A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complain...A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The reaudit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of ￡32490 in a period of 3 mo(￡590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are nonlabour intensive can have a significant impact on service provision and cost.展开更多
Photocatalysis of water with and without ultrasound was studied using rGO supported CdS catalyst utilizing visible light. A higher hydrogen production was observed when ultrasound was used. This is attributed to a fas...Photocatalysis of water with and without ultrasound was studied using rGO supported CdS catalyst utilizing visible light. A higher hydrogen production was observed when ultrasound was used. This is attributed to a faster removal of bubbles of hydrogen from the surface of photocatalyst due to the mechanical energy associated with ultrasound overcoming surface tension. It has been further reported that the rate of hydrogen production decreased with time due to reversible deactivation of catalyst. This has been attributed to decrease in rate of hydrogen desorption with time.展开更多
The tympanic （Jacobson’s） nerve is a useful anatomi-cal structure in the middle ear with both practical and physiological functions extending beyond its origin. The paper reviews its clinical anatomy in adults and ...The tympanic （Jacobson’s） nerve is a useful anatomi-cal structure in the middle ear with both practical and physiological functions extending beyond its origin. The paper reviews its clinical anatomy in adults and its surgical signifcance. English language articles from 5 major databases and Google scholar search engine were used to identify papers outlining the anatomy of the tympanic nerve, associated pathology and surgical relevance. In the majority of cases the tympanic nerve arises from the inferior ganglion of the glossopharyn-geal nerve traversing through the tympanic canaliculus into the middle ear. On the promontory it coalesces with sympathetic fbres from the carotid chain forming the tympanic plexus which has individual variability. Functionally, as well as giving off parasympathetic fbres to the parotid gland via the lesser petrosal nerve, it is a useful anatomical landmark for cochlear implantation. The surgical importance of the tympanic nerve is not only restricted to middle ear surgery; it also extends to salivary gland disorders. The tympanic nerve remains clinically relevant to the modern otolaryngologist and as such a detailed understanding of its anatomy is crucial.展开更多
文摘A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The reaudit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of ￡32490 in a period of 3 mo(￡590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are nonlabour intensive can have a significant impact on service provision and cost.
基金the IIT(BHU)for providing financial support in the form of teaching assistantship
文摘Photocatalysis of water with and without ultrasound was studied using rGO supported CdS catalyst utilizing visible light. A higher hydrogen production was observed when ultrasound was used. This is attributed to a faster removal of bubbles of hydrogen from the surface of photocatalyst due to the mechanical energy associated with ultrasound overcoming surface tension. It has been further reported that the rate of hydrogen production decreased with time due to reversible deactivation of catalyst. This has been attributed to decrease in rate of hydrogen desorption with time.
文摘The tympanic （Jacobson’s） nerve is a useful anatomi-cal structure in the middle ear with both practical and physiological functions extending beyond its origin. The paper reviews its clinical anatomy in adults and its surgical signifcance. English language articles from 5 major databases and Google scholar search engine were used to identify papers outlining the anatomy of the tympanic nerve, associated pathology and surgical relevance. In the majority of cases the tympanic nerve arises from the inferior ganglion of the glossopharyn-geal nerve traversing through the tympanic canaliculus into the middle ear. On the promontory it coalesces with sympathetic fbres from the carotid chain forming the tympanic plexus which has individual variability. Functionally, as well as giving off parasympathetic fbres to the parotid gland via the lesser petrosal nerve, it is a useful anatomical landmark for cochlear implantation. The surgical importance of the tympanic nerve is not only restricted to middle ear surgery; it also extends to salivary gland disorders. The tympanic nerve remains clinically relevant to the modern otolaryngologist and as such a detailed understanding of its anatomy is crucial.
