Clinical medicine (London, England)
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The secondary care work stream of the National COPD Audit Programme aims to improve care and outcomes for patients with exacerbation of chronic obstructive pulmonary disease (COPD) wherever and whenever they are admitted to hospital. To achieve this, prospective audit is combined with real-time feedback of data to individual units, together with support for quality improvement and high-level change levers. ⋯ Only by working collaboratively across emergency, acute and general medicine, respiratory, geriatric and other teams can individual trusts deliver optimal care. This review provides background to the national COPD audit programme, relevant to all those caring for people with COPD exacerbations in secondary care.
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Prescribed opioid misuse in North America is a public health crisis, with huge social, medical and economic repercussions. Surgery is an identified driver for persistent opioid use and misuse. The UK has also seen a surge in opioid consumption per capita and it is now necessary for primary and secondary care to work together to mitigate the problem of perioperative prescribed opioid misuse. This review discusses the identified drivers for persistent opioid use following surgery and discusses the remedial actions that must be taken by all stakeholders to mitigate the UK developing its own perioperative prescribed opioid crisis.
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In this article, we review the evidence underpinning the broader prehabilitation concept and the target behavioural and lifestyle risk factors including their perioperative impact and evidence for prehabilitation intervention. We also identify principles for delivering prehabilitation in practice, alongside lessons for the perioperative setting from well-established allied interventions; cardiac and pulmonary rehabilitation.
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The perioperative period extends from the moment of contemplation of surgery through to recovery at home. Patients on a surgical pathway will experience multiple transition points in their care. ⋯ This article reviews best practice and guidance on handover of care throughout the perioperative period. We will look at models of transition of care beyond the hospital environment and how better use of community resources can smooth the transition of care out of hospital for ongoing rehabilitation.
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In 2016, NHS England set up 10 integrated care systems (ICSs) which aim to devolve some responsibility for delivery of health and social care services to local healthcare providers in partnership with local government, social care, primary care networks, and voluntary and charitable organisations. These are new ways of working and provide an opportunity to better integrate perioperative care across the entire pathway from the moment of contemplation of surgery through to recovery at home. ⋯ We describe examples of initiatives in cancer pathways which are already proving successful and have caught the imagination of the local community at all levels, as well as examples of integrated perioperative care across the country which can be applied to other systems. We hope to demonstrate ways in which perioperative care can add value to a local health population given the right support and chance to deliver it.