A&E tipping points
248 British Journal of Healthcare Management 2015 Vol 21 No 5 © 2 01 5 M A H ea lth ca re L td Figure 2 clearly shows the impact of the last two of these tipping points on AE 2013). No sane health care administration would ever expect to run hospitals at the level of occupancy common in the UK—but sanity appears to be sadly lacking in this case, and the consequences are entirely predictable. The reasons for the sudden jumps in AE Jones and Beauchant, 2015)—although politicians appear determined to avoid any discussion of the real issues for fear of jeopardising their own pet policies. There will be Rod Jones A&E tipping points
Unexpected and disruptive changes in admissions associated with an infectious-like event experienced at a hospital in Berkshire, England around May of 2012.
Aims: To study the effect of a large infectious-like event on admissions to, and bed occupancy in, a very large acute hospital in Reading (western Berkshire) England, observed to commence in the early part of 2012. These changes occurred in parallel with infectious-like spread of an agent leading to increased medical admissions across the whole of Berkshire. Study Design: Longitudinal study of hospital admissions, bed occupancy and deaths. Place and Duration of Study: Admissions and deaths at the Royal Berkshire Hospital NHS Foundation Trust (England) between April 2008 and September 2013. Methodology: A running 12 month total of admissions, deaths and occupied beds was constructed from aggregated hospital admission and discharge data. Trends were analysed by admission type, discharge destination, specialty, International Classification of Diseases (ICD-10) primary diagnosis and Healthcare Resource Group (HRG) v4 chapter. Results: Admissions, deaths and occupied beds all showed a simultaneous step-like increase around March to June of 2012, which led to considerable operational pressure and a marked reduction in elective overnight surgery due to reduced bed availability. The increase in in-hospital Original Research Article Jones; BJMMR, 6(1): 56-76, 2015; Article no.BJMMR.2015.184 57 deaths exhibited a curious time cascade which was specific for various diagnoses. Deaths first increased for those with cancers or intestinal conditions in January 2012, followed by hepatic, diabetic and asthma in February 2012, then a time series of other conditions, through to arthritis and arthrosis conditions in July 2012. All of these occurred at a time when deaths across the whole of the UK showed a large and unexpected increase. Conclusion: A new type of infectious event is strongly implicated which appears to exert its clinical effects via some form of immune impairment. The agent leads to a persistent infection. The immune modifying virus, cytomegalovirus, which (in other studies) is associated with a 20% higher odds ratio for all-cause mortality, has been circumstantially implicated, however, this requires confirmation.
Cryostat use and tissue processing in Mohs micrographic surgery.
Information of cryostat use and reliability was collected from 130 members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. The Damon IEC International cryostat was utilized by 38% of the survey participants, followed by the Reichert Histostat (18%) and the LabTek/TissueTek (13%). Data were also collected on methods of frozen-section embedding and technical training.