FEATURE ARTICLES

Massive weight loss body contouring, after bariatric surgery, encounters unique perioperative and wound healing challenges. But some of the greatest challenges ahead include a postcode lottery and a constricting healthcare budget. LOUISE FRAMPTON REPORTS.

Weight loss surgery in the NHS has faced resistance, but is one of the fastest growing specialties – with demand rising year on year. Gastric bypass is even being investigated as a potential treatment for diabetes in non-obese patients. But what are the unique challenges of performing such surgery and how can safety be optimised? LOUISE FRAMPTON reports

MARK EATON and PHIL HIGTON provide an insight into the key factors that can improve theatre performance, quality and safety

Over one third of post-operative deaths are related, in part at least, to surgical site infections. KATE WOODHEAD RGN DMS looks at the latest clinical guidelines and recommendations aimed at reducing harm to patients.

Recent studies show cardiac services are improving – along with outcomes following surgery. However, issues remain in relation to rehabilitation services and the UK continues to lag behind other developed countries in terms of access to the main cardiac interventions. The Clinical Services Journal reports.

Efforts to reduce rates of MRSA and Clostridium difficile have had a significant impact, but progress has not been reported for all Trusts or for other healthcare-associated infections.

CATHERINE CLEGG reviews the present position on “end of life” care and assisted suicide in light of recent legal developments and proposed guidance

Many patients requiring end of life care experience unnecessary pain and find themselves in hospital when they have no clinical need to be admitted. Front line staff often lack training in delivering basic end of life care, and patients’ wishes, in many cases, are not recorded or respected. The Clinical Services Journal reports.

Hospitals are now providing feedback on a range of infection prevention technologies, selected by the NHS Purchasing and Supply Agency for evaluation. Promising innovations include a system for decontamination, a test device for monitoring the cleanliness of equipment and wards, and a catheter that could help reduce the number of CAUTIs. The Clinical Services Journal reports.

Service redesign and transformation processes are helping Birmingham Children’s Hospital to understand how it can influence and improve the experience of patients, carers and staff. AMANDA BAUGH RGN MBA describes the early stages of the journey for improvement.

NICE guidelines state that laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable.

A two-year pilot project, the Stockport Early Intervention Service (EIS) was developed out of a desire to reduce the frequency and cost of short stay hospital admissions for “ambulatory care sensitive” conditions. Dr ASH PATEL and BRIDGET SMITH provide an insight into this innovative model of care, which could potentially ease pressure on the acute sector.

RICK GEOFFRION and ANDREA VENTURELLI address the question: “Can drug eluting balloons (DEBs) become the next successful and sustainable device platform for treatment of atherosclerosis?”

Dr FRANK PRIOR describes the development of a new method for rapidly and efficiently removing prion protein from stainless steel surgical instruments, which could potentially reduce the infection risk associated with vCJD and other TSEs.

By many accounts, the introduction of digital imaging and PACS in the NHS has been a great success – with PACS now being used in every hospital Trust in England. But what progress has been achieved towards enabling image studies to be shared “seamlessly” across clinical networks? DEWINDER S. BHACHU provides an insight into the challenges ahead.

The Serious Hazards of Transfusion scheme report for 2008 was published recently. The summary of the full report, which is available on the SHOT website or as a hard copy from the SHOT office, is reproduced below.

A national enquiry into inpatient deaths due to acute kidney injury found that a fifth were predictable and avoidable. In many cases, the “very essentials of medical care” were omitted, patients received inadequate investigations and recognition of acute illness, hypovolaemia and sepsis was poor.

Although anaesthetic anaphylaxis is still relatively rare, the numbers of adverse reactions that receive specialist treatment appear to be on the increase. New guidance has been published to help avoid serious consequences. The Clinical Services Journal reports.

A wide range of speakers will educate, motivate and inspire an audience of perioperative practitioners at the AfPP Congress. There will be much to learn from – whether it is the moving account of a family tragedy caused by errors in surgery; a warning of the dangers of smoke inhalation in the operating theatre; or an emotive insight into the work of Mercy Ships in Africa, which is saving lives though the kindness of volunteers.

The Government refusal to offer compensation to all recipients of contaminated blood and blood products has raised deep concerns. Transfusion scientist BARRY HILL examines the background behind this and looks at potential problems ahead for UK blood services.