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Objective: Healthcare teams often forget the possibility of pregnancy when fecund women present for non-obstetric problems. In this patient group, routine pregnancy tests are often omitted and related documentation is missing. This patient safety issue was further highlighted by an anecdotal story when a surgical procedure was performed and mid surgery a pregnancy was identified. Prior to our intervention, simple point of care testing was limited to the emergency department. At ward level, pregnancy tests could only be performed using blood serum. Also, the admission forms did not specifically ask to exclude a pregnancy. Design: We reviewed whether all female surgical admissions of childbearing age underwent pregnancy testing. A baseline audit highlighted the need to introduce point of care pregnancy kits on the surgical ward. The initial audit was presented to surgical and anaesthetic departments. In collaboration with management, funding was secured to provide pregnancy kits for the surgical wards and the admission protocol was changed accordingly. Method: The project was completed over a period of 19 months (delayed by Covid). The base-line data collection was from November to December 2019 with presentation of the results in December 2020. Introduction of pregnancy kits in April 2021 and follow-up data collection in May to June 2021. A total of 159 case notes were reviewed using the hospital patient information system named 'Portal'. In the baseline survey, 86 case notes were screened for pregnancy tests and whether the findings were documented. After the introduction of pregnancy kits, the survey was repeated involving 73 women. The mean age was 32 with a range from 17 to 52 years of age. Results: Results were obtained retrospectively using the Portal system to screen for pregnancy tests (urine/serum β-HCG), any radiation exposure and surgical intervention. In 2021, prior to intervention, 75% of fecund patients were exposed to radiation and 95% underwent surgery without pregnancy testing. In 2021 the rates dropped to 32% for radiation exposure and surgery without pregnancy testing to 27%. Overall pregnancy testing in fecund women for surgical admission improved to 60%. Conclusions: Omitting pregnancy tests and subsequent documentation could be due to time pressures in particular during same day admissions. The remaining 40% could be captured by using a computer-based admission protocol which prompts the health care staff to undertake a pregnancy test, but adds more complexity to an already busy surgical admission ward.
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Introduction: During the COVID-19 pandemic, the ENT department at the Royal Glamorgan Hospital introduced the use of 'Attend anywhere' which is a virtual platform that is used by medical professionals to carry out clinics remotely. It ensures confidentiality between the physician and the patient, as well as practicing social distancing. We assessed the number of patients seen in the virtual clinic, the conversion rate of virtual to face-to-face appointments and technical issues with Attend Anywhere. Method: We carried out a 3-month retrospective data collection on patients seen in the Attend Anywhere clinic. We accessed their clinical records using the Welsh Clinical Portal system. The outcome for each patient was documented. We also assessed any technical issues with the platform. Results: 305 patients were scheduled to be seen on the platform. Of the 305, 264 attended their appointment. 4 of the patients required urgent medical attention and were subsequently scheduled for urgent face-toface appointment within the 24 hours. 19 patients had technical issues with the Attend Anywhere platform, and 14 of them were subsequently converted to telephone consultations. The issues were not specifically documented, but connectivity to webcam was a common recurrence. 70 patients were safely discharged from the ENT department Conclusions: The introduction of the Attend Anywhere virtual clinic has greatly helped prevent a backlog of patients waiting to be seen by the ENT team. 26% of patients were safely discharged back to the GP. The results with the virtual clinic platform are promising and could be a new practice for the NHS.
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What is the topic of this review? Human serum albumin (HSA) a common factor in COVID-19 vulnerabilities. What advances does it highlight? Understanding of HSA capacity, and systemic vulnerabilities to COVID-19. Raising HSA in COVID-19 patients may alleviate systemic injury caused by diminished native HSA binding. A change in fluid therapy administration into the portal system of the liver is proposed to safely raise HSA levels. ABSTRACT: The specific nature of the vulnerabilities to COVID-19 are an intrinsic part of COVID-19 infection in many patients. This paper proposes that vulnerabilities to COVID-19 may be intensified by a decrease in human serum albumin (HSA) as a ligand carrier for nutrients. A mechanism for COVID-19 vulnerabilities is evident from consideration of ligand carriers such as HSA as intermediaries. We hypothesise that low levels of pool HSA binding, caused for whatever reason, affect the performance of albumin as a carrier protein reducing the availability of nutrients. Hypoalbuminaemia (low HSA) has been implicated as an indicator of COVID-19 and long-COVID-19. The levels of HSA directly affect the immune system and vulnerabilities to age, diabetes and obesity in COVID-19. Any slight reduction in available HSA has profound effects on ligand concentrations in the small capillaries where damage occurs in COVID-19. The clinical implication is that attempts should be made to return HSA to clinical levels to compensate for the additional ligands caused by infection (SARS-CoV-2 virions, antibodies and cellular breakdown products). Therapeutic albumin is usually given peripherally, and usual preparations are unbound to ligands, but we suggest that a clinical trial of HSA therapy via the hepatic portal vein should be considered.