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Biomedical subjects

H B Devlin

Publications and source records attributed to H B Devlin.

At least 19 recordsLinked to original sources
PubMed1992

Surgeons' views of day surgery: is there a consensus among providers?

Managers and purchasers of health services are being encouraged to expand day surgery as a means of providing high-quality care and reducing costs per case and waiting times. This study examined general surgeons' views of day surgery with particular reference to day case inguinal hernia repair. A postal questionnaire was completed by 240 consultants (85 per cent) in four Regional Health Authorities. Only 11 per cent were regularly undertaking day case inguinal hernia repair, a further 44 per cent held positive attitudes towards this form of treatment and 45 per cent were not interested, with attitudes varying by age and region. Major constraints perceived by those with positive attitudes were the lack of facilities at a hospital level and problems of community services. Negative attitudes were associated with concerns about post-operative complications and pain, and assumptions about patients' preferences. This demonstrates a considerable range in surgeons' attitudes to day surgery despite its formal endorsement by professional bodies, and identifies what are perceived as the organizational and clinical barriers to its wider introduction. It is suggested that eliciting provider views and concerns forms an important requirement for the successful implementation of organizational change.

Ambulatory Surgical Procedures↗
PubMed1991

Are current techniques of inguinal hernia repair optimal? A survey in the United Kingdom.

Data was collected on the techniques currently employed in adult inguinal hernia repair by means of a postal questionnaire to consultants in four Regional Health Authorities in England. Questionnaires were returned by 240 consultants (85%). This identified a considerable range in methods of repair, with a Moloney nylon darn being the sole method used by 35% of consultants, and the Shouldice technique, either alone or in combination with other methods, being used by 20%. Overall, 51% employ a subcuticular suture for skin closure, and traditional skin sutures are used by 31%. There was no association between consultant's date of qualification or subspecialty and type of repair. Consultants qualifying after 1969 are most likely to use a subcuticular suture. Some 14% of all consultants and 19% of those qualifying since 1969 employ a Shouldice procedure and a subcuticular suture.

Adult↗
PubMed1989

Surgical glove failure rate.

Surgical gloves were collected after day-time operations for a 4-week period. Glove punctures were located by inflating each glove with compressed air and immersing the inflated glove in water. During the period of the study 681 surgical operations were performed. A total of 3790 gloves was collected, 334 gloves (8.8%) had perforations at the end of the surgical procedure. Defects occurred in one or more gloves in 32.0% of all operations.

Equipment Failure↗
PubMed1988

A district general hospital experience of surgical treatment of gastric and duodenal ulcer from 1970 to 1982.

Seven hundred and thirteen patients who had undergone 793 operations for peptic ulcer disease during the years 1970 to 1982 were subsequently referred to a gastric follow-up clinic. The indications for initial elective surgical treatment (514) were failed medical management (448), recent hemorrhage (32) and obstruction of gastric outflow (34); for initial emergency surgical treatment (199), the indications were hemorrhage (97) and perforation (102). Reoperation was required in 80 patients-previous perforation (40), recurrent ulcer (32), reperforation (three), hemorrhage (three) and obstruction of gastric outflow (two). The over-all postoperative mortality rate was 4.2 per cent (33 of 713); 15 deaths occurred after elective surgical treatment (2.5 per cent) and 18 after emergency surgical treatment (8.6 per cent). The postoperative morbidity expressed in terms of duration of postoperative stay was unaltered for each procedure throughout the study period. Follow-up attendance rates at one, three, five and ten years were 86, 85, 74 and 28 per cent, respectively. Iron deficiency anemia was detected in 13.6 per cent of gastric resection procedures and 1.6 per cent of vagotomy and drainage procedures. No instances of macrocytic anemia and only two instances of asymptomatic metabolic bone disease were recorded. By providing accurate data for surgical audit, which suggested that screening for metabolic sequelae in the first decade after surgical treatment is not indicated and which resulted in alteration of policy toward peptic ulcer perforation, a specific follow-up clinic has proved valuable in formulating the over-all management policy regarding surgical treatment for peptic ulcer.

Adult↗
PubMed1987

Length of stay for common surgical procedures: variation among districts.

Lengths of stay for appendicectomy, inguinal hernia repair and cholecystectomy for the 16 districts in the Northern Regional Health Authority (NRHA) and 15 districts in the South East Thames Regional Health Authority (SETRHA) are examined using data recorded in the Hospital Activity Analysis. Considerable variations exist among districts, with the three longest stay districts for each procedure in NRHA having an age-adjusted length of stay of 113 per cent of the regional average for appendicectomy, 125 per cent for hernia and 115 per cent for cholecystectomy. This resulted in greater than 2000 additional bed days per year being occupied in the three longest stay districts in the NRHA compared with the regional average. The age adjusted length of stay for the three shortest stay districts for each procedure is 83 per cent of the regional average for appendicectomy, 75 per cent for hernia and 85 per cent for cholecystectomy. Similar differences are seen in the SETRHA, and derive from differences in the length of both preoperative and postoperative stay. Explanations for the observed variations are considered in terms of population, organizational and clinical variables.

Adolescent↗
PubMed1987

The quality of life with a stoma.

This article considers the problems encountered by the ostomate, reviews the present structure and effectiveness of hospital and community-based resources and offers a basis for improving the quality of stoma care.

Colostomy↗
PubMed1986

Short stay surgery for inguinal hernia: experience of the Shouldice operation, 1970-1982.

Between mid 1970 and mid 1982, 696 patients underwent 718 operations for primary inguinal hernias by the Shouldice surgical technique. Follow-up to 31 December 1983 revealed 6 recurrences, 40 patients died during the follow-up period and 37 were lost to the study. Five patients required re-operation for complications of the suture material. Polypropylene was the most efficacious of the suture materials used during the study. Duration of hospital stay and age at operation do not influence the probability of recurrence. The operation gave consistently good results when performed by either a consultant surgeon or a surgeon in training. Using the Shouldice surgical technique the probability of recurrence of the inguinal hernia at 10 years is only 1 per cent.

Adolescent↗