Abstract:
AIM:To investigate inefficiencies during patients' stay in neurosurgical beds. METHODS:A prospective audit of neurosurgical inpatients was conducted over approximately 2 months. We recorded the causes and duration of inappropriate delays, defined as actions requiring more that 24 h from initiation until completion. RESULTS:One-hundred-and-thirty-eight patients were studied (61 elective and 77 emergency admissions). The audited patients were in hospital for a total of 1665 days. Of these, 482 days (29%) were due to delays. 92.5% of these wasted days involved emergency admissions. The main categories of delay were transfer back to referring hospital (46% of all delays), operative (26%) and radiological (19%). Our own hospital was responsible for the longest transfer delays (6.3 days/patient compared with an average of 2.8 for all hospitals). Operative waits arose because of problems with both the timing and capacity of lists. Radiological delays resulted in particular from waits for MRI scans and neuroradiologist-performed procedures. The effect of eliminating all these inappropriate delays would be equivalent to liberating 10.7 of our 37 neurosurgical beds at any one time. CONCLUSIONS:Clinician-led analysis of organizational aspects of patient care has revealed serious structure, process and capacity problems in efficient bed usage, We have made proposals to address the cause of the inappropriate delays.
journal_name
Br J Neurosurgjournal_title
British journal of neurosurgeryauthors
Chelvarajah R,Lee JK,Chandrasekaran S,Bavetta Sdoi
10.1080/02688690701649488subject
Has Abstractpub_date
2007-12-01 00:00:00pages
610-3; discussion 614-5issue
6eissn
0268-8697issn
1360-046Xpii
788289140journal_volume
21pub_type
杂志文章abstract:OBJECTIVE:The aim of this study was to compare the efficacy, safety, and duration of Remebot robot-assisted frameless brain biopsy with those of standard frame-based stereotactic biopsy. PATIENTS AND METHODS:A retrospective analysis of 66 patients undergoing stereotactic brain biopsy in our department from January 201...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1812519
更新日期:2020-09-17 00:00:00
abstract:OBJECTIVE:Decompressive craniectomy is often emergently performed in an effort to reduce intracranial hypertension. After this urgent intervention, brain-injured patients often start rehabilitation programs but are left with a skull defect. Cranioplasty is often performed in these situations in order to repair this def...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2012.692838
更新日期:2012-12-01 00:00:00
abstract::A series of 510 patients with proven aneurysmal subarachnoid haemorrhage (SAH) is reported. The incidence of recurrent haemorrhage during the period awaiting surgery was 13.7%. There was no significant difference in incidence between good and poor grade patients. Following rebleeding there was an immediate mortality o...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688698808999657
更新日期:1988-01-01 00:00:00
abstract::Internal fixation provides an increased immediate stability for the craniovertebral junction; however, there is no current consensus on the optimal method of occipitocervical (OC) fusion. In this report, we present 25 cases of craniovertebral instability treated with OC fusion by plates and screws instrumentation. The...
journal_title:British journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.1080/02688690400022813
更新日期:2004-12-01 00:00:00
abstract:OBJECT:Animal models provide a basis for clarifying the complex pathogenesis of delayed cerebral vasospasm (DCVS) and for screening of potential therapeutic approaches. Arbitrary use of experimental parameters in current models can lead to results of uncertain relevance. The aim of this work was to identify and analyze...
journal_title:British journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3109/02688691003746274
更新日期:2010-08-01 00:00:00
abstract::Cavernous angiomas affecting the optic pathway are rare. This report describes the case of a 12-year-old girl who presented with a 10-month history of right-sided blurred vision caused by a cavernous angioma affecting the right side of the optic chiasm. The computed tomography (CT) scan demonstrated a hyperdense image...
journal_title:British journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3109/02688697.2012.685820
更新日期:2012-12-01 00:00:00
abstract:INTRODUCTION:Head injury is an important cause of death and disability in young people, with 1.4 million presentations each year in the UK.( 1 ) Extradural haematoma (EDH) is a potentially fatal head injury, which is easily remedied surgically. Several factors influence the mortality of EDH. The mortality of isolated E...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2012.709555
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:There are few agreed quantifiable outcome measures in pituitary surgery. The goal of this study is to present the measurement of resection volume after surgery for pituitary tumours as a surgeon-specific outcome measure that may have use in illustrating the performance of individual surgeons internally and ex...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2013.847172
更新日期:2014-06-01 00:00:00
abstract::Despite advances in imaging of the brain, an accurate diagnosis of brain lesions requires tissue sampling and histological verification. A series of CT-directed procedures has been performed in 300 patients with deep sited, multiple, diffuse, extensive, small or inflammatory lesions, brain stem haematomas and tumours ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688698909002810
更新日期:1989-01-01 00:00:00
abstract::Introduction: Adipose tissue acts as an active endocrine organ and may be involved in the biological mechanism of stroke. Adipokines can serve as key messenger of central energy and metabolic homeostasis and can contribute to the crosstalk between adipose tissue and brain. Recent research has offered vague data on the...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2019.1578862
更新日期:2019-10-01 00:00:00
abstract::Background: Radiation exposure is a known risk factor for meningioma but there are no data regarding hemangiopericytoma and radiation exposure.Case Description: We report a 29-year-old pineoblastoma patient diagnosed with a hemangiopericytoma at a different location, after a successful surgical excision and adjuvant r...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1759779
更新日期:2020-05-07 00:00:00
abstract::A 33-year-old man presented with a history of fits and on initial investigation was suspected of having a left frontal parafalcine meningioma. Initial surgical procedure to excise the lesion had to be abandoned owing to the extreme vascularity of the lesion. Histology revealed it to be a haemangioendothelioma. At a se...
journal_title:British journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.1080/02688699943123
更新日期:1999-12-01 00:00:00
abstract::Subependymomas are rare benign tumours arising from subependymal glial precursors that usually remain asymptomatic or may present due to obstruction of cerebrospinal fluid pathways. We describe the first report of intraventricular haemorrhage from subependymoma and cavernous-like malformation collision tumour in a 74-...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2017.1390063
更新日期:2019-10-01 00:00:00
abstract::Purpose: Today, stereotactic surgery (SRS) is among the treatment options for many intracranial lesions including vascular pathologies. One of the most common late complications of SRS is perilesional edema which can be treated with steroids. In addition to steroids, some new medical therapies are being investigated a...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1742294
更新日期:2020-03-27 00:00:00
abstract::In vestibular schwannomas (VS), the tumour size, as well as the size of the cystic component, have a considerable bearing on the outcome. This study addresses the differences between the cystic and solid variants of giant vestibular schwannomas. The study included 62 patients with giant VSs, of which 40 were solid and...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690802159031
更新日期:2008-08-01 00:00:00
abstract::Objective: The purpose of this study was to assess the association between extent of brachial plexus injury and shoulder abduction/external rotation outcomes after spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer.Methods: A systematic review of the literature was conducted according to PRISMA guideli...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2019.1639620
更新日期:2020-10-01 00:00:00
abstract::A process has been developed by which ventriculoperitoneal hydrocephalus shunts, which are prone to bacterial colonisation, can be impregnated with antimicrobials in order to confer antibacterial activity. Concern that their use might be associated with an increased risk of postoperative seizures has been addressed he...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688699409101187
更新日期:1994-01-01 00:00:00
abstract::Distant intraventricular metastasis is extremely rare in childhood craniopharyngioma. Here, we report the isolated posterior ventricular recurrence of an adamantinomatous craniopharyngioma, in a child previously treated with surgery and proton beam therapy for local progression. The importance of surveillance imaging ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3109/02688697.2016.1139050
更新日期:2017-08-01 00:00:00
abstract::Low-grade (WHO level I) meningiomas are slow-growing, benign tumours typically presenting with unspecific symptoms (e.g. headache), seizures, cranial nerve compression and neuropsychological symptoms determined by location and size of the lesion. Haemorrhagic onset and sequelae are rare, and have been described infreq...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690500208734
更新日期:2005-06-01 00:00:00
abstract::Spontaneous intracranial hypotension (SIH) is an uncommon clinical entity that is often diagnosed after a delay, or it is misdiagnosed due to the variety of clinical presentations and the associated radiological findings. We present here a case of SIH associated with chronic subdural haematoma (SDH) and subarachnoid h...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690701790597
更新日期:2008-04-01 00:00:00
abstract::Seventy patients with spinal arteriovenous malformations (AVMs) referred to the author over a 25-year period (1958-82), were equally divided between congenital, intradural and acquired, dural lesions. Amongst the intradural AVMs, were 22 with subarachnoid haemorrhage (SAH), a presenting feature in 18. The clinical fin...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688699209002895
更新日期:1992-01-01 00:00:00
abstract::We report a case of high thoracic ossification of the ligamentum flavum (OLF) causing a partial Horner's syndrome. A 57-year-old man developed a walking disorder, as well as right-sided miosis and anhidrosis. Magnetic resonance imaging demonstrated a spinal cord compressing T2-T3 OLF. The patient improved after surger...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2018.1441976
更新日期:2018-02-28 00:00:00
abstract:BACKGROUND:Meningiomas are one of the most common tumours to affect the central nervous system. Genetic mutations are important in meningeal tumourigenesis, progression and prognosis. In this study, we aimed to examine the effect of 1p/19q deletion on the diagnosis and prognosis of meningioma subtypes using the fluores...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2016.1181155
更新日期:2016-10-01 00:00:00
abstract::Microdialysis enables the chemistry of extracellular fluid in body tissues to be measured. Extracellular proteases such as the cysteine protease, cathepsin S (CatS), are thought to facilitate astrocytoma invasion. Microdialysates obtained from human brain tumours in vivo were subjected to cathepsin S activity and ELIS...
journal_title:British journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1080/02688690701248190
更新日期:2007-04-01 00:00:00
abstract::Spinal cord stimulation (SCS) is an established treatment modality for chronic pain, angina pectoris, and peripheral vascular disease. This study evaluates experience with SCS over a 13-year period with emphasis on surgical complications, revisions and pain relief. It took the form of a retrospective study of medical/...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690120072496
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:Bilateral anterior cingulotomy is a palliative procedure occasionally used for cancer pain, and human studies suggest anterior cingulate cortex is active in dyspnoeic states. OBJECTIVES:A case of debilitating thoracic wall pain due to malignant mesothelioma relieved by bilateral anterior cingulotomy is desc...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2013.857006
更新日期:2014-08-01 00:00:00
abstract::Multicentre gliomas are a well recognized entity but the occurrence of such tumours both above and below the tentorium remains uncommon. We report the case of an 11-year-old boy who underwent stereotactic biopsy of a brain stem ring enhancing tumour with histology of an anaplastic astrocytoma (Grade 3). Nine months fo...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688699109002887
更新日期:1991-01-01 00:00:00
abstract::In a two-centre study, intrasellar pituitary tissue pressure was measured at transsphenoidal surgery in 107 patients with pituitary adenomas or intrasellar cysts. 'Normal' ISP in patients under anaesthesia with small microadenomas (< 5 mm diameter) or a partial empty sella was 12 +/- 3 mmHg. Raised ISP (> 15 mmHg) was...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688699409029619
更新日期:1994-01-01 00:00:00
abstract::Primary melanocytic tumors of the central nervous system (CNS) are rare lesions, but primary sellar tumors are rarer. Only 10 cases have been reported, and they are often misdiagnosed as pituitary macroadenoma. We report the case of a 54-year-old Chinese man who developed progressive bitemporal hemianopsia and visual ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3109/02688697.2014.967752
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:Hydrocephalus after subarachnoid hemorrhage (SAH) requires temporary cerebrospinal fluid (CSF) drainage using an external ventricular drain (EVD). This drain is removed if patients pass a clamp trial, or a ventriculoperitoneal shunt (VPS) is placed. Little is known about the risk factors for delayed VPS place...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2014.967753
更新日期:2015-04-01 00:00:00