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Emerson H. 984 Hospital Transmission of COVID-19 in Trauma Surgery. Br J Surg 2021. [PMCID: PMC8135868 DOI: 10.1093/bjs/znab134.106] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction A single-site retrospective study identified a suspected cluster of hospital-acquired COVID-19 in trauma patients. The study aims to identify contributing factors in order to minimise future risk to patients and staff. Method A single-site retrospective cohort study including all T&O patients who underwent surgery with confirmed peri-operative COVID-19 infection. The primary outcome was 30-day mortality. Exposures investigated included diagnostic timing and theatre designation. Results 92% of participants were not tested pre-operatively. 75% met the criteria for hospital acquired COVID-19. Only 2 patients were operated on in designated COVID-19 theatres. Two lists accounted for 50% of the T&O COVID-positive patients. Remaining patients on both lists were discharged without further testing. Local 30-day mortality rate (25%) was in line with the findings of the international COVIDSurg Study (23.8%). No further COVID-positive T&O cases identified since the introduction of blanket admission swabbing. Conclusions The majority of patients did not meet criteria for pre-operative testing. Thus, were not operated on in appropriately designated theatres despite unknown COVID status, increasing risk of cross-contamination. Complacency due to designation of “clean” and “dirty” wards, atypical presentation and bay nursing may have contributed to hospital transmission. Findings emphasise the importance of treating patients as COVID positive until proven otherwise.
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Affiliation(s)
- H Emerson
- Gateshead NHS Foundation Trust, Gateshead, United Kingdom
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Hampton T, Allan J, Pearson D, Emerson H, Jones GH, Junaid M, Kanzara T, Lau AS, Siau R, Williams SP, Wilkie MD. A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside. J Laryngol Otol 2020; 134:1-6. [PMID: 33138870 DOI: 10.1017/s0022215120002224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/07/2022]
Abstract
BACKGROUND There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks. METHODS A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites. RESULTS A total of 225 procedures were performed (range of 1.2-9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres. CONCLUSION Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.
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Affiliation(s)
- T Hampton
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - J Allan
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - D Pearson
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - H Emerson
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - G H Jones
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - M Junaid
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - T Kanzara
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Mid Cheshire Hospitals NHS Trust, Crewe, UK
| | - A S Lau
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - R Siau
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - S P Williams
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - M D Wilkie
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
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Brimioulle M, Al-Lami A, Marzouk S, Emerson H, Balfour A, Dhar V, Nixon IJ. Ensuring patient safety when implementing a new diagnostic pathway for thyroid nodules. Ann R Coll Surg Engl 2018. [PMID: 29543048 DOI: 10.1308/rcsann.2018.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
Introduction The aim of this study was to determine whether ultrasound alone is sufficient to safely exclude malignancy in thyroid nodules in a district general hospital setting, to comply with the latest British Thyroid Association guidelines. Methods This retrospective study investigated the quality of ultrasound reporting and the correlation between ultrasound report and histology for individual thyroid nodules. Cases were selected from the thyroid multidisciplinary meeting and included all patients having undergone surgery for a thyroid malignancy in a one-year period. Results Forty-seven patients were included in the study. Ultrasound reports were reviewed and assessed, in which 21 clinicians were involved; 36% of scans included a summary of whether the nodule(s) overall appeared benign, equivocal, suspicious or malignant; 4% of reports included a U classification; 81% of reports commented on cervical lymph nodes. Ultrasound was compared with histology. The sensitivity of ultrasound in correctly identifying nodules requiring further investigation was of 56% and specificity was 81%. Positive predictive value was 81% and negative predictive value was 56%. Discussion These findings suggest that, in a district general hospital setting without a dedicated head and neck radiologist, using only ultrasound and limiting fine-needle aspiration cytology to identify suspicious nodules may not be safe, as a high number of nodules appearing benign on ultrasound may ultimately prove to be malignant.
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Affiliation(s)
- M Brimioulle
- Ear, Nose and Throat Department, Royal Sussex County Hospital, Brighton and Sussex University Hospitals , Brighton , UK
| | - A Al-Lami
- Ear, Nose and Throat Department, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Willesborough , Ashford , UK
| | - S Marzouk
- Ear, Nose and Throat Department, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Willesborough , Ashford , UK
| | - H Emerson
- Ear, Nose and Throat Department, Medway Maritime Hospital , Gillingam , UK
| | - A Balfour
- Ear, Nose and Throat Department, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Willesborough , Ashford , UK
| | - V Dhar
- Ear, Nose and Throat Department, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Willesborough , Ashford , UK
| | - I J Nixon
- Ear, Nose and Throat Department, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Willesborough , Ashford , UK
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Abstract
The epidemics we have observed, were due to the presence and growth in the frogs of Bacillus hydrophilus fuscus. This was proved by recovering the bacillus in pure culture from the body fluids of frogs sick or dead of the disease, and the inoculation of healthy frogs with an emulsion of the pure culture, and by obtaining the same clinical picture and pathological findings as in the original diseased frogs; and, finally, by recovering the bacillus in pure culture from frogs inoculated and sick or dying as a result of the inoculation. The disease is widely distributed throughout North America and Europe, and in this country and Canada is known as "red-leg." It has been observed by us chiefly in the warm weather of September and October. The disease is characterized by congestion of the ventral surfaces of the body, with more or less ulceration in, and hæmorrhage beneath, the skin, bloating due to serous exudation into the lymph sacs, gradual failure to respond to stimuli, which symptoms are followed by coma and death, the last being occasionally preceded by tetanic seizures. After death hæmorrhages into the muscles and degenerative changes in the muscles, spleen, liver, and, to a slight degree, in the intestinal tract, are found. The blood shows an advanced degree of anæmia and leucocytosis. Predisposing causes of the disease are lesions of the skin, which seem to be the usual portal of entry of the infection, and lowered resistance from heat and from anæmia. By a series of controlled experiments with inoculated frogs we have shown that, while temperatures a little above freezing have no harmful effect upon the frogs, they completely control all manifestations of the disease in inoculated or diseased frogs, if the frogs are left in the cold for a period as long as seven days; and, further, that even short periods in the cold chamber will bring about a delay of the fatal results in diseased or inoculated frogs. The anæmia so often found in apparently healthy frogs seems in many cases to be due to the presence in the lungs of the frog of a parasite, the Distomum cylindraceum, which, occurring in sufficiently large numbers in an individual frog, is capable of materially diminishing the available supply of red corpuscles. Severe laking of the blood, the presence of numerous isolated red-cell nuclei, and great diminution in the number, or almost total absence of the red cells in the diseased frogs, are in proportion to the severity of the infection and due to bacterial action. The presence of the hæmatozoan parasite, the Drepanidium, does not play any part as a predisposing or exciting cause of the disease. The ascarid Rhabdomena nigrovenosum, although frequently present as a parasite in the lungs of the frogs, plays no part in causing or promoting the disease.
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Affiliation(s)
- H Emerson
- Laboratories of Physiology and Pathology at the College of Physicians and Surgeons of Columbia University
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Armstrong DB, Chapin CV, Emerson H, Freeman AW, Frost WH, Thompson LR, Winslow CE, Dublin LI. REPORT OF THE COMMITTEE ON MUNICIPAL HEALTH DEPARTMENT PRACTICE. Am J Public Health (N Y) 2008; 14:184-7. [PMID: 18011159 DOI: 10.2105/ajph.14.3.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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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Affiliation(s)
- H Emerson
- De Lamar Institute of Public Health, Columbia University, New York City
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Bunney WE, Emerson H, Fraser DT, Kendrick P, McKhann CF, Top FH, Vaughan HF, Veldee MV, Volk VK. Multiple Antigens for Active Immunization : Report of the Study Committee on Multiple Antigens, Subcommittee on Evalution of Administrative Practices. Am J Public Health Nations Health 2008; 34:452-4. [PMID: 18015981 DOI: 10.2105/ajph.34.5.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Emerson H. Wilmer Cave Wright, Ph.D.-1865-1951. Bull N Y Acad Med 1954; 30:223-226. [PMID: 19312610 PMCID: PMC1804414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Emerson H. Some Distinctions Between Health Services and Care of the Sick. Can Med Assoc J 1944; 51:234-239. [PMID: 20323194 PMCID: PMC1581766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Emerson H. Uniformity in Control of Communicable Diseases. Am J Public Health Nations Health 1942; 32:131-6. [PMID: 18015562 DOI: 10.2105/ajph.32.2.131] [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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Emerson H. The Marriage of Medicine and Civil Government. Bull N Y Acad Med 1941; 17:548-554. [PMID: 19312217 PMCID: PMC1933693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Emerson H. Charles Frederick Chandler 1836-1925. Science 1937; 86:453-61. [PMID: 17815457 DOI: 10.1126/science.86.2238.453] [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: 11/02/2022]
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Emerson H, Freeman AW, Chapin CV, Dublin LI, Rice JL, Vaughan HF, Mountin JW, Walker WF. Recommended Procedures for Diphtheria Immunization: Sub-Committee on Evaluation of Administrative Practices of the Committee on Administrative Practice. Am J Public Health Nations Health 1935; 25:712-4. [PMID: 18014235 DOI: 10.2105/ajph.25.6.712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [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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Emerson H. The Health Foundation for Recovery: Part II. Cal West Med 1935; 42:376-378. [PMID: 18743252 PMCID: PMC1752156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Emerson H. The Health Foundation for Recovery: Part I. Cal West Med 1935; 42:259-262. [PMID: 18743220 PMCID: PMC1752127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Christian HA, Appel TB, Leake JP, Vaughan HF, Williams RC, Emerson H. The Influenza Epidemic. Science 1929; 69:73. [PMID: 17730721 DOI: 10.1126/science.69.1777.73] [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: 11/02/2022]
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Emerson H. University and Educational Notes. Science 1926; 63:229-31. [PMID: 17833828 DOI: 10.1126/science.63.1626.229-a] [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: 11/03/2022]
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Lyte EO, Banter CJ, Cooley EG, Cooper FB, McIver CD, Smith AT, Emerson H, Kern OJ, Goodwin EJ, Bryan WL. Declaration of the National Educational Association at the Asbury Park Meeting. Science 1905; 22:379-80. [PMID: 17835039 DOI: 10.1126/science.22.560.379] [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: 11/02/2022]
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