Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.

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Background : Patients, families, and communities regularly provide feedback about care and treatment received from healthcare services, most of which is positive. The aim of this review was to examine how positive feedback creates change within healthcare settings. Methods : Included documents were empirical studies where the full text is publicly available in English, and where a change has occurred within healthcare services attributed to positive feedback from service users, their families, or the community. They were identified through database searches (ACM Digital Library, AMED, ASSIA, CINAHL, MEDLINE and PsycINFO), forwards and backwards citation, and expert consultation. Data was synthesised into a change model describing forms, mediators and moderators of change. A protocol was prospectively registered: https://osf.io/5x46c . Results : Sixty-eight papers were included, describing research conducted in 32 countries across six continents, with qualitative (n=51), quantitative (n=10), and mixed (n=7) methods. Only two described interventional studies. The most common form of feedback was ‘appreciation’ (n=28). The most common recipients were nurses (n=29). Positive feedback was most commonly given in hospitals (n=27) and community healthcare (n=19). Positive feedback mostly led to positive outcomes categorised as (a) short-term emotional change for healthcare workers (including feeling motivated and improved psychological wellbeing), (b) work-home interactional change for healthcare workers (such as improved home-life relationships), and (c) work-related change for healthcare workers (such as improved performance and staff retention). Undesirable changes included embarrassment when receiving feedback, tension in the patient-professional relationship, and envy when not receiving positive feedback. Conclusion : Positive feedback can provide the opportunity to create meaningful health service change. Healthcare managers may wish to use positive feedback more regularly, and to identify and address barriers to staff receiving feedback. Further interventional research is required to establish the effectiveness of receiving positive feedback in creating change, and to understand the influence of feedback content.