Lagan Valley Hospital

BackgroundDelirium is a complication that presents a frequent challenge on our inpatient wards. Early recognition, detection and diagnosis of delirium can improve patient outcomes. The 4 ‘A’s Test (4AT) is a validated, rapid initial assessment tool that is a sensitive and specific method of screening for delirium in hospitalised patients.AimsTo determine the prevalence of use of the 4AT and to reveal if increasing staff awareness yielded improvement in use of the 4AT and detection of delirium.MethodsInitial data collection analysed inpatient notes on our rehabilitation (rehab) ward and medical assessment unit (MAU), for any terminology suggestive of an underlying delirium. Rehab ward nursing staff had already received training on delirium detection. Following this, formal teaching was delivered to junior doctors, and 4AT lanyard cards were distributed. One month later, another round of data collection was undertaken. Throughout the year, nurses in MAU were educated on delirium. Further data was collected 1 year later.ResultsBaseline data analysis showed use of the 4AT on the rehab ward (75%) was significantly greater than MAU (20%). This was associated with increased detection/diagnosis of delirium on the rehab ward (75% diagnosed, 100% concordance with 4AT use) compared to MAU (20%). After 1 month, use of the 4AT improved dramatically on MAU (50%) and remained high on the rehab ward, improving to 87.5%. Results at 1 year show use of the 4AT continues to remain high on the rehab ward (75%) in at-risk patients. In addition, there remains a sustained improvement in 4AT use on MAU (40%) compared to baseline data (20%). Diagnosis and recording of delirium continues to improve on MAU (100% of suspected patients diagnosed), and remains high (75%) on our rehab ward.ConclusionOur findings support the continued use of the 4AT screening tool and ongoing staff education and training in order to improve knowledge and confidence in detecting signs of delirium.

Purpose: To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). Method: Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. Results: Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η2 = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. Conclusions: Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted.Implications of RehabilitationTreatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment.Observed cognitive impairment(s) tend to be less in patients following endovascular coiling.Following ruptured aneurysm, patients with cognitive impairment report reduced health related quality of life and increased anxiety.Those with identified cognitive impairment(s) may benefit from cognitive remediation.

A 44 year old woman was investigated for a soft, non-tender, reducible swelling, measuring 5 cm in diameter in her left lumbar region. There was no cough impulse. An abdominal computed tomogram revealed a superior lumbar hernia, first …

Much has been said and written about the importance of teams to the success of organisations and emphasis has been given to the benefits of team‐building activities to achieving both team and organisational effectiveness. Describes attempts to move beyond team building and to link organisational development to team effectiveness in a coherent way. In order to achieve this goal, a team effectiveness audit tool has been devised which is based on individual self‐assessment. The audit tool focuses on six domains considered to be important in effective teams. The self‐report audit tool has now been used by over 140 teams across a range of public‐sector organisations and this has enabled a significant database to be built up. This provides a large normative data set against which individual team performance can be gauged. Focuses on data derived from 37 teams within an integrated acute and community health and social services (HSS) trust. Overall the team effectiveness audit tool has been well received and has proven to be an effective mechanism of linking individual and team performance with organisational‐management objectives.

The plasma cholinesterase status of 22 people resident in the same small town was investigated. A high incidence of the atypical cholinesterase gene was found.

AnaesthesiaVolume 40, Issue 6 p. 603-604 Free Access Foreign body K.R. Millican, K.R. Millican Lagon Valley Hospital Hillsborough Road, Lisburn BT28 1JPSearch for more papers by this author K.R. Millican, K.R. Millican Lagon Valley Hospital Hillsborough Road, Lisburn BT28 1JPSearch for more papers by this author First published: June 1985 https://doi.org/10.1111/j.1365-2044.1985.tb10925.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume40, Issue6June 1985Pages 603-604 RelatedInformation

I must thank Dr. Laws for his suggestion that intramural injection of the contrast material may have caused dissection of the aorta and lead to the complications we described. This was one of the possible factors we considered in the period immediately following the aortogram and some time later the excellent article on “Dissection of the Aorta as a complication of trans-lumbar aortography” (1956), by Mr. Gayliss and Dr. Laws, opened our minds once more to the possibility of dissection of the aorta locally at the origin of the inferior mesenteric artery. A more generalised dissection is, I think, unlikely.