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V Wareham

Publications and source records attributed to V Wareham.

2 recordsLinked to original sources

The impact of the introduction of a fast track clinic on ovarian cancer referral patterns.

The aim of this study is to review the referral patterns for ovarian cancer in the Grampian region of Scotland and assess the impact of a 'fast track' clinic on the patient journey. Population-based retrospective analysis of a gynaecological cancer database and patient case notes were used. After its inception, 13.5% of patients were referred through the fast track clinic and 83% were seen within 2 weeks. Thirty-six per cent of patients were admitted as emergencies, mainly surgical or medical. The median general practitioner-to-specialist time was 3 days (range 0-188 days). The median time to diagnosis prior to the fast track clinic was 23 days and 17.5 days after its introduction (P = 0.003). A population-based ovarian cancer referral pattern is presented. Median waiting times are short but do influence time to diagnosis as do referral through a non-cancer specialty and patient performance status. Rapid access through a gynae-oncology clinic has some impact but is underused.

Family Practice↗

Caesarean section audit by peer review.

OBJECTIVE: To provide activity audit data on 50 consecutive caesarean sections and assess the justification for the decision to perform each caesarean section. DESIGN: A retrospective audit with peer review. SETTING: Aberdeen Maternity Hospital. SUBJECTS: Fifty consecutive women undergoing caesarean section. The peer review was undertaken by four consultants and four registrars. MAIN OUTCOME MEASURES: The proportions of caesarean sections by indication stratified according to primiparae or multiparae and emergency or elective procedures. The auditors were asked 'do you think caesarean section was reasonable?' RESULTS: There were 18 (36%) elective caesarean sections and 32 (64%) emergency procedures. Of the 25 (50%) parous women, 14 (56%) had a previous caesarean section and of these 12 (86%) had an elective repeat caesarean section. Foetal distress was the principal indication for emergency caesarean section in 20 (63%) women, with foetal blood sampling performed in only four cases. For emergency caesarean sections the decision to delivery interval ranged from 13 to 160 min (mean 50 min). At least one auditor disagreed with the decision to perform caesarean section in 24 (48%) cases. Between observers the range of disagreement was from 2 to 18 of the decisions. In only 6 (33%) of the 18 elective procedures was there complete agreement. Four (67%) of these women had two previous caesarean sections. There was complete agreement with 20 (63%) of the 32 emergency caesarean sections. Conclusions--Interventions considered as a result of this audit include the introduction of structured diagnostic criteria for caesarean section indications and peer review by the on-call team of the caesarean sections performed in the preceding 24 h.

Adolescent↗