Browsing by Author "Hewitt Smith, Adam"

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    The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety
    (World journal of surgery, 2016) Boyd, Nicholas; Hewitt Smith, Adam
    Current guidelines for the provision of safe anaesthesia from the World Health Organization and the World Federation of Societies of Anaesthesiologists (WFSA) are unachievable in a majority of low and middleincome countries (LMICs) worldwide. Methods Current guidelines for anaesthesia and patient safety provisions from the WHO and WFSA are compared with local ability to achieve these recommendations in LMICs. Conclusions Influential international organizations have historically published anaesthesia guidelines, but for the most part, without impacting substantial documentable changes or outcomes in low-income environments. This analysis, and subsequent recommendations, reviews the effectiveness of existing strategies for international guidelines, and proposes practical, step-wise implementation of patient safety approaches for LMICs.
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    Haemostatic dressings in prehospital care
    (Emergency Medicine Journal, 2013) Hewitt Smith, Adam; Laird, Colville; Porter, Keith; Bloch, Mark
    Massive haemorrhage still accounts for up to 40% of mortality after traumatic injury. The importance of limiting blood loss after injury in order to prevent its associated complications has led to rapid advances in the development of dressings for haemostatic control. Driven by recent military conflicts, there is increasing evidence to support their role in the civilian prehospital care environment. This review aims to summarise the key characteristics of the haemostatic dressings currently available on the market and provide an educational review of the published literature that supports their use. Medline and Embase were searched from start to January 2012. Other sources included both manufacturer and military publications. Agents not designed for use in prehospital care or that have been removed from the market due to significant safety concerns were excluded. The dressings reviewed have differing mechanisms of action. Mineral based dressings are potent activators of the intrinsic clotting cascade resulting in clot formation. Chitosan based dressings achieve haemostasis by adhering to damaged tissues and creating a physical barrier to further bleeding. Acetylated glucosamine dressings work via a combination of platelet and clotting cascade activation, agglutination of red blood cells and local vasoconstriction. Anecdotal reports strongly support the use of haemostatic dressings when bleeding cannot be controlled using pressure dressings alone; however, current research focuses on studies conducted using animal models. There is a paucity of published clinical literature that provides an evidence base for the use of one type of haemostatic dressing over another in humans.
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    Streptococcus bovis Meningitis and Hemorrhoids
    (Journal of clinical microbiology, 2010) Hewitt Smith, Adam; Sra, Harminder K.; Bawa, Sandeep; Stevens, Richard
    A previously fit 61-year-old woman presented to the hospital Accident and Emergency Department with a 2-day history of headache and malaise. Her headache had become rapidly more intense in the hours preceding admission, waking her from sleep, and was associated with severe neck stiffness, nausea, and vomiting. On examination, she was febrile (38.9°C), tachycardic (heart rate of 110 beats per min), was clinically mildly dehydrated, and drowsy, but orientated, and had marked meningism. There was no rash. There was no focal neurological abnormality, and fundoscopy was normal. Peripheral blood samples, including cultures, were taken, and treatment with intravenous (i.v.) ceftriaxone, acyclovir, and fluids was started. Urgent brain computed tomography (CT) scanning was normal. A fall in the patient’s blood pressure to 90/55 mm Hg prompted her transfer to the hospital’s High Dependency Unit, where a lumbar puncture was performed.