Peter's Hospital Research Articles

FRII-05 THE CONTRIBUTION OF SIR THOMAS SPENCER WELLS TO UROLOGY

You have accessJournal of UrologyHistory of Urology: History Forum II1 Apr 2016FRII-05 THE CONTRIBUTION OF SIR THOMAS SPENCER WELLS TO UROLOGY Michael Wanis and Jonathan Goddard Michael WanisMichael Wanis More articles by this author and Jonathan GoddardJonathan Goddard More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2926AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sir Thomas Spencer Wells, from St Alban's in Hertfodshire, was originally a naval surgeon, serving in Malta, before establishing his own practice in London in 1853. He is most notably recognized in the world of Obstetrics, Gynaecology and Ophthalmology. Between 1863 and 1896 he became Surgeon to Queen Victoria’s Household. Although his contribution to Urology is less well known, he was a founding member of St Peter’s Hospital for Stone in London in 1860, the first hospital specialized in the treatment of urological diseases in Britain. METHODS A literature search was performed on the contribution of Spencer Wells in Urology on Medline, Embase, Google Scholar, Public Records Library, UCLH Trust Archives and the Archives of the Royal Society of Medicine. Information was also obtained from published history textbooks of St Peter’s Hospital. RESULTS In 1860 Sir Thomas Spencer Wells, along with Reverend AB Whatton, Mr TP Oldershaw and Mr Armstrong Todd gathered at 16 Burlington Street, the home of Mr Todd. There they discussed the establishment of a hospital for the cure of urinary stone disease. The committee concluded that Wells and Armstrong would be Chief Surgeons at the hospital. Wells subsequently published a paper in the press supporting the need for a specialist hospital for urinary disease. From 1860 to 1862 Wells was diligent in both his duties as a surgeon and member of the committee, which continued to meet on a weekly basis. He conducted regular operating lists and twice weekly clinics. In 1862 Wells departed from St Peter’s Hospital to dedicate himself to Obstetrics and Gynecology at the Samaritan Free Hospital For Women. In his resignation letter he stated that his dedication to the Samaritan Hospital meant he could not devote adequate time to the running of another new hospital. He also expressed his best wishes for the future of St Peter’s Hospital. His job at St Peter’s remained vacant for two years until Walter John Coulson took up the post. During his work at the Samaritan Hospital Wells was one of the first surgeons to recognize the risk and significance of urinary tract injury whilst pioneering ovarian cystectomy. After he died in 1897, the committee at St Peter’s Hospital acknowledged that Wells continued to take a keen interest in the welfare of the hospital throughout his career until his death. CONCLUSIONS Sir Thomas Spencer Wells was a founding member of St Peter’s Hospital and continued to contribute to Urology throughout his career. St Peter's Hospital was one of the first specialist hospitals in London at the time and thus its establishment was a catalyst for the development of Urology as a specialty in its own right. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e522 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Michael Wanis More articles by this author Jonathan Goddard More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Development of a collaborative transitions-of-care program for heart failure patients.

The development and implementation of a pharmacy-led transitions-of-care program to reduce the risk of readmission and increase satisfaction for heart failure (HF) patients are described. A transitions-of-care committee was established at Providence St. Peter Hospital, a 390-bed community teaching facility in Olympia, Washington, and focused on implementing standardized workflow processes for conducting admission medication review and discharge medication review and providing discharge counseling for patients with HF. All HF patients were to have admission medication reconciliation performed within 48 hours of admission. All HF patients were assigned a readmission risk complexity score after being admitted to the medical floor. The pharmacist, resident, and student performed daily patient medication profile reviews on all HF patients to ensure the use of optimal doses of appropriate HF medication regimens. The pharmacist proactively monitored for patient discharges using reports available in the electronic medical record. The pharmacist, resident, student, or HF nurse navigator counseled each patient on the discharge medications and answered any questions or addressed concerns regarding medications. Input from the quality-improvement specialist and data abstracter was used to ensure compliance with HF core measures. The program has resulted in an increase in core measure compliance and a reduction of HF, 30-day, and all-cause readmissions, and patient satisfaction scores have improved. For each avoided readmission, there was an associated decrease of $5652 in variable costs. The implementation of a pharmacy-led transitions-of-care program improved patient care by prioritizing those who needed medication reconciliation and led to increases in HF core measure compliance and patient satisfaction scores.

OC-082 The results of a multi-centre study of surgery for full thickness rectal prolapse: Abstract OC-082 Table 1

Introduction Rectal prolapse is a disabling condition which is under-reported and affects the quality of life of our ageing population. Despite this there is ‘no accepted standard procedure’1a given patient should receive. The perceived risk of surgery has meant that elderly patients often undergo a perineal operation with an abdominal operation being reserved for younger patients or those with recurrence. Randomised controlled trials have found it challenging to recruit patients making comparison between outcomes difficult for abdominal and perineal operations. Method The Surrey and South West London Pelvic floor group was founded in 2014 and includes the following hospitals – Ashford and St Peters Hospital, Croydon University Hospital, East Surrey Hospital, Epsom and St Heliers Hospital, Frimley Park Hospital, Kingston Hospital, Royal Berkshire Hospital, St Georges Hospital and Wexham Park Hospital. All patients who underwent surgery for full thickness rectal prolapse between April 2011 and March 2013 were included. Data was collected retrospectively from the notes using a standardised proforma. Results 244 patients underwent surgery for full thickness rectal prolapse in the study period. Seven patients were excluded due to incomplete data leaving 237 patients. All but four patients were female. Median age at time of operation was 78.4 years with an average ASA of 2.1. The recorded overall recurrence for all surgery was 17.7%. Median length of stay (LOS) was 2 days. Conclusion In this retrospective multicentre study abdominal operations for full thickness rectal prolapse had a significantly lower rate of recurrence than the perineal approach. This was despite there being a higher proportion of patients in the abdominal group who had had previous surgery for rectal prolapse. Although patients in the abdominal group were younger and fitter there was no difference in length of stay and complication rates. The rates of recurrence for perineal operations were similar1but the recurrence rate after abdominal operations was higher than previousy reported in the literature.1This may be a reflection of the individual learning curves for laparoscopic rectal prolapse surgery during the study period (2011–2013). Disclosure of interest None Declared. Reference Senapati A, Gray RG, Middleton LJ, et al.; PROSPER Collaborative Group. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68

FRII-10 A TRIBUTE TO SIR DAVID INNES WILLIAMS: THE FOUNDER OF PEDIATRIC UROLOGY

You have accessJournal of UrologyHistory of Urology Forum II1 Apr 2015FRII-10 A TRIBUTE TO SIR DAVID INNES WILLIAMS: THE FOUNDER OF PEDIATRIC UROLOGY Mohit Sirohi, Aizid Hashmat, Harris Nagler, and Zafar Khan Mohit SirohiMohit Sirohi More articles by this author , Aizid HashmatAizid Hashmat More articles by this author , Harris NaglerHarris Nagler More articles by this author , and Zafar KhanZafar Khan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sir David Innes Williams (1919-2013) was a renowned British surgeon and, arguably, the father of pediatric urology. We recount his life story highlighting his discoveries of some of the more common contemporary urologic diagnoses and his journey leading to the definition of the specialty of pediatric urology. METHODS A comprehensive literature search of primary and secondary sources, including books, journals and the internet was undertaken in order to learn about Dr. Williams's early life and work in the field. Additionally, personal recounts from Dr. Williams's colleagues are included. RESULTS Sir David Innes Williams was born in London, UK in 1919 and received his degree in medicine from University College Hospital in 1942. In 1945, he was called up to serve in the military and assigned to the Royal Army Medical Corps. After his three years in service, he realized that the field of Urology had not been advanced in terms of research or innovation during the war. This lack of advancement interested him and led him to pursue a residency in the field at St. Peter's Hospital for Stone in 1948. It was at this time as a resident in Urology that he decided to expand the extremely limited field of pediatric urology. Dr. Williams was a co-author of “The Urology of Childhood” in 1951, the first major text in pediatric urology. Subsequently, he was appointed to a senior urologist position at the Great Ormond Street Hospital (GOSH) in 1952 as the country's first full-time pediatric urologist. He remained in this position until he retired for an administrative role in 1978. During his time at GOSH, he studied the genitourinary system and broadened on several unknown diseases at the time, examining congenital anomalies and the embryology behind their mal-development. His novel surgical techniques, focusing on reconstruction of these anomalies rather than simply stabilizing the disease were revolutionary in the field. To this day, Dr. Williams's techniques are practiced by pediatric urologists around the globe. Furthermore, Dr. Williams was a great teacher, mentoring several future leaders in pediatric urology who are still carrying out his principles today. CONCLUSIONS The achievements of Sir David Innes Williams in the field of pediatric urology are unparalleled. As the founder of the modern field, his research and teaching has allowed for the subspecialty to grow and for millions of children to lead normal lives, uninhibited by several disorders that once plagued the population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e592 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohit Sirohi More articles by this author Aizid Hashmat More articles by this author Harris Nagler More articles by this author Zafar Khan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Nurse-led consent in endoscopy

In order to implement best practice in the consent process for patients undergoing endoscopy at Ashford and St Peter's Hospitals NHS Trust, the registered nurses at the endoscopy department wanted to determine if nurse-led consent might present to patients a more consistent and high-quality approach to this very important component of the endoscopy experience. This article describes the nurses' efforts in introducing an initiative wherein the endoscopy nurse who admits the patient for the endoscopic procedure also takes the patient's consent. This has led to the nurses developing a good rapport with patients and ensuring the uninterrupted and smooth running of the endoscopy department as well as overall patient care.

Abstract 87: Evolution of the 24-Hour In-House Stroke Team

Background and Issues: In 1998, Providence St. Peter Hospital (PSPH) created its first stroke team. An on-call Stroke RN/neurologist duo responded to pages from the emergency center and inpatient attending physicians and nurses 24 hours a day, 365 days a year. By late 2010, the responsibilities of the stroke team members had significantly increased, but only two Stroke RNs and one neurologist participated on the team. It became clear that the 100% on-call model had become resource limited and processes were now inconsistent. The development of a sustainable new stroke model was critical. Purpose: The purpose of the project was to create a sustainable in-house stroke patient care process that would meet the community’s need for excellent stroke care while maintaining Joint Commission Primary Stroke Center certification. Methods: In early 2011, an interdisciplinary team convened to develop the new process. Members included RNs and physicians from neuroscience, emergency center, and primary care, radiologists, CT technicians, pharmacists, and phlebotomists. Stroke clinical guidelines, best practices and outcome data were reviewed. Operational, financial and clinical opportunities for improvement were identified. Results: As a result, two separate initiatives were implemented, (a) in-house acute stroke response and (b) emergency center acute stroke response, both which are active 24 hours per day, 365 days per year. Seven neurologists now rotate call as the stroke neurologist. One of sixteen neuroscience RNs is onsite 24 hours a day as the Stroke RN. Acquisition of a telestroke robot enables the stroke neurologist to assess the patient immediately and make treatment decisions that are initiated before the neurologist arrives at the hospital. Procedures are outlined for all involved departments, ensuring timely diagnostics completion, appropriate medication administration or intervention, and consistently high standards of care. Conclusions: In conclusion, the revised stroke patient care management processes have proven to be sustainable and effective in ensuring timely intervention and positive outcomes for stroke patients. The program is reviewed and updated monthly.

Do intravenous urograms still have a role in investigating renal colic? A prospective audit of practice in a DGH

Do intravenous urograms still have a role in investigating renal colic? A prospective audit of practice in a DGH

Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study.

BackgroundWorldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15th among the 27 MDR-TB high-burden countries. This study identifies factors associated with the occurrence of MDR-TB in patients who underwent first-line TB treatment in Addis Ababa City.MethodsA case control study was conducted at St. Peter Hospital and five health centers in Addis Ababa from 1 November 2011 to February 30, 2012. Cases were MDR-TB patients who were confirmed with culture and drug-susceptibility testing and were in treatment at St. Peter Hospital during the study period. Controls were patients who were on first-line anti-TB treatment and were registered as cured or having completed treatment in the period 9 April 2009– 28 February 2010, in five health centers of Addis Ababa City. Accordingly, 134 cases and an equal number of controls were included in this study. A structured interview questionnaire was used to assess factors that could potentially be associated with the occurrence of MDR-TB.ResultsFactors that were significantly associated with MDR-TB: drug side effects during first-line treatment (adjusted odds ratio (AOR): 4.5, 95% CI; 1.9 - 10.5); treatment not directly observed by a health worker (AOR = 11.7, 95% CI; 4–34.3); interruption of treatment of at least a day (AOR = 13.1, 95% CI 3.0-56.6); duration of treatment between 2 and 7 months (AOR = 14.8, 95% CI 2.3-96.4); and retreatment with the Category II regimen (P = 0.000). In the current study, HIV infection was not significantly associated with the occurrence of MDR-TB.ConclusionsPatients who were not in strict DOTS programs and did not adhere to first-line TB treatment and patients who experienced side effects during first-line treatment and Category II retreatment were at significantly increased risk of developing MDR-TB. The DOTS program should, therefore, be strengthened to increase patient adherence. Drug-susceptibility testing is also highly recommended for all Category I treatment regimen failures before those patients begin the Category II regimen.

Dr Nathaniel Minton MA, DPM, FRCPsych

Formerly consultant psychiatrist, St Peter's Hospital, Chertsey, The Priory, and Capio Nightingale Hospital, LondonDr Nathaniel Minton, who was born on 28 May 1935, had a unique training in psychiatry for a British graduate, because he spent 3 years (1965–1968) training in psychoanalysis and depth psychotherapy at the C.G.Jung Institute in Zurich, trained individually by Jolande Jacobi, Jung's senior deputy. When later, in 1979, he became a consultant psychiatrist at St Peter's Hospital, Chertsey, he was also recognised as being a psychotherapist at the Royal Holloway University of London.

Ronald Ogier Ward, urologist, hero & first president of BAUS

Ronald Ogier Ward, urologist, hero &amp; first president of <scp>BAUS</scp>

Ultrasound-Guided Regional Anesthesia Tutorial

OPEN ACCESSMarch 6, 2012Ultrasound-Guided Regional Anesthesia Tutorial Martha Johnson, MD, Ben Swoboda, MD Martha Johnson, MD University of Washington School of Medicine Google Scholar More articles by this author , Ben Swoboda, MD St. Peters Hospital Helena MT Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8488 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis web-based tutorial was designed to provide a resource for learning about ultrasound-guided regional anesthesia. This project was the result of one resident's desire to have a resource where one could easily find all that is needed to know to prepare for a block. It is intended for novice learners, but also serves as a quick reference for the advanced practitioner. Our tutorial begins with an in-depth look at the brachial plexus. We then provide instruction modules for six common blocks–interscalene, supraclavicular, infraclavicular, axillary, femoral, and sciatic. We include detailed information on the lumbosacral plexus. Each module contains information about relevant anatomy, indications for the block, instructions on how to perform the block, ultrasound images and video, clinical pearls, risks and benefits, and current topical information from the regional anesthesia literature. There are other websites that are helpful for the regional anesthesia learner/practitioner, however this resource is unique in its content which includes not only technique, but also relevant anatomy, indications, risks and benefits, and current literature review. All of this is presented in a user-friendly format. A provided video adds a real time view of actual blocks being performed. There is a large constituency of anesthesiologists who would like to learn or improve their existing techniques for regional anesthesia and this resource will help them. It has already been used as a training tool for University of Washington Anesthesiology residents and fellows and has been met with uniform excitement and enthusiasm. Learners appreciate the graphics and video as well as the informational content which is “enough but not too much.” Educational Objectives By the end of the module, the learner will be able to: Understand relevant anatomy for upper and lower extremity blocks.Understand indications for blocks.Understand U.S. guided technique for performing blocks.Understand risks and benefits of specific blocks.Understand current topics in the literature related to blocks. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Welcome.doc Axillary Block.ppt BAXIL4.mp4 Brachial Plexus.ppt Complications.ppt Definitions slide.pptx Femoral Block.ppt FNB AUG6.mp4 Infraclavicular Block.ppt Interscalene Block.ppt ISCB video.mp4 SCB_Clip1and2_V1.mp4 SCI_Clip1and2_V1.mp4 SCI3.mp4 Sciatic Block.ppt Supraclavicular Block.ppt TestBLK - AVI2.mp4 Training Workshop Participation.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationJohnson M, Swoboda B. Ultrasound-Guided Regional Anesthesia Tutorial. MedEdPORTAL. 2012;8:8488. https://doi.org/10.15766/mep_2374-8265.8488 Copyright & Permissions© 2012 Johnson and Swoboda. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsPeripheral Nerve BlockLumbosacral PlexusLower Extremity Nerve BlockUltrasound Guided Regional AnesthesiaBrachial PlexusUpper Extremity Nerve Block Disclosures None to report. Funding/Support None to report. Loading ...

Re-opening of Caesarean wound not negligent: Ternent v Ashford and St Peter's Hospital NHS Trust (High Court, 24/3/2010 – Tugendhat J)

Re-opening of Caesarean wound not negligent: <i>Ternent v Ashford and St Peter's Hospital NHS Trust</i> (High Court, 24/3/2010 – Tugendhat J)

Body mass index and mid upper arm circumference measurement at the HIV/AIDS clinic in Saint Peter's Hospital, Addis Ababa, Ethiopia

This study compared body mass index (BMI) with MUAC for HIV/AIDS patients attending a clinic in Addis Ababa, Ethiopia. All 157 HIV/AIDS patients attending the clinic for two weeks in June, 2008, were assessed using both BMI and MUAC. Measurements for MUAC and BMI were correlated (r: 0.62, p&lt;0.001). However, BMI classified 79.6% of the study subjects as normal (≥18.5 kg/m2) while 90% were classified as normal (≥21 cm) by MUAC. Moreover, BMI identified 3.8% each of patients as moderately and severely malnourished while only 1.9% were classified as moderately malnourished by MUAC. No patient was classified as severely malnourished by MUAC. This shows that MUAC under classifies subjects as malnourished compared to BMI. Using MUAC alone might reduce targeting the truly malnourished cases which supposedly should receive nutritional care services. Thus, it is recommended that the current approach of using BMI for assessing nutritional status of HIV/AIDS patients be continued until the two approaches are properly validated in terms of outcomes and are perhaps adjusted for future use.

Celebrate and Commemorate

Correspondence concerning this article should be addressed to St Peter's Hospital, Helena, Montana. E-mail: [email protected]

Thorascopic Sympathectomy Performed Using Laser

Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis. Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter's Hospital between 1987 and 2006. Patients were followed up by telephone interview. A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9-71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner's syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem. Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome.

The Business Role of Healthcare Quality Professionals

1Daniel H. van Leeuwen, MPH RN CPHQ, is a manager in information technology at St. Peter's Hospital in Albany, NY, and has more than 30 years' experience in healthcare delivery, management, and research. He is coeditor of the Journal for Healthcare Quality Quality NETwork column and was a contributing author of Q Solutions: Essential Resources for the Healthcare Quality Professional.

Frank Derek Thompson

Frank Derek Thompson's background in cardiovascular and renal medicine allowed him to combine a dual career as nephrologist at the St Peter's Hospitals and the Harefield and Mount Vernon Group....

30 PET-CT and breast cancer recurrence

1Guildford Diagnostic Imaging, Guildford 2St Peter's Hospital, Chertsey 3North Hampshire Hospital, Basingstoke 4Frimley Park Hospital, Frimley, UK British Nuclear Medicine Society Oral and Poster Abstracts 2007

Retention Strategies for Newly Hired Filipino Nurses

Author's affiliations: Assistant Professor, Linfield College Good-Samaritan School of Nursing, Portland, Ore; Clinical Educator, Providence Saint Peter Hospital, Olympia, Wash; and Medical-Surgical Nurse, Medstaff Network, Portland, Ore. Correspondence: 2255 NW Northrup, Portland, OR 97210-2932 ([email protected]).

An evaluation of diagnostic paracentesis in the acute abdomen.

Journal Article An evaluation of diagnostic paracentesis in the acute abdomen Get access W G Prout W G Prout Surgical Registrar St. Peter's Hospital, Chertsey Present address: St. Thomas's Hospital, London, S.E.1 Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 55, Issue 11, November 1968, Pages 853–857, https://doi.org/10.1002/bjs.1800551112 Published: 08 December 2005