Kent Health News and Events

Hello again, it must have been a while now since I last updated you all on what I’ve been up to. Well since the last time, I’ve just been plodding on as before, retrieving the physical case notes and finding the relevant information to enter into the database.

Dr. Hargroves, one of the consultants I’m working with held a “grand round”, a posh hospital word for a lecture. His lecture was about stroke prevention and treatment of acute stoke, which is almost exactly the same field as what I have been researching in and so was extremely informative and useful.

Other than that, there hasn’t been much else new going on at the William Harvey, and it might be the same for the next couple of weeks. My entries will probably be a bit shorter over the coming weeks as a result, but I’ll still try to keep on blogging! One exciting piece of news I’ve been given is that I may be allowed to continue on after the summer to actually finish the research and perhaps even present at the European Stroke Conference next year! Until next time.

Wow, I can’t believe it’s been 4 weeks already! Time has flown by and so has this placement. About halfway through now and I’ve done a fair amount of work. I think last time I left you I had just attended an MDM, was revising for my UKCAT and I told you all about CT brain perfusion scans. Well, a quick update on the UKCAT – I managed to pass it with an above average score so I am very pleased with that, and it means I have some more time in my evenings for even more fun things like writing personal statements….. Joy.

Since the last post, I’ve managed to do quite a bit with the database. Using a few excel tricks I searched the database for duplicate patient ID numbers, and actually came up with about 7/8 repeats of which I think 2 pairs may be identical events and so need to be deleted. The other duplicates look to be the same people having 2 separate strokes (Very unfortunate people) so these can both be entered onto the database. I’ve managed to get as much information as possible from the various computer programmes where relevant data is stored so now I’ve moved on to physical case notes. It was last week (Friday 30th) when I reserved the first lot of patients notes and they have started trickling into the office today so I’ve managed to complete a few patients event information fully, which is the first step to having a database with no missing data!!

I also went up to Templeman library on the Friday and installed SPSS 21 on my laptop (A statistical analysis software) so that I could start getting accustomed to the techniques I could use to transfer data from the stroke database to the software and then get used to running various tests on the variables. I managed to set up the relevant variables in SPSS and then I started entering the data manually….. Very long and laborious! After about 5 minutes I decided there must be a quicker way, so I linked my laptop up to the monitor of the computer in the office and transferred the database to my laptop. This allowed me to have SPSS on one screen and the database on another, but I was able to control both with the same mouse and keyboard and could simply copy and paste all the data in one fell swoop, which reduced the job time from about a week to 10 minutes – thank goodness!! After doing that I did some initial descriptive analysis as a test to see if I’d done everything correctly, and it returned some believable results which I was pleased with.

There was also a very exciting event for me today (Tuesday 3rd). One of the consultants was answering a thombolysis call and invited me along to observe – which was incredible! We arrived in the clinical setting and the patient was having his CT scan done and a CT angiogram. After looking at all this retrospective data, it really was something to see the actual events happening in front of my eyes. The consultant looked at the CT scan and showed me the area on the brain that looked to be affected, which I’m sure I wouldn’t have found if I had all the time in the world to study the scan, even though he found it in about 3 seconds flat!! Happy with the patient history and the scan results, the decision was made to thrombolyse the patient, which was done so as soon as the patient was moved to the treatment area from the CT scanner. It was very interesting to see the NIHSS being done in front of me and the testing of the limbs to see what side is affected (This patient had left upper limb drift when it was raised in the air and the CT scan showed a dark spot on the right side of the brain – which fits the symptoms). After the tPA infusion was started, the patients symptoms started to worsen and a facial droop appeared, with slurred speech and he was no longer able to keep his left upper limb elevated.

Hopefully tomorrow I’ll be able to find out the progress of the patient and maybe even observe the 24 hour NIHSS being taken (One of my data variables), and I’ll be sure to report to you all next time. For now, I better go as this is telling me I’ve reached a word count of nearly 750!! Which I think is quite enough for one day. Until the next time.

29/08/2013

Hello again! It’s been about a week since I last wrote an entry, so I thought I’d better update you all on what I’ve been doing. Now, I may have written my first entry on the 21st, but due to a number of bumps on the internet road it has only just been published on the same day that I’m writing this one. I think that all the problems have now been ironed out so expect regular updates from me, there’s no stopping me now!!

When I left you last, I was preparing for an MDM at Kent & Canterbury Hospital which Dr. Hargroves invited me to attend. Well I’m pleased to say that the meeting was very interesting. There were multiple patients to discuss and also a few performance reviews and other presentations. One of the most interesting things to see was a mortality audit. There were 3 sets of case notes from the William Harvey Hospital that were reviewed by an unbiased consultant to assess how well the patient was cared for and if there were preventable deaths. I thought this was a brilliant way to keep the standard of healthcare at a very good level, and in fact, 1 of the cases is going to be reviewed again because there were some aspects that weren’t perfect.

The meeting lasted about 4 hours in total (Technically 2 meetings, one from 1pm-2pm and the other from 2-5), after which I was done for the day and made my way home. Another reason for the current scarcity of entries from me (This is only my second entry and I’m nearing the end of my 4th week!) is the fact I am currently muddling my way through an application to graduate entry medicine. This is a time consuming process involving whittling down prospective universities and finding out entry requirements. The universities I think I want to apply for require me to take another test – the UKCAT. I’ve got this booked for this Saturday 31st and so my life now currently consists of work, revision, eating and sleeping – although I haven’t managed much of the sleep!!

Now it’s all very well me talking about my life, but this blog is meant to be about what I’ve been working on. Since the last entry, I’ve been steadily plugging away at the stroke database, going through I don’t know how many reports and case notes. I’ve looked at more brain scans in the last few weeks than I care to remember! In total I’ve managed to get 288 more patients onto the database, although I haven’t filled in every bit of data needed. So that means I’ve looked through 288 different sets of notes, letters, tests and reports – many times more than once, seeing as it’s impossible to glean all the information in one go. I think I’ve gotten as much information as I can get from all the notes available to me on the computer, so in the coming weeks I will be getting out the physical copies of the case files and pouring over them trying to fill in any remaining information.

It’s still an interesting day at work though, I’ve been trying to learn as much as possible when I look through the scans and their corresponding reports, so I can almost analyse a CT perfusion scan myself! The main tests relevant to my study are CT scans, MRIs and CT perfusions, with the perfusion scans being especially important in cases of unknown onset time. CT perfusion scans are based on the central volume principle (CBF = CBV/MTT) where CBF = Cerebral blood flow, CBV = Cerebral blood volume and MTT = Mean transit time. When looking at the results, a ‘mismatch’ of blood flow and blood volume can indicate that the patient is suitable for thrombolytic therapy, and so is extremely useful when trying to evaluate when a SUTO (Stroke of Unknown Time of Onset) patient should be thrombolysed.

I think that’s enough for today, I’d better get back to it now so as always, watch this space!