Quality and impact of appraisal for revalidation: the perceptions of London's responsible officers and their appraisers.

Background: To evaluate NHS England London region's approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice.

Towards saving a million bed days: reducing length of stay through an acute oncology model of care for inpatients diagnosed as having cancer.

Problem: The need to develop a patient pathway for emergency admissions who have a previously undiagnosed cancer.

Design: The existing patient pathway was audited and process-mapped to identify delays and areas for improvement. Discussions with key stakeholders were held to identify their needs from an acute oncology service.

Waiting time to lymph node biopsy is dependent on referral method: don't write, phone!

Introduction: Patients with lymphadenopathy are commonly referred to general surgeons for diagnostic lymph node biopsy. We were concerned at potential long waits for this service in our hospital and thus wanted to compare the efficiency of written and telephone referral with a view to identifying the optimum care pathway for these patients.

Patients And Methods: Sixty patients were included in a 2-year retrospective review (excluding referrals associated with breast lumps which were managed separately).

What proportion of patients referred to secondary care with iron deficiency anemia have colon cancer?

Purpose: Iron deficiency anemia can be the first presentation of right-sided colon cancer. There is an impression that because this presentation is nonspecific it may be associated with a longer delay from referral to diagnosis compared with those patients with symptoms of change in bowel habit and/or rectal bleeding caused by more distal colorectal cancer. This study was designed to determine the incidence of colon cancers in patients referred to the hospital with iron deficiency anemia and to determine what proportion of these patients were referred and diagnosed urgently in line with cancer waiting time targets.

Results of a survey of the role of multidisciplinary team coordinators for colorectal cancer in England and Wales.

Objective: Over the last 6 years, multidisciplinary teams (MDTs) have been established and play a key role in organizing the delivery of cancer care in the UK. There are no published data on the roles of their co-coordinators. To seek the views of colorectal multidisciplinary team co-ordinators (MDTCs) on what they do and how they do it.

Telephonic management of rectal bleeding in young adults: a prospective randomized controlled trial.

Objective: The majority of young adults referred with rectal bleeding to a colorectal specialist clinic have a very low risk of serious disease such as cancer, and a high chance of gaining symptom relief by simple dietary changes. To determine whether young low-risk patients with rectal bleeding can be managed with a structured telephonic interview and dietary advice, rather than an outpatient visit.

Method: A single-blinded, prospective, randomized controlled trial was performed in two stages.

Day-care surgery for pilonidal sinus.

Introduction: The surgical approach to symptomatic pilonidal sinus is open to debate. Many techniques have been described and no single technique fulfils all the requirements of an ideal treatment. Ambulatory treatment with minimal morbidity and rapid return to activity is desirable.

An effective electronic surgical referral system.

Introduction: Electronic booking of out-patient appointments is being rolled out in England under the 'Choose and Book' programme. We set up and ran a local electronic surgical referral service before this. This paper assesses the effect of the electronic surgical referral service on patient waiting times and attendance rates.

Changing trends in the management of colorectal cancers and its impact on cancer waiting times.

Objective: The aim of this study was to compare the differences in the presentation, management and waiting times for new colorectal cancer (CRC) patients over 5 years in a single metropolitan cancer centre.

Methods: A retrospective comparative study of new patients with CRC presenting in the years 1998 and 2003. The groups were compared for referral type, Dukes' stage, site, cancer waiting times and primary treatment.

Where exactly is the deep inguinal ring in patients with inguinal hernias?

It is difficult to distinguish direct from indirect inguinal hernias on clinical examination. This study attempted to determine an anatomical basis for this finding. Fifty adult patients with primary inguinal hernias were assessed.

Randomized clinical trial of the effectiveness of emergency day surgery against standard inpatient treatment.

Background: The aim of this study was to assess the feasibility of treating patients with minor and intermediate general surgical emergency conditions as day cases.

Methods: Emergency referrals for minor and intermediate general surgical conditions were assessed by a surgeon. Those fitting day-case criteria and requiring operation under general anaesthesia were randomized to receive standard inpatient care or day surgery.

A study of pre-registration house officers' clinical skills.

Background: Little is known about the ability of pre-registration house officers (PRHOs) to perform basic clinical skills just prior to entering the medical register.

Objectives: To find out whether PRHOs have deficiencies in basic clinical skills and to determine if the PRHOs themselves or their consultants are aware of them.

Method: All 40 PRHOs at the Chelsea and Westminster and Whittington Hospitals were invited to undertake a 17 station OSCE of basic clinical skills.

Effect of small bowel transplantation, denervation and ischaemia on rat intestinal microflora.

The effects of denervation and warm ischaemia on quantitative and qualitative changes in small intestinal microflora following rat heterotopic small-bowel isotransplantation were assessed. Animals with Thiry-Vella fistula, but without transplants, acted as controls. Thirty and 40-fold increases in bacterial colony counts were seen in the isografts compared to controls at 2 and 7 days, respectively (P < 0.

Method for diagnosing rejection in small bowel transplantation.

Diagnosis of rejection in small bowel transplantation by the identification of a host-cell infiltrate is hampered by the physiological trafficking of host lymphocytes to the 'gut-associated lymphoid tissue' of the graft. This study compared physiological host-cell infiltration of small bowel grafts with that occurring in rejection and stable immunosuppression. Physiological host-cell infiltration, where the graft does not present an immune stimulus to the host, was assessed by transplanting bowel from DA to (DA x PVG) F1 hybrid rats.

Potential candidates for small bowel transplantation.

The number of potential candidates for small bowel transplantation in the UK is unknown. Potential recipients are those with irreversible small intestinal failure, including those treated with permanent parenteral nutrition. This study of one of the largest groups of patients receiving such nutrition identified ten of 25 adult patients as possible recipients.

Ex vivo perfusion of intestinal allografts with anti-T cell monoclonal antibody/ricin A chain conjugates for the suppression of graft-versus-host disease.

The removal of T lymphocytes from intestinal allografts prior to transplantation would prevent graft-versus-host disease and might also weaken the unusually severe rejection response mounted by graft recipients. Ex vivo perfusion by monoclonal antibody-toxin conjugates represents a potentially ideal approach to achieve this goal. Monoclonal antibody-toxin conjugates were prepared by coupling the mouse anti rat CD5 antibody MRC OX19 to the A chain of ricin.

Small bowel transplantation: future prospects.

The mesenteric lymph nodes and Peyer's patches of the small bowel present a significant target for immune attack in rejection. In addition they have the potential to proliferate and cause graft-versus-host disease (GVHD). Immune-mediated impairment of mucosal barrier function will allow translocation of bacteria from the gut lumen into the blood stream.

Major trauma: a district general hospital experience.

A retrospective review of all patients with major trauma admitted to a busy suburban district hospital was conducted over a 1-year period. Outcome for each patient was assessed using the TRISS system which calculates the probability of survival based on anatomical extent of injury and degree of physiological disturbance at the time of admission. Thirty-nine patients were admitted following major trauma, of whom nine died.