncontactable; 88% had become more frail (p < 0.05), and more than half commented positively on their overall quality of life following injury. Conclusions These findings highlight the elevated mortality in elderly major trauma patients, but also indicate that preconceived opinions on quality of life, post injury, might not be appropriate.
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Affiliation(s)
- Louis Koizia
- Major Trauma Centre, St Mary's Hospital, London, UK
| | | | | | - George Peck
- Major Trauma Centre, St Mary's Hospital, London, UK
| | - Mark Wilson
- Major Trauma Centre, St Mary's Hospital, London, UK
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Shipway D, Koizia L, Winterkorn N, Fertleman M, Ziprin P, Moorthy K. Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery. Future Healthc J 2018; 5:108-116. [PMID: 31098544 PMCID: PMC6502563 DOI: 10.7861/futurehosp.5-2-108] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The older surgical patient is well known to be at high risk of increased mortality and medical complications in the perioperative period. These occur due to a variety of patient and service related factors. The need for physician support is recognised and liaison models of care can reduce complications and length of stay (LOS) in some surgical specialties. Limited evidence exists evaluating their role in emergency and planned gastrointestinal surgery. We aimed to establish and evaluate a geriatric surgical liaison service for emergency and elective gastrointestinal surgery. We found that embedded geriatrician liaison and process change throughout the surgical pathway was associated with a mean LOS reduction of 3.1 days for all surgical patients aged >60 years (p=0.007). Mean LOS reduction for emergency surgical admissions aged >60 was 4.4 days (p=0.005). Embedded geriatric surgical liaison models of care can be successfully adapted for emergency general and gastrointestinal surgery. In times of financial constraint, reductions in LOS may make modest investment in similar services economically viable.
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Affiliation(s)
| | - Louis Koizia
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Michael Fertleman
- Imperial College Healthcare NHS Trust, London, UK and Imperial College, London, UK
| | - Paul Ziprin
- Imperial College London, London, UK and honorary consultant colorectal surgeon, Imperial College Healthcare NHS Trust, London, UK
| | - Krishna Moorthy
- Imperial College London and honorary consultant oesophagogastric surgeon, Imperial College Healthcare NHS Trust, London, UK
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11
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Baheerathan A, Chauhan D, Koizia L, O'Neal H. Idiopathic normal pressure hydrocephalus. BMJ 2016; 354:i3974. [PMID: 27534774 DOI: 10.1136/bmj.i3974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Devkishan Chauhan
- Department of Medicine, Kingston Hospital, Kingston-Upon-Thames KT2 7QB, UK
| | - Louis Koizia
- Department of Medicine, Northwick Park Hospital, Harrow HA1 3UJ, UK
| | - Hugh O'Neal
- Care of the Elderly Department, Worthing Hospital, Worthing BN11 2DH, UK
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12
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Koizia L, Zielicka Z, Berman P, Patel PH. A man with lower back pain. Assoc Med J 2013. [DOI: 10.1136/sbmj.e7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Abstract
OBJECTIVES To assess the needs of cancer patients for information about their condition and to understand the psychological impact of their illness. BACKGROUND The discussion of prognosis and treatment options in the palliative setting is an important and difficult part of oncology practice. To evaluate this, we examined the experiences of cancer patients of the physical and psychological impact of their disease on their life, and their opinions on the communication of end-of-life decisions and treatment options. METHODS A patient questionnaire was designed that encompassed communication regarding treatment and prognosis, quality-of-life attitudes subsequent to cancer diagnosis, end-of-life care and cancer drug funding. One hundred and twenty-five patients with a diagnosis of cancer were asked to participate and 96 questionnaires were completed and available for analysis. The questionnaire consisted of 63 questions and was completed in both an inpatient and outpatient setting. RESULTS This survey brought to light a number of controversial issues in cancer service provision, highlighting the emotional and psychological changes brought about by a cancer diagnosis. Major concerns of our patients include fear of death and pain, changes in interpersonal relationships and financial constraints. Only 66% of the patients wanted to be given a prognosis by their clinicians and just 70% of the patients recalled being given a detailed prognosis. 11% of the patients were not prepared to undergo palliative treatment. In all, 7% were not prepared to accept treatment for 1 year and 2% for 5 years of life in exchange for the potential side effects of cytotoxic chemotherapy. 12% of the patients would not want to be in possession of the information that they were in the terminal phase of the illness with a short time to live and 16% would not want this discussed with their next of kin. CONCLUSION This study informs medical professionals about the importance of tailoring information to the needs of the individual patient, and we feel it provides insights into the successes and failures of our communication with cancer patients. It is important that difficult discussions are personalized to the individual patients' wishes. These can vary dramatically both in the area of disclosure of bad news in prognosis and in end-of-life decision making. This study provides compelling evidence for good advanced care planning at an early stage in the management of patients with terminal cancers.
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Affiliation(s)
- C Alifrangis
- Department of Surgery and Cancer, Division of Cancer, Imperial College London, Room 1014, Garry Weston Centre, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
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14
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Koizia L, Zielicka Z. Media and medical response to the introduction of prescription charging in the National Health Service. Pharm Hist (Lond) 2009; 39:59-64. [PMID: 20509505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In April 2009 the National Health Service (NHS) prescription charge rose to pounds 7.20 in England, whereas in Wales prescriptions have been free since 2007. This major difference has led to much controversy amongst the public, media and medical profession. This paper tries to identify the response of the media and medical profession to the introduction of prescription charging in the NHS. When established on July 5th 1948 the NHS provided free healthcare including prescriptions to the entire population of Britain. However, following concerns around finance, the Conservative government introduced a one shilling prescription charge in June 1952. Information gathered from newspapers, despite their differing readerships and political affiliations, revealed that the media generally accepted the charge with little opposition. In contrast, large debate and divisions arose amongst the medical profession, with huge volumes of literature being published on the issue. The London based British Medical Association opposed the charge as they felt doctors were not government tax collectors; whereas rural doctors became concerned that the charge would affect the doctor-patient relationship. This paper identifies that the introduction of the prescription charge, not only aroused debate in parliament, but caused a spectrum of views amongst lay and medical circles.
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