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2 results

  • CHAPTER 4 - Acute gynaecology

  • Edited by Tahir Mahmood, Allan Templeton, University of Aberdeen, Charnjit Dhillon
  • Book:
    Models of Care in Women's Health
    Published online:
    05 July 2014
    Print publication:
    01 June 2009, pp 34-44

  • Summary

    Emergency gynaecology is rapidly developing in the UK but remains mostly fragmented into early pregnancy and acute gynaecology. There is a dearth of literature on patient and service surveys, treatment guidelines and protocols and standards for acute gynaecology. A nationwide audit was therefore commissioned for this work, to facilitate understanding of the state of acute gynaecology services in the UK. Units should be staffed by multidisciplinary teams that include specialist nurses, healthcare support workers and administrative staff, with local determination of numbers and ratios. Staff training should be a priority, irrespective of who provides care. Core staff should have knowledge of sexual health and should be duly certified where necessary. There should be a rolling programme of audit of clinical processes and outcomes determined by both local and national priorities. Research should be actively encouraged within individual units and as part of collaborative multicentre initiatives.

  • Application of Outcome Measures in International Humanitarian Aid: Comparing Indices through Retrospective Analysis of Corrective Surgical Care Cases

  • K.A. Kelly McQueen, William Magee, Thomas Crabtree, Christopher Romano, Frederick M. Burkle, Jr.
  • Journal:
    Prehospital and Disaster Medicine / Volume 24 / Issue 1 / February 2009
    Published online by Cambridge University Press:
    28 June 2012, pp. 39-46
    Print publication:
    February 2009

  • It is common for international organizations to provide surgical corrective care to vulnerable populations in developing countries. However, a current worsening of the overall surgical burden of disease in developing countries reflects an increasing lack of sufficient numbers of trained healthcare personnel, and renders outside volunteer assistance more desirable and crucial than ever. Unfortunately, program evaluation and monitoring, including outcome indices and measures of effectiveness, is not measured commonly. In 2005, Operation Smile International implemented an electronic medical record system that helps monitor a number of critical indices during surgical missions that are essential for quality assurance reviews. This record system also provided an opportunity to retrospectively evaluate cases from previous missions. Review of data sets from >8,000 cases in 2005 and 2006 has provided crucial information regarding the priority of surgery, perioperative and operative complications, and surgical program development.

    The most common procedure provided was unilateral cleft lip repair, followed closely by cleft palate. A majority of these interventions occurred for patients who were older than routinely provided for in the western world. The average child treated had an age:weight ratio at or below the [US] Centers for Disease Control and Prevention (CDC) 50th percentile, with a small percentage falling below the CDC 20th percentile. A majority of children had acceptable levels of hemoglobin, but the relative decreased age:weight ratio nonetheless can reflect mild malnutrition. Complications requiring medical intervention were seen in 1.2% of cases in 2005 and 1.0% in 2006. Thirty percent were reported as anesthesia complications, and 61% reported as surgical complications. One death was reported, but occurred after discharge outside the perioperative period. Complication rates are similar to rates reported in the US and UK and emphasizes the importance of standardization with uniform indices to compare quality performance and equity of care. This study offers an important example of the importance of collecting, analyzing, and reporting measures of effectiveness in all surgical settings.