Research Development

Staff Publications

 Small purple icon of a book with a magnifying glass on top  Staff Publications

Find out what your colleagues have been writing. This section features articles published by staff working for St Helens and Knowsley Teaching Hospitals and Halton, Knowsley and St Helens community staff.

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St Helens and Knowsley Hospital Staff

Metformin-associated lactic acidosis

Abstract A 58-year-old female with known type 2 diabetes mellitus continued to take her usual medications, including metformin, an ACE inhibitor and a non-steroidal anti-inflammatory drug, while suffering from diarrhoea and vomiting. On presentation to the emergency department, she was found to have a profound lactic acidosis, cardiovascular instability and acute..

Published: 08/07/2021
Authors: Fadden E, Longley C, Mahambrey T

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Rare ECG finding in a patient with severe hypercalcaemia

A man in his late 60s with a significant history of decompensated alcohol-related liver disease was admitted to hospital with a 2-week history of increasing jaundice and pruritus as well as confusion, drowsiness and a decreased exercise tolerance. Routine bloods revealed an exceptionally elevated corrected calcium level which peaked at 5.17 ..

Published: 21/06/2021
Authors: Chaplin G, Malik A, Katira R

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Acute urinary retention in a 27-year-old male secondary to benign prostatic hyperplasia

Introduction Benign prostatic hyperplasia (BPH) is common in the ageing male. Clinical manifestations like retention impact on a patient’s quality of life. Alterations in androgen activity at the androgen receptor complex level in the prostate contribute to prostatic hyperplasia with the highest incidence occurring in males in their 70’s...

Published: 19/05/2021
Authors: Napier-Hemy TP, Floyd Jr MS, McNulty S, Omar A, Mistry R, Gana HB

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Letter to the Editor re: Peacock et al. Urological issues in cyclists

  Khattak, AS; Pina, IM; Omar, AH; Floyd, JS Jr. (2021). Letter to the Editor re: Peacock et al. Urological issues in cyclists. J Clin Urol November 2020. Journal of Clinical Urology

Published: 03/05/2021
Authors: Khattak AS, Pina IM, Omar A, Floyd Jr MS

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P179. Comparing roll and magseed in management of impalpable breast lesions a single unit experience

Background Screening and the use of Neoadjuvant therapy has increased the number of breast lesions requiring localisation. The search for the ideal technique is still on. ROLL (Radioisotope guided Occult Lesion Localisation) is a reliable technique though not widely available, Magnetic Seed, is a new alternative. These two techniques have..

Published: 01/05/2021
Authors: Jois RHS, Pushdary KH, Patnam V, Gupta N, Kiernan T, Bathla S, Ray A, Harris O, Chagla LS

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14. Factors leading to the late diagnosis and poor outcomes of breast cancer in Matabeleland South and the Bulawayo Metropolitan Provinces in Zimbabwe

Introduction Breast cancer (BC) is the leading cause of female cancer deaths in Africa, and in Zimbabwe, >80% present with advanced disease. A grant-funded Needs Analysis (NA) was carried out to determine the causes for delayed diagnosis and poor BC outcomes in Bulawayo and Matabeleland South, and to investigate possible solutions...

Published: 01/05/2021
Authors: Chagla LS

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A service evaluation to assess the dietary management of hospitalised patients with diabetes receiving enteral nutrition

Background There has been a big drive from the UK government and Diabetes UK to provide improved psychological care for patients with diabetes. In addition to the emotional burden of having diabetes, people with type 1 and type 2 diabetes have higher levels of anxiety and depression than the general population. We..

Published: 18/04/2021
Authors: Gallagher CG, Westall S, Langan E, Narayanan RP, McNulty S, Bujawansa S, Mitchell L, Archer N, Hardy KJ

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Validation of the factors influencing family consent for organ donation in the UK

Summary Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the..

Published: 16/04/2021
Authors: Tridente A

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A5 (P240) Reduced exercise activity is associated with increased anxiety in type 1 but not type 2 diabetes

Aims Increased physical activity and a healthy lifestyle underpin efforts to prevent type 2 diabetes and are cornerstones in managing type 1 and type 2 diabetes. Not only is reduced activity associated with risk of weight gain and adverse metabolism, but it is also mooted to be associated with impaired psychological wellbeing. We..

Published: 14/04/2021
Authors: Westall S, Narayanan RP, Sullivan H, Bujawansa S, Furlong NJ, McNulty S, Cardwell J, Mitchell L, Jackson J, Hardy KJ

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P167 Perceived problems in diabetes do not correlate with levels of anxiety and depression in a validated structured diabetes education programme

Aims Diabetes-related distress, anxiety and depression are all highly prevalent in people with diabetes. The Problem Areas In Diabetes (PAID) and Hospital Anxiety and Depression Score (HADS) questionnaires can be used to measure these domains. We evaluated the impact of structured education on each of these. Method People with diabetes..

Published: 14/04/2021
Authors: Westall S, Narayanan RP, Langan E, Gallagher CG, Bujawansa S, McNulty SJ, Furlong NJ, Sullivan H, Hardy KJ

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P166 The impact of local, validated structured education programmes on self-care activities in people with diabetes

Background Better glycaemic control is exhibited in patients with higher self-care abilities. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire measures diabetes self-care activities. As part of a local, validated structured education programme, we measure the SDSCA scores before and after completing structured education. Scores are outputted as ‘number of..

Published: 14/04/2021
Authors: Furlong NJ, Westall S, Cardwell J, Jackson J, Cairns J, Mitchell L, Bujawansa S, McNulty S, Narayanan RP, Hardy KJ

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P252 The impact of a validated structured education programme on diabetes-related distress in patients with type 1 diabetes

Background and Aim People with type 1 diabetes experience varying degrees of the emotional burden of diabetes and its treatments. The Problem Areas in Diabetes (PAID) questionnaire can be used to evaluate this domain. As part of a local, validated structured education programme for people with type 1 diabetes, baseline and endpoint..

Published: 14/04/2021
Authors: Narayanan RP, Westall S, Sullivan H, Cardwell J, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Hardy KJ

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A service evaluation to assess the dietary management of hospitalised patients with diabetes receiving enteral nutrition

Background Hospitalised patients with diabetes receiving enteral nutrition (EN), require a management plan from an established multidisciplinary team, including dietitians and diabetes specialist nurses(1). Optimizing glucose control in these patients is associated with better outcomes(2). However, EN may increase the risk of complications such as hyper/hypoglycaemia events(2). There is..

Published: 13/04/2021
Authors: Langan E

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A service evaluation to assess the dietary management of hospitalised patients with diabetes receiving enteral nutrition

Background Hospitalised patients with diabetes receiving enteral nutrition (EN), require a management plan from an established multidisciplinary team, including dietitians and diabetes specialist nurses(1). Optimizing glucose control in these patients is associated with better outcomes(2). However, EN may increase the risk of complications such as hyper/hypoglycaemia events(2). There is..

Published: 13/04/2021
Authors: Gallagher CG, Langan E, Blakeman S, Love J

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Malignant Melanoma: a Case of Mistaken Identity—Case Report

Abstract Incidence of malignant melanoma in the UK has quadrupled since the 1970s, accounts for 90% of skin cancer mortality and is the second most common cancer in people younger than age 50 [11]. Atypical melanoma is often mistaken clinically for other skin tumours such as pigmented basal cell carcinoma, pyogenic granuloma or..

Published: 10/04/2021
Authors: Khaw R

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Toward the Rapid Diagnosis of Sepsis

Abstract This paper reports the detection of the inflammatory and sepsis-related biomarker, interleukin-6 (IL-6), in human blood plasma using functionalized screen-printed electrodes (SPEs) in conjunction with a thermal detection methodology, termed heat-transfer method (HTM). SPEs are functionalized with antibodies specific for IL-6 through electrodeposition of a diazonium linking group and..

Published: 01/04/2021
Authors: Tridente A

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Mechanical circulatory support and its implications for anaesthesia and critical care

Abstract Mechanical circulatory support is an increasingly important strategy for the treatmentof a subset of patients with acute heart failure. Use of extracorporeal circuits withpumps and oxygenators to augment cardiac function can be immediately lifesaving, whereasimplantable therapies can allow patients, with advanced heart disease, to resume nearnormal lives. Options for..

Published: 01/04/2021
Authors: Downes C

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Colchicine in coronary artery disease

Abstract Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Inflammation has been seen to be a key feature of atherosclerosis and CAD, with a raised C-reactive protein being a marker of poor prognosis. Thus, the role of anti-inflammatory agents has been investigated in CAD. Colchicine..

Published: 29/03/2021
Authors: Katira R

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An international survey on aminoglycoside practices in critically ill patients

Background While aminoglycosides (AG) have been used for decades, debate remains on their optimal dosing strategy. We investigated the international practices of AG usage specifically regarding dosing and therapeutic drug monitoring (TDM) in critically ill patients. We conducted a prospective, multicentre, observational, cohort study in 59 intensive-care units (ICUs) in 5 countries..

Published: 19/03/2021
Authors: Barton G

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Impact of the UK COVID‐19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

Extract Letter to the Editor Diabetes mellitus (DM) is a risk factor for poor outcome in patients with COVID‐19.1 However, the focus on mitigating the effects of SARS‐CoV‐2 has resulted in many routine healthcare services, including blood test monitoring in conditions such as DM, being disrupted. We recently explored..

Published: 19/03/2021
Authors: Green L

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The role of teleconsultation in the management of suspected skin malignancy in plastic surgery during COVID-19 outbreak

Abstract The COVID-19 pandemic has had a profound impact on the provision of skin cancer treatment in the UK. To preserve the service, the department transformed the outpatient skin cancer clinic into teleclinic service. This study examines the safety and efficacy of a teleclinic consultation, in comparison to a face-to-face..

Published: 18/03/2021
Authors: Koysombat K, Plonczak AM, West C

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Neuromuscular blocking drugs in the critically ill

The pharmacology of neuromuscular blocking drugs (NMBDs) in the critically ill was reviewed in this journal 15 yrs ago. However, the clinical indications for the use of these drugs in such patients in the intervening period has evolved considerably. This article provides an update on the current indications and evidence base..

Published: 18/03/2021
Authors: Welhengama C

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The right to take risk: are we practising informed consent during the COVID pandemic?

Dear Editor Since the beginning of the global pandemic there has been a paternalistic approach to consenting patients for surgery. This is both because of guidance from overseeing organizations, and individual concern about significant morbidity and mortality. The first wave of the pandemic saw a shift towards less surgery in..

Published: 13/03/2021
Authors: Davidson T, Singh V, Kalaiselvan R, Rajaganeshan R

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A mixed-methods evaluation of the impact of a pharmacist-led feedback pilot intervention on insulin prescribing in a hospital setting

Aims To explore the impact of a prescribing feedback intervention on insulin prescribing. Methods This was a mixed-methods study in a hospital setting. An insulin prescribing feedback intervention was delivered verbally and in writing to twelve doctors. Insulin prescribing error frequency was compared to ten doctors who had not received..

Published: 13/03/2021
Authors: Lloyd M, Bennett N, Wilkinson A, Furlong NJ, Cardwell J, Michaels S

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Collaborative Overview of coronaVIrus impact on ORTHopaedic training in the UK (COVI - ORTH UK)

Introduction COVID-19 was declared a pandemic by the World Health Organization on the 11th of March 2020 with the NHS deferring all non-urgent activity from the 15th of April 2020. The aim of our study was to assess the impact of COVID-19 on Trauma and Orthopaedic trainees nationally. Methods Trauma and Orthopaedic (..

Published: 10/03/2021
Authors: Choudhry N, Hillier D, Khan S, Nagy MT, Ormsby N

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Acute Management of Thermal Hand Burns in Adults

Introduction Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used..

Published: 05/03/2021
Authors: Dargan D, Stubbington Y, Shokrollahi K

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Delay in Initial Debridement for Open Tibial Fractures

Background The current consensus regarding the management of open fracture indicates that the initial debridement should be performed within the first 6 hours after injury. Unfortunately, in Pakistan, the emergency medical services are not well-established and patient arrival at the hospital is delayed the majority of the time. In this study,..

Published: 05/03/2021
Authors: Khan S

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Recommendations for influenza vaccination in burns patients based on a systematic review of the evidence

Abstract Severe burn injury is a serious systemic insult that can lead to life threatening secondary infections. Immunosuppression, inhalation injury and prolonged length of hospital stay are factors which predispose patients to severe respiratory tract infections. Furthermore, evidence shows that burns can put one at risk of infection long after..

Published: 03/03/2021
Authors: Philip L, Mortimer K, Shokrollahi K

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Theatre ventilation

Abstract Introduction Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the..

Published: 01/03/2021
Authors: Theodorou C, Simpson GS

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Atrial Fibrillation and Stroke

Abstract Atrial fibrillation (AF) is the most common cardiac arrythmia and a major cause of stroke, heart failure, sudden death, and cardiovascular morbidity. AF increases risk of thromboembolic stroke via stasis in the left atrium and subsequent embolization to the brain. In patients with acute ischemic stroke, it is essential..

Published: 01/03/2021
Authors: Hill AM

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Invited Discussion on: “The Use of Semi-absorbable Mesh and Its Impact on Donor-Site Morbidity and Patient-Reported Outcomes in DIEP Flap Breast Reconstruction”

  Taghizadeh, R. (2021). Invited Discussion on: “The Use of Semi-absorbable Mesh and Its Impact on Donor-Site Morbidity and Patient-Reported Outcomes in DIEP Flap Breast Reconstruction”. Aesthetic Plastic Surgery. epub 19 Feb  

Published: 19/02/2021
Authors: Taghizadeh R

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Cervical screening uptake and rates of cervical dysplasia

Objectives To compare cervical screening attendance and cytology (high- and low-grade cervical dysplasia [HGCD and LGCD]) between women with RA and the English general population and between biologic DMARD (bDMARD)-naïve and exposed women. Methods The British Society for Rheumatology Biologics Register for RA (BSRBR-RA), a national prospective study..

Published: 15/02/2021
Authors: Abernethy R

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Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome

Abstract Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus..

Published: 05/02/2021
Authors: Gould M, Harrison WD, Cahill-Kearns A, Barton G

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Cannabinoid hyperemesis syndrome as a cause of recurrent vomiting in type 1 diabetes

Abstract Abdominal pain and vomiting are common presentation