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

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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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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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 presentations to the emergency medical ward. Management of recurrent abdominal pain and vomiting can be difficult, especially in patients who have diabetes. People with diabetes can present with vomiting and abdominal pain that can cause a diagnostic dilemma. Are the symptoms due to..

Published: 01/02/2021
Authors: Balafshan T

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Does methotrexate cause progressive fibrotic interstitial lung disease?

Abstract The aim is to evaluate the published evidence on whether methotrexate (MTX) use causes progressive fibrotic interstitial lung disease (fILD). This PRISMA-compliant systematic review has been registered electronically with PROSPERO 2018 ID CRD42018087838, Centre of review and dissemination at the University of York. A total of 29 articles met the inclusion..

Published: 29/01/2021
Authors: Dawson J, Quah E, Amoasii C, Mudawi T

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Diagnosing Omenn syndrome

Abstract Omenn syndrome is a rare combined immunodeficiency mostly associated with RAG1 and RAG2 mutations; the clinical manifestations are well‐described and include neonatal erythroderma. Mortality due to opportunistic infections is a serious risk, and a timely diagnosis with a skin biopsy is an important part of the diagnostic workup...

Published: 29/01/2021
Authors: Walsh ML, Eustace K

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Coronavirus infection in hip fractures (CHIP) study

Aims Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip..

Published: 28/01/2021
Authors: Chan C

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Evaluating the Possibility of Translating Technological Advances

Abstract Lactate is widely measured in critically ill patients as a robust indicator of patient deterioration and response to treatment. Plasma concentrations represent a balance between lactate production and clearance. Analysis has typically been performed with the aim of detecting tissue hypoxia. However, there is a diverse range of processes..

Published: 28/01/2021
Authors: Tridente A

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Maternal temperature in emergency caesarean section (MATES)

Background Temperature regulation in women undergoing emergency caesarean section is a complex topic about which there is a paucity of evidence-based recommendations. The adverse effects of inadvertent peri-operative hypothermia are well described. Hyperthermia is also associated with adverse neonatal outcomes, an increased risk of obstetric intervention and increased treatment for..

Published: 27/01/2021
Authors: Cochrane A

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Palmar psoriasis or missed BCC?

Abstract Case report A 76-year-old Caucasian woman with a history of previous BCCs excised from the head and legs was referred from the dermatology team with a biopsy proven superficial BCC to the left palm. The patient had presented to the dermatology team with the same lesion 7 years prior to..

Published: 21/01/2021
Authors: Ramadan S, Sharma N, Hassan Z

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Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we?

Objective In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. Materials and method A multi-institutional snapshot audit was conducted for..

Published: 17/01/2021
Authors: McCabe JE

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Predicting the length of stay at admission for emergency general surgery patients a cohort study

Introduction Predicting length of stay (LOS) is beneficial to patients and the health service. When a prolonged LOS is predicted, it gives the opportunity for focused therapies and allocation of resources to reduce this period. In emergency general surgery (EGS) there has been limited investigation of variables that may be..

Published: 16/01/2021
Authors: Raybould S

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Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project

Abstract Hot debriefing (HoD) describes a structured team-based discussion which may be initiated following a significant event. Benefits may include improved teamwork, staff well-being and identification of learning opportunities. Existing literature indicates that while staff value HoD following significant events, it is infrequently undertaken in practice. Internationally, several frameworks for..

Published: 13/01/2021
Authors: Langston S, Matthews J

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The perils of diagnosing and managing aortic root prosthetic graft infection

Waldman, S; Noshirwani, A et al. (2021). The perils of diagnosing and managing aortic root prosthetic graft infection. Journal of Cardiac Surgery. 36 (1), 153-155    

Published: 13/01/2021
Authors: Waldman S, Noshirwani A

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Serum lithium test requesting across three UK regions: an evaluation of adherence to monitoring guidelines

Background Bipolar disorder is the fourth most common mental health condition, affecting ~ 1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is widely recommended as a first-line treatment. We previously showed in other areas that laboratory testing patterns are variable with sub-optimal conformity..

Published: 12/01/2021
Authors: Green L

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Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis

Background This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR). Methods MEDLINE, Embase, and the Cochrane Library were searched for studies reporting on the recurrence rates of complete rectal prolapse (CRP) or intussusception (IS) after SR and..

Published: 12/01/2021
Authors: Kearsey C, Rajaganeshan R

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Accuracy in completing theatre listing forms

Introduction The numbers of cancer-related cases are increasing every day. There is a high turnover of patients on the elective lists. The theatre listing form is an important document to complete as it entails details of the procedure, type of anaesthesia, type of skin cancer patient has and many more...

Published: 11/01/2021
Authors: Adjei B, Hassan D, Mostafa A, Ramadan S, Benson A

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Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES)

Background Arthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis. They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness. However, evidence for their..

Published: 08/01/2021
Authors: Hough Y

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Re: Uretero-inguinal hernia with obstructive urolithiasis

To the editor, We read with interest the recent radiology page publication by Rathburn et al. highlighting the case of a 64 year old male with prostate cancer who was incidentally found to have left hydronephrosis and renal impairment during staging. Formal computed tomography revealed a 1cm stone in his distal..

Published: 01/01/2021
Authors: Khattak AS, Feyisetan O, Floyd Jr MS, Samsudin A

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Elective major general surgery in a patient who had recovered from COVID‐19: considerations and complications

We describe unanticipated complications and subsequent management of a patient undergoing major elective general surgery following a recent hospital admission with coronavirus disease‐2019 (COVID‐19). A 63‐year‐old man was admitted to hospital with dyspnoea and hypoxia due to COVID‐19. He reported previously being able to walk for over an hour..

Published: 27/12/2020
Authors: Lightburn T, Dixit T, Pedder S, Kalaiselvan R

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Cutaneous squamous cell carcinoma–mms or MMS?

We read with interest the articles by Kiely et al. discussing the challenges of completely excising cutaneous squamous cell carcinomas (cSCC) with standard surgical excision. The incidence of cSCC places a significant burden on skin cancer services, and thus conventional surgical excision remains the pragmatic standard of care. However, incomplete..

Published: 23/12/2020
Authors: Nayar R, Defty C, Tehrani H, Morton J

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Primary Melanoma of the Breast Parenchyma: An Oncoplastic Approach

Summary Primary melanoma of the breast parenchyma (PMPB) is a rare and aggressive disease, with only a few cases reported in the literature. We present the case of a 50-year old woman who underwent mastectomy and immediate breast reconstruction using a free DIEP flap following recurrence after breast conserving surgery...

Published: 18/12/2020
Authors: Snashall E, Kiernan T, Harper-Machin A, Taghizadeh R

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Evaluating the impact of a pharmacist-led prescribing feedback intervention

Background Prescribing errors are prevalent in hospital settings with provision of feedback recommended to support prescribing of doctors. Feedback on prescribing has been described as feasible and valued but limited by doctors, with pharmacists described as credible facilitators of prescribing feedback. Evidence supporting prescribing feedback has been limited to date...

Published: 16/12/2020
Authors: Lloyd M, O'Brien S, Hardy KJ, Furlong NJ

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Management of osteoarthritis of the knee and other joints in rural India

Abstract This is a retrospective review of patients who presented to the senior author's orthopaedic camps in Ranchi, Jharkhand, East India. The aim of this study is identify the obstacles in educating the patients in management of their joint pain and then getting their consent for the appropriate treatment. During..

Published: 16/12/2020
Authors: Naraen A

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Loco-regional recurrence after skin and nipple-sparing mastectomy

Background Immediate autologous tissue breast reconstruction after skin- and nipple-sparing mastectomy, is becoming increasingly popular, while the benefits are evident, the concern is in leaving breast tissue under the skin envelope, which could potentially lead to a higher chance of recurrence. We aim to determine the incidence and study the..

Published: 12/12/2020
Authors: Shah A, Koshy O, Riogi B, Taghizadeh R, Bennett S, Chagla LS

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Groin dissections in skin cancer: Effect of a change in prophylactic antibiotic protocol

Objectives To determine whether groin dissection surgical site infection (SSI) incidence changed with shorter post-operative antibiotic prophylaxis. Background Post-operative prophylaxis changed due to antimicrobial stewardship, from regular oral antibiotics until drain removal, to three intravenous doses. Both groups had a single intravenous dose at induction. Methods A prospective database of..

Published: 09/12/2020
Authors: Dargan D, Beck D, McConville S, Mortimer K, Brackley P

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Minimal Access Tendon Harvesting without a Harvester

Abstract Tendon grafting is a key component of hand reconstructive procedures. Commercially produced tendon harvesters facilitate this grafting process but are not always available. We present an innovative technique that allows tendon harvest to be undertaken using equipment readily available in all hospitals. Only a scalpel blade and a plastic..

Published: 09/12/2020
Authors: Asmar O, Iqbal A

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BCC metastasis: a very rare sequela of a common disease

Basal cell carcinoma (BCC) is the most common skin cancer worldwide, accounting for approximately 80% of non-melanoma skin cancers. BCC metastasis is an extremely rare sequela with an estimated incidence of 0.0028%–0.5% among all BCC diagnoses. We describe a case of an 82-year-old man with a history of multiple previous BCC excisions...

Published: 08/12/2020
Authors: Mohammad M, Schumacher K, Nayar R, Morton J

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Comment on: COVID 19 and the race to publish: an ethical issue

Dear Editor We read Safieddine and Kassir’s letter1 on the ethics of pandemic publication with interest. They commend the role journal editors play in the academic response to the virus by expediently reviewing and disseminating an overwhelming number of submissions. ‘Corona’, from the Latin ‘crown’, was applied to a..

Published: 08/12/2020
Authors: Nolan G

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Short bowel syndrome and the impact on patients and their families: a qualitative study

Background Short bowel syndrome (SBS) is a malabsorptive condition that can result in intestinal failure (SBS‐IF). Many patients with SBS‐IF require home parenteral nutrition (PN) for survival. However, PN has profound effects on patients and their family members. The present study aimed to understand the lived experience of..

Published: 01/12/2020
Authors: Ablett J

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Minimal Access Tendon Harvesting without a Harvester

Abstract Tendon grafting is a key component of hand reconstructive procedures. Commercially produced tendon harvesters facilitate this grafting process but are not always available. We present an innovative technique that allows tendon harvest to be undertaken using equipment readily available in all hospitals. Only a scalpel blade and a plastic..

Published: 01/12/2020
Authors: Asmar O, , Iqbal A

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The perils of diagnosing and managing aortic root prosthetic graft infection

Adan, A; Waldman, S; Noshirwani, A et al. (2020). The perils of diagnosing and managing aortic root prosthetic graft infection. Journal of Cardiac Surgery. 36 (1), 153-155    

Published: 01/12/2020
Authors: Waldman S, Noshirwani A

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Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease

Introduction Pilonidal disease (PD) is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. However, Laser depilation (LD) has been proposed as an adjunct to surgery and shown improved results in previous..