Communication in the intensive care unit during COVID-19: early experience with the Nightingale Communication Method.

OBJECTIVE: To assess the utility and frequency of use of the Nightingale Communication Method, during the early operational phase of the Nightingale Hospital London (NHL) 4000-bed field hospital's intensive care unit. DESIGN: Survey-based cross-sectional assessment. SETTING: The intensive care unit at the Nightingale London hospital. PARTICIPANTS: Staff working in the clinical area and therefore requiring full personal protective equipment (PPE). INTERVENTION: Survey of all staff members sampled from a single shift at the Nightingale Hospital. This investigated perceived utility and actual use of identification methods (name and role labels on visors and gowns, coloured role identification tapes) and formal hand signals as an adjunctive communication method. MAIN OUTCOME MEASURE: Self-reported frequency of use and perceived utility of each communication and personnel identification adjunct. RESULTS: Fifty valid responses were received (72% response rate), covering all clinical professional groups. Prominent name/role identifications and coloured role identification tapes were very frequently used and were perceived as being highly useful. Formal hand signals were infrequently used and not perceived as being beneficial, with respondents citing use of individual hand signals only in specific circumstances. CONCLUSION: PPE is highly depersonalizing, and interpersonal identification aids are very useful. Despite being difficult, verbal communication is not completely prohibited, which could explain the low utility of formal hand signals. The methods developed at the Nightingale hospital have enhanced communication in the critical care, field hospital setting. There is potential for wider application to a variety of healthcare settings, in both the current situation and future pandemic scenarios.

A systematic review of the diagnostic accuracy of prostate specific antigen.

BACKGROUND: Prostate cancer is the fourth commonest cancer in the UK, and the incidence is rising. The reference standard for diagnosing this condition is prostate biopsy, an invasive procedure. This study systematically reviews recent literature on tPSA accuracy. The time period was restricted to ensure that the estimates referred to contemporary tPSA tests and prostate cancer reference standards. The focus of this review was restricted to European populations as tPSA levels are known to vary by population group. METHODS: Medline was searched (from 01/1998 to 01/2008) and Embase (from 01/1998 to 01/2008), which returned 3087 citations. These were assessed by 6 reviewers, who shortlisted 54 of possible relevance. 2 reviewers assessed each using the following inclusion criteria: data collection between 1998-2008; tPSA measurements for all participants; histological confirmation of the diagnosis; samples from a European population and sufficient data to calculate 2 x 2 tables. The final set of 10 included studies represented 5373 participants. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.0 software was used to analyse the data, including plotting a series of summary receiver operator curve spaces (SROC). RESULTS: tPSA sensitivities ranged from 0.78 to 1.00 and specificities from 0.06 to 0.66. Positive likelihood ratios ranged from 0.83 to 2.90 and negative likelihood ratios ranged from 0.00 to 3.75 CONCLUSION: tPSA has a role to play as one of several indicators for prostate biopsy along with abnormal digital rectal examination and urinary symptoms. However, tPSA test has a high false positive and significant false negative rate. It is important that clinicians understand these limitations.

Rare and unusual case of familial focal dermal hypoplasia (Goltz syndrome) presenting to otolaryngology in the UK.

Goltz syndrome or focal dermal hypoplasia (FDH), is an X-linked dominant condition which predominantly involves the skin, limbs and eyes. In otolaryngology, FDH has been poorly described, but can result in increased symptoms of obstructive sleep apnoea requiring surgery. There have also been documented cases of mixed severe hearing loss secondary to congenital ossicular anomalies. More frequently, patients present to the ear-nose-throat clinic with symptoms of dysphagia, secondary to papillomatosis. A 36-year-old woman presented with pain, irritation and dysphagia with a known diagnosis of FDH. She was subsequently investigated with an oesophago-gastro-duodenoscopy, Barium Swallow and an MRI neck scan with contrast. Lymphoid hyperplasia was found on investigation and the patient underwent a panendoscopy with CO2 laser to the lesion with good clinical outcome. This case report highlights the need for multidisciplinary team involvement to ensure full consideration of management options.

An extremely rare and atypical paediatric presentation of a maxillary sinus haemangioma in the UK.

We present a rare and unusual case of a 16-year-old girl, with no significant medical history, presenting with right nasal obstruction and suspected sinusitis with occasional epistaxis and haemoptysis. On examination, she had a mass lesion in the right nasal cavity, with no evidence of other pathology on assessment of the ears, nose, throat or head and neck. A CT scan revealed an opacified right maxillary sinus with polypoidal mucosa, extending and passing through the accessory ostium into the right nasal cavity. Examination under anaesthesia with functional endoscopic sinus surgery and excision of the lesion was subsequently undertaken. Histological analysis confirmed the mass lesion as a haemangioma. This case report is the first to present a maxillary haemangioma presenting as nasal obstruction with intermittent sinusitis symptoms in a child. The authors discuss the incidence, presentation and management of maxillary haemangiomas in the paediatric population.

How reliable is the "scratch test" versus the Weber test after tympanomastoid surgery?

OBJECTIVES: To identify whether the scratch test can be used as an alternative to the Weber's test after tympanomastoid surgery. METHODS: This twin-center prospective study assessed major tympanomastoid surgery patients over a 6-month period. Patients were assessed postoperatively on Day 0 or Day 1 of surgery using a standardized proforma. A Weber's test was performed using a 512-Hz tuning fork, placed midline on the forehead to assess the direction of sound localization. This was directly compared with a scratch test, by asking the patient the following while scratching the head bandage in the midline: "Can you hear this? And which side is loudest?" RESULTS: Fifty-six patients were assessed in total. Sixteen mastoid explorations, 14 tympanoplasties, 18 combined approach tympanoplasties, and 8 other procedures were included, all of which had standard external auditory canal packing and head bandage. Assessment with Weber's test found 41 patients to have sound lateralizing to the operated ear. In comparison, 50 patients lateralized sound to the operated ear with the scratch test. Overall, Weber's test had a sensitivity of 73.2% and specificity of 100% compared with a sensitivity of 89.3% and specificity of 100% for the "Scratch Test." No patients had a dead ear after surgery. CONCLUSION: The scratch test proved to be more accurate than traditional postoperative tuning fork assessment and provides a quick, accurate, and simple solution for when such equipment is unavailable.

Recent advances in pancreatic transplantation.

Pancreatic transplantation has progressed in the past 25 years since its initial stages, proving to be highly promising for those with diabetes and its resultant multiorgan disorders. Several studies have shown that patients who receive transplants have better glycemic control, blood pressure control, lipid control, and show reversal of microscopic diabetic changes including neuropathy and improved cardiovascular risks. Advances in many fields have made it possible for more than 32,000 procedures to be done worldwide, and 1- and 5-year posttransplant survival to be 95% and 83%. We sought to explore what advances have taken place in surgical techniques, patient selection, and immuno-suppressant therapy to allow this improvement and reduction in complications. New techniques (ie, islet cell implantation) promise early results. However, pancreatic transplant is currently the single existing therapy to establish normal glucose without exogenous insulin.