One Stop Wide Awake Surgery
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One Stop Wide Awake Surgery
One Stop Wide Awake (OSWA) is a surgical model which was initially developed for hand surgery in the United Kingdom. It is recognized as effective by the Royal Society of Medicine. The model centres on complete surgical care within one management stop, and with reduced risks due to the avoidance of general anesthesia, regional anaesthesia, sedation, and tourniquets. This approach to surgery is particularly cost-effective and efficient. It enables complex procedures such as for Dupuytren's contracture to be performed as outpatient procedures under local anaesthesia. With the changes in UK healthcare commissioning and the evolution from primary care trusts to clinical commissioning groups from 2013, this model of surgery is likely to be increasingly important, and may secure the funding of some NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxati ...
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Surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas. The act of performing surgery may be called a surgical procedure, operation, or simply "surgery". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse. The person or subject on which the surgery is performed can be a person or an animal. A surgeon is a person who practices surgery and a surgeon's assistant is a person who practices surgical assistance. A surgical team is made up of the surgeon, the surgeon's assistant, an anaesthetist, a circulating nurse and a surgical technologist. Surgery usually spa ...
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Hand Surgery
Hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder)Hand surgery is extremely difficult, ranking last on what most doctors would consider “easy.” It can cause loss of memory, loss of fingers, loss of hand or hands, loss of leg and, in above average cases, death"About Hand Surgery", American Society for Surgery of the Hand. Retrieved on 2011-02-24. including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery. Plastic surgeons and orthopedic surgeons receive significant training in hand surgery during their residency training. Also, some graduates do an additional one-year hand fellowship. Board certified general, plastic, or orthopedics surgeons who have completed approved fellowship training in hand surgery and have met a number of other practice requirements are q ...
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Royal Society Of Medicine
The Royal Society of Medicine (RSM) is a medical society in the United Kingdom, headquartered in London. History The Society was established in 1805 as Medical and Chirurgical Society of London, meeting in two rooms in barristers’ chambers at Gray's Inn and then moving to Lincoln's Inn Fields where it stayed for 25 years. In 1834 the Society moved to Berners Street and was granted a Royal Charter by King William IV. In 1889 under the leadership of Sir John MacAlister, a Building Committee chaired by Timothy Holmes supervised the move of the quarters of the Society from Berners Street to 20 Hanover Square. In 1905 an eleven-member committee headed by Sir Richard Douglas Powell organised the celebration of the Society's centenary. Two years later the Royal Medical and Chirurgical Society of London came together with seventeen specialist medical societies and, with a supplementary Royal Charter granted by Edward VII, became the Royal Society of Medicine. In 1910 the Society ...
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General Anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. A variety of drugs may be administered, with the overall goal of achieving unconsciousness, amnesia, analgesia, loss of reflexes of the autonomic nervous system, and in some cases paralysis of skeletal muscles. The ...
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Regional Anaesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. The following terms are often used interchangeably: * ''Local anesthesia'', in a strict sense, is anesthesia of a small part of the body such as a tooth or an area of skin. * ''Regional anesthesia'' is aimed at anesthetizing a larger part of the body such as a leg or arm. * ''Conduction anesthesia'' encompasses a great variety of local and regional anesthetic techniques. Medical A local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways (nerve block), effects such as ...
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Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam. Medical uses Sedation is typically used in minor surgical procedures such as endoscopy, vasectomy, or dentistry and for reconstructive surgery, some cosmetic surgeries, removal of wisdom teeth, or for high-anxiety patients. Sedation methods in dentistry include inhalation sedation (using nitrous oxide), oral sedation, and intravenous (IV) sedation. Inhalation sedation is also sometimes referred to as ''relative analgesia''. Sedation is also used extensively in the intensive care unit so that patients who are being ventilated tolerate having an endotracheal tube in their trachea. It can also be used during a long term brain EEG to help patient relax. Risks There are ...
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Tourniquet
A tourniquet is a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation. A simple tourniquet can be made from a stick and a rope, but the use of makeshift tourniquets has been reduced over time due to their ineffectiveness compared to a commercial and professional tourniquet. This may stem the flow of blood, but side effects such as soft tissue damage and nerve damage may occur. Types There are three types of tourniquets: surgical tourniquets, emergency tourniquets, and rehabilitation tourniquets. Surgical tourniquets Silicone ring tourniquets, or elastic ring tourniquets, are self-contained mechanical devices that do not require any electricity, wires or tubes. The tourniquet comes in a variety of sizes. To determine the correct product size, the patient's limb circumference at the desired occlusion location should be measured, as well as their bloo ...
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Dupuytren's Contracture
Dupuytren's contracture (also called Dupuytren's disease, Morbus Dupuytren, Viking disease, palmar fibromatosis and Celtic hand) is a condition in which one or more fingers become progressively bent in a flexed position. It is named after Guillaume Dupuytren, who first described the underlying mechanism of action, followed by the first successful operation in 1831 and publication of the results in ''The Lancet'' in 1834. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be fully straightened. While typically not painful, some aching or itching may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can affect one or both hands. The condition can interfere with activities such as preparing food, writing, putting the hand in a tight pocket, putting on gloves, or shaking hands. The cause is unknown but might have a genetic component. Risk factors include ...
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Outpatient Procedure
A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider. Etymology The word wikt:patient, patient originally meant 'one who suffers'. This English noun comes from the Latin word ', the present participle of the deponent verb, ', meaning 'I am suffering,' and akin to the Ancient Greek, Greek verb (', to suffer) and its cognate noun (). This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in Shared decision-making in medicine, shared decision-making about their care. Outpatients and inpatients An outpatient (or out-patient) is a patient who attends an Outpatient clinic (hospital department), ...
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Local Anaesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. The following terms are often used interchangeably: * ''Local anesthesia'', in a strict sense, is anesthesia of a small part of the body such as a tooth or an area of skin. * ''Regional anesthesia'' is aimed at anesthetizing a larger part of the body such as a leg or arm. * ''Conduction anesthesia'' encompasses a great variety of local and regional anesthetic techniques. Medical A local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways (nerve block), effects such ...
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Primary Care Trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May 2011, they also provided community health services directly. Collectively PCTs were responsible for spending around 80 per cent of the total NHS budget. Primary care trusts were abolished on 31 March 2013 as part of the Health and Social Care Act 2012, with their work taken over by clinical commissioning groups. Establishment In 1997 the incoming Labour Government abolished GP Fundholding. In April 1999 they established 481 primary care groups in England "thereby universalising fundholding while repudiating the concept." Primary and community health services were brought together in a single Primary Care Group controlling a unified budget for delivering health care to and improving the health of communities of about 100,000 people. A PC ...
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Clinical Commissioning Group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integrated care systems as a result of the Health and Care Act 2022. Establishment The announcement that GPs would take over this commissioning role was made in the 2010 white paper "Equity and Excellence: Liberating the NHS". This was part of the government's stated desire to create a clinically-driven commissioning system that was more sensitive to the needs of patients. The 2010 white paper became law under the Health and Social Care Act 2012 in March 2012. At the end of March 2013 there were 211 CCGs, but a series of mergers had reduced the number to 135 by April 2020. To a certain extent they replaced primary care trusts (PCTs), though some of the staff and responsibilities moved to local authority public health teams when PCTs ceased to ...
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