The impact of delayed paper communication to primary care from secondary care and out of hours services.

The safe and effective treatment of patients accessing multiple NHS services relies upon efficient communication between primary care, secondary care, and out of hours providers. There is a theoretical risk to patient safety from delays in these processes, to which paper communications are particularly vulnerable. When letters are received they must be reviewed and prioritised in order of clinical importance, a process that requires both time and clinical resources. This is relevant to the challenge of resource allocation to maximise patient benefit. This retrospective study investigated the impact on patient safety of 249 clinical letters reporting routine clinical encounters in secondary care and out of hours services that were delayed by an average of 18-24 months to a suburban London general practice. No clinical harm could be attributed to the delay. This small study did not suggest delays in routine communications pose a significant risk to patient safety. Conversely, it questions the efficiency and benefit to patients of prioritising clinical time to reviewing routine letters. The adoption of fully integrated, shared electronic patient records with the function to highlight clinically urgent or important communications might ease clinician workload, to the ultimate benefit of patient care.

An Ultra-Low-Power RFID/NFC Frontend IC Using 0.18 µm CMOS Technology for Passive Tag Applications.

Battery-less passive sensor tags based on RFID or NFC technology have achieved much popularity in recent times. Passive tags are widely used for various applications like inventory control or in biotelemetry. In this paper, we present a new RFID/NFC frontend IC (integrated circuit) for 13.56 MHz passive tag applications. The design of the frontend IC is compatible with the standard ISO 15693/NFC 5. The paper discusses the analog design part in details with a brief overview of the digital interface and some of the critical measured parameters. A novel approach is adopted for the demodulator design, to demodulate the 10% ASK (amplitude shift keying) signal. The demodulator circuit consists of a comparator designed with a preset offset voltage. The comparator circuit design is discussed in detail. The power consumption of the bandgap reference circuit is used as the load for the envelope detection of the ASK modulated signal. The sub-threshold operation and low-supply-voltage are used extensively in the analog design—to keep the power consumption low. The IC was fabricated using 0.18 μ m CMOS technology in a die area of 1.5 mm × 1.5 mm and an effective area of 0.7 m m 2 . The minimum supply voltage desired is 1.2 V, for which the total power consumption is 107 μ W. The analog part of the design consumes only 36 μ W, which is low in comparison to other contemporary passive tags ICs. Eventually, a passive tag is developed using the frontend IC, a microcontroller, a temperature and a pressure sensor. A smart NFC device is used to readout the sensor data from the tag employing an Android-based application software. The measurement results demonstrate the full passive operational capability. The IC is suitable for low-power and low-cost industrial or biomedical battery-less sensor applications. A figure-of-merit (FOM) is proposed in this paper which is taken as a reference for comparison with other related state-of-the-art researches.

RFID Technology for Continuous Monitoring of Physiological Signals in Small Animals.

Telemetry systems enable researchers to continuously monitor physiological signals in unrestrained, freely moving small rodents. Drawbacks of common systems are limited operation time, the need to house the animals separately, and the necessity of a stable communication link. Furthermore, the costs of the typically proprietary telemetry systems reduce the acceptance. The aim of this paper is to introduce a low-cost telemetry system based on common radio frequency identification technology optimized for battery-independent operational time, good reusability, and flexibility. The presented implant is equipped with sensors to measure electrocardiogram, arterial blood pressure, and body temperature. The biological signals are transmitted as digital data streams. The device is able of monitoring several freely moving animals housed in groups with a single reader station. The modular concept of the system significantly reduces the costs to monitor multiple physiological functions and refining procedures in preclinical research.

Hydrosurgery: alternative treatment technique for management of chronic osteomyelitis and septic arthritis of hallucial joint of a juvenile foot.

The surgical principles of management of chronic osteomyelitis of metatarsal bone of the foot have remained unchanged, but the debridement tools and level of precision have improved. This study reports the use of the Versajet system to achieve accurate, effective wound debridement during an elective orthopedic surgery in the difficult and confined geometric and anatomical area of the metatarsophalangeal joint of the foot. The patient experienced minimum blood loss and tissue resection during the procedure and healed well without complications.

Does conventional practice prevent occular complications in prone position spinal surgery?

Postoperative visual loss following spinal surgery in the prone position may be the most limiting to the quality of a patient's life and the most likely to entail medico-legal consequences for medical and theatre personnel. We analyse the incidence of occular complications after 181 consecutive spinal surgery in the prone position in a typical district general hospital setting in the United Kingdom. No patient undergoing spinal surgery in the prone position lasting over 2 hours developed postoperative transient or permanent visual loss or any other occular complication (incidence 0%). Perioperative preventative measures were found to be sufficient to prevent any form of occular complications. We should inform and reassure patients of the reduced risk of occular complications in spinal surgery when sufficient perioperative precautionary measures are taken.

Mini-invasive surgical repair of the Achilles tendon--does it reduce post-operative morbidity?

The surgical benefit of minimally invasive tendo Achilles repair (n = 25) with early weight-bearing mobilisation after rupture of the tendo Achilles was compared with operative treatment using an open technique (n = 34) with full weight-bearing after 8 weeks of surgical repair. The minimally invasive technique provided no evidence of wound problems and a functional benefit from early weight-bearing mobilisation. However, we noted that increased post-operative morbidity in terms of wound infection (n = 7) leading to delayed wound healing and wound pain requiring opiate-based analgesia post-operatively in the open repair group may have an additional impact on the patients and health care providers. This study showed that the mini-invasive open surgical repair of the Achilles tendon with the Achillon instrument and early weight-bearing mobilisation in an orthosis for the accelerated rehabilitation may offer cost-effectiveness and less financial burden on the health care provider in terms of associated nursing and physiotherapy costs.

Intraoperative handling and wound healing of arthroscopic portal wounds: a clinical study comparing nylon suture with wound closure strips.

This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate.

A case report of the use of nanocrystalline silver dressing in the management of acute surgical site wound infected with MRSA to prevent cutaneous necrosis following revision surgery.

The authors report the use of nanocrystalline silver (Acticoat 7, Smith and Nephew, London, UK) in an acute surgical wound to prevent localized skin necrosis due to infection, thereby avoiding skin grafting as a secondary procedure. Two patients were successfully treated with Acticoat 7 dressings without using systemic antimicrobials after developing methicillin-resistant Staphylococcus aureus infection in the surgical site. Despite a history of smoking and incision through scar tissues, the wound did not progress into deep infection nor was there recurrence of infection at 2 years follow-up. The intention was to use this particular dressing to assess the effect of silver on infected keratinocytes in an acute wound environment. It is possible that the use of Acticoat 7 may reduce the bacterial loading at the wound site, thereby decreasing a propensity for skin necrosis caused by the infective process. This case report demonstrates that the acute surgical wound with impending cutaneous necrosis due to localized infection may be treated without oral antimicrobials.

Management of a difficult-to-heal chronic wound infected with methycillin-resistant staphylococcus aureus in a patient with psoriasis following a complex knee surgery.

This report presents the difficulties encountered in managing a wound colonized with methycillin-resistant Staphylococcus aureus (MRSA) following a complex knee surgery in an elderly female patient with generalized psoriasis. The patient's chronic wound was successfully treated with nanocrystalline silver-releasing dressings (Acticoat). The patient did not develop a deep-seated infection, nor was removal of the implant needed. However, the wound infection persisted for 6 months. At 3 years follow-up, the patient has satisfactory skin over the implant on the knee.