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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Mersey and West Lancashire Teaching Hospitals NHS Trust – St Helens & Knowsley Staff

How can technology be used to support communication in palliative care beyond the covid-19 pandemic

Background Developments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative..

Published: 14/02/2024
Authors: Thomas A

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Albumin Levels and Risk of Early Cardiovascular Complications After Ischemic Stroke: A Propensity-Matched Analysis of a Global Federated Health Network

Background No studies have investigated the association between albumin levels and the risk of early cardiovascular complications in patients with ischemic stroke. Methods Retrospective analysis with a federated research network (TriNetX) based on electronic medical records (International Classification of Diseases-Tenth Revision-Clinical Modification and logical observation identifiers names and codes) mainly..

Published: 07/02/2024
Authors: Abdul-Rahim A

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The Alopecia Areata Severity and Morbidity Index (ASAMI) Study

Importance Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact. Objective To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI). Evidence..

Published: 07/02/2024
Authors: Meah N

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Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants in the Prevention of Ischaemic Stroke in Patients with Atrial Fibrillation

Introduction Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size, or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received..

Published: 02/02/2024
Authors: Elsheikh S, Irving G, Hill AM, Abdul-Rahim A

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Ten-Year Analysis of Bacterial Colonisation and Outcomes of Major Burn Patients with a Focus on Pseudomonas aeruginosa

Abstract: A retrospective descriptive study included patients admitted with severe burns over the course of 10 years (2008–2018). Across all patients, there were 39 different species of bacteria, with 23 species being Gram-negative and 16 being Gram-positive bacteria, with also five different species of fungi cultured. Pseudomonas aeruginosa was the most commonly isolated organism, with 57.45%..

Published: 25/12/2023
Authors: Gomersall J, Mortimer K, Hassan D, Shokrollahi K

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Ibrutinib as first line therapy for mantle cell lymphoma: A multicentre, real-world UK study

Abstract During the Covid-19 pandemic, ibrutinib +/- rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. As limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib +/- rituximab for untreated MCL were..

Published: 21/12/2023
Authors: Nicholson T

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Changes in prescribing of psychotropic vs some physical health medication in primary care through the COVID-19 pandemic

Introduction The COVID-19 pandemic globally impacted healthcare provision. Prescribing changes in common medications can be used as a marker for new diagnoses. We describe how the prescribing of specific psychotropics was impacted by the pandemic. Methods Primary Care Prescribing data for different classes of drugs from March 2017 to February 2022 were..

Published: 21/12/2023
Authors: Narayanan RP

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The importance of creating a positive learning environment for student nurses

  Thomas, V. (2023). The importance of creating a positive learning environment for student nurses: the value of good quality nurse education and the influence this has in future practice. Dermatological Nursing. 22(4), pp.29-31

Published: 19/12/2023
Authors: Thomas V

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Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network

Abstract:  To investigate the relationship between SDoH and adverse events in a large multinational AF cohort. Design Retrospective study utilizing a global federated health research network (TriNetX). Methods Patients with AF were categorized as socially deprived defined according to ICD codes based on three SDoHs: (i) extreme poverty; (ii) unemployment;..

Published: 07/12/2023
Authors: Abdul-Rahim A

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Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network

Background Few studies have investigated the role of social determinants of health (SDoH) in patients with atrial fibrillation (AF). Aim To investigate the relationship between SDoH and adverse events in a large multinational AF cohort. Design Retrospective study utilizing a global federated health research network (TriNetX). Methods Patients with AF..

Published: 07/12/2023
Authors: Abdul-Rahim A

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Letter to the editor regarding are plastic surgery trainees accurate assessors of their own microsurgical skill?

Abstract We read with interest the article ‘Are Plastic Surgery Trainees Accurate Assessors of Their Own Microsurgical Skill?’1 as we are surgical trainees currently honing our microsurgical skills.   Masterton, G; Evans, N. (2024). Letter to the editor regarding are plastic surgery trainees accurate assessors of their own microsurgical skill?. JPRAS Open. 39,..

Published: 06/12/2023
Authors: Masterton G, Evans N

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Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021

Abstract Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating..

Published: 01/12/2023
Authors: Varia R

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Do we fully understand the impact of cosmetic surgery on our NHS and are we planning for the increased burden?

Abstract We read with interest the article “Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at a NHS plastic surgery unit” 1 ; given we too work within a NHS plastic surgery unit.   Masterton, G; Evans, N. (2024). Do we fully understand the impact of cosmetic surgery..

Published: 01/12/2023
Authors: Masterton G, Evans N

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Multi-nodal basin drainage in lower limb melanoma

Summary Lymph node status is an important factor that influences outcomes in melanoma. Whilst certain anatomical areas have multiple-nodal basin drainage, limb melanomas are thought to have more predictable lymphatic drainage patterns, with lower limb melanomas reliably draining to the corresponding ipsilateral inguinal lymph node basin with occasional popliteal drainage...

Published: 24/11/2023
Authors: Hague A, Platford B, Rehman S, Howes A, Brackley P

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The impact of socioeconomic deprivation on the prevalence of gestational diabetes: An observational study

Background Approximately 3.5% of pregnancies in the United Kingdom are complicated by gestational diabetes mellitus (GDM). Risk factors for this mirror those contributing to type 2 diabetes (T2DM). Though socioeconomic status (SES) is presumed to contribute to GDM, evidence in the United Kingdom is limited. In this unique study, we explored..

Published: 14/11/2023
Authors: Kohli S

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Atrial Fibrillation and Stroke: State-of-the-art and future directions

Introduction Stroke is a major complication of atrial fibrillation (AF). About 25% of ischaemic stroke are cardio-embolic in origin; AF is the most common cause of those.1 Nonvalvular AF carries a 5-fold increased risk of stroke,2 while AF related to mitral stenosis increases the risk of stroke by 20-fold.3 The attributable..

Published: 31/10/2023
Authors: Elsheikh S, Hill AM, Irving G, Abdul-Rahim A

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Haemorrhagic cholecystitis in a young patient, complicated by gallbladder perforation and choledocholithiasis

Abstract Haemorrhagic cholecystitis is a rare condition associated with a high risk of morbidity and mortality. Its pathophysiology is thought to be due to gallbladder wall erosion and infarction secondary to inflammation, which subsequently leads to haemorrhage into the gallbladder lumen or the peritoneal cavity. There is no current official..

Published: 29/10/2023
Authors: Harrison NL

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Small bowel obstruction secondary to phytobezoar in a patient with myotonic dystrophy

Abstract A male patient in his 30s, with myotonic dystrophy (DM), presented to the emergency department with abdominal pain and vomiting. CT imaging revealed a soft tissue lesion in the terminal ileum causing small bowel obstruction (SBO). The patient underwent diagnostic laparoscopy which allowed identification and removal of the obstructing..

Published: 05/10/2023
Authors: Harrison NL, Santoro G, Samad A, Ellerby N

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Ancient genomes illuminate Eastern Arabian population history and adaptation against malaria

Abstract The harsh climate of Arabia has posed challenges in generating ancient DNA from the region, hindering the direct examination of ancient genomes for understanding the demographic processes that shaped Arabian populations. In this study, we report whole genome sequence data obtained from four Tylos-period individuals from Bahrain. Their genetic..

Published: 01/10/2023
Authors: Aloraifi F

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Is the Current Cut Point for Glycated Haemoglobin (HbA1c) Correct for Diagnosing Diabetes Mellitus in Premenopausal Women? Evidence to Inform Discussion

Abstract Women are on average diagnosed with diabetes mellitus at later age than men but have higher mortality. As the diagnosis of diabetes mellitus is primarily based on HbA1c, the use of a non-specific reference range and cut point for diabetes mellitus that does not account for gender differences..

Published: 30/09/2023
Authors: Green L

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Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit

Aim To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness,..

Published: 29/09/2023
Authors: Retnasingam G

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Letter to the editor: Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior urethral stricture disease.

Pina, IM; Omar, A; Floyd Jr MS. (2023). Letter to the editor: Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior stricture disease. Urologia Journal. Epub 23 September [Online]. Available at: https://dx.doi.org/10.1177/03915603231199809 [Accessed 04 January 2023]

Published: 23/09/2023
Authors: Pina IM, Omar A, Floyd Jr MS

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Society for Acute Medicine’s Patients: Learning from Experience Report (SAM-PLER) A service evaluation of patient reported experience in Acute Medicine – establishing the feasibility of a quality improvement collaborative

Abstract Patient reported experience measures (PREMS) are a key part of measured quality. There is no tool currently used in the UK in Acute Medicine. On the 8th of September 2022 10 units based in England, Scotland and Wales collected data for the validated PREM, alongside the EQ-5D and variables from..

Published: 23/09/2023
Authors: Varia R

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A Longitudinal Clinical Trajectory Analysis Examining the Accumulation of Co-morbidity in People with Type 2 Diabetes (T2D) Compared with Non-T2D Individuals.

Abstract Type 2 diabetes mellitus (T2D) is commonly associated with an increasing complexity of multimorbidity. While some progress has been made in identifying genetic and non-genetic risk factors for T2D, understanding the longitudinal clinical history of individuals before/after T2D diagnosis may provide additional insights. Methods In this..

Published: 14/09/2023
Authors: Narayanan RP

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Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing..

Published: 13/09/2023
Authors: Kaul A

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A second update on mapping the human genetic architecture of COVID-19

Extract Investigating the role of host genetic factors in COVID-19 severity and susceptibility can inform our understanding of the underlying biological mechanisms that influence adverse outcomes and drug development1,2. Here we present a second updated genome-wide association study (GWAS) on COVID-19 severity and infection susceptibility to SARS-CoV-2 from the COVID-19..

Published: 07/09/2023
Authors: Shuker K, Tridente A

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Mortality from diabetic kidney disease before and during the COVID pandemic

Background and aims We have previously published 5-and 10-year audits from our UK diabetes kidney clinic reporting outcomes comparable to those in landmark trials of diabetic kidney disease in broadly similar patients. This 2023 (20-year) audit again showed practice consistent with NICE, ADA and Kidney Disease Improving Global Outcomes guidelines, but..

Published: 04/09/2023
Authors: Lewis GA, Cardwell J, Hardy KJ

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Real world safety of methoxyflurane analgesia in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study.

Abstract Low-dose analgesic methoxyflurane (Penthrox R) was approved in Europe for emergency relief of moderate to severe pain in conscious adults with trauma in 2015. A comparative post-authorisation safety study (PASS) was conducted to assess the risk of hepatotoxicity and nephrotoxicity with methoxyflurane during routine clinical practice. Methods This was a..

Published: 30/08/2023
Authors: Kataria H

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Evaluation of the 'Clicky' Hip in the Diagnosis of Developmental Dysplasia of the Hip (DDH).

Abstract Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate the use of a 'clicky' hip as an indication for secondary assessment as per the British Society for Children's Orthopaedic Surgery (BSCOS) consensus statement. Method Prospective cohort..

Published: 30/08/2023
Authors: Ross M

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205 Single-Centre Review on Incisional Hernia After Laparoscopic Anterior Resection: What Is the Ideal Incision for Specimen Extraction?

Abstract Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution. Method We retrospectively..

Published: 30/08/2023
Authors: Win M, Ngo V, Jeyam T, Rajaganeshan R

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An Audit to Evaluate the Prevalence and Efficiency of the 'Acute Abdomen Pathway' Proforma Used in a Large District General Hospital.

Abstract The 'acute abdomen pathway' was introduced with the aim of early identification of patients with an acute abdomen and once identified to increase the efficiency of imaging, senior review and if required surgical intervention. We audited how this pathway was being used by clerking doctors and its benefits to..

Published: 30/08/2023
Authors: Ross M, Kalaiselvan R, Yasin U, Gul A

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The Patient Demographic Details of Referrals for Risk Reducing Breast Surgery and Reconstruction to St Helen's and Knowsley Teaching Hospitals Over a 5 Year Period.

Abstract Breast cancer is the most common cause of cancer in women affecting 1 in 7 women in the UK. Hereditary breast cancers are present in up to 10% of all cases and are most commonly related to BRCA gene mutations. Bilateral risk reducing mastectomy (RRM) +/- reconstruction is the most effective strategy..

Published: 30/08/2023
Authors:

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Handwritten Operative Note Compliance in Plastic Surgery.

Abstract Accurate and comprehensive documentation of operations is crucial to optimise patient care. Omissions may cause compromised management, or medicolegal issues. A closed-loop audit was completed at a plastic surgery centre to identify whether Royal College of Surgeons (RCS) standards were met. It aimed to identify and address limitations of..

Published: 30/08/2023
Authors: Harper-Machin A

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Incidence of Incisional Hernia Post-Colorectal Liver Metastasis Resection - a Longitudinal Radiological Cohort Study.

Abstract The aim of this study is to determine the incidence and time to development of incisional hernia (IH) in post partial hepatectomy (PH) for colorectal liver metastases (CRLM) patients to enable surgeons to prepare and accurately consent patients for the operations. Method The radiological images and reports of all..

Published: 30/08/2023
Authors: Adams S

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220 A Systematic Review on Under-Recognized Condition: Duodenogastric Reflux After Cholecystectomy

Aim Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution. Method We retrospectively..

Published: 30/08/2023
Authors: Win M

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Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes–Patient Operative Delays (ORTHOPOD) study

Introduction Current practice following injury within the United Kingdom is to receive surgery, at the institution of first contact regardless of ability to provide timely intervention and inconsiderate of neighbouring hospital resource and capacity. This can lead to a mismatch of demand and capacity, delayed surgery and stress within hospital..

Published: 22/08/2023
Authors: Wharton D, Rana A, McAllister R, Sasi S, Thomas T

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A study to investigate genetic factors associated with weight gain in people with diabetes: analysis of polymorphisms in four relevant genes

Abstract Background Weight change is often seen in people with diabetes. We investigated the effects of genes associated with weight change/glucose handling/insulin-signalling. Materials/methods DNA from diabetes individuals and non-diabetes individuals, plus clinical data, were available from the DARE study (n = 379 individuals: T1D n = 111; T2D n = 222;..

Published: 15/08/2023
Authors: Narayanan RP

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Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study

Abstract Objective We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. Research Design and Methods We undertook a pragmatic, preplanned observational..

Published: 11/08/2023
Authors: Furlong NJ

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Performance of admission pathways within acute medicine services: Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021.

Abstract  Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating..

Published: 03/08/2023
Authors: Varia R

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Cohort study of short-term outcomes after ACL-reconstruction using autograft with internal brace reinforcement versus isolated autograft demonstrating no significant difference

Abstract Background The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten..

Published: 29/07/2023
Authors: Mohan R, Kwaees TA, Thomas T, Pydisetty R

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Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study

Background Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and..

Published: 29/07/2023
Authors: Nwachukwu O

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Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study.

Abstracts  Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and..

Published: 29/07/2023
Authors: Nwachukwu O

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Preputial advancement flap for delayed urethrocutaneous fistula of the glans following urethral insertion of an ‘AAA’ battery

Abstract Introduction Foreign body insertion associated with sexual gratification is known as polyembolokoilomania. Following removal of the foreign body, long-term complications are infrequently seen. Whilst conservative and endoscopic approaches usually suffice, in extreme cases open surgical approaches are required. We describe an unusual case of polyembolokoilomania in a 25-year-old male..

Published: 25/07/2023
Authors: Atayi AA, Omar A, Floyd Jr MS

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MANAGEMENT OF OSTEOARTHRITIS AND JOINT PROBLEMS IN SEMI-RURAL INDIA.

Abstract This is a retrospective presentation of patients who were treated under the author's care in Eastern India over a period of 13 years. The aim of the this study was to identify and addressing the difficulties faced by the patients in accessing appropriate care and the obstacles in educating and..

Published: 21/07/2023
Authors: Naraen A

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Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis

Abstract Introduction Wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, resource-friendly, and safe. This can be used as an alternative to hand surgery procedures in outpatient units. It can be performed in clinics or operating rooms. Methods We retrospectively evaluated the outcomes of WALANT for carpal tunnel decompression (..

Published: 19/07/2023
Authors: Khan S

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PP-306 An adipose derived decellularised extracellular matrix as a biomaterial for tissue engineering of soft tissue

Introduction Vascularised tissue transplants are currently used to reconstruct soft tissue defects caused by trauma, cancer or infection but is not without its limitations and risks. Decellularised extracellular matrix are tissues that have been processed to remove cellular content whilst retaining its network of structural proteins, glycoproteins and adhesion proteins,..

Published: 17/07/2023
Authors: Yong L

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Commentary on: Repair of Congenitally Defective Types of Earlobe Clefts With Residual Lobular Tissue: A Convenient and Effective Surgical Technique

Extract Innovation in surgical technique is a cornerstone of advancing surgical care. The authors describe a new surgical technique that utilizes residual lobular tissue anterior and inferior to the ear to form a new earlobe.1 The authors believe that this approach brings a number of advantages including a fuller, more..

Published: 13/07/2023
Authors: Shokrollahi K

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Stroke–heart syndrome: mechanisms, risk factors, and adverse cardiovascular events

Extract New-onset cardiovascular complications following an ischaemic stroke, hereafter termed stroke–heart syndrome, are a major medical challenge of the 21st century, yet are under-recognized and under-researched.1,2 Acutely, stroke–heart syndrome associates with poorer functional prognosis and increased mortality following stroke.3 In the long term, stroke–heart syndrome associates with..

Published: 28/06/2023
Authors: Hill AM

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Machine-learning derived heart and brain age are independently associated with cognition

Cameron, A.C.; Lip, Y.H.; Abdul-Rahim, AH. (2023). Machine-learning derived heart and brain age are independently associated with cognition. European Journal of Neurology. epub 23 June(.), p... [Online]. Available at: https://doi.org/10.1111/ene.15953 [Accessed 26 June 2023]  

Published: 23/06/2023
Authors: Abdul-Rahim A

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P039 Adult onset Varicella zoster infection presenting as probable Mpox (Monkeypox)

  Introduction A 56 year old cis-male who has sex with men (MSM) presented to our semi-rural Genitourinary Medicine (GUM) service with fever, rigors, arthralgia, lymphadenopathy, headache and rash. He had recently returned from Gran Canaria and was triaged as a probable case of Mpox. Methods He had a past medical history..

Published: 20/06/2023
Authors: Okecha E, Reddin J, Harrison S, McKiernan J, Bateman A, Fishwick L, Thomson-Glover R

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P165 Rates of isolated extragenital chlamydia trachomatis and neisseria gonorrhoeae in heterosexual patients attending a sexual health clinic

Abstract Introduction BASHH guidance advises offering testing at extra genital sites for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) dependant on sexual history in heterosexual males and females. We examined the roll out of offering routine additional extragenital testing in heterosexual patients attending the sexual health clinic. Methods Genitourinary Medicine..

Published: 20/06/2023
Authors: Okecha E, Ahmed A, Fishwick L, Thomson-Glover R

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External validation of the Oldham composite Covid-19 associated mortality model (OCCAM), a prognostic model for death in patients hospitalised with Covid-19

Objective External validation of the Oldham Composite Covid-19 associated Mortality Model (OCCAM), a prognostic model for Covid-19 mortality in hospitalised patients comprised of age, history of hypertension, current or previous malignancy, admission platelet count < 150 × 103/µL, admission CRP ≥ 100 µg/mL, acute kidney injury (AKI), and radiographic evidence of > 50% total lung field..

Published: 19/06/2023
Authors: McLeneghan D

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732 An audit of admission into a high-dependency unit of a large district general hospital. Is there compliance with national guidance?

Abstract Objective To audit the reasons for admission to the Paediatric high dependency unit (PHDU) using the Paediatric critical care society (PCCS) criteria for PHDU admission (1). To review the demography of children admitted and the duration of admission. Method This was a retrospective audit of children < 18 years old admitted to..

Published: 19/06/2023
Authors: Kayode-Awe O, Garr R

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369 The role of children’s hospitals in reducing health inequalities: a review of organisational policies

Abstract Objectives Health inequalities are ‘avoidable, unfair and systematic differences in health between different groups of people’, including differences in access to care and quality of healthcare received.1 The Children’s Hospital Alliance (CHA) is a group of English children’s hospitals, collaborating through the National Paediatric Accelerator Programme.2 This..

Published: 19/06/2023
Authors: Brennan L

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P26 Standardising outpatient care for primary biliary cholangitis patients in a hospital trust

Abstract Introduction Primary biliary cholangitis (PBC) is a progressive autoimmune mediated cholangiopathy. There are well recognised treatments for both the underlying disease and symptom control highlighted by British Society of Gastroenterology (BSG) guidelines. Anecdotally, clinical practice does not reflect this. One likely reason is that patients are seen in various..

Published: 18/06/2023
Authors: Zhang M, Fox M

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P250 RNASeq identifies differential gene expression in colorectal and duodenal adenomas in familial adenomatous polyposis (FAP)

Abstract Introduction Familial adenomatous polyposis (FAP) is an autosomal dominant condition caused by a germline mutation in the APC gene (Campos et al., 2015). Patients develop hundreds to thousands of polyps along their intestinal tract in the second and third decades of life (Vasen et al., 2008). Without prophylactic colectomy, the lifetime..

Published: 18/06/2023
Authors: Fedail A

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P40 Re-engagement of haemochromatosis service users to provide best practice

Abstract Introduction Haemochromatosis is a medical condition that causes patient to absorb too much iron from their diet. This can accumulate around the body over time, damaging many organs and eventually causing disease. Inheritance of a faulty gene is responsible for an increase in the amount of iron in the..

Published: 18/06/2023
Authors: Allcoat A

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Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project

Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with..

Published: 14/06/2023
Authors: Bassi A

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Current concepts in the management of “Terrible Triad” injuries of the elbow

Abstract Terrible triad injuries of the elbow are complex injuries which can result in long term complications and significant disability. They must be identified correctly, and managed appropriately in order to maximise functional outcomes. A clear understanding of the bony and ligamentous anatomy is essential to plan appropriate surgical reconstruction..

Published: 14/06/2023
Authors: Franklin M

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Risk of myocardial infarction and ischemic stroke in individuals with first-diagnosed paroxysmal vs. non-paroxysmal atrial fibrillation under anticoagulation

Aims There is conflicting evidence on whether the type of atrial fibrillation (AF) is associated with risk of cardiovascular events, including acute myocardial infarction (MI) and ischemic stroke. The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed..

Published: 07/06/2023
Authors: Abdul-Rahim A

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Epilepsy-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications in patients with Epilepsy

Background The risks of cardiovascular events(CVEs) in people with epilepsy(PWE) are not well understood. Objectives To establish the short- and long-term burden of CVEs in PWE. Methods Electronic health records from a global federated health research network(TriNetX) were used to establish a cohort of PWE. Primary outcomes..

Published: 07/06/2023
Authors: Abdul-Rahim A

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P 12.018 Specialist Palliative Care at the Front Door

Background and aims At a time of significant pressure within the NHS, patients with palliative care needs often present to the emergency department in crisis. This makes the ED an important site for specialist palliative care assessment. It is widely recognised that 40 million people a year globally will require palliative..

Published: 07/06/2023
Authors: Howarth S, Thompson A, Beck D

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Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support...

Background Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion, clinicians are often reluctant to initiate enteral nutrition. Methods This was a retrospective cohort study in a single large pediatric intensive care unit in..

Published: 31/05/2023
Authors: Tse C

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Delayed diagnosis of a scaling genodermatosis

Description A man in his early 60s presented to the dermatology clinic with a lifelong history of dry, scaling skin. He had congenital deafness but no other medical problems. He had received a diagnosis of ichthyosis vulgaris several years ago and was treating the condition with topical emollients. Further questioning..

Published: 17/05/2023
Authors: Harnett C, Al-Jubouri M, Meah N

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642 Impact of bridging therapy vs endovascular thrombectomy alone on outcomes in anticoagulated patients with atrial fibrillation presenting with mild-moderate ischaemic stroke

Background and aims The aim was to assess the impact of bridging intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT), compared to EVT alone, in anticoagulated patients with atrial fibrillation (AF) presenting with mild-moderate acute ischaemic stroke. Method(s) A retrospective analysis (01/09/2018-01/09/2022) using a global health research network was conducted...

Published: 16/05/2023
Authors: Abdul-Rahim A

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The Optimal Management for People with Acute Stroke and Minor Deficits: Intravenous Thrombolysis or Medical Management?

Cameron, AC and Abdul-Rahim, AH. (2023). The Optimal Management for People with Acute Stroke and Minor Deficits: Intravenous Thrombolysis or Medical Management?. Thrombosis and Haemostasis. e-pub 12 May(.), p... [Online]. Available at: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2077-5642 [Accessed 12 June 2023].

Published: 12/05/2023
Authors: Abdul-Rahim A

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O132 Preliminary results of radiofrequency ablation for haemorrhoidal disease at a district general hospital

Introduction Haemorrhoidal disease (HD) is a common perianal condition. There is still limited data on the role of minimally invasive surgery for HD. The aim of our study was to report the outcome of radiofrequency ablation of haemorrhoids under local anaesthetic (RAFAELO) at our institution. Methods 23 patients who had a..

Published: 10/05/2023
Authors: Win M, Ngo V, Rajaganeshan R

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Use of volar distal radius plate dorsally for wrist arthrodesis in patients with upper limb spasticity: A retrospective

Summary Standard wrist arthrodesis implants are generally designed for adult joints with arthritis. They are often too big for patients with limb spasticity who generally tend to have osteopenic and smaller bones for their age, resulting in high complication rates. We previously described the novel use of volar distal radius..

Published: 07/05/2023
Authors: Bamal R, Sultan R, Cappuyns L, Hassan Z, McArthur P

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A bibliometric analysis of publication trends in UK plastic surgery

Introduction Publication is seen as the pinnacle of academia and is actively encouraged from an early stage in a junior doctor's career. It forms the bedrock of evidence-based practice, allowing clinicians and researchers to share experiences which may lead to an improvement in patient outcomes. High quality research with robust..

Published: 27/04/2023
Authors: Khalil K

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P281 Impact of pre-pregnancy counselling on HbA1c level and pregnancy outcomes in women with pre-existing diabetes

Aims The aim of our study was to assess uptake of pre-pregnancy counselling and its impact on HbA1c level. We looked to establish whether lower HbA1c levels and counselling improved outcomes in pregnant women with pre-existing diabetes. Methods Electronic record of all pregnant women with pre-existing diabetes booked..

Published: 25/04/2023
Authors: Collings S, Christian S, Pankaja S, McNulty S, Davies H, Milne R, Gallagher CG, Bujawansa S

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P280 Impact of introducing an intensive support package alongside continuous glucose monitoring on neonatal outcomes and...

Aims The National Diabetes in Pregnancy Audit in 2020 demonstrated that the percentage increase of women with type 1 diabetes under our service achieving an HbA1c

Published: 25/04/2023
Authors: Milne R, McNulty S, Pankaja S, Davies H, Gallagher CG, Christian S, Bujawansa S

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P277 Patient and public involvement (PPI) exploring the experiences of women with gestational diabetes...

Aim Gestational Diabetes (GDM) affects 1 in 23 UK pregnancies and can lead to adverse maternal & neonatal outcomes. PPI empowers those affected by a condition to influence future care. The aim of this project was to explore the experiences of GDM care for a group of women and their partners attending a..

Published: 25/04/2023
Authors: Gallagher CG, Christian S, Pankaja S, McNulty S, Davies H, Milne R, Bujawansa S

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P137 Follow up screening for diabetes after gestational diabetes 2019 versus 2022

Aims NICE guidelines for screening state that all GDM patients should be screened for diabetes at 6 to 12 weeks postpartum. Previous published data have given a national rate of less than 20% [1]. Our previously published data showed a 45% follow up [2]. We re-reviewed our screening rate after the interventions of: discussion with and..

Published: 25/04/2023
Authors: McNulty S, Milne R, Gallagher CG, Pankaja S, Christian S, Davies H, Bujawansa S

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A62 (P227) Risk of 12-month mortality following a severe inpatient hypoglycaemic event...

Aims At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed..

Published: 25/04/2023
Authors: Taylor J, Michaels S, Hatton DA, Caton K, Cardwell J, Hardy KJ, Strong AJ, Bujawansa S

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P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

Published: 25/04/2023
Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

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P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty SJ, Bujawansa S, Cardwell J, Hardy KJ

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P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Balafshan T, Cardwell J, Hardy KJ

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A new protocol for improving immediate monitoring of skin-island free flap with near-infrared spectroscopy and ultrasound

Background Postoperative monitoring is essential for detecting early complications and improving the salvage rate of free flaps. We propose a new protocol for free flap monitoring based on the combination of near-infrared spectroscopy (NIRS) and ultrasound. Methods All free flaps with a skin paddle were included and divided into two..

Published: 20/04/2023
Authors: Taghizadeh R

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446 A qualitative exploration using focus groups, of the perceived barriers and enablers of hospital pharmacists to participating in simulation based training

Introduction The role of hospital pharmacists has changed significantly over the past decade with a need for further educational interventions to support their professional development. Simulation based training (SBT) is widely used by other healthcare professionals to enhance skill acquisition and performance (1). However, the use of SBT does not appear..

Published: 13/04/2023
Authors: Lea N, Lloyd M, Bennett N

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Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients

Data It is widely believed that fractures in children have excellent clinical outcomes due to their capacity to remodel. There are, however, certain fractures that require careful management to avoid long-lasting functional impairment. Functional outcomes following hand fractures in children are poorly studied. Materials and Methods We performed a retrospective..

Published: 11/04/2023
Authors: Nolan G

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Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response

  Kazmi, A; Moussa, A; Meah, M et al. (2023). Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response. Journal of the American Acadamy of Dermatology. epub 05 April. [Online]. Available at: https://doi.org/10.1016/j.jaad.2023.03.041 [Accessed 28 April 2023]]  

Published: 04/04/2023
Authors: Meah N

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Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study

Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients..

Published: 03/04/2023
Authors: Pushdary KH

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Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics

Introduction Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce..

Published: 31/03/2023
Authors: Barton G

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Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias

Purpose of Review Atrial fibrillation (AF) is a major risk factor for systemic embolism and ischaemic stroke. Furthermore, AF-related strokes are associated with higher mortality, greater disability, longer hospital stays and lower rates of hospital discharge than strokes caused by other reasons. The aim of this review to summarise the..

Published: 28/03/2023
Authors: Abdul-Rahim A

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A Review of Emerging Factor XI inhibitors

Introduction Whilst the introduction of direct oral anticoagulants (DOACs) has improved the prevention of thromboembolic events, there is still a need for safer anticoagulants. This is particularly so, for specific populations of patients, such as those with an increased bleeding risk or those with severely reduced kidney function. People with..

Published: 16/03/2023
Authors: Elsheikh S

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Wide-Awake Local Anesthesia No Tourniquet (WALANT) for Flexor Tendon Repairs...

Background The coronavirus disease 2019 (COVID-19) pandemic forced many changes. In our unit, there was a significant shift from traditional anesthesia (TA) which included general or regional anesthesia, to Wide-Awake Local Anesthesia No Tourniquet (WALANT) for the treatment of flexor tendon injuries. Zones I and II injuries have always been a..

Published: 15/03/2023
Authors: Bamal R, Bastouros E, Nolan G, Griffiths S, Bell D

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165 A NICE accredited guideline for the management of malignant ascites

Introduction Ascites is the accumulation of fluid in the peritoneal cavity, often associated with a poor quality of life and poor prognosis. There is limited national guidance on management of malignant ascites .This guideline has been produced to enable healthcare professionals to make evidence-based, patient-centred decisions about the management of..

Published: 14/03/2023
Authors: McLintock S, Evans K

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Long-term Management Considerations for Retinal Artery Occlusion and Cardiovascular and Cerebrovascular Mortality

Extract In this issue of JAMA Network Open, Hwang et al1 report a population-based, retrospective, cohort study using the Korean National Health Insurance Service claims database to determine the incidence of retinal artery occlusion (RAO), and its associated rate (and cause) of death compared with the general population. RAO has 2..

Published: 10/03/2023
Authors: Abdul-Rahim A

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Prophylactic intravenous gentamicin with sedation-free cystoscopic injection of BoNT-A

Objectives To determine whether administration of single dose prophylactic intravenous gentamicin prior to intravesical injection of botulinum toxin type A (BoNT-A) is associated with adverse extravesical neuromuscular effects in idiopathic overactive bladder syndrome. Patients and methods A retrospective analysis of 220 consecutive idiopathic overactive bladder patients following sedation-free flexible cystoscopic injection..

Published: 02/03/2023
Authors: Chamsin A, Floyd Jr MS, Samsudin A, Omar A

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Heart was the key to the diagnosis

Extract We present the case of a man in his 70s who was referred to gastroenterology with several months’ history of offensive smelling loose stools and weight loss. He underwent a standard panel of initial investigations including colonoscopy for his chronic diarrhoea. Colonoscopy was reported as normal and the results..

Published: 28/02/2023
Authors: Watters C

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The Effect of the COVID-19 Pandemic on HbA1c Testing

Introduction Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control..

Published: 22/02/2023
Authors: Green L

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#217 Parallel Session - Aid Experience in the Real-World - in the United Kingdom

Abstract AID experience in the real‐world in the United Kingdom Background Hybrid closed loop (HCL) technology automates insulin delivery and improves outcomes in people living with Type 1 diabetes. We report real‐world outcomes from adults with Type 1 diabetes with raised HbA1c despite insulin pump therapy and flash glucose..

Published: 21/02/2023
Authors: Furlong NJ

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Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing

Aims The COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres. Methods Using routinely collected laboratory data, we estimated the..

Published: 17/02/2023
Authors: Green L

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Tranexamic acid use in meningioma surgery – A systematic review and meta-analysis

Abstract Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. The aim of this review was to evaluate the effect of TXA use on intraoperative and postoperative outcomes of meningioma surgery. A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and..

Published: 14/02/2023
Authors: Keshwara S

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Potential Embolic Sources in Embolic Stroke of Undetermined Source in Patients with Patent Foramen Ovale: Look Harder.

ElSheikh, S; Lip, GYH; Abdul-Rahim, AH. (2023). Potential Embolic Sources in Embolic Stroke of Undetermined Source in Patients with Patent Foramen Ovale: Look Harder. Cerebrovascular Diseases. epub 7 Feb, [Online]. Available at: https://doi.org/10.1159/000529105 [Accessed 17 February 2023].

Published: 07/02/2023
Authors: Elsheikh S, Abdul-Rahim A

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The management of developmental dysplasia of the hip in children aged under three months

Aims A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment..

Published: 01/02/2023
Authors: Mavrotas J

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Antiplatelet Agents and Oral Anticoagulant Use in Patients with Atrial Fibrillation and Carotid Artery Disease After First-Time Ischaemic Stroke

Introduction People with atrial fibrillation (AF) frequently have competing mechanisms for ischaemic stroke, including extracranial carotid atherosclerosis. The objective of this study was to determine associations between use of oral anticoagulants (OACs) plus antiplatelet agents (APA) after ischaemic stroke and outcomes for patients with AF and carotid artery disease. Methods..

Published: 24/01/2023
Authors: Hill AM

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Accuracy of a tool to prioritise patients awaiting elective surgery: an implementation report

Study objective The objective of this study was to evaluate the accuracy of a new elective surgery clinical decision support system, the ‘Patient Tacking List’ (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis. Methods We constructed ROC curves based on risk predictions produced by the tool and..

Published: 20/01/2023
Authors: Pritchard-Jones R

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Trichorrhexis nodosa improving with oral minoxidil: a case report

  McFeely, O; Meah, N; Sinclair, R; Wall, D. (2023). Trichorrhexis nodosa improving with oral minoxidil: a case report. Clinical and Experimental Dermatology. epub 19 Jan. [Online]. Available at: https://doi.org/10.1093/ced/llad019 [Accessed 21 February 2023]  

Published: 19/01/2023
Authors: Meah N

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Short And Long Term Outcomes After Surgical Resection Of Tumours Of The Splenic Flexure – A Two Institutions’ Experience

Background This study was conducted as a part of our service evaluation of colorectal resections. Our primary outcomes were 30 day mortality, 90 day mortality, complication rate and recurrence rates at 3 and 5 years. The secondary outcomes were lymph node harvest >12 and length of stay. Methodology Retrospective data collection from a prospectively maintained..

Published: 17/01/2023
Authors: Rajendiran A

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Giant cell arteritis causing multifocal ischaemic stroke with normal erythrocyte sedimentation rate: a case report

  Introduction Giant cell arteritis (GCA), a medium-to-large-vessel vasculitis affecting the over-50s, is a rare cause of ischaemic stroke, favouring the vertebrobasilar circulation. Erythrocyte sedimentation rate (ESR) is often used to help exclude the diagnosis but this is not always reliable. We discuss a case of ischaemic stroke due to..

Published: 17/01/2023
Authors: Kaul A, Seed A, Cooney L

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A multicentre observational cohort study of cardiovascular risk and outcomes following stroke: The Liverpool-Heart And bRain Project (L-HARP)

  Introduction Improving risk prediction models for adverse outcomes following stroke, such as atrial fibrillation (AF), recurrent stroke, and cognitive impairment and dementia, would help target secondary prevention and other intervention strategies. The primary aim of the Liverpool-Heart And bRain Project (L-HARP) is to establish a prospective cohort study of adults..

Published: 17/01/2023
Authors: Hill AM, Choi S, Elsheikh S, Sagris D, Alobaida M

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019 Nil by mouth and peri-operative medicines administration in trauma and emergency surgery patients

Background An 88-year-old woman attends theatre for dynamic hip screw (DHS) 2 days after a trip and fall, delayed due to clinical pressures. BP, usually well controlled, is through the roof and her atrial fibrillation (AF) is no longer rate controlled; her anaesthetic risk is now considerably greater than prior to..

Published: 10/01/2023
Authors: Dunn J

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Improving family experience through better communication for postoperative patients

Background It is with great stress and anxiety that relatives wait until they get some news about their loved ones being back from a surgical procedure [1]. We aimed to implement a system to improve patient and relative experience through a gesture of updating the relatives about the general condition of..

Published: 10/01/2023
Authors: Jayan N, Khirwadkar R

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Atrial fibrillation and stroke

Introduction Stroke is one of the leading causes of mortality and morbidity globally. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is set to reach epidemic proportions. AF is associated with a five-fold increase in risk of stroke. Strokes caused by AF more often are fatal or..

Published: 08/01/2023
Authors: Hill AM, Abdul-Rahim A

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Evaluation of Huawei smart wearables for detection of atrial fibrillation in patients following ischemic stroke: The Liverpool-Huawei stroke study.

Background Atrial fibrillation (AF) often remains undetected following stroke. Documenting AF is critical to initiate oral anticoagulation, which has proven benefit in reducing recurrent stroke and mortality in patients with AF. The accuracy and acceptability of using smart wearables to detect AF in patients following stroke is unknown. Methods The..

Published: 06/01/2023
Authors: Choi S, Elsheikh S

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Endovascular treatment for ischemic stroke patients with and without atrial fibrillation, and the effects of adjunctive pharmacotherapy: a narrative review

Introduction Endovascular thrombectomy (EVT) is associated with good clinical outcomes in patients with ischemic stroke, but the impact of EVT on clinical outcomes in patients with ischemic stroke with and without atrial fibrillation (AF), and the effect of adjunctive pharmacological therapies with EVT, remains unclear. Areas covered The goal of..

Published: 01/01/2023
Authors: Hill AM

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Mystery of Joint Pain: Is It Rheumatoid Arthritis (RA) or Hereditary Hemochromatosis (HH)?

Abstract A 58-year-old lady with a previous diagnosis of rheumatoid arthritis (RA) was referred to Rheumatology to manage her joint pains. On evaluation, it was noted that the lady did not have any signs of synovial inflammation. The patient had a negative anti-cyclic citrullinated peptide (anti-CCP) (

Published: 28/12/2022
Authors: Chit Su HM

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Do preoperative leukocyte and neutrophil levels have a predictive value on the complications of hypospadias repair in children?

Objective Surgeons observed that the outcomes after the same repair technique in the same type of hypospadias performed by the same surgeon may be different. There may be some indeterminate factors that influence the results such as subclinical inflammation. Our study evaluated the predictor values of inflammatory hematologic parameters on..

Published: 27/12/2022
Authors: Adali E

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Commentary on “An assessment of urethral radiation exposure in the treatment of endometrial and rectal cancers”

Abstract This retrospective cohort study was aimed at comparing urethral radiation exposure during two common radiotherapy modalities. Vaginal brachytherapy (VBT) is commonly used to treat endometrial cancer, with external beam radiation (EBRT) therapy used to treat rectal cancer. The study hypothesised that urethral radiation dose varies between these two modalities...

Published: 15/12/2022
Authors: Harrison NL

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Classification of Systemic Lupus Erythematosus Using Raman Spectroscopy of Blood and Automated Computational Detection Methods

Abstract The aim of this study was to explore the proof of concept for using Raman spectroscopy as a diagnostic platform in the setting of systemic lupus erythematosus (SLE). We sought to identify unique Raman signatures in serum blood samples to successfully segregate SLE patients from healthy controls (HC). In..

Published: 14/12/2022
Authors: Nugent L

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O.15 Pulse dye LASER - treatments can be safely delivered without formal test patching in children

Introduction Pulse dye LASER (PDL) traditionally requires test patching prior to full treatment, to assess for efficacy and side effects. In our unit, in children under age 6, this requires a general anaesthetic. The aim of this study was to ascertain whether results of test patching change settings chosen for subsequent..

Published: 14/12/2022
Authors: Naji S

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Purpuric lesions in the large bowel

Abstract A 54-year-old woman presented with a 1-week history of a rash starting in her feet. This was associated with arthralgia and myalgia. Her bowel habit was initially unchanged; however, she developed bloody diarrhoea shortly after admission to the hospital. She had no constitutional symptoms. Her medical history included myocardial..

Published: 07/12/2022
Authors: Kiladze G, Cannan R, McClements D, Brice R

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Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: Impact of atrial fibrillation

Objectives Endovascular thrombectomy (EVT) is associated with good clinical outcomes in ischaemic stroke, but the risk of intracerebral haemorrhage (ICH) and mortality remains common following ischaemic stroke. The effect of concomitant atrial fibrillation (AF) on clinical outcomes following acute ischaemic stroke in patients receiving EVT remains unclear. The aim is..

Published: 05/12/2022
Authors: Hill AM, Harrison S, Lip G

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Faricimab for treatment of diabetic macular oedema

Abstract Diabetic macular oedema (DME) is a common cause of sight impairment in people with diabetes. Twenty-seven percent of people with type 1 diabetes develop DME within nine years of the disease onset. For people with type 2 diabetes, 25.4% of insulin dependent and 13.9% of those who do not use insulin have DME...

Published: 05/12/2022
Authors: Kovacova A

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Development of guidance for initiation and deprescribing PPI

Abstract It is important to consider whether the risks outweigh the benefits in long term proton pump inhibitor as there has been increasing use of PPIs in hospital settings and community especially in elderly care. Data collection was done on the patients admitted to care of elderly wards in Whiston..

Published: 05/12/2022
Authors: Thein M

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Post-stroke visual impairment: how big is the problem, how do we identify it, what we can do about it, and why does it matter?

In the UK, 100,000 new strokes occur each year, with 1.3 million stroke survivors. This article will focus on post-stroke visual impairment, discussing topics of how common it is, how it can be detected, possible management options and how it impacts stroke survivors.   Hepworth, L.R. (2022). Post-stroke visual impairment: how big is..

Published: 01/12/2022
Authors: Hepworth LR

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Cross-specialty identification of the JAK1 inhibitor trial agent filgotinib as a potential therapy for alopecia areata

  Fagan, N; Doherty, Meah, N; Sinclair, R; Wall, D. (2022). Cross-specialty identification of the JAK1 inhibitor trial agent filgotinib as a potential therapy for alopecia areata. British Journal of Dermatology. epub 25 Nov. [Online]. Available at: https://doi.org/10.1093/bjd/ljac103 [Accessed 21 February 2023]  

Published: 25/11/2022
Authors: Meah N

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Re: Do no harm: the role of perioperative heparin in urethroplasty. Lee et al. IUN (2022)

  Jones, R.E; Omar, A.M; Garth, L.E; Floyd Jr; Michael S. (2022). Re: Do no harm: the role of perioperative heparin in urethroplasty. Lee et al. IUN (2022). International Urology and Nephrology. 55(2), pp.321-322. [Online]. Available at: https://link.springer.com/article/10.1007/s11255-022-03417-9 [Accessed 20 February 2023]  

Published: 22/11/2022
Authors: Jones R

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Patient-reported outcome measures (PROMs) in stone surgery: A multi-centre study of patient experience of flexible ureteroscopy (fURS) versus extracorporeal shockwave lithotripsy (SWL)

Objectives To compare patient-reported outcome measures (PROMs) for patients with symptomatic renal stone disease treated by flexible ureterorenoscopy (fURS) and shockwave lithotripsy (SWL). Introduction Historically, surgical outcomes are measured by surgeon-specific outcomes such as ‘stone-free rates’. More recently, there is increasing emphasis on PROMs to ascertain a patient’s perspective..

Published: 18/11/2022
Authors: Hughes K

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Separating the components of an abdominal wall fellowship

Abstract Complex abdominal wall reconstruction is an emerging subspecialty yet, despite the abundance of abdominal wall hernias requiring treatment and the increasing complexity of this type of surgery, there are few opportunities for surgeons to gain subspecialist training in this field. In this paper we discuss the need for focused..

Published: 14/11/2022
Authors: Adams ST, Scott M, West C

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Impact of COVID-19 policies on perceptions of loneliness in people aged 75 years and over in the cognitive function and aging study (CFAS II)

Background The COVID-19 pandemic and associated social distancing measures have profoundly impacted society and social contact patterns, with older people disproportionately affected. Concerns have been raised about a resulting pandemic of loneliness in older people, although the current evidence is mixed. This study provides a unique perspective on the prevalence..

Published: 12/11/2022
Authors:

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CXR-Net: A Multitask Deep Learning Network for Explainable and Accurate Diagnosis of COVID-19 Pneumonia from Chest X-ray Images

Abstract Accurate and rapid detection of COVID-19 pneumonia is crucial for optimal patient treatment. Chest X-Ray (CXR) is the first-line imaging technique for COVID-19 pneumonia diagnosis as it is fast, cheap and easily accessible. Currently, many deep learning (DL) models have been proposed to detect COVID-19 pneumonia from CXR images...

Published: 09/11/2022
Authors: Lechareas S, Tridente A

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COVID-19 related myopericarditis and cardiac tamponade: a diagnostic conundrum

Abstract We report the case of a 45-year-old man presenting with worsening shortness of breath and chest tightness on a background of type 2 diabetes mellitus, hypertension and stable angina. He felt generally unwell and had a productive cough two weeks prior to presentation. Initial examination found quiet heart sounds and..

Published: 09/11/2022
Authors: Meah NA, Wai H, Bhamidipati K

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Patient satisfaction with telephone consultations in cardiology outpatients during the COVID-19 pandemic

Abstract The COVID-19 pandemic required a radical change in healthcare delivery methods, including the remote delivery of many outpatient services. We aimed to understand patient satisfaction with telephone consultations. Patients who had undergone a cardiology telephone consultation between 24 February and 19 July 2021 were asked to complete a survey. The survey assessed..

Published: 09/11/2022
Authors: Goodall J, Katira R

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Emergency Urology procedures during the COVID-19 pandemic in the UK: A 3-month prospective study

Objective COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency surgical care. Specific to Merseyside, Tier 4, Tier 2 and Tier 5 restrictions were introduced in late 2020 and early 2021. The purpose of this study was to examine the nature and workload of emergency urological..

Published: 08/11/2022
Authors: Georgiou M, Ridzuan-Allen A, Chamsin A, Siddiqui Z, Tolofari S, Ejikeme C, Jones R, Napier-Hemy TP, Rotas S, Hughes KE, Khattak AQ, McCabe JE, Omar A, Mistry R, Samsudin A, Gana HB, Floyd Jr MS

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A Comparative Study of Symptoms, Nasal Eosinophilia and Pulmonary Function Tests Before and After Short Term Treatment with Corticosteroid Nasal spray in Patients with Allergic Rhinitis

Abstract Allergic rhinitis has been on the rise because of urbanization and major population shift in addition to changes in the particulate matter in the atmosphere. Intranasal corticosteroid sprays are recommended as first-line prescription treatment in all cases of allergic rhinitis. The propensity of co-existing non-apparent lower airway hyper-responsiveness is..

Published: 08/11/2022
Authors: Pai KM, Pai HS

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A comparison of age-banded and weight-based oral paracetamol dosing in hospitalized children

Introduction The British National Formulary for Children contains two dosing strategies for oral paracetamol; age-banded dosing for pain and pyrexia or weight-based dosing for post-operative pain. Only weight-based is used in our hospital. The aim of this study was to compare these dosing strategies using weights from a pediatric inpatient..

Published: 03/11/2022
Authors: Wright K

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Safety and effectiveness of ustekinumab in elderly Crohn’s disease patients

Objective Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn’s patients. Methods This retrospective multi-centre cohort study included Crohn’s patients ≥60..

Published: 01/11/2022
Authors: Liaros A

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Perceptions of arthritis glove wear of patients with rheumatoid arthritis and persistent hand pain

Introduction Arthritis gloves are prescribed in rheumatoid arthritis (RA) to reduce hand pain, stiffness, and improve hand function. As part of a randomised controlled trial, this study investigated participants' perceptions of wearing arthritis gloves. Method Participants with RA and persistent hand pain (n = 206) were randomly assigned and prescribed either loose-fitting..

Published: 31/10/2022
Authors: Hough Y

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

Published: 27/10/2022
Authors: Westall S, Narayanan RP, Irving G, Hardy KJ

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Letter to the Editor re: Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection

  Gadelrab, M; Chamsin, A; Khadr, R; Omar, AM; Floyd Jr, MS. (2022). Letter to the Editor re: Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection in the Treatment of Neurogenic Lower Urinary Tract Dysfunction. Urology Journal. epub 25 October(.), p.7345. [Online]. Available at: https://journals.sbmu.ac.ir/urolj/..

Published: 25/10/2022
Authors: Gadelrab M, Chamsin A, Omar A, Floyd Jr MS

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Morton Neuroma

Continuing Education Activity Morton neuroma is a compressive neuropathy of the interdigital nerve in the forefoot due to compression and constant irritation at the plantar aspect of the transverse intermetatarsal ligament. It is not a true neuroma as the condition is degenerative rather than neoplastic. It is also referred to..

Published: 25/10/2022
Authors: Munir U, Morgan S

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An intertriginous hyperpigmented macular eruption

Abstract A 23-year-old woman presented with a hyperpigmented intertriginous eruption unresponsive to topical steroids and to topical and systemic antifungals. Histopathological assessment demonstrated patchy inflammatory infiltrate at the demoepidermal junction with pigment incontinence.   Harnett, C; Meah, N; Low, SE; Eustace, K. (2022). An intertriginous hyperpigmented macular eruption. Clinical and Experimental Dermatology. 47(12),..

Published: 14/10/2022
Authors: Harnett C, Meah N, Low SE, Eustace K

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P-135 First experience with a new closed incision negative pressure wound therapy, Prevena TM

Aim Surgical site infection (SSI) contributes a significant proportion of post operative morbidity in patients undergoing abdominal wall reconstruction (AWR). PrevenaTM closed incision negative pressure wound therapy (ciNPT) has been demonstrated to reduce SSI rates in the elective and emergency laparotomy setting. However, there is no evidence for PrevenaTM use..

Published: 13/10/2022
Authors: Dixon S, Benson A, Kalaiselvan R, Kanwar S, Samad A, Pritchard-Jones R, West C, Scott M

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Augmented Reality–Assisted Design of Local Flaps: A New Practical and Educational Tool in the Field of Plastic Surgery

Abstract: Augmented reality (AR) is a new and promising technology that has been incorporated into several aspects of our everyday life, including surgery. Examples of its application throughout various fields of surgery, although most of them are in experimental stage, have already been demonstrated and published. In this article, we..

Published: 10/10/2022
Authors: Kyriazidis I, Jones C, Shokrollahi K, Benson A

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OC-022 Maintaining an elective abdominal wall reconstruction service during the COVID 19 pandemic

Aim Elective surgery services suffered significantly due to the COVID-19 pandemic. The aim of this study was to analyse the impact and outcomes of abdominal wall reconstruction (AWR) performed during the COVID-19 pandemic, assessing safety and sustainability. Material & Methods A retrospective review of all patients undergoing AWR in a single..

Published: 10/10/2022
Authors: Dixon S, Benson A, Kalaiselvan R, Kanwar S, Samad A, Pritchard-Jones R, West C, Scott M

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P0490 Opioid exposure in IBD and associated factors: a UK prospective multicentre audit of 1362 patients

Introduction Opioid exposure in inflammatory bowel disease (IBD) is associated with premature mortality, yet exposure in IBD increasing. International guidelines have been introduced to rationalise opioid use. While opioids may improve acute pain, long term exposure is rarely beneficial and is associated with side effects.We conducted a multicentre audit..

Published: 09/10/2022
Authors: Bassi A

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Hormone therapy for uterine and endometrial development in women with premature ovarian insufficiency

Background Premature ovarian insufficiency (POI) is a clinical syndrome resulting from loss of ovarian function before the age of 40. It is a state of hypergonadotropic hypogonadism, characterised by amenorrhoea or oligomenorrhoea, with low ovarian sex hormones (oestrogen deficiency) and elevated pituitary gonadotrophins. POI with primary amenorrhoea may occur as a..

Published: 06/10/2022
Authors: Vinayagam S

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Hormone therapy for uterine and endometrial development in women with premature ovarian insufficiency

Background Premature ovarian insufficiency (POI) is a clinical syndrome resulting from loss of ovarian function before the age of 40. It is a state of hypergonadotropic hypogonadism, characterised by amenorrhoea or oligomenorrhoea, with low ovarian sex hormones (oestrogen deficiency) and elevated pituitary gonadotrophins. POI with primary amenorrhoea may occur as a..

Published: 06/10/2022
Authors: Vinayagam S

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Antibiotic Review Kit for Hospitals (ARK-Hospital): a stepped wedge cluster randomised controlled trial

Background Strategies to reduce antibiotic overuse in hospitals depend on prescribers taking decisions to stop unnecessary antibiotic use. There is scarce evidence for how to support these decisions. We evaluated a multifaceted behaviour change intervention (ie, the antibiotic review kit) designed to reduce antibiotic use among adult acute general medical..

Published: 04/10/2022
Authors: Gray K

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Augmented Reality–Assisted Design of Local Flaps: A New Practical and Educational Tool in the Field of Plastic Surgery

Abstract Augmented reality (AR) is a new and promising technology that has been incorporated into several aspects of our everyday life, including surgery. Examples of its application throughout various fields of surgery, although most of them are in experimental stage, have already been demonstrated and published. In this article, we..

Published: 03/10/2022
Authors: Kyriazidis I, Jones C, Shokrollahi K, Benson A

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Stroke-heart syndrome: sex-specific incidence, risk factors, and major adverse cardiovascular events in 486,515 patients

Background Newly diagnosed cardiovascular complications post-stroke, termed stroke-heart syndrome, are common and associate with worsened prognosis. Purpose To investigate the sex-specific incidence and 5-year major adverse cardiovascular events following stroke-heart syndrome, stratified by pre-existing risk factors (sex, age, obesity, hypertension, type 2 diabetes mellitus, and high LDL cholesterol). Methods A retrospective..

Published: 03/10/2022
Authors: Hill AM

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Hallux Varus

Continuing Education Activity Hallux varus is a clinical condition characterized by medial deviation of the great toe at the metatarsophalangeal (MTP) joint. This condition has multiple etiologies and patients may present with various symptoms and with varying severity of hallux varus. Adult acquired hallux varus deformity is commonly iatrogenic, occurring..

Published: 25/09/2022
Authors: Munir U, Morgan S

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Electrochemotherapy for the treatment of cutaneous squamous cell carcinoma: The INSPECT experience (2008-2020)

Introduction Cutaneous squamous cell carcinoma (cSCC) is a frequent skin cancer with a high risk of recurrence characterized by tumor infiltration and, in advanced cases, a poor prognosis. ECT (electrochemotherapy) is an alternative treatment option for locally advanced or recurrent cSCC that is unsuitable for surgical resection. In this study,..

Published: 20/09/2022
Authors: Pritchard-Jones R

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Signposts to the Promised Land in Alopecia Areata

Abstract Alopecia areata (AA) is an autoimmune disease of the hair and nails. Although genotype alters the risk, the etiology remains unclear. AA typically presents as one or more hairless patches; however, full loss of scalp hair occurs in about 15% of patients (Cranwell et al., 2019; Ikeda, 1965). The relative ease in..

Published: 18/09/2022
Authors: Meah N

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Signposts to the Promised Land in Alopecia Areata

Clinical Implications Costs associated with emerging therapies will require disease severity to be redefined. The Severity of Alopecia Tool score was not predictive of life quality. Patient-reported outcomes provide a more accurate depiction of diminished life quality.   Wall, D; Rees, H; Bokhari, L; Meah, N; York, K; Sinclair, R. (2023). Signposts..

Published: 18/09/2022
Authors: Meah N

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Can a prostate biopsy be safely deferred on PI-RADS 1,2 or 3 lesions seen on pre-biopsy mp-MRI?

Introduction Multi-parametric magnetic resonance imaging (mp-MRI) is currently used to triage patients with suspected prostate cancer, before deciding on prostate biopsies. In our study, we evaluated normal and equivocal pre-biopsy mp-MRIs to see whether it is safe to avoid biopsy with such findings. Methods A retrospective study was conducted at..

Published: 13/09/2022
Authors: Hosny K

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Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018–2020

Background Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with..

Published: 12/09/2022
Authors: Tridente A

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A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries

Background Glutamine is thought to have beneficial effects on the metabolic and stress response to severe injury. Clinical trials involving patients with burns and other critically ill patients have shown conflicting results regarding the benefits and risks of glutamine supplementation. Methods In a double-blind, randomized, placebo-controlled trial, we assigned patients..

Published: 09/09/2022
Authors: Shokrollahi K

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Current practice and surgical outcomes of neoadjuvant chemotherapy for early breast cancer: UK NeST study.

Abstract: oadjuvant chemotherapy (NACT) is increasingly being used to treat early breast cancer, and offers several advantages, including reducing the extent of breast and axillary surgery, and providing an in vivo assessment of tumour sensitivity to treatment1–4. Clinical trials have identified tumour subgroups with high rates of pCR. A pCR..

Published: 09/09/2022
Authors: Alfred J, Lennon H

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P014 Video assisted anal fistula treatment (VAAFT): A 5 year review

Aim VAAFT is claimed to be the only technique that allows the surgeon to see inside the anal fistula tract and locate the internal opening using an endoscope light. It is designed to only affect the fistula tract and there preserve sphincter function and faecal continence. Our aim was to..

Published: 06/09/2022
Authors: Alfred J, Santoro G, Beggs R, Brookes J, Rajaganeshan R

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P066 Incisional hernia rate following laparoscopic anterior resection. Does extraction site matter?

Aim Incisional hernia are an established complication following abdominal surgery. There is limited data available on the relationship between formation of an incisional hernia and choice of extraction site for patients undergoing a laparoscopic anterior resection. This study aimed to determine the prevalence of incisional hernia following this operation and..

Published: 06/09/2022
Authors: Botzenhardt E, Clifford R, Rajaganeshan R

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Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: Results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study

Background Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD). Aim To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to their second, irrespective of drug sequence Methods We conducted a UK-wide, multicentre, retrospective cohort study..

Published: 29/08/2022
Authors: Chandy R, Baig D, Jagdish R

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287 Retrospective Review of a Single Surgeon 5-Year Experience of Paediatric Breast Reconstruction

Aim This case series reviews the presentation, clinical and surgical management of paediatric breast cases undertaken by a single surgeon. The series demonstrates the powerful role of lipomodelling when used with breast reshaping techniques to achieve good outcomes and avoid the need to commit young patients to breast implants. Method..

Published: 19/08/2022
Authors: Nelson A, Taghizadeh R, Hassan D

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622 Tranexamic Acid Use in Meningioma Surgery – a Systematic Review and Meta-Analysis

Aim Meningioma surgery is associated with increased intraoperative bleeding and transfusion requirement. Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. This review aimed to evaluate the effect of TXA use on bleeding and transfusion requirement, and functional outcomes in meningioma surgery. Method A systematic..

Published: 18/08/2022
Authors: Keshwara S

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945 Usefulness of Skull X-Ray in diagnosis and management of craniosynostosis and suspected NAI in children less than 4 years, results of three years retrospective observational study

Aims Evidence for the indications of skull X rays (SXR) in children is limited. There is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adult. The risks from exposure to ionizing radiation are dependent on the age at which exposure occurs, and..

Published: 17/08/2022
Authors: Ahmad A, Hamed Z, Vataha K, Abdelaziz M

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67 The occurrence of contaminated blood culture in paediatric unit in DGH, simple intervention to prevent cost and unnecessary treatment

Aims Micro-organisms are present on the skin surface of patients, staff and the immediate patient environment which can result in contamination of blood cultures. Contamination can lead to inappropriate treatment, prolonged hospital stay, increased cost (estimated: £5000/contaminated culture), family and patient inconvenience and it affect mandatory surveillance data and protocols...

Published: 17/08/2022
Authors: Mohamed A, Vardhan M

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853 Disseminating new clinical guidance during a pandemic

Aims Establishing an innovative method of disseminating a new bronchiolitis guideline in a tertiary paediatric hospital. The ripple effect of the Covid-19 pandemic and subsequent lockdown periods on the paediatric population has been far reaching.1 With isolation drawing to a close, we saw a resurgence of patients presenting to hospital..

Published: 17/08/2022
Authors: Cocks Z

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905 Comparison of prednisolone vs dexamethasone in acute asthma and viral induced wheeze

Aims Early oral corticosteroid therapy is recommended in the treatment of acute asthma exacerbations in children. BTS/SIGN guidelines recommend that children with severe symptoms of viral induced wheeze (VIW) should still receive oral steroids, and that it is advisable in moderately severe cases without a previous diagnosis of asthma...

Published: 17/08/2022
Authors: Humphreys S, Lisboa L, Chilukuri L

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784 Review of bronchopulmonary dysplasia services in the North West of England

Aims Bronchopulmonary dysplasia (BPD) or neonatal chronic lung disease is the commonest adverse outcome in very premature neonates. BPD incidence is increasing unlike other prematurity associated conditions and despite advances in aetiological understanding. BPD incurs substantial healthcare costs which extend beyond initial hospitalisation, such as home oxygen therapy, recurrent admissions..

Published: 17/08/2022
Authors: Krishnamurthy S, Chilukuri L

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1224 Audit of neonatal hypoglycaemia in Whiston Hospital and study of incidental hypoglycaemia during sepsis screen

Aims Babies at risk of hypoglycaemia should be identified at birth and placed on a care pathway that includes early commencement of feeds, regular glucose monitoring and clinical assessment. Our hospital has a hypoglycaemia policy for managing these babies and this project aims to examine current local practice through auditing..

Published: 17/08/2022
Authors: Alexopoulou V, Green J, Garr R

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1074 Surgical care closer to home: is it up to the mark?

Aims Paediatric surgery is challenging and training in this area is subspecialised including anaesthesia and post operative care. The Royal College of Surgeons Standards of Surgical care for Children, 2013 supports the ‘provision of care closer to home’ in patients with access to appropriate level of care. Typically this is district..

Published: 17/08/2022
Authors: Maddipati T, Chilukuri L, Abdelaziz M

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677 GP with Extended Remit (GPwER) in Paediatrics-Ensuring children and young people are seen in the right place, at the right time, by the right person

Aims The GPwER for paediatrics manages a defined cohort of paediatric conditions in a community setting, ensuring patients are seen at the right time, in the right place by the right clinician. By bringing the skills of a generalist to a specialist area, care is delivered to children & young people..

Published: 17/08/2022
Authors: Chang R, Abdelaziz M, Barrow A

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A survey of UK critical care pharmacists research involvement and associated barriers

Introduction Pharmacist led research provides evidence of impact of safe, effective and economic advanced pharmaceutical care in critical care medicine. Examples include impact of extracorporeal therapies on drug handling1; sedation delirium management2; medication safety3 and broader pharmacist interventions.4 The New Zealand Hospital Pharmacist Association (NZPHA), Society of Pharmacists of Australia (..

Published: 15/08/2022
Authors: Barton G

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TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines

Aims The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality >5%) managed on ICU..

Published: 09/08/2022
Authors: Banks J, Macadam R

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Invited Discussion on: “Comparison of Classic Mastopexy Method Versus Double-pedicled Auto-augmentation Mastopexy with with Conic-Shaped Modified Inferior Butterfly Flap".

  Taghizadeh, R. (2022). Invited Discussion on: “Comparison of Classic Mastopexy Method Versus Double-pedicled Auto-augmentation Mastopexy with with Conic-Shaped Modified Inferior Butterfly Flap". Aesthetic Plastic Surgery. epub 4 August(.), p... [Online]. Available at: https://doi.org/10.1007/s00266-022-03016-0 [Accessed 16 August 2022]

Published: 04/08/2022
Authors: Taghizadeh R

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Review of Burn Resuscitation: is Plasmalyte® A Comparable Alternative to Ringer’s Lactate?

Abstract Ringer’s lactate has been the most widely used fluid for burn resuscitation for decades. Plasmalyte®, a newer balanced crystalloid, is gaining popularity for use in the critically ill, including patients with burns. This popularity is partly due to the fact that Plasmalyte® theoretically offers a favourable metabolic profile,..

Published: 02/08/2022
Authors: Cappuyns L, Tridente A, Stubbington Y, Shokrollahi K

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Medical Student Perspectives on Undergraduate Oncology Education in the UK

Aims The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced. Materials and methods Students attending two BONUS revision days received a questionnaire assessing their experience..

Published: 01/08/2022
Authors: Keshwara S

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National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

Introduction Keratinocyte or non-melanoma skin cancer (NMSC) is the most common malignancy worldwide, encompassing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The mainstay of treatment for NMSC is excision. The likelihood of recurrence is directly related to achieving tumour-free margins. Just 1 per cent of BCCs recur where..

Published: 27/07/2022
Authors: Nolan G, Pritchard-Jones R

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The frequency and clinical significance of centromere enumeration probe 17 alterations in human epidermal growth factor receptor 2 immunohistochemistry-equivocal invasive breast cancer

Background and Aims Keratinocyte or non-melanoma skin cancer (NMSC) is the most common malignancy worldwide, encompassing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The mainstay of treatment for NMSC is excision. The likelihood of recurrence is directly related to achieving tumour-free margins. Just 1 per cent of BCCs..

Published: 25/07/2022
Authors: Chagla LS

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Clinical Outcomes and Risk Stratification of Early-Stage Melanoma Micrometastases From an International Multicenter Study

Purpose Indications for offering adjuvant systemic therapy for patients with early-stage melanomas with low disease burden sentinel node (SN) micrometastases, namely, American Joint Committee on Cancer (AJCC; eighth edition) stage IIIA disease, are presently controversial. The current study sought to identify high-risk SN-positive AJCC stage IIIA patients who are more..

Published: 18/07/2022
Authors: Nolan G, Pritchard-Jones R

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Retrospective Review of Arthroplasty Radiographs: How to Define an Adequate Radiograph

Introduction Adequacy of postoperative hip and knee radiographs has a direct impact on its interpretation. We undertook a quality improvement project by creating local standards to meet the arthroplasty team expectations for a satisfactory radiograph. The purposes of the study are 1. Assessment of the adequacy of radiographs according to defined..

Published: 09/07/2022
Authors: Khan S

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Editorial commentary: COVID-19 and COVID-19 vaccination: Observations on thrombosis and thrombocytopenia

  Elsheikh, S; Lip, GYH. (2022). Editorial commentary: COVID-19 and COVID-19 vaccination: Observations on thrombosis and thrombocytopenia. Trends in Cardiovascular Medicine. 32 (5), 257-258

Published: 08/07/2022
Authors: Elsheikh S

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BONUS: the National Oncology Network for Students and Junior Doctors

The British Oncology Network for Undergraduate Societies (BONUS) is a national oncology network for medical students and junior doctors. The network aims to promote careers and education in clinical, medical, surgical and interventional oncology, a subspeciality of interventional radiology, and is, therefore, a ‘pan-oncology society’ [[1]]. Both a recent Royal College..

Published: 07/07/2022
Authors: Keshwara S

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BONUS: the National Oncology Network for Students and Junior Doctors

The British Oncology Network for Undergraduate Societies (BONUS) is a national oncology network for medical students and junior doctors. The network aims to promote careers and education in clinical, medical, surgical and interventional oncology, a subspeciality of interventional radiology, and is, therefore, a ‘pan-oncology society’ [[1]]. Both a recent Royal College..

Published: 07/07/2022
Authors: Keshwara S

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Desmoplastic trichoepithelioma: an uncommon adnexal tumour with a predilection for cosmetically sensitive sites

Introduction Desmoplastic trichoepithelioma is an uncommon adnexal tumour (Rahman et al, 2020) predominantly affecting young women in cosmetically sensitive sites (Mamelak et al, 2010). Detection is often incidental and histological diagnosis can be impeded by biopsies that are insufficiently deep (Mamelak et al, 2010). Clinically and histologically it can mimic morphoeic basal cell..

Published: 06/07/2022
Authors: Morton J

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Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy

Objective To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. Data Sources MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published..

Published: 05/07/2022
Authors: Martin H

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H17: Botulinum toxin: from lethal adversary to dermatological sensation – how the power of poison was harnessed

Abstract Botulinum toxin, produced by the bacterium Clostridium botulinum, is a remarkably versatile agent. Its dermatological applications include the treatment of both hyperhidrosis and rhytides, and its myriad of medical functions are numerous and far reaching. Yet, capable of inducing paralysis and subsequent death, its origins belie the reputation it..

Published: 05/07/2022
Authors: Winters S

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BI27: Two cases of capecitabine-induced subacute cutaneous lupus erythematosus

Abstract Capecitabine-induced subacute cutaneous lupus erythematosus is a documented but seemingly underappreciated phenomenon. We report our experience of two cases reviewed in a specialist immunochemotherapy dermatology clinic. A 73-year-old woman with a background of stage 4 oesophageal cancer presented with a rapidly progressive pruritic eruption. She had received one cycle of..

Published: 05/07/2022
Authors: Winters S, Hindle E

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E 389 - Survey of Bronchopulmonary Dysplasia (BPD) Services in Twenty Hospitals in the North West Region of England

Abstract The purpose of this report is to analyze the functioning of BPD services, in accordance with evidence-based medicine, in a range of North West hospitals and then suggesting changes to the service if needed. To enable this, the authors have designed a standardized questionnaire to interview the hospitals which..

Published: 30/06/2022
Authors: Chilukuri L, Maddipati T

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E 389 - Survey of Bronchopulmonary Dysplasia (BPD) Services in Twenty Hospitals in the North West Region of England

Abstract The purpose of this audit is to assess the efficacy of single dose oral dexamethasone in preventing acute readmissions in comparison with a three-day course of oral prednisolone. A new local guideline was introduced in 2019, that recommends the use of single dose oral dexamethasone for management of asthma in..

Published: 30/06/2022
Authors: Chilukuri L, Humphreys S, Lisboa L, Maddipati T

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P23 Comparative safety and effectiveness of ustekinumab and vedolizumab in elderly crohn’s disease patients

Background Anti-TNF agents are effective in treating elderly Crohn’s disease (CD) patients but its use is limited by increased risk of infections and treatment discontinuation. Evidence for safety and efficacy of non-anti-TNF biologics in the elderly is limited. We aimed to compare the safety and effectiveness of ustekinumab and..

Published: 19/06/2022
Authors: Liaros A

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O16 Gastrostomy placement in MND: the impact of weight loss and respiratory compromise

Introduction Motor neurone disease (MND) is a neurodegenerative condition causing progressive deterioration of muscle weakness that affects breathing, movement and swallowing. The Progas study1 is the largest study in recent years focussing on nutrition in MND, demonstrating that 30 day mortality post PEG (percutaneous endoscopic gastrostomy) insertion was 10.7 times higher in..

Published: 19/06/2022
Authors: Roberts S, Theis V, Clark K

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O15 Benefits of gastrostomy tract dilatation following gastrostomy tube displacement

Introduction It is estimated that 2% of gastrostomies will become displaced in the first 10 months of placement and 37% within five years.1 Replacement of a displaced gastrostomy tube should only be attempted 4 weeks after initial placement, as prior to this, the tract may not be fully formed and the risk of misplacement..

Published: 19/06/2022
Authors: Roberts S, Theis V, Clark K

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Prevention and management of post-deep inferior epigastric perforator flap abdominal bulge

Background Abdominal bulge in the absence of a hernia is a known complication following free abdominal flap breast reconstruction and can be associated with significant aesthetic and functional morbidity. This study aims to review the impact of permanent subrectus mesh placement on the incidence of post-DIEP bulge. Methods All patients..

Published: 17/06/2022
Authors: Jakeman M, Barnes J, Taghizadeh R

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992 Results of a pilot HIV/Frailty Clinic - can comprehensive geriatric assessment benefit frail people living with HIV?

Introduction Frailty has been recognised among people living with human immunodeficiency virus (HIV) and will become more prevalent in coming years given treatment success (Pathai et al J Gerontol A Biol Sci Med Sci 2014;69:833–842). Assessment of frailty and its common syndromes through comprehensive geriatric assessment (CGA) is routinely delivered by..

Published: 14/06/2022
Authors: Morrow H, Horner M, Thomson-Glover R

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P1141: Ibrutinib and rituximab as first line therapy for mantle cell lymphoma: a multicentre, real-world UK study

Background Ibrutinib (IBR) is an oral covalent Bruton tyrosine kinase inhibitor (BTKi), licensed for treatment of relapsed or refractory mantle cell lymphoma (MCL). Under NHS interim Covid-19 agreements in England, IBR with or without rituximab (R) was approved for the frontline treatment for MCL patients (pts) as a safer alternative..

Published: 14/06/2022
Authors: Nicholson T

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Commentary on: Utilization of Free Soft Tissue Grafts in Otoplasty: A Simple Yet Effective Way to Avoid Suture Extrusion

Extract The authors have summarized their experience from over 200 cases relating to soft-tissue interposition between postauricular skin and suture knots in suture-based otoplasty.1 Suture extrusion is one of the most common complications in procedures that utilize concho-mastoid or concho-scaphal sutures. Therefore, any intervention that reduces this complication should be seriously..

Published: 11/06/2022
Authors: Shokrollahi K

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P10-9 Correlation of Hounsfield units and stone volume with LASER time in stone surgery

Introduction Time taken for stone disease surgeries are variable and can be unpredictable. Appropriate planning of cases and theatre lists improves efficiency, saves costs, and prevents cancellations. This study aims to determine if Hounsfield units (HU) and stone volume (SV) has a correlation with various factors, in particular LASER time...

Published: 10/06/2022
Authors: Agarwal K, McCabe JE

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Developing priorities for quality improvement in acute medicine using a modified Delphi method

Introduction The SAM Quality Improvement Committee (SAM-QI), set up in 2016, has worked over the last year to determine the priority Acute Medicine QI topics. They have also discussed and put forward proposals to improve QI training for Acute Medicine professionals. Methods A modified Delphi process was completed over four rounds..

Published: 09/06/2022
Authors: Varia R, Rigby A

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The scope for radiology to contribute to the NHS net zero target: findings from a survey of radiology staff in the UK

Aim To assess attitudes towards the climate emergency among radiology staff and to identify current practices that may contribute towards the National Health Service (NHS) net zero target. Materials and methods An online survey of radiology staff was conducted assessing current attitudes to the climate emergency. Further questions focused on..

Published: 07/06/2022
Authors: Gendy D, Zaman S

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P04 Adverse events following immunization (AEFI) with COVID-19 vaccines: case series and literature review

Abstract There currently exists no formal consensus on advice given to patients who have experienced an adverse event following immunization (AEFI) (WHO definition) following COVID-19 vaccination. The incidence of vaccine-related cutaneous events is only likely to increase with the UK launching subsequent vaccine doses as part of the mass vaccination..

Published: 03/06/2022
Authors: Walsh ML, Trehan P

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Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty

Aims Achieving purchase in native glenoid bone is essential for the stability of the glenoid baseplate when bone graft is used to address bone loss in both primary and revision shoulder arthroplasty procedures. The aim of this study is to assess the required depth of the baseplate peg in native..

Published: 01/06/2022
Authors: Makki D

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Corticosteroids for the treatment of Kawasaki disease in children

Background Kawasaki disease (KD), or mucocutaneous syndrome, is the leading cause of childhood‐acquired heart disease in high‐income countries. There is much controversy on how best to treat children with KD and in particular who may benefit from additional treatment beyond the standard intravenous immunoglobulin (IVIG) and aspirin, such..

Published: 27/05/2022
Authors: Green J

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Metastatic melanoma to the heart causing ventricular tachycardia: looking beyond the troponin

  Abstract: A man in his mid-50s presented with palpitations, chest pain and syncope. After initial workup for a non-ST elevation myocardial infarction, a CT scan revealed metastatic melanoma. The malignancy was infiltrating his right ventricle, resulting in recurrent ventricular tachycardia. Although initially hard to manage, his arrhythmias were eventually..

Published: 25/05/2022
Authors: Goodall J, Beveridge NER, Rasoul D, Bhamidipati K

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Digital screening for postnatal depression: mixed methods proof-of-concept study

Background: Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to..

Published: 23/05/2022
Authors: Agass R

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Medical Student Perspectives on Undergraduate Oncology Education in the UK

Influence of MRI use on surgical outcomes in lobular breast cancer Aims The British Oncology Network for Undergraduate Societies (BONUS) surveyed students who attended an oncology revision day to determine their views on the current quantity, quality and type of curriculum-based oncology teaching they have experienced. Materials and methods Students..

Published: 18/05/2022
Authors: Keshwara S

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Restoration of smile: The role of the masseteric to facial nerve transfer in facial reanimation

Objectives The masseteric nerve has become a popular donor nerve for transfer in facial reanimation surgery. Results are comparable to, if not better than other nerve transfer techniques. This article describes the use of a masseteric to facial nerve transfer for facial reanimation in a group of patients with facial..

Published: 17/05/2022
Authors: Snashall E, Harper-Machin A, Martin H

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Variability in Test Interval Is Linked to Glycated Haemoglobin (HbA1c) Trajectory over Time

Aims: We previously showed that the glycated haemoglobin (HbA1c) testing frequency links to diabetes control. Here, we examine the effect of variability in test interval, adjusted for the frequency, on change in HbA1c (ΔHbA1c). Materials & Methods: HbA1c results were collected on 83,872 people with HbA1c results..

Published: 16/05/2022
Authors: Green L

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Evaluation of the Indications for Sentinel Node Biopsy in Early-Stage Melanoma with the Advent of Adjuvant Systemic Therapy

Background Patients presenting with early-stage melanoma (AJCC pT1b-pT2a) reportedly have a relatively low risk of a positive SNB (~5–10%). Those patients are usually found to have low-volume metastatic disease after SNB, typically reclassified to AJCC stage IIIA, with an excellent prognosis of ~90% 5-year survival. Currently, adjuvant systemic therapy is..

Published: 13/05/2022
Authors: Nolan G, Pritchard-Jones R

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Epidemiology of Neonatal Acute Respiratory Distress Syndrome: Prospective, Multicenter, International Cohort Study

Objectives Age-specific definitions for acute respiratory distress syndrome (ARDS) are available, including a specific definition for neonates (the “Montreux definition”). The epidemiology of neonatal ARDS is unknown. The objective of this study was to describe the epidemiology, clinical course, treatment, and outcomes of neonatal ARDS. Design Prospective, international, observational, cohort..

Published: 10/05/2022
Authors: Tridente A

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Nephrogenic metaplasia in a female person with spinal cord injury

  Introduction Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia. Case presentation A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within..

Published: 09/05/2022
Authors: Hasan NU

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Developing a burn-specific peri-operative checklist: Version zero, a starting point

Winning poster presentation in the Care category at the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction: The World Health Organization (WHO) surgical safety checklist is a widely applied tool in surgical practice aimed at identifying potential faults..

Published: 04/05/2022
Authors: Cappuyns L, Holme H, Mandal A, Gurusinghe D, Shokrollahi K

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Photodynamic antimicrobial chemotherapy coupled with the use of the photosensitizers methylene blue and temoporfin as a potential novel treatment for Staphylococcus aureus in burn infections

Winning poster presentation in the Research category at the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Aim This study aimed to assess the antimicrobial efficacy of methylene blue (MB) - and temoporfin-mediated PACT against both Gram+ve and..

Published: 04/05/2022
Authors: Shokrollahi K

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Aesthetic tattoos as a treatment adjunct for scars from burns & trauma: A literature review and treatment approach

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Aesthetic tattoos are extremely common in the UK and around the world. Medical tattoos have been employed in a variety of subspecialties across burns and plastic..

Published: 04/05/2022
Authors: Cappuyns L, Khaw R, Shokrollahi K

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Burn fluid resuscitation using plasmalyte®: Is it a safe replacement for ringers lactate and what is the potential cost saving?

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Fluid resuscitation remains the basis of early burn management. Both the type and volume of fluids can impact the outcome of burn patients. Appropriate fluid resuscitation..

Published: 04/05/2022
Authors: Cappuyns L, Tridente A, Stubbington Y, Shokrollahi K

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A service evaluation of the Cosmetic camouflage service at a UK regional plastic surgery department

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction The negative impact of scars and cutaneous dermatoses including vitiligo and rosacea are well known. Cosmetic camouflage is one potentially helpful intervention and involves the application..

Published: 04/05/2022
Authors: Oke S, Cappuyns L, Shokrollahi K

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Further perspectives on burns from E-cigarette battery explosions: a public health concern

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Electronic cigarettes (e-cigarettes) are a fairly recent invention which substitutes conventional cigarettes. The use of e-cigarettes is on the rise as these devices are often marketed..

Published: 04/05/2022
Authors: Stone S, Cappuyns L, Philip L, Gurusinghe D, Shokrollahi K

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Overcoming challenges around wounds and wound dressings in burn patients requiring nerve conduction studies

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Conclusions Through collaborative efforts a new protocol and a SOP are being developed which address the logistics around performing the tests in patient who have unhealed burns..

Published: 04/05/2022
Authors: Cappuyns L, Murray E, Gurusinghe D, Deshpande M, Nwe M, Shokrollahi K

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A patient’s perspective of extravasation injury treated at a burns centre

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Aim We sought to understand better the patient experience and journey in the aftermath of an extravasation injuries and how care pathways for these patients might be..

Published: 04/05/2022
Authors: Hussien M, Cappuyns L, Murgatroyd E, Eccles L, Shokrollahi K

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The role of burns professionals in public health awareness and strategies to prevent burns

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction A number of plants and other naturally occurring substances have been shown to cause skin irritation or cutaneous chemical burns. In many of these cases the..

Published: 04/05/2022
Authors: Ebbs S, Cappuyns L, Giannopoulos I, Mandal A, Gurusinghe D, Shokrollahi K

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Hypothermia in severe burns presenting at a regional burns centre

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Conclusions Our study demonstrates a link between hypothermia and mortality but not whether this link is causative. Our study also demonstrates a link between TBSA and hypothermia...

Published: 04/05/2022
Authors: Cappuyns L, Philip L, Ramadan S, Ebbs S, Gurusinghe D, Shokrollahi K

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An audit of ward-level pain management at a regional burn centre: Is the National standard adequate?

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Aims To audit pain management practice at ward level against set national standards. To gauge the adequacy of that standard. To assess the true effectiveness of pain..

Published: 04/05/2022
Authors: Cappuyns L, Ramadan S, Gurusinghe D, Shokrollahi K

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The Peroneus Brevis muscle flap for distal third tibia reconstruction in burns and trauma – a non-microsurgical and expeditious technique offering rapid wound healing of a complex wound.

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Reconstructive options for defects of the distal third of the tibia are often limited, challenging and cited as requiring free tissue transfer. Local options can be..

Published: 04/05/2022
Authors: Cappuyns L, Gurusinghe D, Bell D, Shokrollahi K

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Is the use of a powered dermatome an aerosol-generating procedure (AGP)? Implications for personal protection against COVID-19 virus.

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Many healthcare workers have contracted SARS-CoV-2 during the pandemic, many cases of which have resulted in severe illness and death. No studies have assessed the potential..

Published: 04/05/2022
Authors: Kyriazidis I, Shokrollahi K, Zack-Williams SDL, Jones C, Murgatroyd E, Gurusinghe D

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Ulnar nerve compression at the elbow secondary to burn related heterotopic ossification – a case report and literature review of management options

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Heterotopic ossification (HO) is a poorly understood pathological process which can complicate the management of burns. It is thought to be mediated by tissue hypoxia amongst..

Published: 04/05/2022
Authors: Ramadan S, Cappuyns L, Shokrollahi K, Gurusinghe D

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Preliminary experience of HDR Brachytherapy for treatment of keloid scars

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Keloids are challenging with significant recurrence External beam radiotherapy has been effective in recurrent keloids but with significant exposure. Brachytherapy allows for surgical excision of keloids..

Published: 04/05/2022
Authors: Wahal A, Gurusinghe D, Shokrollahi K

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Use of DERMABOND® PRINEO® Skin Closure System to optimise results of excision and direct closure in acute burns

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Primary excision and direct closure of deep/full thickness burn is historically contraindicated due to purported risk of complications. Self -adhering mesh (Prineo™ and glue (Dermabond™..

Published: 04/05/2022
Authors: Wahal A, Cappuyns L, Gurusinghe D, Shokrollahi K

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Tangential excision and skin grafting for sever chronic ulcerative allergic reaction to tattoo pigment. A case report and review of literature in the context of a European ban on coloured pigment tattoos

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Tattooing is used in both recreationally and for scar management including burn patients to disguise burn scar knowledge about the clinical spectrum, pathogenesis and treatment of..

Published: 04/05/2022
Authors: Wahal A, Cappuyns L, Stubbington Y, Gurusinghe D, Shokrollahi K

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Giant Hogweed: The role of burns professionals in public health awareness and strategies to prevent burns

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction A number of plants and other naturally occurring substances have been shown to cause skin irritation or cutaneous chemical burns. In many of these cases the..

Published: 04/05/2022
Authors: Ebbs S, Cappuyns L, Giannopoulos I, Mandal A, Gurusinghe D, Shokrollahi K

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Influence of MRI use on surgical outcomes in lobular breast cancer

Introduction Lobular carcinomas account for around 10% of invasive breast cancers. Accuracy of pre-operative evaluation can be troublesome. NICE guidelines recommend MRI "to assess the tumour size if breast-conserving surgery is being considered for invasive lobular cancer". However, each additional investigation introduces cost and potentially prolongs the treatment pathway, which is..

Published: 02/05/2022
Authors: Wadsworth P, Rimmer L, Sepesiova L, Fong J, Kiernan T, Harris O

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Feasibility of breast lesion localisation using Sirius Pintuition

Introduction Impalpable breast cancers can be localised using different techniques. Recently, magnetic seed localisation systems have been developed and shown to offer benefits over traditional wire guided techniques. This study aims to assess the feasibility of a new seed localisation device, Sirius Pintuition, at St Helen's and Knowsley NHS Trust.  ..

Published: 02/05/2022
Authors: Foster R, Bathla S, Harris O, Jois RHS, Kiernan T, Ray A, Chagla LS

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Reverse abdominoplasty advancement flap: An effective and low morbidity reconstruction option for the radical mastectomy patient

Introduction Radical mastectomy (RM) is indicated for patients with locally uncontrolled breast carcinoma or angiosarcoma of the breast, for either local control or with curative intent. Flap coverage is routinely offered using pedicled or free flap reconstruction, committing the patient to a long post-operative recovery and risks significant donor site..

Published: 02/05/2022
Authors: Hunter-Smith A

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Formalised mentorship within oncoplastic breast surgery training - Is it indicated? A systematic review

Introduction Oncoplastic breast surgery places unique psychosocial and multi-disciplinary demands upon its trainees. As such, a healthy balance of personal and professional spheres are necessary to cultivate resiliency, emotional intelligence and self-awareness. Whilst the UK is a global leader in oncoplastic breast surgery training, no current trainee self-development scheme exists..

Published: 02/05/2022
Authors: Hunter-Smith A, Chagla LS

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Preparing to survive: Improving outcomes for young women with breast cancer

Introduction Young women with breast cancer (YWBC) have unique needs compared to their older-age counterparts, due to life-stage at diagnosis; often yet to start a family, responsible for young children, and/or in the midst of career progression. Interventions to address this are limited. We aimed to understand the unmet..

Published: 01/05/2022
Authors: Hunter-Smith A

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P115 Optimising obstetric care in high BMI patients: should we offer elective caesarean sections based on BMI?

Introduction Obesity in the obstetric population is increasing. Obese patients pose obstetric and anaesthetic challenges, contributing to maternal and fetal morbidity and mortality [1]. Our maternity department is increasingly busy, with 4000 deliveries/year. More women with high BMIs are booking, and increasingly require involvement of the anaesthetic team, especially out-of-hours, when..

Published: 01/05/2022
Authors: Robinson E, John S, Singh P

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Implementation of a telemedicine service to provide skin cancer care in a tertiary plastic surgery unit during COVID-19 – a comprehensive review

Background In response to the COVID-19 pandemic, our tertiary skin cancer service had to adapt rapidly to reduce hospital footfall. Consequently, all clinic appointments for skin cancer patients were converted to telephone consultations. This study aims to provide a comprehensive review of this new service. Methods This study consisted of..

Published: 23/04/2022
Authors: Jakeman M, Khaw R, Zack-Williams SDL, Brackley P

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The utility of the lateral orbital orbicularis propeller flap in periocular reconstruction

Aims: The lateral orbital orbicularis propeller flap (LOOP) is a propeller flap raised on a non-axial orbicularis oculi pedicle. Once mastered, it is speedy to raise, extremely reliable, and capable of transposing thin, supple, and relatively hairless skin and subcutis from the temple region to the periocular region. We aim..

Published: 21/04/2022
Authors: Parneet G, Defty C, Morton J

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...

Published: 20/04/2022
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Hardy KJ

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Athena speciality certificate examination case for cyclical angioedema in a young female

  Harnett, C; Drumm, C; Meah, N; Eustace, K. (2022). Athena speciality certificate examination case for cyclical angioedema in a young female. Clinical and Experimental Dermatology. epub 11 April

Published: 11/04/2022
Authors: Harnett C, Meah N, Eustace K

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Athena Speciality Certificate Examination case for cutaneous allergy

Abstract We present a case of cyclical periorbital angio-oedema, and highlight the appropriate investigations to support the clinical diagnosis of this rare dermatosis.   Harnett, C; Drumm, C; Meah, N; Eustace, K. (2022). Athena Speciality Certificate Examination case for cutaneous allergy. Clinical and Experimental Dermatology. epub 11 Apr

Published: 11/04/2022
Authors: Harnett C, Meah N, Eustace K

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Two years of Freestyle Libre (FSL) use: impact on glycaemic control and hypoglycaemia awareness in people with diabetes

Background and Aims We have previously shown beneficial effectsof FSL monitoring on glycaemic control and hypoglycaemia awareness in people living with diabetes. In this study we investigate the long term (≥ 2 years) effect of FSL on glycaemic control and hypoglycaemia awareness. Methods Clinicians from 106 NHS hospitals in the U.K. submitted..

Published: 11/04/2022
Authors: Furlong NJ

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Subspecialist abdominal wall reconstruction services in Canada

Extract Recent years have seen considerable increases in both the demand for, and complexity of, ventral hernia repairs. This has led to calls for abdominal wall surgery to become a recognized subspecialty in the United States and Europe, with some centres responding by forming specialized, multidisciplinary teams for abdominal wall..

Published: 08/04/2022
Authors: Adams ST

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The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis

Aims The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE). Methods This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE..

Published: 01/04/2022
Authors: Lipscombe S

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The British Orthopaedic Surgery Surveillance study: Perthes' disease

Aims The aim of this study was to evaluate the epidemiology and treatment of Perthes’ disease of the hip. Methods This was an anonymized comprehensive cohort study of Perthes’ disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children’s hip disease in the UK participated over..

Published: 01/04/2022
Authors: Lipscombe S

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Patients’ experience of a nutrition MDT clinic

Abstract The nutrition multi-disciplinary (MDT) clinic at a district general hospital (DGH) runs monthly and includes a gastroenterology consultant, dietitian and nutrition nurse specialist. Patients that are seen typically have complex nutritional problems including gastroparesis and short bowel syndrome and require review by multiple members of the MDT. 29 Patients attended..

Published: 01/04/2022
Authors: Roberts S, Tyrer J, Theis V

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A multidisciplinary approach to reducing percutaneous endoscopic gastrostomy tube site infections within 30 days of placement

Abstract Percutaneous endoscopic gastrostomy (PEG) site infection is a known complication of PEG tube placement. Whilst difficult to know the true incidence of PEG site infections as rates vary1, it is thought that infection rates fluctuate between 5% and 25%2. Thirty day infection rates form part of an annual audit of PEG..

Published: 01/04/2022
Authors: Roberts S, Clark K, Theis V, Tyrer J

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Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke

Background The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We, therefore, investigated the association between cardiac rehabilitation and major adverse..

Published: 31/03/2022
Authors: Hill AM

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BSH22-PO108 Tranexamic Acid use to improve outcomes in Meningioma Surgery

Introduction Meningioma surgery is associated with intraoperative bleeding and large transfusion requirement. Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. This review aimed to evaluate the effect of TXA use on operative and postoperative outcomes. Methods A systematic review and meta-analysis was conducted in..

Published: 31/03/2022
Authors: Keshwara S

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BSH22-EP74 The emerging advanced nurse practitioner role in haematology

Abstract Advanced nurse practitioners (ANPs) are experienced healthcare professionals often considered to be ‘the link’ between medicine and nursing. The position carries a high degree of autonomy and complex decision-making, supported by a master’s degree. ANPs are integral members of the multi-professional team with a significant contribution to the..

Published: 31/03/2022
Authors: Jackson R, Keegan D

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BSH22-PO118 The future of Outpatient Haematology: Self Supported Follow-up (SSFU) for patients with Chronic Lymphocytic Leukaemia (CLL) and Monoclonal Gammopathy of Undetermined Significance (MGUS)

Abstract The primary aim of face to face follow-up is to recognise early disease relapse or progression and to identify physical or psychological concerns, the latter often being overlooked during increasingly busy clinics. Due to advances in diagnostics and treatments, current follow-up models are proving unsustainable, with most haematological conditions..

Published: 31/03/2022
Authors: Jackson R

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Analysing electronic prescribing data to detect potential undocumented adverse reactions to medications

Objectives Identifying instances where medications have been discontinued due to an adverse/allergic reaction however the patients’ allergy status has not been updated appropriately. Data were evaluated in an established electronic prescribing and medicines administration system within a medium-sized teaching hospital. Methods Details of all medications stopped due to allergic..

Published: 30/03/2022
Authors: Logan B, Hill AM

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Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services

Introduction The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine's Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic. Methods All acute hospitals in the UK were invited..

Published: 28/03/2022
Authors: Varia R

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Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit

Introduction Medical admissions to hospital represent a diverse range of patients, from those managed on ambulatory pathways through Same Day Emergency Care (SDEC) services, to those requiring prolonged inpatient admission. An understanding of current patterns of admission through acute medicine services and patient factors associated with longer hospital admission is..

Published: 28/03/2022
Authors: Varia R

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P181 Diabetes nurse specialist–led glucose balance telephone support clinic associated with improved HbA1c

Aims Foot ulceration is a major burden for patients with diabetes, with a lifetime risk of up to 34%, and precedes most amputations. Hyperglycaemia is associated adverse outcomes and improving glycaemic control is key. We report the effect of diabetes specialist nurse (DSN) - led telephone support on glycaemic balance in..

Published: 23/03/2022
Authors: Cairns J, Pendlebury H, Sullivan H, Lee C, Furlong NJ

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P244 Planning services for people with type 2 diabetes: Is incidence still increasing

Aims Government plans for integrated care systems and integrated care boards are a welcome move towards more joined-up diabetes care between the NHS and local authorities, between health and social care and between specialist, community and primary care services. To plan effectively, for example, structured education for all newly diagnosed..

Published: 23/03/2022
Authors: Westall S, Mitchell L, Cardwell J, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ, McNulty S

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P124 Covid-19 pandemic associated with three-fold increase in demand for diabetes specialist advice

Aims The covid-19 pandemic was associated with legally restricted public movement (lockdowns) and reduced access to face-to-face consultation for diabetes in primary and specialist care. The aim of this study was to assess the impact of the pandemic on requests for specialist telephone support. Methods Retrospective analysis of calls for..

Published: 23/03/2022
Authors: Archer N, Westall S, Cardwell J, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ, McNulty S

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P243 Digital diabetes care: How well equipped are patients and what do they think about it

Aims Covid-19 precipitated an abrupt shift to non-face-to-face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods We..

Published: 23/03/2022
Authors: Westall S, Mitchell L, Cardwell J, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ, McNulty S

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P169 Service evaluation to determine the reason for increased gestational diabetes (GDM) referrals following SARS-CoV-2 pandemic

Aims England and Wales report on average, 700,000 annual pregnancies. From these 5% are complicated with hyperglycaemia with 87.5% of these Gestational diabetes (GDM). Pregnant women living with obesity are at higher risk of developing GDM. There is a linear relationship between glucose and adverse pregnancy outcomes. We noted a marked increase in..

Published: 23/03/2022
Authors: Gallagher CG, Milne R, Davies H, McNulty S, Pankaja S, Bujawansa S

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P98 Variability in test interval is linked to glycated haemoglobin (HbA1c) trajectory over time in people with diabetes

Introduction Frequency of HbA1c testing links to outcome in terms of HbA1c control in diabetes. The influence of the variability of test-retest interval on HbA1c change needs to be determined. Methods HbA1c results were collected from laboratory records on 3,872 people: HbA1c results at baseline and 5..

Published: 23/03/2022
Authors: Green L

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P91 Top to toe examination: An audit to assess the documentation of a foot exam for those admitted to hospital under medicine with diabetes

Background 10% of people with diabetes will suffer from a diabetes foot condition at some point. Those with diabetes related foot disease have high morbidity and mortality rate. They are at higher risk of pressure ulcers and other diabetes related complications such as heart disease or stroke. Patients with neuropathy and..

Published: 23/03/2022
Authors: Sullivan H, Westall S, Furlong NJ, McNulty S, Balafshan T, Narayanan RP, Bujawansa S, Hardy KJ, Pendlebury H

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P88 Recognition and management of hyperglycaemia at the front door: A retrospective audit and QI project conducted in Accident and Emergency (A&E) and Acute Medicine Unit (AMU) of a large district general hospital

Background Hyperglycaemia frequently occurs in acutely unwell patients and its improper recognition and treatment leads to undesirable consequences, including diabetic emergencies and impaired recovery. Morbidity and mortality for this group can be improved through early disease detection and treatment modification, and the acute admission window represents an important opportunity to..

Published: 23/03/2022
Authors: Cho S

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P147 Quick reference insulin safety medicine binder: A change in practice in St Helens & Knowsley Teaching Hospitals NHS Trust

Aim Despite national initiatives to improve practice, the National Diabetes Inpatient Audit (NADIA) 2019 still reported high levels of medication and insulin errors. A quick reference insulin safety binder was produced to promote insulin safety and support registered nurses whilst undertaking medication rounds. The binder is an eye catching, easy to..

Published: 23/03/2022
Authors: Strong AJ, Michaels S, Cardwell J, Bujawansa S

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P145 Service evaluation examining the understanding of breastfeeding among women with diabetes

Aims Breastfeeding is beneficial for a mother, baby and society. Enhancing breastfeeding rates has potential to save lives and drive improvements in public health. Breastfed babies have a lower risk of developing childhood-onset diabetes. On average breastfeeding rates in St Helens are between 26.5% and 31.6% at 6-8 weeks. The aim of..

Published: 23/03/2022
Authors: Gallagher CG, Bujawansa S, Milne R, Michaels S, McNulty S, Westall S

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P143 Non-attendance at structured type 2 diabetes education increases with deprivation

Aims Inequalities exacerbate poor health outcomes in diabetes. Structured education in type 2 diabetes is the cornerstone of supported self-management, but many people with newly diagnosed type 2 diabetes in the UK are not offered structured education and non-attendance in those accepting an offer of structured education is high. The aim of..

Published: 23/03/2022
Authors: Cardwell J, Mitchell L, Westall S, McNulty S, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ

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P257 Focus groups to explore the views of carbohydrate counting education sessions

Aims To identify key themes in adults with type 1 diabetes about their views on insulin-carbohydrate counting education (ICE) sessions using focus groups. Methods We used a qualitative methodology utilising individual, semi-structured, taped, transcribed and analysed focus groups with individuals who previously attended an ICE session. Four focus groups were conducted..

Published: 23/03/2022
Authors: Edon E, Westall S, Gallagher CG

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P193 Therapeutic inertia: Do patients get to target dose after glucagon-like peptide-1 receptor agonist (GLP-1-RA) initiation

Aims A recent primary care database study (J Rachman, Eli Lilly & Co) suggests that only about half of UK patients initiated on subcutaneous semaglutide (Ozempic) reach target maintenance dose. To assess the extent to which these data represent UK practice, we audited semaglutide dose optimisation and metabolic outcomes in our..

Published: 23/03/2022
Authors: Cardwell J, Edon E, Westall S, McNulty S, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ

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Dermatological manifestations of cardiac conditions

Abstract Various cardiac disorders seen in general and acute medicine have dermatological manifestations that may provide critical clues to the underlying disease. This review will discuss the important dermatological signs seen in cardiac conditions. We believe greater interdisciplinary liaison will improve our understanding of the link between the dermatological and..

Published: 23/03/2022
Authors: Katira R

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Electroanalytical point-of-care detection of gold standard and emerging cardiac biomarkers for stratification and monitoring in intensive care medicine - a review

Abstract Determination of specific cardiac biomarkers (CBs) during the diagnosis and management of adverse cardiovascular events such as acute myocardial infarction (AMI) has become commonplace in emergency department (ED), cardiology and many other ward settings. Cardiac troponins (cTnT and cTnI) and natriuretic peptides (BNP and NT-pro-BNP) are the preferred biomarkers..

Published: 15/03/2022
Authors: Tridente A

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The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES)

Background While ureteric stent removal remains a frequently performed endourological procedure stent migration either proximally or distally can present the endourologist with a significant intraoperative dilemma. In cases where the stent is of large calibre or impacted into the mucosa of the ureter, retrieval may prove refractory to traditional approaches...

Published: 14/03/2022
Authors: Floyd Jr MS, Samsudin A

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COVID-19 and COVID-19 vaccination: Observations on thrombosis and thrombocytopenia

    Elsheikh, S; Lip, G.Y.H.. (2022). COVID-19 and COVID-19 vaccination: Observations on thrombosis and thrombocytopenia. Trends in Cardiovascular Medicine. epub 12 Mar.

Published: 12/03/2022
Authors: Elsheikh S

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Multiple Eruptive Clear Cell Acanthomas Successfully Treated with CO2 Laser Ablation

Abstract Clear cell acanthoma (CCA) is a rare, benign epidermal lesion of clear glycogen-containing keratinocytes. The exact etiology is unknown. Although CCA usually appear as solitary lesions, cases of multiple CCAs have also been described. The rare eruptive CCA variant describes cases with more than 30 lesions. Current therapeutic evidence for..

Published: 03/03/2022
Authors: Ngan K, Crema J, Defty C

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229 A Systematic Review Protocol Examining the Role of Immobilisation in Hand Infections

Aim Hand infections are common and varied, leading to long-term complications when managed poorly. Splinting of the hand in a position of safe immobilisation (POSI) is frequently used to avoid complications including pain and stiffness, however it is not a universally accepted technique because the effects of splinting in hand..

Published: 28/02/2022
Authors: Nolan G

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125 Surgical Outcomes and Graft Use in Quadriceps & Patella Tendon Rupture Repairs

Aim Quadriceps and patella tendon ruptures are relatively uncommon injuries affecting approximately 1% and 0.5% of the population respectively. The literature surrounding preferable surgical technique, graft implant used, and surgical outcomes are relatively obscure. We audited all quadricep and patella tendon repairs within the trust to identify whether they have the same..

Published: 28/02/2022
Authors: West C, Kwaees TA

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124 Administration of Fascia Iliaca Block to Patients Who Have Suffered a Neck of Femur Fracture

Aim Hip fractures are the most common serious injury affecting elderly people and are associated with a total cost to the health and social services over £1 billion per year. This injury takes approximately 1% of the NHS budget. Furthermore current 30-day mortality rate is 6.5% so has serious implications for patients. NICE..

Published: 28/02/2022
Authors: West C, Wright C

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Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery

Background Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two..

Published: 16/02/2022
Authors: Chadwick M, El-Taji OM, Rimmer L, Matthews J, Cheng J, Anderson L

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0028 Acid ceramidase: A potential biomarker for locally advanced rectal cancer? (RSM Prize Winner)

Purpose/Background We have previously utilized proteomic and immuno-histochemical data to validate that high levels of acid ceramidase (AC) expression confers poorer neoadjuvant response in rectal cancer. Biological (siRNA, plasmid and CRISPR) AC manipulation altered radiosensitivity in-vitro. We aimed to assess the radiosensitising effect of pharmacological AC inhibitions and elucidate..

Published: 15/02/2022
Authors: Clifford R

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P083 IMPACT – ReCaP: rectal cancer management during the COVID-19 pandemic

Purpose/Background With enhanced strain on healthcare systems and avoidance of routine surgery and systemic therapy during the COVID-19 period due to increased morbidity and mortality alternative oncological approaches have been employed. We aimed to determine the variation in strategies adopted nationally across the United Kingdom (UK) and long-term associated..

Published: 15/02/2022
Authors: Clifford R

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Moulded cast compared with K-wire fixation after manipulation of an acute dorsally displaced distal radius fracture: the DRAFFT 2 RCT

Background Patients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking. Objective To compare functional outcomes, quality-of-life outcomes, complications and resource use among..

Published: 11/02/2022
Authors: Lipscombe S

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Implant-Based Reconstruction following Mastectomy in Patients Who Have Had a Previous Breast Augmentation

Background Breast augmentation is the most commonly performed cosmetic procedure, and increasingly women in this group present with breast cancer or request risk-reducing surgery, but their optimal management is unclear. The authors explored the clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction following previous augmentation and compared..

Published: 09/02/2022
Authors: Kiernan T, Clifford R, Chagla LS, Iqbal A

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O79 A survey of physiotherapists’ confidence in treating patients following shoulder surgery and their behaviour surrounding seeking support

  Purpose A prior service evaluation of physiotherapy musculoskeletal provision was conducted at a five hospital site, single trust, multi-surgeon service of all elective shoulder surgery patients. The data analysis from this revealed wide variation in the number of treatment sessions between, and within, subgroups of surgeries. The current study aimed..

Published: 08/02/2022
Authors: Hodson K

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P215 Shoulder stabilisation surgery: Exploring patient satisfaction and barriers to physiotherapy engagement

Purpose Evaluation of physiotherapy provision following elective shoulder stabilisation surgery revealed variation in the number of treatment sessions attended by patients. Patient non-attendance following stabilisation surgery is a recurrent problem and has implications on the success of patient functional outcomes. The aim was to investigate physiotherapy therapeutic satisfaction and identify..

Published: 08/02/2022
Authors: Hodson K

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Eye problems in people with diabetes: more than just diabetic retinopathy

Abstract While diabetic retinopathy and maculopathy are leading causes of premature visual loss in people with diabetes, other retinal and non-retinal pathology should be considered in the differential diagnosis. These include issues with both eye movement and vision, and can be split into: those which are extraocular, including orbital cellulitis..

Published: 01/02/2022
Authors: Kovacova A

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Implant-Based Reconstruction following Mastectomy in Patients Who Have Had a Previous Breast Augmentation

Background Breast augmentation is the most commonly performed cosmetic procedure, and increasingly women in this group present with breast cancer or request risk-reducing surgery, but their optimal management is unclear. The authors explored the clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction following previous augmentation and compared..

Published: 01/02/2022
Authors: Kiernan T, Clifford R, Chagla LS, Iqbal A

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Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

Abstract The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate..

Published: 18/01/2022
Authors: Tridente A, Shuker K

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Letter to the editor re: Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures

McNicholas, DP; Omar, AM; Khadr, RN; Floyd, MS Jr. (2022). Letter to the editor re: Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures: should the novel methods become the new standard in radiological diagnosis of urethral stricture disease? Mikolaj et al., IJUN (October 2021). International Urology and..

Published: 13/01/2022
Authors: Omar A, Floyd Jr MS

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Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence

Purpose There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic. Method(s) Database searches..

Published: 13/01/2022
Authors: Adams ST

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Clinical Characteristics of COVID-19 Patients in a Regional Population With Diabetes Mellitus: The ACCREDIT Study

Objective To identify clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care admission amongst diabetes patients admitted with COVID-19. Research Design and Methods We conducted a cohort study collecting data from medical notes of hospitalised people with diabetes and COVID-19 in 7 hospitals within the Mersey-Cheshire region from 1..

Published: 13/01/2022
Authors: Narayanan RP, Furlong NJ, Westall S

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Advances in hair growth

Abstract Hair is a deeply rooted component of identity and culture. Recent articles in this series have focused on scientific evidence relating to hair growth and new insights into the pathogenesis and mechanism of hair loss. This article reviews emerging evidence that has advanced our understanding of hair growth in..

Published: 12/01/2022
Authors: Meah N

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Recurrence and Metachronous Disease in Children with Benign Ovarian Tumors: A Systematic Review of the Literature

Aim The majority of ovarian tumors in children are benign, with good prognosis following complete resection. Little is published on the incidence of tumor recurrence and metachronous disease, and follow-up management of children with benign ovarian tumors (BOTs) remains a matter of debate. This systematic review aimed to evaluate the..

Published: 11/01/2022
Authors: Smith C

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054 Evaluation of the regional anaesthesia service provided for upper-limb plastic surgery

Background This study evaluates the impact of preoperative education on the length of hospital stay after foot and ankle surgery. There are several studies on the benefits of preoperative education prior to hip and knee arthroplasty, especially their role in facilitating early discharges. But studies on the benefits of foot..

Published: 11/01/2022
Authors: Murtagh L, Mukhtar K

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Nonaesthetic Applications for Botulinum Toxin in Plastic Surgery

Extract We applaud the original article “Nonaesthetic Applications for Botulinum Toxin in Plastic Surgery,”1 which aims to highlight the evolution of the alternative uses of botulinum toxin by the plastic surgery community. It succeeds in providing an overview of the range of indications, using an evidence-based approach for the benefit..

Published: 10/01/2022
Authors: Gill P, Henry A, Hassan Z, McArthur P

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Non-randomised comparison of efficacy and side effects of bicalutamide compared with LHRH analogues in combination with radiotherapy in the xxxxxx trial

Background XXXXX is a randomised trial evaluating moderately hypofractionated radiotherapy for treatment of localised prostate cancer. 97% of participants had concurrent short course hormone therapy (HT), either Luteinising Hormone Releasing Hormone analogues (LHRHa) or bicalutamide 150mg daily. This exploratory analysis compares efficacy and side effects in a non-randomised comparison. Method(s) 2700..

Published: 08/01/2022
Authors: Malik Z

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Nonrandomized Comparison of Efficacy and Side Effects of Bicalutamide Compared With Luteinizing Hormone-Releasing Hormone (LHRH) Analogs in Combination With Radiation Therapy in the CHHiP Trial

Purpose CHHiP is a randomized trial evaluating moderately hypofractionated radiation therapy for treatment of localized prostate cancer. Of all participants, 97% of them had concurrent short-course hormone therapy (HT), either luteinizing hormone-releasing hormone analog (LHRHa) or 150 mg of bicalutamide daily. This exploratory analysis compares efficacy and side effects in a nonrandomized..

Published: 08/01/2022
Authors: Malik Z

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Reading a preoperative CT scan to guide complex abdominal wall reconstructive surgery

Abstract Computed tomography (CT) scanning is the imaging modality of choice when planning the overall management and operative approach to complex abdominal wall hernias. Despite its availability and well-recognised benefits there are no guidelines or recommendations regarding how best to read or report such scans for this application. In this..

Published: 05/01/2022
Authors: West C, Scott M, Benson A

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CT perfusion: stroke, seizure or both?

Abstract An 88-year-old male with a history of hypertension, ischaemic heart disease and Bell's palsy presented with symptoms and signs of an acute ischaemic stroke. National Institutes of Health Stroke Scale (NIHSS) was 19 at presentation, indicative of potential large vessel occlusion. The initial CT scan revealed evidence of small vessel..

Published: 30/12/2021
Authors: Elnagi F

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Letter to the Editor re: An unusual case of LUTS in an adolescent man; a case report and literature review

  Napier-Hemy, T; Georgiou, M; Omar, AM; Floyd, MS Jr. (2021). Letter to the Editor re: An unusual case of LUTS in an adolescent man; a case report and literature review, J Clin Urol March 2021. Journal of Clinical Urology. epub 29 Dec  

Published: 29/12/2021
Authors: Georgiou M, Omar A, Floyd Jr MS

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Colorectal resections during the COVID-19 pandemic: a national survey of practice during first lockdown

Introduction The first wave of the COVID-19 pandemic led to an unprecedented time for the management of colorectal cancer, with uncertainty as to cancer-specific risks and the circumventing of gold standard oncological strategies. Our study aimed to acquire a snapshot of the practice of multidisciplinary team (MDT) management and variability..

Published: 23/12/2021
Authors: Rajput K, Clifford R, Rajaganeshan R, Kalaiselvan R

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Foot school: Preoperative education before day case elective foot and ankle surgery reduces the length of stay after surgery

  Background This study evaluates the impact of preoperative education on the length of hospital stay after foot and ankle surgery. There are several studies on the benefits of preoperative education prior to hip and knee arthroplasty, especially their role in facilitating early discharges. But studies on the benefits of foot..

Published: 23/12/2021
Authors: Thomas T, Khan S, Saldanha K, Morgan S, Stott R

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Can we check serum lithium levels less often without compromising patient safety?

Background Lithium is viewed as the first-line long-term treatment for prevention of relapse in people with bipolar disorder. Aims This study examined factors associated with the likelihood of maintaining serum lithium levels within the recommended range and explored whether the monitoring interval could be extended in some cases. Method We..

Published: 17/12/2021
Authors: Green L

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P-O03 The Management of Gallbladder Polyps at a Single Trust: Are we compliant with European Guidelines?

Background Gallbladder polyps affect approximately 5% of the global population, with rates highest in those of Indian descent. 10% of polyps will have malignant potential based on their size or rapid growth rate, which are associated with a poor 5-year survival once advanced of less than 25%. As gallbladder polyps are common but..

Published: 16/12/2021
Authors: Jamieson E, Short C, Clifford R, Rajput K

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Hallux varus: A literature review

Abstract Hallux varus is a rare foot deformity due to iatrogenic, post-traumatic, idiopathic, inflammatory, spontaneous, or congenital pathologies. Acquired hallux varus, in particular, iatrogenic type, is the commonest. The primary pathology is the abnormal musculotendinous forces secondary to soft tissue or bony imbalance exerting varus deforming force. Understanding the anatomy..

Published: 15/12/2021
Authors: Dhotare S, Morgan S

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Perspectives From a Regional Plastic Surgery Centre on Evidence for the Purported Link Between SGLT2 Inhibitors and Fournier's Gangrene

Introduction The recent report issued by the MHRA indicating an association of Sodium glucose linked transporter type 2 (SGLT2) Inhibitors with the contraction of Fournier's Gangrene (FG), has been drawn with insufficient supporting evidence and without an adequately powered study to make any meaningful assertions or recommendations. We aimed to look..

Published: 10/12/2021
Authors: Asmar O, Mandal A, Tridente A, Hardy KJ, Shokrollahi K

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Insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Background Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1..

Published: 09/12/2021
Authors: Furlong NJ

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Fellowship review: Training interface group (TIG) fellowship in mohs surgery

Abstract Mohs surgery in the United Kingdom has traditionally been performed by dermatologists and as such training and exposure for surgeons has been limited. To address this, a 6-month fellowship in Mohs micrographic surgery has been established for surgical trainees as part of the Training Interface Group (TIG) fellowship programme...

Published: 06/12/2021
Authors: Gill P, Tehrani H

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Online prescribing for sexually transmitted infections – what’s on offer? An evaluation of internet pharmacies based in the United Kingdom

Background Online pharmacies offer an alternative approach for patients to manage their sexual health. Our aim was to determine the type of antimicrobials sold as treatment for sexually transmitted infections (STIs) by UK internet pharmacies and if providers were adhering to national guidelines. Methods A search engine results page (SERP)..

Published: 02/12/2021
Authors: Okecha E

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A novel plastic surgery simulation model for medical students

Extract Despite most training programs moving towards competency-based training programs 1 , the Halstedian principle of “See one, do one, and teach one,” still often applies to Surgery. The learning curve in Plastic Surgery can be challenging, including a melange of advanced skills and complex decision making, on a background of substantial..

Published: 29/11/2021
Authors: Lymperopoulos NS, Shokrollahi K

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Frontal Fibrosing Alopecia survey of severity assessment methods in routine clinical practice

Background Lack of validated and responsive outcome measures in the management of Frontal Fibrosing Alopecia (FFA) significantly limits our ability to assess disease progression and treatment response over time. Objectives The aim of this study was to understand how FFA extent and progression is currently assessed in UK specialist centres,..

Published: 21/11/2021
Authors: Meah N

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Management of Seymour Fractures in Children and Adolescents: A Systematic Review and Meta-Analysis

Purpose Seymour fractures are injuries with a potentially high risk of infection and osteomyelitis. The optimal management of this pediatric open fracture is unknown. We performed a systematic review and meta-analysis to summarize the best evidence for these fractures and determine their optional management based on primary clinical studies. Methods..

Published: 19/11/2021
Authors: Nolan G

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Fatal Co-infections with SARS-CoV-2 and Legionella pneumophila, England

Abstract Both Legionella pneumophila and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pneumonia. L. pneumophila is acquired from water sources, sometimes in healthcare settings. We report 2 fatal cases of L. pneumophila and SARS-CoV-2 co-infection in England. Clinicians should be aware of possible L. pneumophila infections among SARS-CoV-2 patients.   Chalker,..

Published: 09/11/2021
Authors: Adler H, Ball R

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Phenotypic spectrum of serious cutaneous only adverse event following immunisation with COVID-19 vaccines

Abstract A phenotypic plethora of exclusively cutaneous adverse events following immunisation (AEFI) with COVID-19 vaccines have been described. Currently, there is no formal consensus on advice given to affected individuals, pertaining to their subsequent COVID-19 vaccines, which is increasingly pertinent as countries such as the United Kingdom launch a further..

Published: 08/11/2021
Authors: Trehan P, Hanna-Bashara L, Walsh ML

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Phenotypic spectrum of serious cutaneous-only adverse event following immunization with COVID-19 vaccines: a multicentre case series and literature review

Abstract A phenotypic plethora of exclusively cutaneous adverse events following immunisation (AEFI) with COVID‐19 vaccines have been described. Currently, there is no formal consensus on advice given to affected individuals, pertaining to their subsequent COVID‐19 vaccines, which is increasingly pertinent as countries such as the United Kingdom launch a further..

Published: 08/11/2021
Authors: Walsh ML, Trehan P

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PTU-84 Accelerated accreditation for bowel cancer screening colonoscopist in cheshire and merseyside

Introduction In 2020, as the COVID pandemic spread through the UK, Bowel Cancer screening invitations were paused. In Cheshire and Merseyside (C & M) there were as many as 100,000 patients waiting for their invitations. In addition, there were a large number of patients who had already been tested but waiting for colonoscopy..

Published: 07/11/2021
Authors: Bassi A

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PTH-17 The virtual referral triage clinic – A beneficial change in practice?

Introduction Due to the COVID 19 pandemic gastroenterology elective activities were suspended in March 2020. When elective services were reinstated, social distancing imposed within the Trust resulted in a significant loss in traditional F2F (face to face) clinic capacity. A Consultant led Virtual Referral Triage Clinic (VRTC) was introduced with the..

Published: 07/11/2021
Authors: Priestley S, Liaros A

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PMO-36 Safety and efficacy of ustekinumab for Crohn’s disease in the elderly population

Introduction The rising incidence of inflammatory bowel disease (IBD) worldwide and an ageing population has led to a marked increase in elderly IBD patients. Anti-tumour necrosis factor (TNF) agents are associated with an increased risk of serious infections and treatment discontinuation among elderly IBD patients; little is known about non..

Published: 07/11/2021
Authors: Liaros A

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PTU-50 Watch and wait, a rational management for lower gastrointestinal bleeding in the elderly?

Introduction Many patients presenting to hospital with lower gastrointestinal bleeding (LGIB) are elderly and co-morbid. British Society of Gastroenterology (BSG) guidelines recommend LGI endoscopy for all patients admitted with LGIB. As the majority of LGIB ceases spontaneously and risks of endoscopy increase with patient age, a ‘watch and wait’ management..

Published: 07/11/2021
Authors: Baig D

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PTH-55 Next available please: real world waiting times and availability of endoscopy for lower gastrointestinal bleeding

Introduction Current British Society of Gastroenterology (BSG) guidelines recommend all patients admitted to hospital with lower gastrointestinal bleeding (LGIB) undergo an inpatient colonoscopy on the next available list as part of providing a 7-day endoscopy service. The real-world availability of a 7-day service and adherence to this guidance is unknown...

Published: 07/11/2021
Authors: Baig D

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PTH-109 The bottom line: real world management of acute lower gastrointestinal bleeding compared to BSG guidelines

Introduction Lower gastrointestinal bleeding (LGIB) is a common hospital presentation, from self-limiting per-rectal bleeding to a life-threatening haemorrhage. British Society of Gastroenterology (BSG) acute LGIB guidelines define a clear management approach including risk stratification for patient management. However, real-world management of LGIB in relation to this guidance is currently unknown...

Published: 07/11/2021
Authors: Baig D

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Venetoclax with Azacitidine or Low Dose Cytarabine As an Alternative to Intensive Chemotherapy in Fit Adults during the COVID19 Pandemic

Background Based on early evidence of a high rate of coronavirus mortality in patients with acute myeloid leukaemia (AML) undergoing intensive chemotherapy (IC), the national health service (NHS) in the United Kingdom temporarily made venetoclax available as an alternative therapy, with the aim of reducing both mortality and healthcare resource..

Published: 05/11/2021
Authors: Loizou E

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Providing community intravenous therapy during the COVID-19 pandemic

Abstract Community Intravenous Therapy is well established in most regions of the United Kingdom. Although there are national Good Practice Recommendations detailing the service provision of Outpatient Parenteral Antibiotic Therapy (OPAT), examples of extended service delivery of other therapies are limited. This article describes the growth of the community IV..

Published: 01/11/2021
Authors: Hodgkins P

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EP.FRI.763 Impact of COVID-19 on the rates of emergency laparotomies at an acute general hospital in the United Kingdom

Aims The aim of this study was to analyse if the COVID-19 pandemic had any effect on the number of emergency laparotomies performed each month at a single NHS Foundation Trust. Method This single-centre retrospective observational study included all patients that underwent an emergency laparotomy that was registered as part..

Published: 28/10/2021
Authors: Wright C, Kirkham S, Millward A, Macadam R

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EP.FRI.50 Morbidity of presumed temporary loop de-functioning stomas in patients with colorectal cancer

Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma...

Published: 28/10/2021
Authors: Alfred J, MacDonald S, Kalaiselvan R

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Photodynamic antimicrobial chemotherapy coupled with the use of the photosensitizers methylene blue and temoporfin as a potential novel treatment for Staphylococcus aureus in burn infections

Abstract Photodynamic antimicrobial chemotherapy (PACT) is a novel alternative antimicrobial therapy that elicits a broad mechanism of action and therefore has a low probability of generating resistance. Such properties make PACT ideally suited for utilization in localized applications such as burn wounds. The aim of this study was to determine..

Published: 27/10/2021
Authors: Shokrollahi K

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Hip Hemiarthroplasty: The Misnomer of a Narrow Femoral Canal and the Cost Implications

Objective Hemiarthroplasty has been identified as the treatment of choice for displaced intracapsular femoral neck fractures. A modular prosthesis is sometimes preferred for its sizing options in narrow femoral canals, despite its higher cost and no advantage in clinical outcomes. Thus, in this study, we investigated the factors affecting surgeons’..

Published: 22/10/2021
Authors: Choudhry N

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The authors’ reply re: The role of teleconsultation in the management of suspected skin malignancy in plastic surgery

Dear Sir, Thank you for your comments with regards to our letter 1. The decision to deviate from the planned operative procedure on the day was made by the operating surgeon. The operating surgeon was not blinded to the participant allocation method (teleclinic vs face to face) as that would imply..

Published: 22/10/2021
Authors: Plonczak AM, Koysombat K, West C

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Assessment of the effect of the COVID-19 pandemic on UK HbA1c testing: implications for diabetes management and diagnosis

Aims The COVID-19 pandemic, and the focus on mitigating its effects, has disrupted diabetes healthcare services worldwide. We aimed to quantify the effect of the pandemic on diabetes diagnosis/management, using glycated haemoglobin (HbA1c) as surrogate, across six UK centres. Methods Using routinely collected laboratory data, we estimated the..

Published: 13/10/2021
Authors: Green L

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Nonserious Infections in Patients With Rheumatoid Arthritis

Objective To describe the frequency and predictors of nonserious infections (NSI) and compare incidence across biologic agents within the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). Methods The BSRBR-RA is a prospective observational cohort study. An NSI was defined as an infection that did not require hospitalization..

Published: 13/10/2021
Authors: Abernethy R

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Dermatology COVID-19 Registries: Updates and Future Directions

  Freeman, EE; Meah, N et al. (2021). Dermatology COVID-19 Registries: Updates and Future Directions. Dermatologic Clinics. 39 (4), 575-585

Published: 12/10/2021
Authors: Meah N

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1549 Patient Perception on Hand Trauma Management Through a Plastic Surgery Trauma Clinic

Aim We assessed patient perceptions of hand trauma management through a plastic surgery trauma clinic. We also assessed effects of educating patients about outcomes of their condition on their desire to have prompt surgery. Method A prospective survey review was conducted at our plastic surgery trauma clinic. Patients included were..

Published: 12/10/2021
Authors: Khan M, Iqbal A

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60 The Effect of the 2020 COVID-19 Pandemic on Periprosthetic Joint Infection in Hip Fracture Surgery

Aim To assess whether this change of practice had an effect on the infection rate in hip fracture surgery. Method An audit was conducted to assess the re-operation rate on hip fracture patients over the three months of the initial “lockdown” (23rd March to 23rd May 2020) and compared to the 2..

Published: 12/10/2021
Authors: Hillier D, MacDonald S, Emms N, Howard N

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100 Assessing the Admission Proforma: A Multi-Cycle Audit Evaluating the Quality of Documentation of The Burns Admission Proforma At the Regional Mersey Burn Unit

Introduction A thoroughly completed Burns Proforma can provide vital information for the effective management of a burn and enables the sharing of information with other members of the multidisciplinary team. Aim We aimed to assess the quality of record-keeping of the new Burns Proforma, compared it with the previous cycle,..

Published: 12/10/2021
Authors: Mandal A, Shokrollahi K

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99 Perfecting the Proforma – A Full-Cycle Audit on The Quality of Documentation of The Hand Trauma Proforma At the Regional Plastic Surgery Department

Aim We aimed to assess the quality of record-keeping of the departments hand trauma proforma, identify areas of improvement, and to implement and assess the quality of an updated proforma. Method Data from 101 parameters was collected for 20 patients undergoing surgery for an upper limb injury in November 2019. An updated proforma..

Published: 12/10/2021
Authors: Phillips B, Hosain M, Bell D

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1350 Wide-Awake Local Anaesthetic No Tourniquet (WALANT) Vs General/Regional Anaesthetic for Flexor Tendon Injuries: A Single-Centre, Retrospective Cohort Study

Aim Flexor tendon repairs are commonly performed under general/regional anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has potential advantages including the ability to test the repair intra-operatively; removal of the risks of general anaesthesia; no aerosol generation, thus reducing COVID-19 transmission risk. An ongoing systematic review identified no comparative..

Published: 12/10/2021
Authors: Greasley L, Nolan G, Bamal R, Bell D

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1234 Emergency Urology Procedures During COVID-19 Pandemic: A 2 Monthly Prospective Study

Introduction COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency care. Specific to Merseyside Tier 4 and Tier 2 restrictions were introduced in late 2020. At the onset of the pandemic in the Spring, elective work ceased, and emergency admissions were minimal. The purpose..

Published: 12/10/2021
Authors: Georgiou M, Ridzuan-Allen A, Chamsin A, Tolofari S, Ejikeme C, Jones R, Siddiqui Z, Napier-Hemy TP, Rotas S, Hughes KE, Khattak AQ, McCabe JE, Omar A, Mistry R, Samsudin A, Gana HB, Floyd Jr MS

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1082 Are Trauma and Orthopaedics Consultant Posts Decreasing in Frequency and Increasing in Subspecialisation?

Aim Changes to the configuration of the NHS Trauma Services in T&O and the level of subspecialisation are changing and could impact training and the number of consultant posts available at CCT. The aim of this study was to review the number of T&O Consultant posts and determine..

Published: 12/10/2021
Authors: Ansari SA

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742 Transurethral LASER Ablation (TULA): A Safe and Well Tolerated Procedure for The Treatment of Bladder Tumours Up To 4cm In Diameter in An Outpatient Setting

Aim Traditionally the management of recurrent non-muscle invasive bladder cancer (NMIBC) involves rigid cystoscopy and bladder biopsies/tumour resection under general/regional anaesthesia. As a result, many frail patients endure frequent anaesthetics and therefore are at increased risk of adverse outcomes including cognitive decline. Discontinuation of anti-platelet/anti-coagulation is not..

Published: 12/10/2021
Authors: Siddiqui Z, Morland L, Speakman S, Birley R, Hughes KE

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968 Delivering Human Factors and Non-Technical Skills Training Using Interactive Online Platforms in the COVID Era

Aim To evaluate the impact and effectiveness of an interactive online human factors (HF) and non-technical skills (NTS) course delivered to Core Surgical Trainees during the COVID-19 pandemic Method A 1-day HF and NTS course was conducted online, using the Zoom platform, to Core Surgical Trainees in the North West...

Published: 12/10/2021
Authors: Nolan G

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255 Relationship between acute urinary retention episode and risk of death in men

Introduction Acute urinary retention (AUR) is a urological emergency, with incidence increasing with age, being highest amongst men over 70 years. Such adverse events need to be managed properly to avoid complications. Studies have highlighted the association between urinary retention and death. Advancing age and co-morbidities are the two significant factors..

Published: 12/10/2021
Authors: Ejikeme C

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1118 Implementation of a neonatal daily review sheet on a post-natal ward

Background The paediatric team review babies daily on the busy post-natal ward located within the maternity unit. It was noted that there was lack of clarity in the daily documentation regarding neonates. Current documentation was in a folder comprised of multiple documents written on randomly assorted continuation sheets. There is..

Published: 11/10/2021
Authors: Garr R, Scowcroft R, Vataha K

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1042 Does the use of technology improve glycosylated haemoglobin levels in children with type 1 diabetes mellitus (T1DM)?

Background The 2017/18 National Paediatric Diabetes Audit (NPDA) in the U.K. reported that on average, insulin pump users with continuous glucose monitors achieved lower HbA1c levels compared to manual glucose checks. Objectives This study involves children and young people (CYP) aged below 19 years with Type 1 Diabetes Mellitus (T1DM)..

Published: 11/10/2021
Authors: Yasso K

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1388 Evaluation of availability of specialist psychological services for paediatric cystic fibrosis patients in district general hospitals and tertiary centres. Archives of Disease in Childhood

Background Cystic Fibrosis (CF) is a life-limiting genetic disorder. Given the chronic, progressive and disabling nature of CF, it is well recognised that living with CF can have an emotional and psychological impact. A significant number of CF patients report experiencing stress, anxiety, low mood and difficulties in managing their..

Published: 11/10/2021
Authors: Prasad A

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1172 Umblical granulomas: A pinch of salt dries it up

Background An umbilical granuloma is an overgrowth of tissue that usually occurs when the umbilical stump has fallen off. It occurs commonly in the neonatal period usually after Day 15 of life. Parents usually describe a fleshy mass and persistent cumbersome discharge from the umbilical area. The potential risk of omphalitis..

Published: 11/10/2021
Authors: Igboekwu T, Ahmad I

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447 Risk factors for limb ischaemia during femoral arterial catheterisation in the neonatal intensive care unit

Background Intravascular arterial access is used during neonatal intensive care for continuous accurate monitoring of arterial blood pressure and for reliable blood gas measurements. Common vascular access sites are the umbilical arteries (UAC) and some peripheral arteries. When these routes are not available, a femoral artery catheter can be inserted (..

Published: 11/10/2021
Authors: Turner L

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1345 Sharp rise in new onset type 2 diabetes in a large DGH post lockdown

Background Type 2 diabetes in children is on the rise in the UK alongside childhood obesity. NPDA 2018/19 data reported that the percentage of children and young people with Type 2 diabetes managed in Paediatric Diabetes Units (PDU) in UK has risen from 1.3% in 2012/13 to 2.6% in 2018/19. Pietrobeli et al 2020 reported that after the..

Published: 11/10/2021
Authors: Thomas E, Upadrasta S

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PO557 Faecal immunochemical test (FIT) in secondary care: Prioritising lower GI two week wait patients during the COVID-19 pandemic

Introduction FIT provides a safe, rapid and accurate way to determine a patient’s risk of having a lower GI cancer and it may possibly be used to exclude cancer for patients with negative result. It will reduce primary care referrals by enabling GPs to determine likelihood of lower GI..

Published: 11/10/2021
Authors: Bassi A

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The Role of Indocyanine Green Fluorescence Angiography in Complex Abdominal Wall Reconstruction

Background Indocyanine green fluorescence angiography (ICGFA) is a technique for assessing vascularity and perfusion which has multiple proven applications across a variety of surgical procedures. Studies have been performed assessing its potential role in evaluating skin flap viability in complex abdominal wall reconstruction (CAWR) in order to avoid postoperative surgical..

Published: 08/10/2021
Authors: Adams ST, West C

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Could you become a chief nurse information officer?

Abstract During the first wave of the pandemic, I was working as a diabetes specialist nurse at St Helens and Knowsley Teaching Hospitals NHS Trust. When seeing patients face to face was deemed too high risk, a lot of my clinical practice shifted to remote working, with patient consultations carried..

Published: 07/10/2021
Authors: Hayes N

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Mohs micrographic surgery for cutaneous malignancy of the hand & upper limb

Summary Mohs Micrographic Surgery (MMS) is primarily recognised for use in facial tumours,however it should also be considered to aid excision of tumours of the hand, wherepreservation of tissue and maintenance of function are key factors. Mohs surgery canserve to facilitate decision making both by the patient and surgeon...

Published: 06/10/2021
Authors: Wain R, Lloyd-Hughes H, Tehrani H, Nayar R

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'Teach Trolley' teaching: A simple solution to teaching during a pandemic?

Background The impact of the COVID-19 pandemic on medical education has been widely documented [1] but its effect on workplace training for healthcare professionals is yet to be determined. As the pandemic eases, opportunities for formal teaching outside of the clinical environment may remain limited with the need to escalate elective..

Published: 22/09/2021
Authors: Pal S, Robinson E, Longley C, Jain N

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Intrathecal diamorphine vs. fentanyl-lidocaine-ketamine infusion for laparoscopic bowel resection

Background Departmentally, fentanyl-lidocaine-ketamine (FKC) infusion (10 mug.ml-1 fentanyl, 1 mg.ml-1 ketamine, 10 mg.ml-1 lidocaine) at a rate of 1-2 mg.kg-1.h-1 of lidocaine [1] is being used for bowel resections. We sought to compare patient outcomes between peri-operative FKC infusion versus intrathecal diamorphine (ITD). Methods This is a retrospective review..

Published: 22/09/2021
Authors: Lightburn T, Little R, Raftery S, Dixit T

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Gentamicin double-dosing in Confidential Enquiry into Perioperative Deaths theatre at a Trust using a hybrid prescribing system

Background Gentamicin is commonly used in prophylaxis of peri-operative infection. It has a narrow therapeutic index, necessitating careful dose adjustment, and is usually administered once daily. Patients undergoing emergency surgery may have received gentamicin pre-operatively during resuscitation, conservative management, or treatment of a comorbid infection. At the Trust audited, a..

Published: 22/09/2021
Authors: Jones B, Saggar A

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FC6.6 Use of lateral DEXA scanning for identifying and monitoring vertebral fractures in patients affected by Duchenne Muscular Dystrophy

Introduction International guidelines for management of Duchenne Muscular Dystrophy (DMD) advise active screening for vertebral fractures (VF), complications of which include pain, scoliosis and impact on ambulation. Vertebral fracture assessment (VFA) is a technique of visualising thoracic and lumbar vertebrae with a lateral view on dual energy X-ray absorptiometry (DEXA)..

Published: 22/09/2021
Authors: Turner L

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Repair of Large Hiatal Hernias With the Use of Mesh and Autologous Platelet-Rich Plasma

Background According to recent studies, large hiatal hernias (HH) can be associated with a lower content of type-I and type-III collagen in the phrenoesophageal ligament (POL). We therefore hypothesize that the use of a mesh implant with autologous platelet-rich plasma (PRP) for repair of large HH would have a positive..

Published: 21/09/2021
Authors: Patel R

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Assessment and management of fatigue in patients with cancer

Background Fatigue is a common and debilitating symptom experienced by patients with life limiting illness. Aim(s) To audit clinical practice against regional standards and to use outcomes to update regional standards and guidelines. Methods A systematic literature review of the management of fatigue in cancer patients was performed. The..

Published: 20/09/2021
Authors: Hynes J

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A rare case of pulmonary haemosiderosis associated with coeliac disease: Lane Hamilton syndrome

Introduction Idiopathic pulmonary haemosiderosis (IPH) is a rare disorder characterised by haemoptysis, diffuse alveolar infiltrates and iron deficiency anaemia. Even rarer is the Lane Hamilton syndrome where IPH is associated with coeliac disease. Background(s) A 37 year old woman presented with haemoptysis and breathlessness. Computerised tomography pulmonary angiogram showed multiple..

Published: 15/09/2021
Authors: Low SE

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Dissecting the outcomes of anterior resections in a high-volume center

Purpose To analyse outcomes of patients undergoing anterior resections in a high-volume colorectal unit as proposed by the ACPGBI guidelines. Methods Retrospective analysis of 218 patients, undergoing anterior resections between January 2017 and December 2019. Results Median age was 67 years (IQR: 58–76), including 9 emergency resections. Indications were benign disease in 49 patients and malignancy in 169; 55..

Published: 15/09/2021
Authors: Rowe AK, Adderley A, Samad A, Javed M

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Impact of Mucopexy during Trans-Anal Haemorrhoidal Dearterialization on Post-operative pain and Recurrence in Hemorrhoidal Disease

Background Single center experience of trans-anal haemorrhoidal dearterialization (THD) with and without mucopexy; evaluating differences in recurrence, pain and post-operative complications Method Retrospective analysis of all patients undergoing THD between October 2014-September 2016, with and without mucopexy procedure depending on clinical need. Primary outcome was symptom recurrence; this was evaluated during..

Published: 15/09/2021
Authors: Kearsey C, Javed M, Rajaganeshan R

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Predictors of continuous positive airway pressure (CPAP) response in severe hypoxaemic respiratory failure due to COVID-19 pneumonitis

Abstract CPAP is advocated as a bridge to invasive mechanical ventilation (IMV) in severe COVID-19 pneumonitis. Its effectiveness in preventing intubation is unknown. We aimed to evaluate the outcomes COVID-19 patients suitable for IMV receiving CPAP following failure of standard oxygen therapy and predictors of CPAP response. We performed a..

Published: 14/09/2021
Authors: Thompson J

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Morbidity of presumed temporary loop de-functioning stomas in patients with colorectal cancer

Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma...

Published: 13/09/2021
Authors: Alfred J, MacDonald S, Kalaiselvan R

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Case report-malignant adenomyoepithelioma: A rare tumour of the breast

Background: We present a case report of a 45 year old female who presented with bilateral breast masses and one of these was shown to be a rare primary breast tumour. Malignant adenomyoepithelioma (AME-M) exhibits a classic biphasic proliferation of epithelial and myoepithelial cells, either or both of which have undergone..

Published: 08/09/2021
Authors: Stevenson J, Kiernan T, McKeown D, Innes H, Shaw M

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The Risk of Bleeding Complications in Intra-Articular Injections and Arthrocentesis

Abstract Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal atrial fibrillation, acute coronary syndrome, and in elderly patients. Well-known benefits of novel oral anticoagulants include predictable pharmacokinetics, pharmacodynamics, and shorter half-life. However, as with any anticoagulant, there are..

Published: 06/09/2021
Authors: Khan S

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The Surgical Art Face©: Developing a Bespoke Multimodal Face Model for Reconstructive Surgical Education

Abstract Surgical and educational challenges exist in relation to the teaching of facial reconstructive surgery due to the complexities of the facial landscape and training models available. This chapter will describe the development and implementation of alternative modes of teaching facial reconstructive techniques in a multi-disciplinary setting, pioneered by Surgical..

Published: 04/09/2021
Authors: Harper-Machin A

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To support safe provision of mechanical thrombectomy services for patients with acute ischaemic stroke

This document supersedes the existing professional multisociety consensus guidance published in 2015. It has been produced in order to respond to the considerable volume of relevant new high-quality trial evidence that has become available since September 2015. It should be emphasised that this document remains applicable to all constituent nations of the..

Published: 03/09/2021
Authors: Hill AM

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Book review: Plastic and Reconstructive Surgery of Burns—An Atlas of New Techniques and Strategies

  Mandal, A; Shokrollahi, K. (2021). Plastic and Reconstructive Surgery of Burns—An Atlas of New Techniques and Strategies (Book review). Annals of Plastic Surgery. 87 (3), 238.

Published: 01/09/2021
Authors: Mandal A, Shokrollahi K

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307- Clinical characteristics of COVID-19 patients in a regional population with diabetes: the ACCREDIT study

Background and aims Diabetes is associated with greater COVID-19 morbidity and mortality. However, it is unclear if characteristics specific to this cohort affect the prognosis of COVID-19. ACCREDIT study explored clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care amongst diabetes patients hospitalised with COVID-19. Materials and..

Published: 01/09/2021
Authors: Narayanan RP

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Laparoscopic colorectal resections during the COVID-19 pandemic – business as usual?

Introduction To analyse the outcomes of major colorectal resections performed during the COVID-19 pandemic, to assess safety and explore all precautionary measures. Method All patients who underwent major elective colorectal resections at St Helens and Knowsley Teaching Hospital NHS Trust between 24th March 2020 (the date that the Royal Colleges of..

Published: 31/08/2021
Authors: Kalaiselvan R, Scott M, Samad A

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034 Colorectal cancer resections during COVID-19: to do or not to do?

Introduction Ascertaining the practice of colorectal cancer (CRC) resections during the COVID-19 pandemic in England and Wales. Method A list of all colorectal multi-disciplinary teams (MDTs) was obtained from the National Bowel Cancer Audit (NBOCA) database. A survey was designed using Google Forms and emailed to at least one consultant..

Published: 30/08/2021
Authors: Barter R, Kalaiselvan R

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Management of acute scaphoid fractures: a pragmatic approach for the non-specialist

Abstract Scaphoid fractures are common and can cause significant morbidity if treated incorrectly. Thus, a working knowledge of the initial assessment and management of scaphoid fractures by non-specialists is crucial to allow quick diagnosis and avoid potentially catastrophic complications of scaphoid fracture. This article summarises the anatomy of the scaphoid,..

Published: 30/08/2021
Authors: Ansari SA

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Combination of Pembrolizumab with Electrochemotherapy in Cutaneous Metastases from Melanoma

Simple Summary Electrochemotherapy (ECT) combines a cytotoxic agent with locally applied electric pulses to enhance its antitumor effect. Over the last 15 years, ECT has been safely applied to patients with skin metastases in combination with other oncologic treatments and, more recently, with systemic immunotherapy. In this study, we aimed to..

Published: 25/08/2021
Authors: Pritchard-Jones R

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Ethnicity and breast cancer in the UK: Where are we now?

Abstract Outcomes from breast cancer for women in the UK have improved significantly over recent decades. These gains are largely attributable to a combination of earlier diagnosis and access to treatments delivered to patients by the National Health Service irrespective of cost. Ethnic minority groups make up almost fifteen percent..

Published: 23/08/2021
Authors: Chagla LS

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Interstitial granulomatous dermatitis associated with myelofibrosis

  Phillips, D; Qazi, E; Low, SE; Khirwadkar, N; Ngan, K. (2021). Interstitial granulomatous dermatitis associated with myelofibrosis. British Journal of Hospital Medicine. 82 (8), 1

Published: 17/08/2021
Authors: Low SE, Ngan K

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Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis

Objective To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA). Methods We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (..

Published: 12/08/2021
Authors: Chadwick L

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Cutaneous manifestations secondary to panitumumab therapy

  Lavery, MJ; Forsysth, L; Forsyth, L. (2021). Cutaneous manifestations secondary to panitumumab therapy. Clinics in Dermatology. epub 08 Aug  

Published: 08/08/2021
Authors: Lavery MJ, Hindle E

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A Review of Four Practice Guidelines of Inflammatory Bowel Disease

Abstract Inflammatory bowel disease (IBD) is a term that encompasses conditions characterized by chronic inflammation of the gastrointestinal tract (GIT). It includes Crohn's disease and ulcerative colitis. Major scientific organizations interested in gastrointestinal systems or GIT-focused organizations worldwide release guidelines for diagnosing, classifying, managing, and treating IBD. However, there are..

Published: 03/08/2021
Authors: Olusoji R

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Letter to the Editor re Gration, 'From indwelling Foley to fail safe voiding: Proposed changes in design and thinking'

  Pina, IM; Khattak, AS; Omar, AM; Floyd Jr, MS. (2021). Letter to the Editor re Gration, 'From indwelling Foley to fail safe voiding: Proposed changes in design and thinking', Journal of Clinical Urology, 4 November 2020. Journal of Clinical Urology. epub 2 Aug    

Published: 02/08/2021
Authors: Pina IM, Khattak AS, Omar A, Floyd Jr MS

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The Cheshire & Merseyside Collaborative trainee-led on-call service: a review of safety and efficiency

Aim To assess safety and efficiency of the Cheshire & Merseyside Collaborative, the largest trainee led on-call service in the UK, based on discrepancy rates and time taken to issue reports. Materials & Methods All studies reported by the collaborative in a 4-week period were evaluated for discrepancy and the time taken..

Published: 01/08/2021
Authors: Wide J

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Psychological distress and trauma during the COVID-19 pandemic

Extract Editor—There have now been two major pandemic response phases in the UK and Ireland: one in the spring of 2020 and one in the winter of 2020/21. This has placed an unprecedented strain on frontline healthcare workers.1,2 Earlier research during the first pandemic response identified high rates of psychological distress..

Published: 01/08/2021
Authors: Ramazany M, Langston S, Abela N

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Research news in clinical context

Extract Regular use of an antibacterial mouthwash does not prevent oropharyngeal gonococcal infection The double-blind Oral Mouthwash use to Eradicate GonorrhoeA (OMEGA) trial randomised men who have sex with men to rinse and gargle at least once daily for 60 s with either an antibacterial mouthwash (Listerine; n=219) or a mouth..

Published: 19/07/2021
Authors: Thomson-Glover R

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Surgical fixation of the adult distal radius fracture: when and why?

Abstract Distal radius fractures (DRF) are common. They have a bimodal distribution typically occurring as a high-energy injury in the young or a low-energy injury in the older patient with osteoporosis. With the number of DRF predicted to rise, it is important to know how to manage DRF appropriately. The..

Published: 15/07/2021
Authors: Chan C, Lipscombe S

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The COVID-19 Pandemic: Implications for Medical Students and Plastic Surgery Residency Applicants

  Kiely, AL; Nolan, GS. (2021). The COVID-19 Pandemic: Implications for Medical Students and Plastic Surgery Residency Applicants. Plastic and Reconstructive Surgery. 148 (1), 153-154

Published: 12/07/2021
Authors: Nolan G

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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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A retrospective observational study to evaluate the clinical outcomes and routine management of patients with chronic lymphocytic leukaemia...

Summary Idelalisib (IDL) is an oral first-in-class phosphatidylinositol 3-kinase delta (PI3Kδ) inhibitor approved for chronic lymphocytic leukaemia (CLL) alongside rituximab (R) since 2014. However, little data exist on routine practice. The RETRO-idel was a protocol-led, retrospective study of 110 patients [n = 27 front-line (1L)] who received IDL-R. The primary end-point was clinical..

Published: 08/07/2021
Authors: Nicholson T

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Mapping the human genetic architecture of COVID-19.

Abstract: The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-191,2, host genetics may also be important. Identifying host-specific genetic factors may reveal biological..

Published: 08/07/2021
Authors: Tridente A

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Quality: What does it mean in Acute Medicine and how do we measure it?

Abstract Acute Medicine is a specialty that is not defined by a single organ system and sits at the interface between primary and secondary care. In order to document improvements in the quality of care delivered a system of metrics is required. A number of frameworks for measurements exist to..

Published: 06/07/2021
Authors: Varia R

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Intrauterine contraception

Abstract Key content An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD) or intrauterine contraception (IUC) offers reliable long-acting reversible contraception; however, some patients can be hesitant to choose this option because of misconceptions about side effects and perceived complications. A comprehensive knowledge of IUC is required to..

Published: 05/07/2021
Authors: Phelan N

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CPC12: Eosinophilic dermatosis of haematological malignancy

  Extract A 73‐year old man presented with a 10‐month history of a generalized pruritic eruption. No close contacts had a rash or itch. There was no history of weight loss, loss of appetite or B symptoms. The general practitioner had given oral prednisolone to good effect, but the rash soon..

Published: 01/07/2021
Authors: Lavery MJ, Low SE, MacBeth K

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Influence of Wrap Fixation Technique on the Results of Fundoplication

Background Different techniques of wrap fixation in laparoscopic Nissen fundoplication (LNF) have been proposed with of the aim to reduce the complications, but the optimal technique is yet to be determined. The aim of our prospective study was to evaluate several techniques of wrap fixation and determine whether the application..

Published: 29/06/2021
Authors: Patel R

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Identifying and managing eating disorders in type 1 diabetes mellitus: An all-Wales study

Background Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating..

Published: 23/06/2021
Authors: Spector-Hill I

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Evaluating a competency assessment framework for ANPs

Abstract Advanced nurse practitioners play a vital role in delivering high-quality care to patients attending the acute medical unit and must be highly skilled and competent. In the absence of national standards, a structured competency assessment framework was developed and its usefulness then evaluated in a teaching hospital. The framework..

Published: 23/06/2021
Authors: Puravady S

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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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P10-7 Establishing a transurethral LASER ablation (TULA) service during the Covid-19 pandemic

Introduction Traditionally the management of non-muscle invasive bladder cancer (NMIBC) involves rigid cystoscopy and bladder biopsies/tumour resection under general/regional anaesthesia. The COVID-19 pandemic forced hospitals to reduce operating lists and increase bed availability. An outpatient TULA service was recently started at our trust. TULA is performed via a..

Published: 21/06/2021
Authors: Siddiqui Z, Morland L, Speakman S, Birley R, Hughes K

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P3-3 Tolerability of Rezūm steam ablation using transrectal ultrasound guided periprostatic nerve block

Introduction Rezūm is a widely adopted minimally invasive treatment for LUTS BPH. It is conventionally performed under GA, regional anaesthesia or heavy sedation. Performing it in a safe and tolerable way under local anaesthesia would be advantageous for treating high risk patients and allow administration in an outpatient setting...

Published: 21/06/2021
Authors: Napier-Hemy TP, Starmer B, McCabe JE

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Predictors of diabetes-related distress before and after FreeStyle Libre-1 use

Aim To identify the baseline demographic and clinical characteristics associated with diabetes-related distress (DRD) and factors associated with improvement in DRD after initiating use of the FreeStyle Libre (FSL) in people living with type 1 diabetes (T1D). Methods The study was performed using baseline and follow-up data from the Association..

Published: 17/06/2021
Authors: Furlong NJ

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Re: Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series

  Pina, IM; Omar, AM; Davies, MC; Floyd Jr, MS. (2021). Re: Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series (Conway et al., J Clin Urol Feb 21). Journal of Clinical Urology. epub 16 Jun

Published: 16/06/2021
Authors: Pina IM, Omar A, Floyd Jr MS

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Comparing tolerability of local anaesthetic transperineal and transrectal prostate biopsies

Objectives Local anaesthetic transperineal prostate biopsies have been demonstrated as tolerable. However, to date, the tolerability has not been directly compared to the standard of care for transrectal biopsy. We set out to prospectively compare the tolerability of local anaesthetic transperineal and transrectal prostate biopsies. Patients and methods All patients..

Published: 16/06/2021
Authors: Starmer B, McCabe JE

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Impact of the coronavirus pandemic and national lockdown on a lung cancer service – opportunities for innovation

Background Timely diagnosis and access to treatment are key factors in improving outcomes in lung cancer. The emergence of the coronavirus pandemic posed unprecedented challenges, with impacts felt across the entire care pathway from presentation to diagnosis and access to treatment. Objective(s): To compare referrals and outcomes for key..

Published: 16/06/2021
Authors: Malhotra P, McIntosh A, Peers V

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The consequences of unnecessary requesting and reporting of the direct antigloblin test in neonates

Background: BSH (British Society of Haematology) guidelines recommend that the Direct Antiglobulin Test (DAT) is only requested when clinically indicated in neonates. Prophylactic anti-D (PAD) administered routinely to Rh D Negative mothers during pregnancy can cause a positive DAT in the neonate that is not clinically relevant as PAD does..

Published: 15/06/2021
Authors: Bonney S, Pannikodu E, Samani S, McNulty J, Chunara U

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Reducing waiting lists for laparoscopic cholecystectomy: An intensive approach to aid COVID-19 recovery

Background Laparoscopic cholecystectomy is one of the most frequently performed operations in the United Kingdom, commonly due to symptomatic gallstones. Delay between diagnosis and definitive surgical intervention often leads to a significant readmission rate, growing financial burden and increased complexity of the ultimate surgical intervention. Resource reallocation and reduced operational..

Published: 14/06/2021
Authors: Clifford R, Rajput K, Naing CY, MacDonald K, Pantak T, Kaul A

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Invited Discussion on: Management of Nipple Areola Deformity

  Taghizadeh, R. (2021). Invited Discussion on: Management of Nipple Areola Deformity. Aesthetic Plastic Surgery. 45 (4), 1416-1418

Published: 11/06/2021
Authors: Taghizadeh R

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2388 Multidisciplinary management of pregnancy with ruptured splenic artery aneurysm in a DGH

Objective We report a case of ruptured splenic artery aneurysm in pregnancy which is a rare clinical entity often missed antenatally and diagnosed on laparotomy for other suspected causes of intraabdominal haemorrhage. This case highlights the importance of maintaining a high index of suspicion and multidisciplinary approach to achieve good..

Published: 09/06/2021
Authors: Mathur P, Jones F, D'Costa D, Srivastava N, Idama TO

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X Chromosome Contribution to the Genetic Architecture of Primary Biliary Cholangitis

Background & Aims Genome-wide association studies in primary biliary cholangitis (PBC) have failed tofind X chromosome (chrX) variants associated with the disease. Here, we specificallyexplore the chrX contribution to PBC, a sexually dimorphic complex autoimmune disease. Methods We performed a chrX-wide association study, including genotype data from 5 genome-wideassociation studies (from Italy,..

Published: 01/06/2021
Authors: McLindon J

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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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91 An audit of COVID-19 Awareness and Public Health Message Effectiveness in the Hospital Setting Over the Course of the Pandemic

Introduction An audit of healthcare workers investigated the effectiveness of Public Health England’s (PHE) information campaign across COVID’s timeline and assess knowledge between job roles. Method IData was collected across 3 cycles in 3 hospitals. A questionnaire assessed four domains: symptoms; spread; risk factors and the means to reduce transmission...

Published: 04/05/2021
Authors: John S

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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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P164 The impact of a local, validated structured education programme on anxiety and depression in people with diabetes

Background People with type 1 and type 2 diabetes experience greater degrees of anxiety and depression than the general population. The Hospital Anxiety Depression Scale (HADS) can evaluate this. Scores ≥8 on HADS-A (anxiety) or HADS-D (depression) indicate potential cases of anxiety or depression. Methods As part of a validated structured education programme,..

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

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BSH2021-PO-115 The effect of an ambulatory care pathway on management of anaemia in a district general hospital

Abstract The burden of iron deficiency anaemia (IDA) is reflected by the rising number of emergency admissions related to IDA and reports of the monumental cost of managing the condition as an inpatient. The National Health Service spends approximately £55 million per annum on IDA-related non-elective admissions, many of which could..

Published: 14/04/2021
Authors: Bonney S

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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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78 A Quality Improvement Project on Oxygen Administration Within the Geriatrics COVID-19 Cohort Ward

Introduction Due to the COVID-19 pandemic, many medical and surgical wards were reassigned as COVID-19 cohort wards to accommodate the number of patients admitted with the virus. Nurses and healthcare assistants (HCAs) from various departments and backgrounds were redeployed to these areas. Within the geriatrics population, patients with severe COVID-19..

Published: 16/03/2021
Authors: Hickey L, Liu AKL, Kawafi K, Gowda V

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Cardiac Electrophysiology Clinics

  Essa, H; Hill, AM; Lip, GYH. (2021). Atrial Fibrillation and Stroke. Cardiac Electrophysiology Clinics. 13 (1), 243-255.    

Published: 16/03/2021
Authors: Hill AM

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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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Genetic mechanisms of critical illness in COVID-19

Abstract Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244..

Published: 03/03/2021
Authors: Tridente A, Shuker 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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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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Novel use of distal radius plates for wrist arthrodesis in upper limb spasticity

Abstract Wrist arthrodesis is commonly performed to improve wrist position, flexion crease hygiene and appearance in patients with spastic upper limbs. These patients often have smaller bones and large commercially available implants lead to complications such as prominence of plate, pain and periprosthetic fractures. Authors hypothesized that Medartis® distal radius..

Published: 12/01/2021
Authors: Bamal R, McArthur P

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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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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: 09/01/2021
Authors: Kearsey C, Rajaganeshan R

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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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A panel of urinary proteins predicts active lupus nephritis and response to rituximab treatment

Objectives ∼30% of patients with SLE develop LN. Presence and/or severity of LN are currently assessed by renal biopsy, but biomarkers in serum or urine samples may provide an avenue for non-invasive routine testing. We aimed to validate a urinary protein panel for its ability to predict active renal involvement..

Published: 12/12/2020
Authors: Dawson J, McCaffrey P, Graham D, Williams E, Clewes A, Hornby N

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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..

Published: 01/12/2020
Authors: Javed M, Kalaiselvan R, Rajaganeshan R

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Role of clinical judgement in offering adjuvant chemotherapy for Breast Cancer patients

Aim NICE recommends Oncotype Dx for patients with oestrogen receptor‐positive, human epidermal growth factor receptor 2 (HER2)‐negative and lymph node (LN)‐negative patients in the decision for adjuvant chemotherapy. Oncotype Dx predicts cancer recurrence and benefits from chemotherapy based on Recurrence Score (RS >26 significant chemotherapy benefit). We aimed to..

Published: 01/12/2020
Authors: Patnam V, Pushdary KH

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Two‐Stage Flexor tendon repair versus Primary repair

Introduction & Aim In the anatomical extremity, the hand is constantly exposed to the potential risk of injury. If a flexor tendon is injured and recognized as needing surgical intervention, two options are available; Two‐stage Flexor Tendon (TSFT) repair or Primary repair. We evaluated the subjective and functional outcomes of..

Published: 01/12/2020
Authors: Richards B

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Knife to the skin timing in emergency laparotomies (NELA patients): Are we quick enough?

Aim Definitive source control is pivotal in achieving ideal outcomes in patients undergoing emergency laparotomy. NELA suggests that 84% requiring immediate or urgent surgery arrived in theatre in congruous timeframe but does not comment on Knife to skin timings for absolute source control. We aimed to assess time difference of arrival..

Published: 01/12/2020
Authors: Patnam V, Barter R, Kanwar S

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Laser Management of Scars

This book addresses the management of scars using lasers and light. The authors provide a comprehensive overview of the current laser modalities and the science and evidence behind them. They also present various treatments, including those using carbon dioxide lasers, Erbium:YAG lasers, pulsed dye lasers and Q-switched lasers. The..

Published: 25/11/2020
Authors: Shokrollahi K

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Comparison of Scarf-Akin osteotomy with Lapidus-Akin fusion

Background Hallux Valgus associated with medial column instability (disrupted Meary’s line) can be corrected either with Lapidus-Akin or Scarf-Akin procedure. This study compares these two procedures to ascertain if type of surgical procedure performed affects the correction achieved and recurrence rate at 6 months following operative intervention. Materials and Methods..

Published: 25/11/2020
Authors: Thomas T, Khan S, Morgan S, Ballester J

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Introducing video content into Scars, Burns & Healing

Tridente, A. (2020). Introducing video content into Scars, Burns & Healing. Scars, Burn and Healing. 6  

Published: 24/11/2020
Authors: Tridente A

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A radon seed identified during skin surgery

A 76‐year‐old man presented to clinic with a 3‐week history of a lesion on his central forehead. The lesion was slowly increasing in size, becoming darker and occasionally bled. A black crusted papule, 3 × 3 mm in size, was visualized on the central forehead. Dermoscopy revealed areas of superficial haemorrhage suggestive..

Published: 13/11/2020
Authors: Lavery MJ, Lorenzelli D, Crema J

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Simultaneous Reconstruction of a Complex Full Thickness Ala and Perialar Defect Involving Multiple Lip and Nasal Subunits

Hassan, D; Morton, J; Defty, C. (2020). Simultaneous Reconstruction of a Complex Full Thickness Ala and Perialar Defect Involving Multiple Lip and Nasal Subunits. Dermatologic Surgery. epub Nov    

Published: 10/11/2020
Authors: Hassan D, Morton J, Defty C

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Delayed hypersensitivity to multiple glucocorticoid agents in a patient with cranial giant cell arteritis

Extract DEAR EDITOR, Hypersensitivity reactions to systemic glucocorticoids (GCs) are uncommon and paradoxical, because GCs are used to treat such reactions. The World Allergy Organization divides drug hypersensitivity reactions into immediate (occurring within 1 h of the administered dose) and delayed (appearing after 1 h, although most reactions start after 6 h). Immediate..

Published: 09/11/2020
Authors: Sze JT, Abernethy R

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Rheumatoid arthritis related interstitial lung disease – improving outcomes over 25 years: a large multicentre UK study

Objective This study explores whether the prognosis of interstitial lung disease in rheumatoid arthritis (RA-ILD) has improved over time and assesses the potential influence of drug therapy in a large multicentre UK network. Methods We analysed data from 18 UK centres on patients meeting criteria for both RA and ILD diagnosed..

Published: 04/11/2020
Authors: Dawson J

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Coronavirus (COVID-19) and young people's sexual health

Background COVID-19 has reduced health-seeking behaviour in the UK including in sexual health services (SHS). We sought to describe changes in sexual health attendances among young people (YP) within a semirural service setting (A) and at services based in London and Surrey (B) during the weeks preceding and following lockdown...

Published: 02/11/2020
Authors: Thomson-Glover R, Hamlett H

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DIEP flap reconstruction as salvage option for Poland syndrome breast hypoplasia

Dear Sir, Poland syndrome is a congenital abnormality mostly associated with unilateral hypoplasia of the sternocostal head of pectoralis major, rib cage and upper limb abnormalities. It may include absent or hypoplastic breast can which have a significant psychological impact in female patients who often experience body image disorders. Mild..

Published: 01/11/2020
Authors: Ramadan S, Koshy O

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The effect of the COVID‐19 pandemic on skin cancer surgery in the United Kingdom: a national, multi‐centre, prospective cohort study and survey of Plastic Surgeons

Editor The COVID‐19 pandemic has negatively affected all skin cancer treatment. A national audit of skin cancer excisions by Plastic Surgeons was adapted to establish what effect the pandemic had on the provision and delivery of skin cancer treatment in the United Kingdom. Throughout ‘lockdown’ (March 16th – June 14th 2020) a..

Published: 01/11/2020
Authors: Nolan G, Pritchard-Jones R

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Improving care in ventilated inter‐hospital transfers: a trainee‐led quality improvement project

In Mersey, the location of tertiary centres on distinct sites necessitates frequent emergency inter‐hospital transfers of critically ill patients. Local audits found a median transfer time of 5 h for ventilated patients to our tertiary neurosurgical centre, and the recommended target time of 2 h for ‘door‐to‐balloon’ in primary..

Published: 27/10/2020
Authors: Furniss T

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The use of a non-medicated dressing for superficial-partial thickness burns in children

Background: Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed®; Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial..

Published: 27/10/2020
Authors: Araia E

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Proceeding with a general anaesthetic in a patient with ongoing symptoms of a hemiplegic migraine

This is the first case in the literature to report a case of hemiplegic migraine aura resolving post‐general anaesthesia. A patient known to have frequent hemiplegic migraines had left‐sided facial droop in the pre‐operative period for elective day‐case surgery. She awoke in recovery with no facial..

Topic
Published: 26/10/2020
Authors: Singh P, Goel R

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Comfort care for burns patients

Zack-Williams, SDL; Gurusinghe, D; Tridente, A; Shokrollahi, K. (2020). Comfort care for burns patients: The gold standard for assessment and delivery of care remains in a burn center. Burns. epub 24 Oct    

Published: 24/10/2020
Authors: Zack-Williams SDL, Gurusinghe D, Tridente A, Shokrollahi K

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Electrochemotherapy in the treatment of cutaneous malignancy

Background Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. Methods Twenty-eight centres across Europe prospectively uploaded data over an 11-year period. Response rates were investigated..

Published: 21/10/2020
Authors: Pritchard-Jones R

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G615(P) Beware! The emerging superbug

Abstract A fit and healthy 8-year old boy presented with a 10-day history of asymptomatic superficial ulcerations initially on the left great toe, and then the left elbow. He was systemically well. The general practitioner had prescribed oral flucloxacillin for infected bite marks but the patient took for 2–3 days as..

Published: 14/10/2020
Authors: Lavery MJ, MacBeth K, Walsh ML

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A Rule of Thumb for Hand Burns

Abstract Hand burns are common and often complex injuries, requiring referral to specialist centers. The patient's thumbprint is a rapid means of accurately assessing hand burn surface area. This study aimed to establish categories and evaluate sites of hand burn surface area in order to facilitate comparison of hand burns...

Published: 13/10/2020
Authors: Adjei B, Dargan D, Shokrollahi K

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Enhancing Reporting of After Action Reviews of Public Health Emergencies

Objective This literature review aimed to identify the range of methods used in after action reviews (AARs) of public health emergencies and to develop appraisal tools to compare methodological reporting and validity standards. Methods A review of biomedical and gray literature identified key approaches from AAR methodological research, real-world AARs,..

Published: 13/10/2020
Authors: Davies R

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Improving foundation year doctors’ confidence with routine suprapubic catheter change

Khattak, AS; Omar, AM; Khattak, AQ; Floyd, MS Jr. (2020). Letter to the editor re: Improving foundation year doctors’ confidence with routine suprapubic catheter change using an easily reproducible simulation model. Journal of Clinical Urology. Pub online 7 Oct.

Published: 07/10/2020
Authors: Khattak AS, Omar A, Khattak AQ, Floyd Jr MS

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Improving foundation year doctors’ confidence with routine suprapubic catheter change

  Khattak, AS; Omar, AM; Khattak, AQ; Floyd Jr, MS. (2020). Letter to the editor re: Improving foundation year doctors’ confidence with routine suprapubic catheter change using an easily reproducible simulation model. Journal of Clinical Urology. epub 7 Oct    

Published: 07/10/2020
Authors: Khattak AS, Omar A, Khattak AQ, Floyd Jr MS

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The development of a diabetes screening service for the homeless population in St Helens

Aim To screen members of the homeless community in St. Helens for diabetes, and offer advice, support, diabetic eye screening and diabetic foot screening for those with diabetes, following two diabetes-related deaths in this population in 2018. Method(s) The Teardrops Hub staff promoted the drop in service to their service..

Published: 07/10/2020
Authors: Pendlebury H, Bujawansa S, Cardwell J

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Evaluating the views of doctors and nurses on the delivery of a safe insulin tips (SIPS) educational programme

Aim To evaluate the views of doctors and nurses on the delivery and use of a safe insulin tips (SIPS) educational programme. Methods Twelve SIPS were developed covering key areas of safe insulin use by a multi‐professional collaboration of patients and healthcare professionals. Individual SIPs were emailed weekly over 12..

Published: 07/10/2020
Authors: Lloyd M, Michaels S, Cardwell J, Furlong NJ

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Setting up a total contact casting service within a diabetes foot ulcer service

Aims The National Institute for Health and Care Excellence (NICE) recommend total contact casting (TCC) for neuropathic ulceration in the diabetic foot. The St Helens and Knowsley Hospitals Trust, Diabetes Team, determined the feasibility of starting and developing a TCC service within their diabetes foot ulcer service. Method The type..

Published: 07/10/2020
Authors: Pendlebury H, Furlong NJ, Sullivan H

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

Background and Aim 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..

Published: 07/10/2020
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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The impact of a validated structured education programme diabetes-related distress in patients with type 2 diabetes

Background and Aim Patients with type 2 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 2 diabetes, baseline and endpoint..

Published: 07/10/2020
Authors: Cardwell J, Bujawansa S, McNulty S, Furlong NJ, Narayanan RP, Jackson J, Mitchell L, Westall S, Hardy KJ

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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: 07/10/2020
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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The impact of a validated structured education programme on anxiety and depression in patients with type 2 diabetes

Background There has been a big drive from the UK government and Diabetes UK to provide improved psychological care for patients with diabetes. People with type 2 diabetes experience greater degrees of anxiety and depression than the general population. The Hospital Anxiety and Depression Scale (HADS) questionnaire can evaluate this. As..

Published: 07/10/2020
Authors: Westall S, Jackson J, Mitchell L, Cairns J, Sullivan H, Bujawansa S, McNulty S, Furlong NJ, Narayanan RP, Hardy KJ

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Perceived problem areas in diabetes do not correlate with levels of anxiety and depression

Background and Aim 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. Methods..

Published: 07/10/2020
Authors: Westall S, Narayanan RP, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Cardwell J, Hardy KJ

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The impact of a validated structured education programme on anxiety and depression in patients with type 1 diabetes

Background and Aim People with type 1 diabetes experience greater degrees of anxiety and depression than the general population. The Hospital Anxiety and Depression Scale (HADS) questionnaire can evaluate this. As part of a local, validated structured education programme for people with type 1 diabetes, baseline and endpoint measurements of anxiety and..

Published: 07/10/2020
Authors: Sullivan H, Westall S, Jackson J, Cairns J, Cardwell J, Bujawansa S, McNulty S, Furlong NJ, Narayanan RP, Hardy KJ

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The impact of seven-day working by a diabetes specialist nurse (DSN) team within an acute hospital trust

Aim Inpatient Diabetes Specialist Nurse Cover nationally is varied. Post a successful NHS England Transformation funding bid the aim was to provide greater support for ward areas, reduce error rates and increase satisfaction rates through the implementation of seven‐day working and an emergency advice line led by a diabetes..

Published: 07/10/2020
Authors: Michaels S, Bujawansa S, Hardy KJ, Cardwell J, Milne R, Strong AJ, Lee C, Smith R

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Reviewing current type 1 diabetes education provision across Merseyside

Aims NICE guideline NG17 recommend individual care plans agreed with the person with type 1 diabetes (PWT1D), reviewed annually and to include diabetes education provision. Where and how this education should be delivered is up for debate. A group was established in Merseyside to look at education offered to PWT1..

Published: 07/10/2020
Authors: Strong AJ, Cardwell J

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Measuring inpatient diabetes related staff satisfaction using a SurveyMonkey questionnaire

Background We introduced seven‐day working and increased support for inpatients from the diabetes specialist nursing (DSN) Team in 2017. Previous surveys using hand‐delivered or postal questionnaires had resulted in low response rates. This year we used an online survey via SurveyMonkey® to measure inpatient diabetes related staff satisfaction. Aim..

Published: 07/10/2020
Authors: Milne R, Bujawansa S, Hardy KJ, Cardwell J, Michaels S, Smith R, Lee C

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Financial impact of improving diabetes‐related clinical outcomes

Background Our Trust received funding through the NHS Diabetes Transformation Programme to improve inpatient care and foot care. The monies received for inpatient care was used to increase the number of diabetes inpatient nurses by fivefold. We introduced extended weekday coverage (0,800–2,200), weekend cover and an emergency support line. The funding..

Published: 07/10/2020
Authors: Bujawansa S, Furlong NJ, Narayanan RP, Westall S, Cardwell J, Mitchell L, Michaels S, Hardy KJ

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Improved structured education uptake by systematising the offer

Aims In the UK, attendance at diabetes‐structured education is poor. Indeed, even evidence of a formal offer of structured education is sometimes lacking. Our aim was to improve education update by mailing a validated letter offering structured education to every person registered with diabetes in our borough. Methods With..

Published: 07/10/2020
Authors: Mitchell L, Cardwell J, Bujawansa S, Hardy KJ

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Follow‐up screening for diabetes after gestational diabetes (GDM)

Aims NICE guidelines for screening state that all GDM patients should be screened for diabetes at 6–12 weeks postpartum. Previous published data have given a national rate of less than 20%1. We reviewed our screening rate after the interventions of: discussion with the patient at first and last visit, written instructions to..

Published: 07/10/2020
Authors: McNulty SJ, Wilkinson P, Michaels S, Davies H, Sullivan H, Bujawansa S

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Improving glycaemic and cardiovascular risk assessment and management in diabetic foot ulcer patients

Introduction Diabetic foot ulcer increases the risk of cardiovascular disease, nephropathy and mortality. There is over a twofold increase in mortality compared to patients without diabetic foot ulcer, regardless of other risk factors. Aim To improve glycaemic and cardiovascular risk assessment and management on first presentation to the multidisciplinary diabetic..

Published: 07/10/2020
Authors: Roberts H, Kejem H, Furlong NJ

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Comparison of Procedural Outcomes in Transcatheter Aortic Valve Replacement

Background Mechanically expanded valve (MEV) was designed to reduce paravalvular leak and to provide the ability to reposition during transcatheter aortic valve replacement (TAVR). We have assessed recent evidence on procedural outcomes between MEV and the self-expandable valve (SEV). Methods Two independent researchers performed an extensive search on PubMed and..

Published: 01/10/2020
Authors: Akhtar KJ

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Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta-analysis

Background Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. Objectives We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta‐analysis of primary clinical studies. Methods A PRISMA‐..

Published: 01/10/2020
Authors: Nolan G

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Re: Evaluation of erectile function after anastomotic vs substitution urethroplasty for bulbar stricture

Dear Editor, We read with interest the recent paper by Omar et al. [1] regarding the evaluation of erectile function (EF) following bulbar urethroplasty. A prospective non-randomised study of 34 patients with stricture who underwent either anastomotic or substitution urethroplasty is presented with specific emphasis on the effects of the procedure on..

Published: 01/10/2020
Authors: Floyd Jr MS, Omar A

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Outcome of revision surgery for bisphosphonate related subtrochanteric fracture non-union following failed intramedullary nailing

Background Bisphosphonates use is a recognised cause of atypical femur fractures. Intramedullary nailing is the first line of treatment for these fractures, but failure is a common problem due to altered biology, resulting in a non-union and a challenging problem. Purpose There is lack of evidence in the literature on..

Published: 26/09/2020
Authors: Nagy MT, Kwaees TA, Saldanha K

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Is the use of a powered dermatome an aerosol-generating procedure (AGP)? Implications for personal protection against COVID-19 virus

Introduction Many healthcare workers have contracted SARS-CoV-2 during the pandemic, many cases of which have resulted in severe illness and death. No studies have assessed the potential for powered dermatomes to generate aerosol, an essential technique in burns and plastic surgery. The primary aim of the present study was to..

Published: 25/09/2020
Authors: Shokrollahi K, Kyriazidis I, Zak-Williams S, Murgatroyd E, Gurusinghe D

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The association of socioeconomic deprivation and paediatric open tibia fractures

Abstract The primary aim of this study is to test the association of open tibial fractures (OTF), in a paediatric age group, with socioeconomic deprivation. The secondary objectives are to more clearly define the epidemiological characteristics of these high-energy injuries. A consecutive series of patients with OTF presenting to a..

Published: 16/09/2020
Authors: Harrison WD

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P009 The value of random mucosal biopsies in the diagnosis of microscopic colitis

Introduction The incidence of microscopic colitis (MC) has recently increased to that of ulcerative colitis and Crohn's disease but its diagnosis can be difficult. Aim To establish the incidence of MC and the diagnostic value of random mucosal biopsies. Method 100 consecutive patients (35 men and 65 women; median age 58.5 years, ranging from 19..

Published: 16/09/2020
Authors: Brice R

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Corticosteroids reduce mortality and prevent ICU admission in Covid-19 pneumonia

Abstract Can early use of corticosteroids prevent progression of Covid-19 pneumonia to full-blown ARDS, and reduce mortality? Clinical data for use of corticosteroids in severe coronavirus infections are mixed - there is a particular lack of evidence in patients in the pre-critical care stage of illness i.e. before decompensation..

Published: 16/09/2020
Authors: Heaton J, Malhotra P, Stockton P, Rossiter L

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Immature platelet indices alongside procalcitonin for sensitive and specific identification

Abstract Hematological markers that can be rapidly analyzed and regularly monitored during a patient’s stay on ICU, and that can identify bacterial causes of sepsis are being extensively sought. The significance of platelets in early immunological responses provides justification for assessing their usefulness in the identification of bacteremia amongst..

Published: 08/09/2020
Authors: Tridente A

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The role of BAUS Section of Trainees (BSoT) as we negotiate our way through a difficult time in training

The year 2020 has certainly been challenging on a personal and professional level for surgical trainees. Many of us have been redeployed to work in less familiar specialities pushing the boundaries of our professional abilities in order to ensure safe care for all patients during this global pandemic. Educationally, life has..

Published: 08/09/2020
Authors: Tolofari S

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Post‐caesarean section venous thromboembolic prescription: do we need a defined prescriber role?

Venous thromboembolic (VTE) disease remains an important cause of perinatal morbidity and mortality [1]. All patients undergoing a caesarean section (CS) ‘should be considered for thromboprophylaxis with low molecular weight heparin (LMWH) for 10 days after delivery’, as per Royal College of Obstetricians [2]. Anecdotally, within our region, the responsibly of VTE prophylaxis..

Published: 01/09/2020
Authors: Robinson E, Singh P

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Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization

OBJECTIVE The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions. RESEARCH DESIGN AND METHODS..

Published: 01/09/2020
Authors: Furlong NJ

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Simultaneous Augmentation Mammoplasty and Vacuum-Assisted Breast Biopsy for Enhanced Cosmesis and Efficacy

Taghizadeh, R. (2020). Invited Discussion on: Simultaneous Augmentation Mammoplasty and Vacuum-Assisted Breast Biopsy for Enhanced Cosmesis and Efficacy. Aesthetic Plastic Surgery. 44 (0), 2048-2050

Published: 01/09/2020
Authors: Taghizadeh R

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Anthropometric Parameters for Nose Evaluation and Nasal Surgery Planning

Background The esthetic characteristics of face and nose are commonly evaluated before rhinoplasty using a completely subjective method, due to the lack of validated and reliable methods for quantifying facial esthetics and for accurate nose treatment planning. The aim of the study was to review the literature to determine and..

Published: 01/09/2020
Authors: Zace P

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Skin cancer surgery during the COVID-19 pandemic: A national, multicentre, prospective cohort study and survey of plastic surgeons

Abstract Skin cancer is the most common malignancy worldwide. The COVID‐19 pandemic has caused an unprecedented reorganization of healthcare services. This study established what effect the pandemic has had on the provision of skin cancer surgery by plastic surgeons in the U.K., one of the worst affected countries globally...

Published: 01/09/2020
Authors: Nolan G, Pritchard-Jones R

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A regional patch test audit against the 2019 British Association of Dermatologists’ Cutaneous Allergy Service Standards

Abstract The aim of this audit was to assess regional patch testing services in accordance with the British Association of Dermatology's (BAD) Cutaneous Allergy Service Standards, published in July 2019. Audit points incorporated recommendations from a regional audit carried out after the publication of the 2017 BAD contact dermatitis guidelines, in addition..

Published: 01/09/2020
Authors: Pang E

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Beyond corticosteroids for the management of patients with cutaneous immune-related adverse events secondary to immune checkpoint inhibitors

Abstract Immune checkpoint inhibitors (ICIs) restore antitumour immunity and have revolutionized the treatment of several types of malignancy, including melanoma. However, these immunotherapeutic agents are often associated with immune‐related adverse events (irAEs), most commonly in the skin. Guidelines from the European Society for Medical Oncology recommend the use of..

Published: 01/09/2020
Authors: Hindle E

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Surgeon led Urethrography: Procedure, Pitfalls and Pickups: an 18 month review

Introduction: Stricture disease remains an uncommon pathology with an incidence of 0.9%. Urethrography remains an important diagnostic tool in evaluating urethral disease as it provides information regarding stricture length and location. Ideally urethrography should be performed by the operating surgeon. In 2018 a urethral centre was established in Whiston Hospital, Merseyside and..

Published: 01/09/2020
Authors: Floyd Jr MS

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PLASTA National Webinar Series: A developing model for remote surgical education

Dear Sir, We enjoyed the recent publication on the growth of high-quality webinar-based teaching from the Plastic Surgery Trainees Association (PLASTA) and would like to offer some reflections. We agree webinars have many advantages in terms of cost, accessibility, convenience as well as the ability to place experts in niche..

Published: 27/08/2020
Authors: Nolan G

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Development of V-FAST: a vision screening tool for ambulance staff

Background About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy..

Published: 11/08/2020
Authors: Bates R

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Acquired reactive perforating collagenosis in association with pregnancy

A 32 year-old woman, at 17 weeks gestation, presented to dermatology with a pruritic erythematous urticarial-like eruption present on the trunk and limbs. A diagnosis of polymorphic eruption of pregnancy (PEP) was made and the patient was referred for ultraviolet B TL01 phototherapy. However at 24 weeks gestation, a separate papular eruption on..

Published: 01/08/2020
Authors: Lavery MJ, Winters S, Lorenzelli D, Low SE, Sharma N, Ngan K

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Reliability and validity of the Wrightington classification of elbow fracture-dislocation

Aims The Wrightington classification system of fracture-dislocations of the elbow divides these injuries into six subtypes depending on the involvement of the coronoid and the radial head. The aim of this study was to assess the reliability and reproducibility of this classification system. Methods This was a blinded study using..

Published: 31/07/2020
Authors:

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Common variable immunodeficiency with granulomatous-lymphocytic interstitial lung disease and preceding neurological involvement

Background Common variable immunodeficiency (CVID) is a group of heterogeneous primary immunodeficiencies characterised by a dysregulated and impaired immune response. In addition to an increased susceptibility to infection, it is also associated with noninfectious autoimmune and lymphoproliferative complications. CVID is rarely associated with neurological complications. Pulmonary involvement is more common,..

Published: 31/07/2020
Authors: Stevenson J

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High rates of stillbirth and preterm delivery in women with covid-19 and the efficacy of ECMO in pregnancy

The initial data reported by the UK Obstetric Surveillance System study were of great interest, and the findings have been discussed in our multidisciplinary maternity team. The rates of pregnancy loss, stillbirth, and preterm delivery seem considerably higher than those reported elsewhere. As noted by Magee and colleagues, the stillbirth..

Published: 27/07/2020
Authors: Kingston E

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People with obsessive-compulsive disorder often remain symptomatic following psychological treatment

Background Previous meta-analyses conclude that efficacious psychological treatments for obsessive-compulsive disorder (OCD) exist. However, determining the efficacy of psychological treatments requires multiple forms of assessment. We conducted an individual patient data meta-analysis of randomised controlled trials (RCTs) of manualised psychological therapy for adults with OCD. Methods Four electronic databases were..

Published: 25/07/2020
Authors: Rigby JW

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The effect on the surgeon of surgical complications: Are we doing enough to provide support?

Introduction Surgical complications have been shown to effect surgeons in a wide variety of domains, including psychological consequences and change in practice. A recent systematic review including over 8500 participants concluded that more formal support for surgical wellbeing after complications is required. We aimed to assess the effect of surgical complications..

Published: 16/07/2020
Authors: Clifford R, Kalaiselvan R

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Incidence of genitourinary dysfunction following left‐sided colorectal cancer (CRC) resections

Purpose CRC patients are at an increased risk of developing genitourinary symptoms post‐operatively due to the pelvic dissection. Our primary aim was to evaluate the incidence of genitourinary dysfunction after CRC resections and secondary aim was to look at the documentation about the risk of genitourinary dysfunction in consent..

Published: 15/07/2020
Authors: Javed M, Clark E, MacDonald S, Kalaiselvan R

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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..

Published: 15/07/2020
Authors: Liyanage A, Javed M, Kalaiselvan R, Rajaganeshan R

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Is it time for colorectal surgeons to follow the gynaecologists when removing left sided specimens?

Purpose To analyze different extraction sites for specimen extraction following left sided colorectal resections and risk for developing an IH. Methods Retrospective analysis of 107 patients undergoing laparoscopic left sided colorectal resections. Patients were divided into 3 groups based on extraction sites; midline, transverse (right or left) or pfannenstiel incisions. Data regarding..

Published: 15/07/2020
Authors: Javed M, Thomas E, West C, Chadwick M, Samad A, Rajaganeshan R

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What is the fate of an Ostomy following Emergency Laparotomy?

Purpose To analyse outcomes of patients undergoing emergency laparotomy and stoma formation particularly: stoma reversal, stoma associated complications (SAC) and cost implications. Methods Retrospective analysis of 57 patients identified from NELA database between January 2014 and December 2015. Results Median age was 72 years (IQR: 60–82), M:F = 25:32. The median time duration between admission and..

Published: 15/07/2020
Authors: Javed M, Ting L, Appleton ND, Chadwick M, Rajaganeshan R, Kalaiselvan R

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Overall survival of elderly colorectal cancer (CRC) patients

Purpose Advances in surgical techniques and perioperative care have improved cancer‐related outcomes. This study aims to describe the outcomes of elderly who had curative surgery or symptomatic management for CRC. Methods Retrospective study of consecutive CRC patients between 2014 to 2016 in a DGH, who were 70 years old or above. Demographic..

Published: 15/07/2020
Authors: Javed M, Airey G, Kearsey C, Samad A, Chadwick M, Rajaganeshan R

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Re: Boomerang technique, The Buccal Mucosal Grafting Harvesting Model for Long Urethral Stricture Urethroplasty

Floyd, MS; Omar, AM. (2020). Re: Boomerang technique, The Buccal Mucosal Grafting Harvesting Model for Long Urethral Stricture Urethroplasty: A case series. Urology Journal. 17 (5), 530

Published: 08/07/2020
Authors: Floyd Jr MS, Omar A

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An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals

Background Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. These infusions are typically administered over 24 h due to currently available safety data. The ability to deliver prescribed medication by CSCI..

Published: 07/07/2020
Authors: Kirk J

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The presentation, diagnosis and management of non-traumatic wrist pain

Objectives The study aims were to assess the burden of non-traumatic wrist pain in terms of numbers of referrals to secondary care and to characterize how patients present, are diagnosed and are managed in secondary care in the UK National Health Service. Methods Ten consecutive patients presenting with non-traumatic wrist..

Published: 07/07/2020
Authors: Lipscombe S

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Adjuvant therapy with pegylated interferon-alfa2b vs observation in stage II B/C patients

Background Subgroup analyses of two large EORTC adjuvant interferon-alpha2b (IFNα-2b) vs observation randomised trials demonstrated that a treatment benefit was observed only in patients with an ulcerated melanoma without palpable nodes (hazard ratio [HR] for recurrence-free survival [RFS] was 0.69). This was confirmed by a meta-analysis of 15 adjuvant..

Published: 01/07/2020
Authors: Marshall E

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Negative pressure wound therapy versus conventional dressing for open fractures in lower extremity trauma

Aims It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the..

Published: 30/06/2020
Authors: Khan S

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Invited Discussion on: Fat Necrosis After DIEP Flap Breast Reconstruction: A Review of Perfusion-Related Causes

Taghizadeh, R. (2020). Invited Discussion on: Fat Necrosis After DIEP Flap Breast Reconstruction: A Review of Perfusion-Related Causes. Aesthetic Plastic Surgery. 44 (0), 1462-1465

Published: 23/06/2020
Authors: Taghizadeh R

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Discretionary technology bootlegging tensions in institutional healthcare work

Abstract We explore individuals who take some of their technology use ‘underground’, described as ‘bootlegging’, to enhance healthcare work. We find that healthcare professionals’ informal use of mobile applications in healthcare work sometimes ‘sticks out’ and this produces professional identity tensions: (1) conflict with perceptions of professional behaviour, and (2) defilement of..

Published: 08/06/2020
Authors: Pritchard-Jones R

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Understanding technology mediation and new service provider roles in health care

Purpose Service research holds that as services become more technology dominated, new service provider roles emerge. On a conceptual level, the potential impact of different roles has been discussed with regard to service provider readiness, job performance and overall experience. However, as yet, there is sparse empirical support for these..

Published: 08/06/2020
Authors: Pritchard-Jones R

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Current role of sentinel lymph node biopsy in the management of cutaneous melanoma

Summary Sentinel node biopsy (SNB) has been at the forefront of the surgical staging of melanoma patients for the past 15 years. The high accuracy of this prognostic staging procedure is now recognised in all international guidelines for melanoma. However during this period there have been a number of important changes..

Published: 08/06/2020
Authors: Pritchard-Jones R

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Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT

Background Progesterone is essential for a healthy pregnancy. Several small trials have suggested that progesterone therapy may rescue a pregnancy in women with early pregnancy bleeding, which is a symptom that is strongly associated with miscarriage. Objectives (1) To assess the effects of vaginal micronised progesterone in women with vaginal bleeding..

Published: 04/06/2020
Authors: Rao S

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Low rate of bacterial co-infection in patients with COVID-19

We agree with Michael J Cox and colleagues that clinical management of COVID-19 would be enhanced by further characterisation of bacterial co-infections. A few case reports have described examples of such co-infections. However, national and international6 guidelines recommend empirical antibiotics for all patients who are severely ill with suspected COVID-19,..

Published: 03/06/2020
Authors: Adler H, Ball R, Fisher M, Mortimer K, Vardhan M

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Management of the axilla following neoadjuvant chemotherapy - A change in practice

Introduction Chemotherapy in the neo adjuvant setting has allowed downsizing of breast tumours thus allowing patients to benefit from breast conservation surgery. The effect of neoadjuvant chemotherapy (NAC) has also been observed in the axilla but most units are still treating the axilla with axillary lymph node dissection (ALND). Method(..

Published: 01/06/2020
Authors: Riogi B, Barker D, Harris O, , Chagla LS, Sripadam R

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P067: Assessment of burnout among breast surgeons in the United Kingdom

Background Burnout among physicians has gained significant attention recently because of its rising prevalence, and detrimental impact on quality of care and professional satisfaction. Little is known about burnout among breast surgeons in the United Kingdom (UK). We sought to identify factors that influence overall burnout and professional fulfilment in..

Published: 01/06/2020
Authors: Chagla LS

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P094: Breast school: A holistic approach to optimise recovery following breast surgery

Background The Enhanced Recovery Programme with emphasis on better patient education and preparation encouraged us to introduce a Breast School with a view to increasing Day Cases and improving patient experience and outcomes. This School has been developed by a team of surgeons, anaesthetists, breast care nurses, dieticians, physiotherapists and..

Published: 01/06/2020
Authors: Power G

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The impact of glucocorticoid initiation on the diagnostic accuracy of ultrasound

Background Temporal and axillary artery ultrasound (US) has been recommended by EULAR as the first-line investigation in patients with suspected giant cell arteritis (GCA).1 US is reported as having a 77% sensitivity and 96% specificity for GCA.1 However, these figures have largely been derived from studies carried out in specialist centres where..

Published: 01/06/2020
Authors: Sze JT, Dawson J

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Targeted high concentration botulinum toxin A injections in patients with Raynaud’s phenomenon

Abstract Raynaud’s phenomenon is a vasospastic condition affecting hands and feet which may lead to rest pain, ischemic ulcers and gangrene. Botulinum toxin A has been shown to improve peripheral circulation and relieve vasospastic symptoms. Our aim was to assess our treatment outcomes following Botulinum toxin A injections in..

Published: 23/05/2020
Authors: Nagarajan M, McArthur P

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I’m a new ICU Doc, get me out of here!

Background Junior doctors rotate between hospitals and departments on a frequent basis and need to be able to provide safe and effective care from the first day in their new rotation. Good, timely local induction helps with this, however junior doctors are still required to familiarise themselves with a large..

Published: 20/05/2020
Authors: Cochrane A, Howarth O

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The EIC-ICU (Enhancing Interprofessional Collaboration in the Intensive Care Unit) toolkit

Introduction Effective interprofessional collaboration (IPC) in intensive care units (ICUs) has been associated with better patient outcomes such as reduced mortality rates and length of ICU stay. The level of IPC also predicts the degree to which team members report understanding their patient care goals and how productive they are..

Published: 20/05/2020
Authors: Cochrane A

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Quality Improvement Project to Improve Documentation of Predicted Body Weight

Introduction In patients with acute lung injury or acute respiratory distress syndrome, there is a significantly lower mortality when ventilated with a lower tidal volume (TV) of 6 ml per kg of predicted body weight (PBW) than the traditional TV of 12 ml per kg of PBW.1 In our Intensive Care Unit (..

Published: 12/05/2020
Authors: Tanqueray E, Cochrane A

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Case Report: An Overdose of Melanotan 2 – the Barbie Drug

Background We present a case of accidental Melanotan 2 overdose. Melanotan 2 is an illegal injectable drug consisting of an Alpha Melanocyte Stimulating Hormone analogue used to increase tanning and sexual performance, and known colloquially as the Barbie Drug. Currently the evidence base for management of Melanotan 2 overdose is limited to several..

Published: 04/05/2020
Authors: Gibney E

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The cost-effectiveness of progesterone in preventing miscarriages

Objectives To assess the cost‐effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. Design Economic evaluation alongside a large multi‐centre randomised placebo‐controlled trial. Setting Forty‐eight UK NHS early pregnancy units. Population Four thousand one hundred and fifty‐three..

Published: 01/05/2020
Authors: Rao S

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The landscape of systemic regimens used routinely in the neoadjuvant setting in the UK

Introduction Neoadjuvant systemic therapy (NST) for breast cancer has potential advantages over adjuvant treatments in selected patient groups. Previous studies identified significant variation in NST utilisation across the UK and a lack of data on routine treatment regimens and real-world outcomes. Aims/Objectives The NeST prospective multi-centre cohort study aimed..

Published: 01/05/2020
Authors: Whitehead IJ

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036 Major lower gastro‐intestinal surgery peri‐operative service evaluation project (RESECT)

St Helens and Knowsley Teaching Hospitals NHS Trust is the centre for the largest number of bowel resections within the region, with the aim of becoming a tertiary unit for major lower gastro‐intestinal (GI) surgery. Due to the nature of the operations performed, peri‐operative management and analgesic control..

Published: 01/05/2020
Authors: Herold J, Dixit T

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Surgical outcomes following neoadjuvant chemotherapy

Introduction Potential advantages of neoadjuvant systemic therapy (NST) include downstaging disease to minimise surgery, and in vivo assessment of tumour sensitivity to therapeutic drugs. Considerable variation in NST use remains, however, and it is unclear whether pathological response rates reflect those reported in trials, or whether the downstaging achieved with..

Published: 01/05/2020
Authors: Whitehead IJ

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070 QUENCH: the quality‐improvement project to reduce pre‐operative dehydration times

Pre‐operative fasting aims to minimise the risk of pulmonary aspiration during anaesthesia. Patients often fast for longer than the advised standard times of 6 h for food and 2 h for fluids [1], on a fluctuating emergency list, compromising optimal physiology and patient experience. Peri‐operative quality‐improvement programme (PQIP) data shows..

Published: 01/05/2020
Authors: Jones K

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059 Encouraging standardisation of documentation in anaesthetics using the intensive care framework of central lines

The Faculty of Intensive Care Medicine (ICM) produced a series of World Health Organization (WHO) style checklists, the Local Safety Standards for Invasive Procedures (LocSSIPs), based on a framework from NHS England's Safety Domain to ensure safe practice of invasive procedures and prevent a never event [1, 2]. In Whiston Hospital, the..

Published: 01/05/2020
Authors: Mahambrey T

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The Analysis of Teaching of Medical Schools (AToMS) survey

Background What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based..

Published: 01/05/2020
Authors: Phillips B, Aspinall E

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Exploring UK medical school differences

Background Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction,..

Published: 01/05/2020
Authors: Phillips B, Aspinall E

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An evaluation of emergency department patients referred for urgent lumbar magnetic resonance imaging with suspected cauda equina syndrome

Purpose Failing to correctly diagnose Cauda Equina Syndrome (CES) in the Emergency Department (ED) can have catastrophic consequences for the patient and be costly for the National Health Service (NHS). The ED clinician bears a weight of responsibility in the decision to refer for urgent Magnetic Resonance Imaging (MRI) in..

Published: 01/05/2020
Authors: McCarthy L

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Second primary malignancies in patients receiving treatment with ruxolitinib for myelofibrosis – a regional experience

Patients with myeloproliferative neoplasms (MPN) are at an increased risk of second primary malignancies (SPM) compared with matched‐controls and the general population. The Surveillance, Epidemiology and End Results (SEER) database (US cancer registries) reported that patients with primary myelofibrosis (PMF) had an incidence of SPM of 5·3% after a median..

Published: 01/05/2020
Authors: Nicholson T

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Global incidence of incomplete surgical excision in adult patients with non-melanoma skin cancer

Abstract Background Non-melanoma skin cancer, which includes basal cell carcinoma and cutaneous squamous cell carcinoma, is the commonest malignancy worldwide. The mainstay of treatment is surgical excision. Despite this being an exceptionally common procedure, it is not known what the accepted standard is for incomplete excision. Multiple single-centre, regional and..

Published: 17/04/2020
Authors: Nolan G

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

Abstract Introduction Pilonidal disease 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 has been proposed as an adjunct to surgery and has shown improved results in some..

Published: 17/04/2020
Authors: Liyanage A, Javed M, Defty C, Shaaban H, Kalaiselvan R, Rajaganeshan R

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Electrochemotherapy in the treatment of ulcerated malignant tumors: Results from the inspect registry

Background Electrochemotherapy (ECT) is an effective local treatment for cutaneous tumors and metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. The aim of this study was to investigate the effectiveness of ECT in ulcerated versus non-ulcerated cutaneous tumors and metastases. Methods 22..

Published: 15/04/2020
Authors: Liew S

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National utilisation of neoadjuvant systemic therapy and impact on surgical treatment

Introduction Potential advantages of neoadjuvant systemic therapy (NST) include downstaging disease to minimise surgery, and in vivo assessment of tumour sensitivity to therapeutic drugs. Considerable variation in NST use remains, however, and it is unclear whether pathological response rates reflect those reported in trials, or whether downstaging achieved impacts on..

Published: 04/04/2020
Authors: Whitehead IJ

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Management of the axilla following neoadjuvant chemotherapy for breast cancer

Objectives Chemotherapy in the neo adjuvant setting has allowed downsizing of breast tumours thus allowing patients to benefit from breast conservation surgery. The effect of neoadjuvant chemotherapy (NAC) has also been observed in the axilla but most units are still treating the axilla with axillary lymph node dissection (ALND). Materials..

Published: 04/04/2020
Authors: Riogi B, Barker D, Harris O, , Chagla LS

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Avoiding Stroke: A Continuous Monitoring Challenge

Extract Stroke is a leading cause of death and disability worldwide. Risk factors such as advancing age, hypertension, cigarette smoking, atrial fibrillation (AF), diabetes mellitus and prior cardiovascular disease are well established and provide significant opportunities through public health policy to reduce both the disease burden and the socio-economic cost..

Published: 04/04/2020
Authors: Hill AM

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Multiple Lobulated Nodules: Answer

Answer The clinical presentation is consistent with a diagnosis of erythema elevatum diutinum (EED) but with a histological overlap of features characteristic of palisaded neutrophilic granulomatous dermatitis (PNGD). The patient was commenced on dapsone 100mg once daily. After only 4 weeks of treatment, the lesions almost completely resolved. Eustace, K; Carr,..

Published: 17/03/2020
Authors: Eustace K

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Outcomes of Geriatrician Input in Older Patients Undergoing Emergency Laparotomy in a District General Hospital

Abstract With the increasing median age of survival in the UK, there is an increased burden on the provision of medical and surgical care to the population. The 2010 National Confidential Enquiry into Patient Outcome and Death report, “An Age Old Problem,” emphasizes the early involvement of surgical and geriatric consultant..

Published: 17/03/2020
Authors: Mubarik A

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Biologic monotherapy in the biologic naïve patient with rheumatoid arthritis (RA)

Abstract Approximately one-third of patients on biologic therapy for rheumatoid arthritis (RA) receive them as monotherapy. There are few head-to-head randomised control trials comparing biologics as monotherapy. Our aim was to compare the efficacy and persistence of multimodal biologic agents as monotherapy in biologic naïve patients with RA in..

Published: 17/03/2020
Authors: Abernethy R

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Validity of direct magnetic resonance arthrogram in patients with femoroacetabular impingement

Abstract Femoroacetabular Impingement is an established cause of labral tears and chondral delamination. The aim was to test the validity of direct magnetic resonance arthrogram [dMRA] in the diagnosis of the same. We also looked at the short term functional outcome in these patients post hip arthroscopy. The dMRA is..

Published: 17/03/2020
Authors: Mohan R, Gudena R

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Re: A rare case of renal collision tumour of oncocytoma and sarcomatoid renal cell carcinoma

Floyd, MS Jr. (2020). Letter to the Editor re: A rare case of renal collision tumour of oncocytoma and sarcomatoid renal cell carcinoma , Chang et al. Journal of Clinical Urology. 13 (1), 70-71

Published: 17/03/2020
Authors: Floyd Jr MS

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Health workers’ views on audit in maternal and newborn healthcare in LMICs

Objectives To identify and summarise health workers’ views on the use of audit as a method to improve the quality of maternal and newborn healthcare in low‐ and middle‐income countries (LMICs). Methods We conducted a qualitative evidence synthesis. PubMed, CINAHL and Global Health databases were searched using keywords, synonyms..

Published: 16/03/2020
Authors: Kammath V

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Can the Surgical Approach to Total Knee Arthroplasty Influence Early Postoperative Outcomes?

Background Trivector approach to total knee arthroplasty (TKA) is a quadriceps tendon sparing approach, whereas the medial parapatellar (MPP) approach involves making a longitudinal incision in quadriceps tendon. We postulated that quadriceps-sparing approach such as trivector should make postoperative rehabilitation easier and ultimately reduce the length of hospital stay. Objectives..

Published: 16/03/2020
Authors: Reddy G, Islam SUI, Attar FG

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An economic evaluation based on the PRISM Trial

Objectives To assess the cost‐effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. Design Economic evaluation alongside a large multi‐centre randomised placebo‐controlled trial. Setting Forty‐eight UK NHS early pregnancy units. Population Four thousand one hundred and fifty‐three..

Published: 16/03/2020
Authors: Rao S

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Comparison of pharmacy technicians’ and doctors’ medication transcribing errors at hospital discharge

Objectives To compare the transcribing error rates of discharge prescriptions between pharmacy technicians and doctors in an acute hospital setting. Methods Pharmacy technicians were trained in the transcribing of discharge medications from inpatient to discharge medication charts. Prospective prescribing audits were undertaken over 5 days on eight hospital medical wards by..

Published: 03/03/2020
Authors: Lloyd M

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Patient-reported outcomes (PROMs) in stone surgery:

Introduction Patient-reported outcome measures (PROMs) assess the quality of care delivered from a patient’s perspective. There is a paucity of evidence reporting PROMs in the treatment of urolithiasis. In this study, we aimed to assess the impact of urological stone procedures on patients’ morbidity. Methods Data were prospectively collected..

Published: 22/01/2020
Authors: Tolofari S, Starmer B, Agarwal K

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National snapshot audit on the surgical management of LUTS/BPE: what has changed over the past two decades?

Introduction Surgical treatment for lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BHP) has experienced changes over the years, with the addition of new treatments. There are limited data on the current national practices when compared with historical data. Method A national audit (audit of surgical management of benign prostatic..

Published: 22/01/2020
Authors: McCabe JE

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Bilateral hamstring origin calcification: rare presentation of Gitelman syndrome

Abstract This case report is the first case to our knowledge of intratendinous or peritendinous calcification reported in Gitelman syndrome (GS) patients. GS represents the clinical manifestations of inactivation of the Slc12a3 genes encoding the thiazide-sensitive sodium chloride cotransporter and the Trpm6-Mg genes encoding the magnesium transporters in..

Published: 21/01/2020
Authors: Mohan R, Dhotare S, Jakaraddi CA

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The role of dry-lab and cadaveric simulation for cystoscopy

Background The aim of this study is to assess validity of the ETXY Multifunctional trainer (ProDelphus, Olinda, Pernambuco, Brazil), a bench-top dry-lab model for simulation of cystoscopy and intravesical injections of Botulinum Toxin A (BTX-A) injections, in terms of educational value, feasibility and acceptability as well as evaluating the use..

Published: 21/01/2020
Authors: McCabe JE

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Identifying patient concerns during consultations in tertiary burns services: development of the Adult Burns Patient Concerns Inventory

Objectives Identifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The..

Published: 20/01/2020
Authors: Shokrollahi K

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The NeST (neoadjuvant systemic therapy in breast cancer) study

Introduction Neoadjuvant systemic therapy (NST) has several potential advantages in the treatment of breast cancer. However, there is currently considerable variation in NST use across the UK. The NeST study is a national, prospective, multicentre cohort study that will investigate current patterns of care with respect to NST in the..

Published: 20/01/2020
Authors: Whitehead IJ

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Multiple Lobulated Swellings: Answer

Answer The clinical presentation is consistent with a diagnosis of erythema elevatum diutinum (EED) but with a histological overlap of features characteristic of palisaded neutrophilic granulomatous dermatitis (PNGD) The patient was commenced on dapsone 100mg once daily. After only 4 weeks of treatment, the lesions almost completely resolved. Eustace, K; Carr,..

Published: 20/01/2020
Authors: Eustace K

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Cangrelor

Introduction Acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in people with diabetes. Diabetes is a critical risk factor for the development of ACS and its complications. Guidance on primary coronary intervention (PCI) for ACS from several authorities recommends the use of a P2Y12 inhibitor..

Published: 20/01/2020
Authors: Katira R

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Assessing the quality of information delivered to patients in the pre-operative period

Understanding patient experiences during their anaesthetic journey is essential to assessing quality of care being delivered. At Whiston hospital, as part of maintaining our Anaesthesia Clinical Services Accreditation standards [1], we wanted to evaluate our performance in this domain, particularly in relation to patient understanding and satisfaction following information given to..

Published: 01/01/2020
Authors: Glennon K

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Etomidate in the management of severe Cushing’s disease and MRSA bacteraemia

Abstract We report our experience on managing a case of florid Cushing’s disease with Methicillin-resistant Staphylococcus aureus (MRSA) sepsis using intravenous etomidate in the intensive care unit of a UK district general hospital. Wong, SWP; Yap, Y; Narayanan, RP; Al-Jubouri, M; Grossman, A; Daousi, C; Mahgoub, Y. (2019). Etomidate in..

Published: 23/12/2019
Authors: Wong S, Yap Y, , Al-Jubouri M

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Anti-N-methyl- d -aspartate receptor encephalitis: A case series and review of the literature

Abstract Anti-NMDAR (N-methyl-d-aspartate receptor) encephalitis is a potentially severe form of encephalitis associated with antibodies against NR1 and NR2 subunits of the NMDAR. Anti-NMDAR encephalitis is a treatable cause of encephalitis. An underlying tumor should be actively looked for as this is also considered to be a paraneoplastic syndrome. We..

Published: 23/12/2019
Authors: Abdelaziz M

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Starting a Urethroplasty Service: Initial results from a UK centre

Introduction Stricture disease remains uncommon with an incidence of 0.9%. Most cases are initially managed endoscopically. Urethral reconstruction remains a specialised field and is typically concentrated in specialised centres. In 2018 a urethral centre was established in Whiston Hospital, Merseyside to cater for local demand. Method(s) Sixteen patients who underwent urethral..

Published: 23/12/2019
Authors: Floyd Jr MS

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Posters in imaging & therapy practice

Sharkey, K; Marsh, K. (2019). Posters in imaging & therapy practice . Imaging & Therapy Practice. October (-), 22

Published: 23/12/2019
Authors: Sharkey K, Marsh K

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Radiographer abnormality detection systems: how accurate are we?

Fenning, LA; Melling, R. (2019). Posters in imaging & therapy practice: radiographer abnormality detection systems: how accurate are we? . Imaging & Therapy Practice. Nov (-), 20

Published: 23/12/2019
Authors: Fenning L, Melling R

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Reflection on 30 years as a PDSN

Abstract In her final editorial for the Paediatrics section, Helen Thornton reflects on the advancement of diabetes management over the last 30 years. Thornton, H. (2019). Reflection on 30 years as a PDSN . Journal of Diabetes Nursing. 23 (5), 94

Published: 23/12/2019
Authors: Thornton H

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Low-carbohydrate diets for children and young people with type 1 diabetes

Abstract The use of low-carbohydrate diets in children and young people with type 1 diabetes is receiving increased interest, particularly online; however, it is controversial due to a lack of evidence and concerns about safety. This article provides a detailed review of the current evidence regarding low-carbohydrate diets and the potential..

Published: 23/12/2019
Authors: Brown J

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Re-excision After Breast Conservation Surgery – Our Breast Unit experience

Background The benefit of re-excision surgery for involved margin after BCS among the patient receiving adjuvant radiotherapy is unclear. Omission of re-excision surgery for selected patients with focally involved margin after BCS did not alter DFS and OS. Knowing the biology of cancer may assist to select patients benefiting with..

Published: 23/12/2019
Authors: Pushdary KH, Atherton J, Ray A, Jois RHS

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Breast School: A Holistic Approach to Optimise Recovery Following Breast Surgery

Background The Enhanced Recovery Programme with emphasis on better patient education and preparation encouraged us to introduce a Breast School with a view to increasing day cases and improving patient experience and outcomes. This School has been developed by a team of surgeons, anaesthetists, breast care nurses, dieticians, physiotherapists and..

Published: 23/12/2019
Authors: Power G

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Eccrine hidrocystoma of the external meatus in a hypospadiasis patient

Pina, IM; Omar, AM; Floyd, MS Jr. (2019). Eccrine hidrocystoma of the external meatus in a hypospadiasis patient: a rare finding . Journal of Clinical Urology. epub Aug 20

Published: 23/12/2019
Authors: Pina IM, Omar A, Floyd Jr MS

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Time for a new approach?

Fenning LA. (2019). Time for a new approach? . Imaging & Therapy Practice. Aug (0), 18-24.

Published: 23/12/2019
Authors: Fenning L

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Introducing a quick reference guide for emergency uterotonic and uterine relaxant drug use

Abstract The responsibility of administering drugs for uterine relaxation or contraction during caesarean section often falls to the anaesthetist. This can be particularly challenging for staff who are unfamiliar with these drugs or do not undertake regular obstetrics sessions. In the past, general anaesthesia for caesarean section was far more..

Published: 23/12/2019
Authors: Veal A, Goel V

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PA13 Paediatric 2-week-wait skin cancer audit

Abstract The incidence of skin cancers is rising, and dedicated 2-week wait skin cancer clinics have been set up throughout the U.K. However, skin cancer in paediatric patients is relatively rare, with a reported incidence in the U.S.A. of 1.1 per million in 1 4 year olds, and 10.4 per million..

Published: 23/12/2019
Authors: Hanley T

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P097 Cutaneous toxicity from immune checkpoint inhibitors

Abstract Immune checkpoint inhibitors (ICIs) are immunomodulatory agents used in the treatment of an increasing number of malignancies. They inhibit tumour-induced immunosuppression and reactivate tumour-specific cytotoxic T lymphocytes resulting in control of malignant disease (Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer 2012; 12: 252-64). However, off-target..

Published: 23/12/2019
Authors: Hindle E

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DP18 A rare association between interstitial granulomatous dermatitis and myelofibrosis

Abstract A 61-year-old woman presented with an 18-month history of a widespread eruption, which had started on her face and later spread to involve her neck, chest, upper back and upper limbs. She had been previously been treated for rosacea with metronidazole gel (MetroGel) and 1% hydrocortisone cream without improvement. Her..

Published: 23/12/2019
Authors: Low SE, Ngan K

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Perils of the Pneumatic Tube: How Clean Are Your Pods?

Abstract Pneumatic tube systems (PTS) are useful features in hospitals for efficient transport of items but further scrutiny reveals their potential risks. We investigated the extent of contamination of pods, used within the PTS with specific alert organisms, namely meticillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE) and carbapenemase-producing Enterobacterales (..

Published: 23/12/2019
Authors: McMullen P, Lewis P, McGugan O, Mortimer K

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Data from national media reports of ‘Acid attacks’ in England: A new piece in the Jigsaw

Introduction There has been considerable concern in the UK with what seems to have been an increase in so-called ‘Acid Attacks’. The key data sources (Police data, Hospital admissions and Burns unit data) have limitations in capturing the acid attacks comprehensively. Incidents not reported to the police are missed in..

Published: 23/12/2019
Authors: Nagarajan M, Mohamed S, Asmar O, Stubbington Y, George S, Shokrollahi K

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Extraction of Fractured Femoral Stem in Primary Cemented Hip Replacements

Abstract Extracting a fractured stem poses a technical challenge in revision surgery. A number of techniques have been described based on method of fixation (cemented or uncemented); location of the fracture; and composition of the stem alloy. These include the drilling and cortical window techniques. We describe our surgical removal..

Published: 23/12/2019
Authors: Matar HE,

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Metalwork Prominence and Operative Interventions for Treating Olecranon Fractures

Abstract In this systematic review of randomized controlled trials, we aimed to assess the effects of different surgical treatments for olecranon fractures in adults, especially the rate of metalwork prominence. We searched the Cochrane Bone, Joint, and Muscle Trauma Group's Specialized Register (2018), the Cochrane Central Register of Controlled Trials (CENTRAL, 2018,..

Published: 23/12/2019
Authors: Matar HE

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Outcomes of Implant-Arthrodesis as Limb Salvage

Purpose We sought to evaluate our consecutive series of knee-implant arthrodesis patients for failed total knee arthroplasties with medium term clinical and radiographic outcomes. Methods We conducted a retrospective review of a consecutive series of 4 patients (average age, 75 years; range, 69–79) with failed knee arthroplasties and deficient extensor mechanism who underwent..

Published: 23/12/2019
Authors: Matar HE, Stritch P, Emms N

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The “dermal cage”: Inferiorly based dermal flap technique for breast reconstruction after mastectomy

Summary “Direct to implant,” “one-stage,” or “immediate” breast reconstruction procedures have become extremely popular in the last decade. The additional task of covering the lower pole of the prosthetic implant for stability can be achieved by one of two principal methods: either the use of acellular dermal matrix (ADM) or..

Published: 23/12/2019
Authors:

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Failure of Cemented Constrained Acetabular Component

Abstract Constrained acetabular components are used as a salvage option for unstable total hip arthroplasties particularly in elderly low demand patients. Their indications include multiple failed revisions with abductor deficiency, neurologic or neuromuscular impairment, recurrent dislocations where the cause of instability cannot be identified despite well-aligned components. Failure of these..

Published: 23/12/2019
Authors: Matar HE, Stritch P, Emms N

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Effectiveness of Negative-Pressure Wound Therapy following Total Hip and Knee Replacements

Abstract In this review, we assess the effects of negative-pressure wound therapy (NPWT) following primary hip and knee replacement surgery with a systematic review of randomized controlled trials (RCTs). We searched the Cochrane Bone, Joint, and Muscle Trauma Group's Specialized Registry on June 12, 2018; the Cochrane Central Register of Controlled Trials (..

Published: 23/12/2019
Authors: Matar HE, Emms N

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Book Review: Special Types of Finger Replantation

McAllister, R; Hassan, D; Shokrollahi, K. (2019). Book Review: Special Types of Finger Replantation . Annals of Plastic Surgery. 83 (5), e1

Published: 23/12/2019
Authors: McAllister R, Hassan D, Shokrollahi K

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Assessment of steroid use as a key performance indicator in inflammatory bowel disease

Background Patients with inflammatory bowel disease (IBD) are at risk of excess corticosteroids. Aims To assess steroid excess in a large IBD cohort and test associations with quality improvement and prescribing. Methods Steroid exposure was recorded for outpatients attending 19 centres and associated factors analysed. Measures taken to avoid excess were..

Published: 23/12/2019
Authors: Bassi A

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Protecting our digital medicine infrastructure

On Friday 12th May at 11:30 a.m., the information technology (IT) helpdesk at our hospital received four calls from people around our organisation, who reported seeing a strange message appear on their screen. The message displayed would become familiar to many thousands of computer users over the ensuing few hours..

Published: 23/12/2019
Authors: Connor M

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Dermatologic Complications With Body Art Tattoos, Piercings and Permanent Make-up

Nagarajan, M; Shokrollahi, K. (2019). Book review: Dermatologic Complications With Body Art Tattoos, Piercings and Permanent Make-up . Annals of Plastic Surgery. 83 (5), e2

Published: 23/12/2019
Authors: Nagarajan M, Shokrollahi K

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Systematic literature review investigating whether methotrexate causes chronic pulmonary fibrosis

Conclusion Conclusion Our systematic literature review found high-quality unbiased evidence that methotrexate does not cause chronic pulmonary fibrosis in humans. In patients with RA, chronic pulmonary fibrosis is due to the underlying disease and not methotrexate. It is important to now address this across all disciplines and reject the hypothesis..

Published: 23/12/2019
Authors: Quah E, Amoasii C, Mudawi T, Dawson J

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Biomechanical considerations for strategies to improve outcomes

Abstract This article is a systematic review of the recent published literature on the biomechanics of volar locking plate fixation of distal radius fractures. PUBMED/MEDLINE and EMBASE databases were searched on 13th Sep 2018. Biomechanical papers on volar locking plate fixation of distal radius fractures since 2010 were included. Papers were..

Published: 23/12/2019
Authors: Ramavath AL, Howard N, Lipscombe S

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Gynaecomastia: a cosmetic concern or a concerning clinical sign?

Abstract Gynaecomastia is common and often physiological, leading to frequent dismissal as a cosmetic condition. It can however be a symptom of underlying hormone imbalance, which requires further assessment to exclude underlying sinister pathology. We discuss a rare cause of gynaecomastia that demonstrates the importance of a holistic approach to..

Published: 20/12/2019
Authors: Whitehead IJ

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Validity of the International Prostate Symptoms Score

Abstract Postoperative urinary retention necessitating catheterization after major lower limb arthroplasty surgery adds to the patients’ postoperative discomfort and increases the risk of urinary tract infection with potential risk of transient bacteraemia and seeding of infection to prosthetic joints. Preoperative evaluation of patients with lower urinary tract symptoms may help..

Published: 20/12/2019
Authors: Jakaraddi CA

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Ultrasound evidence of bladder outlet obstruction secondary to lichen sclerosus et atrophicus in boys

Background Lichen sclerosus (LS), (balanitis xerotica obliterans), causes pathological phimosis. Many boys present with obstructive symptoms, the cause is usually obvious on examination so ultrasound scans (USS) of the urinary tract are not routinely indicated. We review a series of abnormal USS in boys with LS. Methods Retrospective note review..

Published: 20/12/2019
Authors: Hughes KE

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Re: MR urethrography compared with operative findings

Floyd, MS Jr; Omar AM. (2019). Re: MR urethrography compared with operative findings for the evaluation of urethral strictures . International Urology and Nephrology. 51 (11), 1985-1986

Published: 20/12/2019
Authors: Floyd Jr MS, Omar A

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Identifying Preoperative Factors

Taghizadeh, R. (2019). Identifying Preoperative Factors Associated with the Volume Discrepancy in Patients Undergoing Breast Reconstruction with the Extended Latissimus Dorsi Musculocutaneous Flap Coverage . Aesthetic Plastic Surgery. 43 (6), 1497–1499

Published: 20/12/2019
Authors: Taghizadeh R

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Stroke emergency trolley to improve outcomes in stroke related emergency situations

Introduction High quality care on a HASU requires staff who are skilled in stroke emergencies, a multidisplinary simulation package was introduced on the stroke unit so staff were equipped with the skills to manage stroke emergencies. This identified a development of a stroke specific emergency trolley. Method(s) Members of..

Published: 18/12/2019
Authors: Attwood K

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UGIC P73 Role of peritoneal cytology as part of multi-modal staging in oesophago-gastric cancers: A single centre experience

Background Over 16,000 cases of oesophago-gastric cancer are diagnosed in the UK annually. Multi-modality staging of these cancers include computer tomography, endoscopic ultrasound and positron emission topography. Laparoscopy and peritoneal lavage are recommended as an additional staging modality due to the propensity of these cancers to rapidly metastasise to lymph nodes..

Published: 01/11/2019
Authors: Kaul A

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000363 An international survey on aminoglycoside practices in critically ill patients: The AMINO III study

INTRODUCTION The optimal dosing strategy of aminoglycosides (AG) remains debated in intensive care units (ICUs). OBJECTIVES We investigated the international practices of AG regarding dosing and therapeutic drug monitoring in ICU patients. METHODS A prospective, multicentre, observational, cohort study was conducted in 59 intensive care units (ICUs) across 5 countries. All patients..

Published: 19/09/2019
Authors: Barton G

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P132 Minimally invasive techniques in the management of pilonidal disease

Background Pilonidal sinus disease remains a challenging entity because of the high morbidity of most treatment options and recurrence of symptoms. Minimally invasive methods have been described to minimise the morbidity associated with wound care and reduce time off work. We undertook this systematic review to study the effectiveness of..

Published: 11/09/2019
Authors: Kalaiselvan R

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Microsurgery and Vessel Caliber Mismatch

Introduction The evolution and progress of microsurgery has brought about numerous advances but some challenges still remain. Among these are discrepancies in the vessel size. A significant size discrepancy still equates to technical difficulty and high rate of flow turbulence possibly resulting in subsequent thrombosis. This article reviews the most..

Published: 11/09/2019
Authors: Mohammad M, Adjei B, George S, Alfeky H, Mostafa A, El-Gawad A

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1013 Upper GI Cancer MDT Decision Making

Aim Management of complex oesophago-gastric cancer is difficult and decision making in multidisciplinary team (MDT) meetings may vary between centres across the country. There is currently no absolute standard for management of complex oesophago-gastric cancers. We describe the results of a scenario-based decision making survey sent out to all Upper..

Published: 01/09/2019
Authors: Cheung F, Kalaiselvan R

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0162 Outcomes of surgery following chemoradiotherapy for anal cancer: A 10-year retrospective study

Aim Anal cancer accounts for less than 1% of all cancers but carries considerable morbidity and mortality. We reviewed clinicopathological outcomes for patients undergoing surgery following chemoradiotherapy (CRT) for anal cancer. Method(s) A retrospective review of casenotes from patients undergoing surgery for anal cancer from 2008 -2018 was performed. Patients were..

Published: 01/09/2019
Authors: Liew S

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0070 Comparison of outcomes of transrectal ultrasound guided biopsy (TRUS) and transperineal template guided biopsy

Introduction With the onset of PSA testing, more people are diagnosed with prostate cancer. TRUS guided biopsies has been used as a standard in all prostate re-biopsies. With MRI scans detecting possible prostate cancer foci and the advent of template, the role of TRUS biopsy is questioned for those on..

Published: 01/09/2019
Authors: Ejikeme C, Mistry R

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Co-relation between clinical assessment, CT and intra-operative findings in emergency laparotomy. Is it time to rethink the algorithm?

Aims Although clinical diagnosis has essential value in an emergency setting, CT (computed tomography) has become the central tool of diagnosis to aid the need for emergency laparotomy. Delay in CT can often drastically alter the outcome, especially in patients over the age 60. We aimed to assess if initial clinical..

Published: 01/09/2019
Authors: Patnam V, Altaf K, Holdsworth J, Muttoni E, Rajaganeshan R

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P Th A.13 Video-assisted sinus surgery (VASS): New technique for treatment of surgical site sinus: A case series

Introduction Sinus formation after a procedure is a recognised complication. While most settle without requiring any treatment, many can continue to cause persistent symptoms. These have always been managed by exploration of the sinus tract under general anaesthetic, laying open, excision of the tract or debridement. Results post-surgery may not..

Published: 01/09/2019
Authors: Altaf K, Hajnik J, Patnam V, Rajaganeshan R

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SP 7.2.7- Role of Pre-Operative Chemical Component Separation(Botox) in Abdominal Wall Reconstruction

Aim It is accepted that CCS (Botulinum toxin A, BOTOX) is a useful pre-operative tool to enable successful AWR. UsuallyBOTOXis used in selected complex cases.We propose the routine use of CCS in allmidline defects of more than 5 cm size. To evaluate the outcome of pre-operative US guided injection of..

Published: 01/09/2019
Authors: Singh S, Atherton P, Samad A, Ross S, Benson A, Scott M

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P We F.6- Can satisfactory outcomes be achieved for Abdominal WallReconstruction (AWR) surgery in patients with a Body Mass Index (BMI)above 32kg/m2?

Introduction A high BMI has long been thought to be a negative predictive factor for post-operative outcomes. For AWR surgery, a BMI of 32 is often used as a cut-off. Due to the increasing prevalence of obesity, this is not always possible. Aim This study compared the outcomes of patients undergoing..

Published: 01/09/2019
Authors: Wright C, Singh S, Samad A, West C, Ross S, Scott M

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SP 5.9- Clinical and cost effectiveness of CT scan as first lineinvestigation in diagnosis and treatment of acute abdominal pain – Is it time to change?

Background Abdominal x-ray (AXR) is currently used as a first line radiological investigation in assessing acute abdominal pain, often followed by a CT scan, which may delay diagnosis and treatment.We aimed to assess if AXR was needed at all in assessing these patients and its impact on patient outcomes...

Published: 01/09/2019
Authors: Altaf K, Muttoni E, Holdsworth J, Patnam V, Rajaganeshan R, MacDonald S

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SP 11.5- Adoption of ‘Agile’ project management principles significantly accelerated the development of a multidisciplinary Emergency Laparotomy pathway

Aims Creating patient pathways and protocols that require the input of multiple senior clinicians can be challenging and projects may be delayed, deadlines missed, and ultimately patients may have poorer outcomes. Method(s) 'Agile' is an approach to software development using collaborative self-organizing teams, often in different locations. Trello is..

Published: 01/09/2019
Authors: Kirkham S, Vitovska E, Pantak G, Macadam R, Singh S

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A HaemSTAR-led, UK-wide 'flash-mob' audit of -intravenous immunoglobulin use in immune -thrombocytopenia

Introduction Intravenous immunoglobulin (IVIg) is a common therapy for patients with immune thrombocytopenia (ITP). The initial response rate for IVIg is 80%1 and is typically rapid, with some patients responding in 24 hours, although usually in 2–4 days.2 When IVIg is used alone, the response is relatively short, averaging around 2–4 weeks. Potential side..

Published: 13/08/2019
Authors: Loizou E, Garth L

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Re: Professional protectionism; a barrier to employing a sonographer graduate?

Wolstenhulme, S; Daulby, M. (2019). Re: Professional protectionism; a barrier to employing a sonographer graduate? . Radiography. 25 (3), 274-275

Published: 13/08/2019
Authors: Daulby M

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Suprapubic catheter change, what could go wrong?

Abstract Some patients with neurological bladder dysfunction rely on suprapubic catheters (SPCs) for the management of their urinary symptoms. These catheters are usually changed without incident. However, problems can, and do, arise. We present the case of a 56-year-old woman who had a SPC change which was complicated by the..

Published: 13/08/2019
Authors: Chidozie E

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Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury

Floyd, MS Jr; Khadr, RN. (2019). Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication? . Internatiobal Brazilian Journal of Urology. 45 (4), 860-1.

Published: 13/08/2019
Authors: Floyd Jr MS

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Boosting morale: “good job, junior”

Barton MA. (2019). Boosting morale: “good job, junior” . BMJ. 365 (24 June), l4344

Published: 13/08/2019
Authors: Barton MA

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EP282 Revising the RCA; Streamlining Root- Cause Analyses for bacteraemias on ITU

Abstract Sepsis is a leading cause of mortality within the Intensive care environment.1 Over the last 3 decades, the recognition of sepsis has greatly improved and blood cultures form an integral part of both diagnosis and management. At the authors’ institution, any detected bacteraemia is examined through a process of Root..

Published: 13/08/2019
Authors: Saunders R, Clark S, Stubbington Y, Tridente A

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EP265 De- Bugging ITU; What to do with a positive blood culture. Journal of the Intensive Care Society

Abstract Positive blood cultures form a cornerstone in the diagnosis and treatment of sepsis. Falsely positive blood cultures due to contamination pose a significant clinical conundrum for the treating clinician. We aimed to develop a tool to aid decision making in the process of distinguishing the postive from the false..

Published: 13/08/2019
Authors: Saunders R, Clark S, Tridente A, Stubbington Y

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EP229 Initial Measurement of Ideal Body Weight in Ventilated Patients to Guide Tidal Volumes

Introduction Lung hyperinflation is a known contributing factor to ventilator-induced lung injury. Tidal volume (Vt) strategies utilising 6 ml/kg targets have shown decreased mortality and fewer days of ventilation when compared to more traditional Vt approaches1,2. Early measurement of Ideal Body Weight (IBW) on admission to critical care is essential..

Published: 13/08/2019
Authors: Edwards M, Tridente A

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Short-term outcomes of endoscopic pilonidal sinus treatment

​Kalaiselvan, R; Liyanage, A; Rajaganeshan, R. (2019). Short-term outcomes of endoscopic pilonidal sinus treatment. Annals of the Royal College of Surgeons of England. 5, p1-4. Introduction : Endoscopic treatment for pilonidal disease was initially described by Meinero in 2013. This minimally invasive technique has both technical and aesthetic advantages. The diagnostic application helps..

Published: 13/08/2019
Authors: Kalaiselvan R, Liyanage A, Rajaganeshan R

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RE: Sevens and Reeves ‘Professional protectionism; a barrier to employing a sonographer graduate?’ and Mitchell and Nightingale ‘Sonography culture: Power and protectionism’

​Wolstenhulme, S. and Daulby, M.. (2019). RE: Sevens and Reeves ‘Professional protectionism; a barrier to employing a sonographer graduate?’ and Mitchell and Nightingale ‘Sonography culture: Power and protectionism’. Radiography . 25 (3), p.276 Letter to the editor: No abstract available.

Published: 09/08/2019
Authors: Daulby M

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Developing today's trainees to become tomorrow's clinical researchers - an innovative collaboration driving improvements in clinical training and research delivery

Aims: To develop a unique partnership that enables specialty trainees to become regional champions in research, contributing to the ‘delivery of best research for best health’ while gaining essential clinical research skills for their future.  Methods: The National Institute for Health Research (NIHR) UK vision is to deliver the ‘best..

Published: 09/08/2019
Authors: Loizou E

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Re: Paratesticular sarcomas: a case series and literature review

Dear Editor, We read with interest the recent paper by Keenan and colleagues ‘Paratesticular sarcomas: a case series and literature review’.1 The authors discuss the histological subtypes of paratesticular sarcomas and discuss the radiological diagnosis. Floyd, MS Jr; Omar AM. (2019). Letter to the editor re: Paratesticular sarcomas: a case series..

Published: 27/06/2019
Authors: Floyd Jr MS, Omar A

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A randomized trial of progesterone in women with bleeding in early pregnancy

Background Bleeding in early pregnancy is strongly associated with pregnancy loss. Progesterone is essential for the maintenance of pregnancy. Several small trials have suggested that progesterone therapy may improve pregnancy outcomes in women who have bleeding in early pregnancy. Methods We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate..

Published: 27/06/2019
Authors: Rao S

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Awareness of surgical expenditure amongst UK trainees and consultants

Introduction Limited knowledge of surgical device and service costs restricts a surgeon's ability to make cost efficient choices and contribute to the efficiency savings required by the NHS to reduce the financial deficit. This study aims to assess how aware surgeons are of surgical equipment and regularly used services. Methods..

Published: 27/06/2019
Authors: Blacker S

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Understanding randomised controlled trials: a guide for prescribers

​Randomised controlled trials are popular studies used to compare two or more groups or treatment interventions. Randomised controlled trials often create evidence to inform clinical practice; therefore, it is important that prescribers are able to interpret the design and findings of these studies, which support formulary and policy decisions, and..

Published: 27/06/2019
Authors: Lloyd M, Williamson J

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Letter to the editor re: Penile paraffinoma: A rare but important presentation. A Gaukroger et al.

​Letter - no abstract available. Pina, IM; Hughes, KE, Floyd, MS Jr; Shokrollahi, K; Omar, AM . (2019). Letter to the editor re: Penile paraffinoma: A rare but important presentation. A Gaukroger et al.  Journal of clinical urology . 1-2

Published: 27/06/2019
Authors: Floyd Jr MS, Hughes KE, Omar A, Pina IM, Shokrollahi K

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Re: The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study.

Comment in: REPLY TO THE AUTHORS: RE: The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. [Int Braz J Urol. 2019] Comment on: The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. [Int Braz J Urol. 2019] Floyd, MS Jr; Omar, AM; Baird, AD;..

Published: 27/06/2019
Authors: Floyd Jr MS, Omar A

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Vasculitis in Juvenile-Onset Systemic Lupus Erythematosus

​Juvenile-onset systemic lupus erythematosus (JSLE) is a rare, heterogeneous multisystem autoimmune disease that can affect any organ, and present with diverse clinical and serological manifestations. Vasculitis can be a feature of JSLE. It more commonly presents as cutaneous vasculitis than visceral vasculitis, which can affect the central nervous system, peripheral..

Published: 27/06/2019
Authors: Lythgoe H

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An anomalous accessory flexor digitorum profundus muscle to the ring finger originating from the flexor pollicis longus tendon

​Letter - no abstract available. Adjei, B; George, C; McArthur, P. (2019). An anomalous accessory flexor digitorum profundus muscle to the ring finger originating from the flexor pollicis longus tendon. Journal of hand surgery (European volume) . Published ahead of print

Published: 27/06/2019
Authors: Adjei B, George S, McArthur P

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Autoimmune encephalitis presenting with cognitive decline and hyponatraemia

The article describes the case of a 69-year-old man with a history of increasing confusion, memory loss, unsteadiness and body spasms and was diagnosed with anti leucine-rich glioma inactivated 1 (LGI1) limbic encephalitis with associated faciobrachial dystonic seizures and hyponatraemia Chin, G; Allsup, S; Fratalia, L. (2019). Autoimmune encephalitis presenting with cognitive..

Published: 26/06/2019
Authors: Allsup S, Chin G, Fratalia L

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A unique presentation of destructive shoulder arthropathy in the chronic phase of chronic myeloid leukaemia

​We present a previously unreported case of rapidly progressing, destructive shoulder arthropathy as an initial presentation of chronic phase chronic myeloid leukaemia. This patient initially presented to clinic for consideration of an arthroplasty for symptom relief; however, her loss to follow-up yielded a rapid progression of her symptoms. Bone marrow..

Published: 26/06/2019
Authors: Connolly S, Howard J, MacKenzie B, Nicholson T,

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An 11-year analysis of head and neck melanomas following Sentinel lymph node biopsy

Conference Abstract Purpose: A long-term follow-up analysis of head and neck melanoma (HNM) patients undergoing sentinel lymph node biopsy (SLNB), their outcomes, looking specifically at differences between mapping performed the day before, or of surgery. Method(s): A retrospective study of all patients undergoing SLNB for HNM from 25/10/2006 - 27/12/2017, in..

Published: 26/06/2019
Authors: Barnes J, Howes A, Shaaban H, Touil L

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Impact of frailty on critical care and hospital mortality in critically-ill patients with decompensated alcoholic liver disease

Introduction We aimed to assess the effect of frailty as assessed by Clinical Frailty Scale (CFS) and Karnofsky performance score (KPS) on critical care (CC) and hospital mortality in this group at a non-specialist tertiary critical care unit. Methods Patients admitted to critical care were identified from our electronic database..

Published: 26/06/2019
Authors: Tridente A

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Re: Late Presentation of a 9mm Bullet in the Ureteropelvic Junction

Pina, IM; Omar, AH; Floyd, MS Jr. (2019). Re: “Late Presentation of a 9mm Bullet in the Ureteropelvic Junction Causing Acute Renal Failure in a Solitary Functioning Left Kidney” by Jhaveri and D'Angelo (J Endourol Case Rep. 2018;4:173–175) . Journal of Endourology Case Reports. 5 (1), 28-29

Published: 26/06/2019
Authors: Floyd Jr MS, Omar A, Pina IM

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Exploring the impact of a pharmacist‐led feedback intervention on insulin prescribing error frequency

Aims The aim of this research was to explore the impact of pharmacist‐led feedback on insulin prescribing. Methods This study was undertaken in a large UK teaching hospital. Ward pharmacists were trained in the delivery of prescribing feedback. Definitions of insulin prescribing errors were based on the National Diabetes..

Published: 26/06/2019
Authors: Bennett N, Cardwell J, Furlong NJ, Hart A, Lloyd M, Michaels S

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Simulation-based training to support healthcare staff in the management of hypoglycaemia

Aims To evaluate the use of multiprofessional high‐fidelity simulation to educate nurses and healthcare assistants on the management of hypoglycaemia and diabetic ketoacidosis. Methods A simulation‐based training event was developed by a multidisciplinary team. Nurses and healthcare assistants on two hospital wards were invited to participate. Effectiveness of..

Published: 26/06/2019
Authors: Cardwell J, Furlong NJ, Hart A, Lloyd M, Michaels S, Rowson M

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Exploring the impact of a feedback intervention on insulin prescribing behaviour

Aims The aim of this research was to explore the impact of feedback on insulin prescribing behaviour. Method(s) Doctors that had received feedback on their insulin prescribing were invited to participate in the study. Semi-structured interviews were used to explore the potential impact of feedback on their insulin prescribing...

Published: 26/06/2019
Authors: Bennett N, Cardwell J, Furlong NJ, Hart A, Lloyd M, Michaels S

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Autologous breast reconstruction in patients with achondroplasia

Touil, LL; Saggar, AK; Taghizadeh, R. (2019). Autologous breast reconstruction in patients with achondroplasia: Reconstructive and anaesthetic challenges . Journal of plastic, reconstructive & aesthetic surgery: JPRAS. 72 (7), 1219-1243    

Published: 26/06/2019
Authors: , Touil L, Taghizadeh R

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Methodological challenges in European ethics approvals for a genetic epidemiology study in critically ill patients

Background During the set-up phase of an international study of genetic influences on outcomes from sepsis, we aimed to characterise potential differences in ethics approval processes and outcomes in participating European countries. Methods Between 2005 and 2007 of the FP6-funded international Genetics Of Sepsis and Septic Shock (GenOSept) project, we asked..

Published: 14/05/2019
Authors: Tridente A

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P3. What have Clinical Librarians ever done for us? A case study with a Regional Burns Service

Introduction In August 2016 a Clinical Librarian service was established for the first time in the Trust. In November 2016 the Clinical Librarian received a request to work with the Regional Burns Service with the purpose of fulfilling two aims: To increase the use of evidence based literature in their everyday practice..

Published: 08/05/2019
Authors: Stubbington Y, Shokrollahi K

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Review: Could this be measles?

​Infection with the measles virus causes an unpleasant disease with many potentially serious complications. It is predominantly a childhood illness but can affect any age. Measles is extraordinarily contagious, but immunisation with measles containing vaccine provides comprehensive protection. An international programme of universal immunisation from the mid-1980s has been..

Published: 08/04/2019
Authors: Nee PA, Vardhan M

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Malakoplakia of the parotid gland: a case report and review of localised malakoplakia of the head and neck

INTRODUCTION:  Malakoplakia is a rare chronic inflammatory disorder, predominantly affecting the urinary tract. In the head and neck region, it is very rare and may confuse the clinicians during investigations, as features may mimic malignancy. MATERIALS AND METHODS:   We report a case of malakoplakia involving the parotid gland and review..

Published: 29/03/2019
Authors: , Nandapalan V, Samian C, Santosh S

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Basal cell carcinoma and electrochemotherapy

Background Basal cell carcinoma(BCC) is one of the most common skin malignancies worldwide. In comparison to current management strategies for BCC, electrochemotherapy (ECT) proved to be a valid alternative in the management of primary and secondary lesions. ECT refers to intratumoural or intravenous injection of bleomycin followed by the..

Published: 12/03/2019
Authors: Liew S

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Electrochemotherapy as an adjunct to the surgical management of metastatic melanoma

Background Electrochemotherapy is a treatment for tumours in the skin, both primary and metastatic. The international Network for sharing practices on Electrochemotherapy (InspECT) group gathers information on treatment outcomes in a common database with defined, outcome parameters in order to improve and guide the use of Electrochemotherapy (ECT). Over a..

Published: 12/03/2019
Authors: Liew S

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Effect of body mass index on depression in a UK cohort of 363 037 obese patients: A longitudinal analysis of transition

​With obesity levels increasing, it is important to consider the mental health risks associated with this condition to optimize patient care. Links between depression and obesity have been explored, but few studies focus on the risk profiles of patients across stratified body mass index (BMI) classes above 30 kg/m2 . This..

Published: 12/03/2019
Authors: Muttoni E

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From Socioeconomic Disadvantage to Obesity: The Mediating Role of Psychological Distress and Emotional Eating

OBJECTIVE Lower socioeconomic status is robustly associated with obesity; however, the underpinning psychological mechanisms remain unclear. The current study sought to determine whether the relationship between lower socioeconomic status and obesity is explained by psychological distress and subsequent emotional eating as a coping strategy. It also examined whether psychological resilience..

Published: 12/03/2019
Authors: Christiansen P, Hardman CA, Spinosa J

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Minimally invasive techniques in the management of pilonidal disease

Background Pilonidal sinus disease (PD) is a chronic condition involved in natal cleft. Excision surgery carries equally morbid course of recovery to that of disease itself. Minimally invasive treatments therefore have been developed to minimise morbidity and improve healing rates. This review looks at the literature on effectiveness of endoscopic..

Published: 12/03/2019
Authors: Allen W, Bathla S, Kalaiselvan R, Liyanage A

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Checking expertise in anticipated difficult airway situations

Awake fibreoptic intubation of a patient with an obstructed upper airway is among the more challenging of airway procedures 1. A multidisciplinary approach to safe management is essential 2, with an experienced Ear, Nose and Throat (ENT) surgeon immediately available to perform emergency surgical tracheostomy should awake fibreoptic intubation performed by an..

Published: 12/03/2019
Authors: Angus W, Miller S

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Appendicectomy in older patients with acute appendicitis is not an indication for routine colonoscopy

Dear Editor In the recent article by Mohamed et al., the authors concluded that post-appendicectomy patients aged ≥ 55 years should be offered colonoscopy to exclude coexistent caecal pathology. Considering the small number of positive findings in the study, the results should be more cautiously interpreted, and few potential limitations warrant attention...

Published: 22/02/2019
Authors: Hamedelneel AO

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Porcine vs bovine surfactant therapy for preterm neonates with RDS

Background Bovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine surfactants at their licensed dose should be preferred to treat respiratory distress syndrome in preterm neonates. Methods We performed a comprehensive review of biochemical and pharmacological features of surfactants to understand the biological..

Published: 22/02/2019
Authors: Tridente A

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Front of neck access: whose responsibility is it?

Background Management of an airway is a vital skill for many specialties. Front of neck access (FONA) is often a feared and unexpected event in a ‘can’t intubate, can’t oxygenate’ (CICO) scenario. Unless a clear plan is formed, further clinical difficulties could arise [1]. The Difficult Airway Society (DAS)..

Published: 21/02/2019
Authors: Jain N, Kainth R, Kennedy T

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The impact of the 21-gene recurrence score (Oncotype DX)

Purpose The 21-gene recurrence score (Oncotype DX) (RS) informs systemic therapy decision making in ER-positive HER2-negative early breast cancer (BC). To date no study has described the more nuanced discussions that take place regarding systemic therapy or the impact of the RS on concordance in such decision making. Here..

Published: 20/02/2019
Authors: Kiernan T

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Potential use of PCSK9 inhibitors as a secondary preventative measure

Background Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a major development in the prevention of cardiovascular disease (CVD) and is one of the most significant discoveries since the development of statin therapy. Administration of two human monoclonal antibodies to PCSK9 (alirocumab and evolocumab) can significantly reduce low-density lipoprotein cholesterol (..

Published: 20/02/2019
Authors: Elamin AFM, Katira R

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P133 An evaluation of nurses’ experiences of short-term physiotherapy teaching

  Knowles, L; Buttress, S; Clayson, T. (2019). An evaluation of nurses’ experiences of short-term physiotherapy teaching on a trauma and orthopaedic unit in Ethiopia . Physiotherapy. 105 (Sup 1), e147-148

Published: 20/02/2019
Authors: Knowles L

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P057 Internet educational videos: improving functional recovery following arthroscopic meniscectomy?

  Litchfield, F; Buttress; S. (2019). P057 Internet educational videos: improving functional recovery following arthroscopic meniscectomy? . Physiotherapy. 105 (Sup 1), e93-94.

Published: 20/02/2019
Authors: Litchfield F

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An audit of the use of prothrombin complex concentration

Background Prothrombin complex concentrate (PCC) is licensed for emergency reversal of anticoagulation in severe and life-threatening bleeding, intracranial haemorrhage and prior to emergency surgery. It is an expensive resource costing approximately Eur2000 per adult dose. There is evidence of inappropriate use of PCC leading to delays to treatment, inappropriate dosing..

Published: 20/02/2019
Authors: Bonney S, Nee PA, Schofield J

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EPI-28 Neuropathic pain in ALS/MND

Background Although pain worsens quality of life for patients with ALS/MND, it is an under explored aspect of the disease (1). Objectives To investigate in ALS/MND: 1) the prevalence and severity of neuropathic pain (NP) and whether the severity of NP was associated with age, gender or disease duration; 2) whether..

Published: 20/02/2019
Authors: Syrimi ZJ

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Idiopathic intracranial hypertension in the British population with obesity

Purpose Idiopathic intracranial hypertension (IIH) is a syndrome that is characterized by persistently high intracranial pressure and associated with high rates of morbidity and visual loss. Its exact etiology and clinical picture is poorly understood, but it is known to be associated with obesity. The aim of this study was..

Published: 20/02/2019
Authors: Muttoni E

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Salvaging Digital Replantation and Revascularisation

Background Distal digital replantation and revascularisation remains one of the demanding microsurgical procedures due to the difficulty of vascular anastomosis. Venous congestion is the most commonly encountered problem after replantation due to the difficulty of venous anastomosis in traumatic injuries. Heparin, among other drugs, is commonly used to facilitate venous..

Published: 20/02/2019
Authors: McArthur P

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Multiple Lobulated Swellings: Challenge

A 51 year old man presented with a 12-month history of progressive skin nodules. They first appeared on his dorsal hands and elbows and then extended to involve up to his lower limbs. They were occasionally tender and frequently caught in his clothing. He was systemically well with no weight loss...

Published: 20/02/2019
Authors: Eustace K

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Is ferritin estimation and optimisation important in cerebral palsy children

Conclusion We conclude that preoperative haemoglobin estimation alone is not enough in cerebral palsy patients who require single-event multilevel surgery especially those with high Gross Motor Function Classification System (GMFCS) score. This study showed that these patients had low ferritin reserves and many of these patients with low ferritin reserves..

Published: 18/02/2019
Authors: Dhotare S, Mohan R

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Incidence and treatment of malignant tumors of the genitourinary tract

  Floyd, MS; Khattak, AQ. (2018). Re: Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients . International Brazilian Journal of Urology. epub 10 October  

Published: 18/02/2019
Authors: Floyd Jr MS, Khattak AQ

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The evolving role of the chaperone in medicine-protection and training

The role of the chaperone is integral in clinical examination and with this short communication aim to highlight the evolving role of the chaperone as a “witness” who with the appropriate training and standardised documentation can act as an observer of the behaviour of all parties during the consultation. Touil,..

Published: 18/02/2019
Authors: Gill P, , Sofos S, Touil L

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Exploring the impact of pharmacist-led feedback on prescribing behaviour: A qualitative study

Background Prescribing errors occur frequently in hospital settings. Interventions to influence prescribing behaviour are needed with feedback one potential intervention to improve prescribing practice. Doctors have reported a lack of feedback on their prescribing previously whilst the literature exploring the impact of feedback on prescribing behaviour is limited. Objectives To..

Published: 16/01/2019
Authors: Furlong NJ, Hardy KJ, Lloyd M

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Custom-Made Cement-Linked Distal Femoral Replacement

Abstract Interprosthetic femur fractures between total hip and total knee replacements are challenging injuries with rising incidence. Stability of the either implants, quality, and quantity of remaining bone as well as patients' comorbidities play an important role in operative management. Open reduction and internal fixation, advanced revision arthroplasty techniques, and..

Published: 24/12/2018
Authors: Emms N, Matar HE, Stritch P

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Cancelled operations: a 7 day cohort study of planned adult inpatient surgery

Background Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical..

Published: 24/12/2018
Authors: Adeney C, Behl S, Chadwick M, Coleman T, Dealing S, Ellwood J, Goel V, Kennedy T, Miller T, Reilly R, Syratt T, Welfare E

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Calcific myonecrosis: imaging and radiographic findings

  ​Matar, HE; Stritch, P; Emms, N . (2018).Calcific myonecrosis: imaging and radiographic findings. British journal of hospital medicine . 79 (11), p654

Published: 29/11/2018
Authors: Emms N, Matar HE, Stritch P

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Assessment and Management of Hypotension in the Elderly Patient

Introduction:  Elderly patients often present to the emergency department (ED) with nonspecific signs of infection and excessive fluid loss, with limited research into their management. The purpose of this audit was to assess the initial management of hypotensive elderly patients in the ED: observations within 15 min, fluid challenge within 1 h,..

Published: 29/11/2018
Authors: Jacobson MA, Kataria H

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Child abuse in Pakistan: A qualitative study of knowledge, attitudes and practice amongst health professionals

​Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan. Healthcare professionals (..

Published: 29/11/2018
Authors: Maul KM

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Achondroplasia and deep inferior epigastric artery perforator flap reconstruction

Abstract Achondroplasia is the commonest form of dwarfism, with patients presenting significant anaesthetic challenges. Airway management is problematic due to macrocephaly, midface hypoplasia and narrow nasopharynx. Neck manipulation is dangerous owing to potential pre-existing cervicomedullary stenosis. Other problems may include restrictive lung disease, obstructive sleep apnoea, difficult venous access, hypersalivation..

Published: 31/10/2018
Authors: Jain N

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Implications of deranged activated partial thromboplastin time

Summary Bleeding during and after surgery ranges from trivial to fatal. Bleeding is in part determined by the patient's coagulation status. The UK National Institute for Health and Care Excellence recommends a pre‐operative clotting test for patients with a history of abnormal bleeding. Anaesthetists are familiar with the prothrombin..

Published: 31/10/2018
Authors: Loizou E

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The myth that shames us all

Any aspect of care demands a wise balance between benefits and risks, but problems arise when these are exaggerated, minimised, ignored, or hidden. Although arguments over most drugs have been settled through evidence, the arguments over opioids have persisted despite half a century of evidence.   Coyle, S et al. (2018). The..

Published: 19/10/2018
Authors: Coyle S

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Saccular internal carotid artery aneurysm

An 84-year-old woman presented to the emergency department with a 3-day history of progressive binocular diplopia on right-sided horizontal gaze, accompanied with gradual-onset right-sided periorbital headache, vomiting and diarrhoea. Medical history consisted of hypertension and chronic kidney disease, stage 2. Clinical examination demonstrated right-sided VI cranial nerve palsy, normal pupillary light..

Published: 19/10/2018
Authors: Mohsin N

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Role of clinical psychology in UK hospices

Objective The National Institute of Clinical Excellence (NICE) (2004) guidance recommends a tiered approach to psychological care within cancer care. This includes the provision of Clinical Psychologists to support other professionals to deliver high-quality psychological care at levels 1 and 2 and to provide direct input to patients experiencing high levels of distress..

Published: 19/10/2018
Authors: Russell C

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A review of paediatric cervical spinal trauma

Abstract Significant spinal trauma in the paediatric population is uncommon. Cervical spine injuries account for approximately 1.5% of injuries. In paediatric patients a far higher proportion of injuries which affect the spinal column occur in the cervical spine in comparison with adults. The assessment of paediatric spinal injuries and radiographs can..

Published: 25/09/2018
Authors: Brown P

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Book Review: Hand Trauma Illustrated Surgical Guide of Core Procedures

  Homer, LE; George, S. (2018). Book Review: Hand Trauma Illustrated Surgical Guide of Core Procedures . Annals of Plastic Surgery. 81 (4), e2

Published: 24/09/2018
Authors: George S, Homer LE

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Decompressive craniectomy in paediatric traumatic brain injury

​ Introduction Paediatric traumatic brain injury (pTBI) is one of the most frequent neurological presentations encountered in emergency departments worldwide. Every year, more than 200,000 American children suffer pTBIs, many of which lead to long-term damage. Objectives We aim to review the existing evidence on the efficacy of the decompressive craniectomy (DC)..

Published: 24/09/2018
Authors: Muttoni E

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Idiopathic intracranial hypertension in class III obese patients

​ Objectives Idiopathic intracranial hypertension (IIH) is a syndrome characterised by persistently high intracranial pressure (ICP) in the absence of identifiable ventricular or parenchymal disease. It mainly affects obese patients, with symptoms ranging from persistent headache to complete visual loss. IIH often requires lifelong medical treatment or neurosurgical intervention. Despite its..

Published: 24/09/2018
Authors: Muttoni E

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Is 4 still the floor?

​ Abstract In her Paediatrics section editorial, Helen Thornton discusses new definitions of hypoglycaemia from the International Hypoglycaemia Study Group and their relevance to clinical care. Thornton H. (2018). Is 4 still the floor? . Journal of Diabetes Nursing. 22 (4), 31

Published: 24/09/2018
Authors: Thornton H

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Facilitating physical activity for young people with type 1 diabetes

​ Abstract It is recommended that all young people should do at least 60 minutes of physical activity each day. NICE guidance suggests that exercise should be encouraged on a regular basis in young people with diabetes to reduce the risk of developing cardiovascular disease. However, physical activity can pose additional challenges..

Published: 24/09/2018
Authors: Brown J, Thornton H

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Neonatal urticaria: Could it be CAPS?

​ Abstract A neonatal boy presented with a persistent urticarial rash. Initial investigations showed raised inflammatory markers and evidence of systemic inflammation. A working diagnosis of cryopyrin‐associated periodic syndrome (CAPS) was made, and the patient responded extremely well to Anakinra. Molecular genetic testing revealed a somatic mutation (affecting 12.5% of cells)..

Published: 24/09/2018
Authors: Eustace K

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Assessment and management of infected total knee replacements

​ Abstract Infection following total knee replacement surgery is a challenging and devastating complication. Clinical assessment including history, examination, radiographs, blood tests and knee aspirations helps to establish the diagnosis. Revision surgery is typically required to eradicate infection and restore function. This has traditionally been performed through two-stage revision surgery, although..

Published: 24/09/2018
Authors: Emms N, Matar HE, Stritch P

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Technical refinements to a validated autologous fat harvesting technique

Abstract Autologous fat transfer is used for a wide variety of reconstructive purposes and in the areas of hand, facial and breast aesthetics, primarily to treat contour and volume deficits and for tissue rejuvenation.1,2 Modifications to the originally described fat harvesting techniques have aimed to achieve a method which is..

Published: 24/09/2018
Authors: Iqbal A,

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Is there preventable mortality in the postoperative period of hip fracture patients?

​ Objective To identify the risk factors leading to increased risk of mortality in patients with neck of femur fracture treated surgically in a district hospital in UK.  Method Retrospective study of records of patients with neck of femur fracture admitted between 1 January 2017 to 31 December 2017 was made.  Results 475 patients with neck..

Published: 21/09/2018
Authors: Hamlet L, Naraen A, Roberts C

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Vessel Health and Preservation Framework

Background: Vascular access is an important part of many patient care management plans, but has unwanted risks. A working group led by the Infection Prevention Society (IPS) produced a Vessel Health and Preservation (VHP) Framework. Based on current evidence, a framework was developed for frontline staff to assess and select..

Published: 21/09/2018
Authors: Weston V

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Endourologic strategies for a minimally invasive management

  Pina, IM; Floyd Jr, MS; Stubington, SR. (2018). Re: Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion. International Brazilian Journal of Urology. 44 (4), 846-847.

Published: 21/09/2018
Authors: Floyd Jr MS, Pina IM

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Asymptomatic Indurated Plaque in a 16-Year-Old Girl

A 16 year old girl of Chinese origin presented with a 1 year history of an asymptomatic slowly enlarging lesion on the right upper thigh. There was no previous history of skin disease in the patient or any of the family members. She was otherwise well and was under no regular medications...

Published: 21/09/2018
Authors: Aslam A, Xu J

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Novel management of the under diagnosed and difficult to treat arteriosclerotic ulcer of Martorell

Abstract The aim of this case report is to raise awareness and report a novel treatment of an under diagnosed and difficult to treat form of lower limb ulceration, arteriosclerotic ulcer of Martorell. Arteriosclerotic ulcer of Martorell is an intensely painful anterolateral lower leg ulcer with necrosis, that occurs in..

Published: 20/09/2018
Authors: Brackley P

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An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service

Background Burns patients are at high risk of nosocomial infection, and Pseudomonas aeruginosa is one of the most common causes of wound and systemic infections resulting in significant morbidity and mortality in burns patients. Aim To describe an outbreak of multidrug-resistant P. aeruginosa (MDR-Pa) at a specialist burns service and..

Published: 20/09/2018
Authors: Mortimer K, Shokrollahi K, Wilkinson D

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Higher failure rate of two-stage revision for infected knee arthroplasties

Purpose To evaluate clinical outcomes of two-stage revision arthroplasty for managing infected knee arthroplasties in significantly compromised patients (host-C).   Methods This was a prospective consecutive series of two-stage revisions of infected total knee arthroplasties in host-C-type patients with a minimum 2-year follow-up using objective and patient-reported outcome measures. Thirteen consecutive..

Published: 20/09/2018
Authors: Emms N, Matar HE, Stritch P

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Simple hip dislocations in the elderly

​The hip joint is an intrinsically stable joint as a result of the bony and labral anatomy of the acetabulum and femoral head. Hip dislocations are often associated with major trauma. Pure or simple dislocations without associated fractures are rare (Foulk and Mullis, 2010). Elderly patients tend to have hip or..

Published: 29/08/2018
Authors: Attar FG, Matar HE

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Sepsis 3 and the burns patient: do we need Sepsis 3.1?

Sepsis definitions and their relevance to the burns patient Sepsis has been described as ‘one of the oldest and most elusive syndromes in medicine’. Since ancient times, the human mind has been able to conceptualise infection and the possibility of its spread from a localised area to the rest of..

Published: 29/08/2018
Authors: Tridente A

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Could this be whooping cough?

Whooping cough is a notifiable bacterial respiratory infection caused by Bordetella pertussis . It may produce serious disease, especially in immunocompromised individuals and very young children. The number of reported cases increases in the winter months and the incidence peaks every 4–5 years. However, this periodicity is variable and is inconsistent between..

Published: 24/08/2018
Authors: Nee PA, Vaidya A, Vardhan M

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Inferiorly based lotus petal flap & laser therapy in difficult pilonidal sinus management

​Aim To assess the efficacy of the lotus petal flap in difficult pilonidal sinus management. Background Pilonidal sinuses may be difficult to treat. Five year recurrence rates range from 18% to 50% Recurrence rates fall with primary closure rather than healing by secondary intention. Techniques such as z-plasty however, distort natal architecture...

Published: 24/08/2018
Authors: Hamnett K, Iqbal A, Nagarajan M

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Malignant proliferating trichilemmal tumour

Proliferating trichilemmal tumours are benign but locally aggressive skin neoplasms arising from hair follicles. Rarely, they can become malignant and must be appropriately managed to prevent recurrence and metastasis. One must have a low threshold for diagnosing this rare neoplasm ​Singh, P; Usman, A; Motta, L; Khan, I.. (2018).Malignant proliferating..

Published: 24/08/2018
Authors: Khan I, Usman A

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Palliative care in the emergency department

​ Background: Despite a fast-paced environment, the emergency clinician has a duty to meet the palliative patient’s needs. Despite suggested models and interventions, this remains challenging in practice. Aim: To raise awareness of these challenges by exploring the experience of palliative care patients and their families and informal carers attending..

Published: 15/08/2018
Authors: Cooper E

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Core obstetric anaesthesia: A comparison of three models of training

​ Introduction It has been previously documented that over 25% of anaesthetic trainees feel underprepared to enter obstetric on-calls following core obstetric anaesthesia training. The RCoA mandate that core trainees complete the Initial Assessment of Competence in Obstetric Anaesthesia before starting on-call duties. There are different ways to structure training to meet..

Published: 15/08/2018
Authors: Kennedy T

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Blood tests required before labour neuraxial block: A midwife-focused service intervention

Introduction There is no guidance in the UK on what blood tests are required before neuraxial block, or their timing. In labouring women, the decision regarding the safety of spinal and epidural block is left to each individual anaesthetist. This leads to delays in delivery of epidural analgesia and results..

Published: 15/08/2018
Authors: Gerrard C

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Cautionary Tales of Tachypneic Infants in the Bronchiolitis Season

​ Abstract Although the diagnosis of bronchiolitis is usually straightforward, cardiac, metabolic, musculoskeletal and hematological conditions may present in a similar way and therefore, should not be overlooked. Methods We describe four cases presenting with increased work of breathing that were treated initially as bronchiolitis. However, the progressive clinical course of..

Published: 15/08/2018
Authors: Chilukuri L

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Can internal surgical adhesive facilitate drain-free mastectomy?

​Introduction Mastectomy closure without drains has many potential advantages. This study compares a lysine-based high strength adhesive with standard wound drain application.  Methods An ethically approved post-market non-inferiority multicentre randomized trial compared standard closure with drains (SWC) vs drain-free closure with adhesive (DFTG) in mastectomy +/-SLNB. Primary outcome was the..

Published: 15/08/2018
Authors: Kiernan T

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Increased recurrence in Scarf osteotomy for mild & moderate hallux valgus with Meary’s line disruption

​Background Scarf osteotomy for hallux valgus is a successful procedure. Neverthless recurrence of deformity is reported as 5–8%. First ray instability is a recognised risk factor for recurrence. We investigate whether a radiographic marker such as Meary’s line can be used to predict recurrence. This paper aims to test the..

Published: 15/08/2018
Authors: Bagshaw O, Ballester J, Conway L, Faroug R

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Comparison of pharmacy technicians’ and doctors’ medication transcribing errors at hospital discharge

Objectives  To compare the transcribing error rates of discharge prescriptions between pharmacy technicians and doctors in an acute hospital setting.   Methods  Pharmacy technicians were trained in the transcribing of discharge medications from inpatient to discharge medication charts. Prospective prescribing audits were undertaken over 5 days on eight hospital medical wards by..

Published: 14/08/2018
Authors: Lloyd M

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Mini-delayed reverse flow sural artery flap: Maximising the reach and minimising the hospital stay

​Aim Microsurgical free tissue transfer is the gold standard for reconstruction of the lower leg defects. However it can be technically difficult or unavailable, hence local tissues can provide the solution. The distally based sural artery flap with or without delaying is one of the available options. Methods 14 patients with..

Published: 14/08/2018
Authors: Alfeky H

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Improvement in hand trauma service at a regional plastics surgery unit in merseyside (BSSH Guidelines)

​Aim The 2007 British Society for Surgery of the Hand (BSSH) guideline contains the timeframe in which all hand trauma needs to be assessed and managed. Whiston Hospital is one of the regional plastic surgery units in the UK. An institutional audit performed in 2015 found the overall compliance with the guideline..

Published: 14/08/2018
Authors: Adjei B, Alfeky H, Bell D, Kelsey C, Nair M

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Single centre outcomes of surgery following chemoradiotherapy for anal cancer

​Aim Anal cancer accounts for less than 1% of all cancers but carries considerable morbidity and mortality. We reviewed clinicopathological outcomes for patients undergoing surgery following chemoradiotherapy (CRT) for anal cancer. Methods A retrospective review of casenotes from patients undergoing surgery for anal cancer from 2008-2017 was performed. Patients were identified..

Published: 14/08/2018
Authors: Liew S

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Maximising the outcomes of proximal upper limb replantation

​Aim Proximal hand and forearm amputations are devastating injuries, the prediction of the success is always uncertain due to multi factorial risk factors including the mode of injury, level of amputation, presence of contamination and the extent of the damage to the neuro-vascular tree. General patient status and co-morbidities affect..

Published: 14/08/2018
Authors: Alfeky H

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Perforator based V-Y flaps: Versatility in upper lip reconstruction

​Aims The upper lip is a unique unit of the face which is formed of three subunits itself. Upper lip cancer is one of the commonest cancers plastic surgeon have to deal with. With the paucity of tissues in this anatomically special area, it is difficult some times to reconstruct..

Published: 07/08/2018
Authors: Alfeky H

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Laparoscopic right hemicolectomy – dissection before ligation

​Aims Laparoscopic right hemicolectomy (LRH) is the standard for removal of right-sided colon cancers. Commonly, vessel ligation occurs before mobilisation of the colon or lateral to medial dissection from the caecum. We describe the outcomes of an alternative method: mobilise from transverse colon so that retroperitoneal structures are visible before..

Published: 07/08/2018
Authors: Cheung F, Kalaiselvan R, Samad A, Telfer R

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A Z-plasty training model

Aims The Z-Plasty is often a difficult concept for the trainee to design and execute. Our aim was to simulate a scar that needs either re-orientation or lengthening. Method The authors researched fabrics with different properties (strength, elasticity and anisotropy) along with mechanisms to simulate scar tension. A number of..

Published: 07/08/2018
Authors: Alfeky H, Bell D, Khan I,

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Adjuvant bevacizumab for melanoma patients at high risk of recurrence

​Background Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor (VEGF) shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and Methods Patients with resected AJCC stage IIB, IIC and III cutaneous..

Published: 24/07/2018
Authors: Marshall E

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Book Review: Handbook of Otolaryngology

  Asmar, O and George, S. (2018). Book Review: Handbook of Otolaryngology. Annals of Plastic Surgery. 81 (2), 140

Published: 24/07/2018
Authors: Asmar O, George S

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Lung cancer stage-shift following a symptom awareness campaign

Background  Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes.   Methods  An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates..

Published: 24/07/2018
Authors: Malhotra P

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Paediatric cystolitholapaxy through the Mitrofanoff/Monti channel

Abstract We read with interest the recent publication by Thomas et al. detailing the first series of 13 cases of paediatric cystolitholapaxy via either the Mitrofanoff or the Monti channel. Specific to this series no complications were reported and holmium laser fragmentation was used in one case only but the time..

Published: 24/07/2018
Authors: Floyd Jr MS, Pina IM

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Long-term persistence with rituximab in patients with rheumatoid arthritis

Objectives To investigate the long term persistence of rituximab (RTX) in a large observational RA cohort, investigate persistence of RTX when used as a first or second line biologic DMARD (bDMARD), to characterize subsequent bDMARD treatment following RTX. Methods Patients with RA starting treatment with RTX (MabThera) between 2008 and 2011 were..

Published: 24/07/2018
Authors: Abernethy R

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Improved analgesia by correction of hypomagnesaemia?

Abstract The role of magnesium as an analgesic in patients is unclear. Hypomagnesaemia is a common electrolyte abnormality, in the chronic state symptoms are insidious and often non-specific. It is often undiagnosed and thus untreated. There is evidence from animal studies that magnesium is involved in pain control including an..

Published: 24/07/2018
Authors: Coyle S

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A multidisciplinary simulation training programme in the hyperacute stroke unit

Background and Aims High-quality care of stroke patients delivered on Hyperacute Stroke Units (HASUs) has been one of the primary contributors to reductions in stroke mortality and institutionalisation. Effective multidisciplinary management of the unwell stroke patient is an essential skill unique to this environment. Simulation training is a well-recognised means..

Published: 10/07/2018
Authors: Attwood K, Hill AM, Rowson M, Seed A

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Contemporary management of ureteral strictures

Abstract Ureteral stricture disease is a luminal narrowing of the ureter leading to functional obstruction of the kidney. Treatment of strictures is mandatory to preserve and protect renal function. In recent times, the surgical management of ureteral strictures has evolved from open repair to include laparoscopic, robotic and interventional techniques...

Published: 10/07/2018
Authors: , Javed S, , McCabe JE, Wong K

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Pain and outcomes of carpal tunnel release

Abstract We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a tourniquet..

Published: 10/07/2018
Authors: Doorgakant A, Iqbal HJ, Lipscombe S, , Ramavath AL, Rehmatullah NNT

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Formulating a Patient Concerns Inventory specific to adult burns patients

Background Over the past century, advances in the care of the burned patient have been unprecedented. Mortality has decreased significantly owing to our improved understanding of the pathophysiological response to injury and progress in intensive care, nutrition, surgical techniques and infection control. Subsequently, there has been a paradigm shift from..

Published: 10/07/2018
Authors: Shokrollahi K

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Optic Disc Pit Maculopathy Triggered by Childbirth

Abstract We describe a case of a healthy lady with a known optic disc pit who developed serous maculopathy a few hours after childbirth. We believe this is the first published description of a trigger factor responsible for serous macular detachment in eyes known to have a disc pit. She..

Published: 08/06/2018
Authors: Akram I

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A survey of learning methods

  Mohamed, S; Dunne, J; Rawlins, J. (2018). A survey of learning methods used by Plastic Surgery and Anaesthetics trainees in burn care. Burns. 44 (4), 1023.

Published: 08/06/2018
Authors: Mohamed S

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Low cost "commercial off-the-shelf" software in busy pain clinic

Objectives Online based surveys offer unprecedented degree of flexibility to a physician conducting audit of their patients' experiences after clinical intervention. They also enhance patient's experience by offering a convenient process to feedback their progress to their treating physician. The physician's affiliating organisation benefits too by employing a low cost..

Published: 08/06/2018
Authors: Clayton J, Levshankov K

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Transition to adulthood with a bladder augmentation

  Pina, IM; Omar, AM; Khadr, RN; Floyd, MS Jr . (2018). Re: Transition to adulthood with a bladder augmentation: histopathologic concerns. International Brazilian Journal of Urology. 44 (epub 3 March)

Published: 05/06/2018
Authors: Floyd Jr MS, Omar A, Pina IM

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Haematology Speciality Trainees Driving NIHR Clinical Research

Abstract In 2016, the NIHR Haematology National Speciality Group founded a pilot programme to develop the clinical research skills of Haematology trainees within Non‐Malignant Haematology (NMH). This unique initiative has since been rolled out successfully throughout CRNs nationwide and equips Haematology trainees with the skills to become future leaders in..

Published: 05/06/2018
Authors: Loizou E, Nicholson T

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Book Review: New Concepts on Abdominoplasty and Further Applications

  Alfeky, H; George, S; Shokrollahi, K. (2018). Book Review: New Concepts on Abdominoplasty and Further Applications. Annals of Plastic Surgery. 80 (6), 595

Published: 05/06/2018
Authors: Alfeky H, George S, Shokrollahi K

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Infected total hip replacements

Abstract Infected total hip replacements pose a diagnostic and management challenge. Careful history, clinical examination, blood tests, plain radiographs and hip aspiration are all part of the clinical assessment. International consensus on establishing the diagnosis helps surgeons to formulate management plans. Management strategies include debridement and prosthesis retention, single-stage revision,..

Published: 05/06/2018
Authors: Emms N, Matar HE, Stritch P

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British Thoracic Society quality standards for the investigation and management of pulmonary nodules

Introduction  The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Methods  Development of..

Published: 18/05/2018
Authors: Malhotra P

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Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects

Extract I should like to thank Drs. Chang, Esmaeli, and Butler for citing my article, “Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects,” in their recent CME article in Plastic and Reconstructive Surgery. May I respectfully point out, however, that this otherwise most helpful article perpetuates..

Published: 18/05/2018
Authors: Morton J

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Exploring hospital pharmacists’perceptions of their medication communication with prescribers

Abstract Prescribing errors are common and problematic in hospital settings in the UK. Pharmacists have been described as integral in the interception of prescribing errors, with effective medication communication between pharmacists and prescribers important to resolve and optimize prescribing outcomes. However, poor communication between healthcare professionals, including pharmacists and prescribers,..

Published: 16/05/2018
Authors: Furlong NJ, Hardy KJ, Lloyd M

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Calcific myonecrosis: diagnostic dilemma

Abstract Calcific myonecrosis is a rare benign condition affecting mainly the muscles of a single leg compartment. It is thought to follow a history of trauma with a latent period of years. Patients present with a slowly growing mass. Differential diagnosis from a malignant tumour can be made from the..

Published: 16/05/2018
Authors: Connolly S, Emms N, Matar HE, Stritch P

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Does magnesium sulfate have a role in the management of severe traumatic brain injury

Introduction  Traumatic brain injury (TBI) is a significant cause of combat morbidity. Currently, the medical management of TBI is limited to supportive critical care. Magnesium sulfate has been studied as a potentially beneficial therapeutic agent. Methods  A systematic review and meta-analysis was undertaken, examining the role of magnesium in the..

Published: 16/05/2018
Authors: Blackshaw WJ

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Electrochemotherapy for Breast Cancer—Results From the INSPECT Database

Background Cutaneous recurrence from breast cancer can pose a clinical challenge. It might be the only disease site, or could be part of disseminated disease, and often profoundly affects quality of life. Electrochemotherapy is a palliative treatment using electric pulses to locally permeabilize tumor cells and thereby significantly increase bleomycin..

Published: 16/05/2018
Authors: Liew S

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Admission to our frailty unit reduces length of stay and readmission rate

Background Comprehensive Geriatric Assessment (CGA) improves outcomes for older people admitted to hospital as an emergency. Our Frailty Unit (FU) provides rapid access to CGA for frail older people. We compare outcomes for patients admitted to the FU with patients who have been accepted for the unit but are admitted..

Published: 14/05/2018
Authors: Bussin J, Horner M, Oakdene G

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Book Review: Operative Management of Vascular Anomalies

George, SC; Shokrollahi, K. (2018). Book Review: Operative Management of Vascular Anomalies . Annals of Plastic Surgery. 80 (5), 467

Published: 14/05/2018
Authors: George S, Shokrollahi K

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Medically expulsive therapy (MET) has no benefit in improving spontaneous stone passage (SSP)

Introduction & Objectives There is conflicting evidence on the role of medical expulsive therapy (MET) in spontaneous stone passage in patients with acute ureteric colic. Randomised trial data has not shown a role for MET use, though these have been underpowered to explore its role in specific patient subgroups. It is..

Published: 14/05/2018
Authors: Mbuvi J

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G418 The clinical spectrum of dorsal stream dysfunction in autism

Aims  Bilateral dysfunction of the parieto-occipital cortex, linked to the visual cortex by the dorsal stream, variably produces simultanagnosia (SIM), optic ataxia (OA), and gaze apraxia. This triad, rarely reported in childhood, comprises ‘Balint syndrome’. ‘Dorsal stream dysfunction’ (DSD) describes milder degrees of this disorder. This study aimed to determine..

Published: 11/05/2018
Authors: Assheton D

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Severe perianal dermatitis following surgical correction of Hirschsprung disease

  Walsh, M; Boardman, G; MacBeth, K. (2018). Severe perianal dermatitis following surgical correction of Hirschsprung disease successfully managed with topical sucralfate. British Journal of Dermatology. 178 (2)

Published: 11/05/2018
Authors: Boardman G, MacBeth K, Walsh ML

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P576 Impact of improved access to biologic therapies and physician engagement on excess steroid exposure: Results from a UK audit of 3561 patients

Background Steroid-free remission is an important goal of IBD therapy. Improved access to effective therapies and changes in physician awareness of excess steroid exposure might impact this goal. The aim of this study was to evaluate temporal changes in steroid prescribing in UK IBD outpatients in the context of major..

Published: 09/04/2018
Authors: Bassi A

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Magnetic resonance imaging signal artefacts

Abstract We report a case of exuberant artefacts on the magnetic resonance imaging scan of the elbow produced by invisible metal debris secondary to previous surgery.   Makki, D; Naikoti, K; Murali, SR. (2018). Magnetic resonance imaging signal artefacts from invisible metal debris following surgery to the elbow. Shoulder & Elbow. 10 (2), 133-135

Published: 09/04/2018
Authors:

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Hand burns surface area: A rule of thumb

Introduction Rapid estimation of acute hand burns is important for communication, standardisation of assessment, rehabilitation and research. Use of an individual’s own thumbprint area as a fraction of their total hand surface area was evaluated to assess potential utility in hand burn evaluation. Materials and methods Ten health professionals..

Published: 20/03/2018
Authors: Dargan D, Mandal A, Shokrollahi K

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Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty

A light bulb moment in the late 2000s during a tricky otoplasty operation resulted in me raising the postauricular fascia based distally (anteriorly) rather than proximally as previously described. It was immediately apparent that this versatile tissue could play a greater role in the development of otoplasty than simply covering..

Published: 20/03/2018
Authors:

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Checking expertise in anticipated difficult airway situations

Awake fibreoptic intubation of a patient with an obstructed upper airway is among the more challenging of airway procedures. A multidisciplinary approach to safe management is essential, with an experienced Ear, Nose and Throat (ENT) surgeon immediately available to perform emergency surgical tracheostomy should awake fibreoptic intubation performed by an..

Published: 20/03/2018
Authors: Angus W, Miller S

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Analgesic efficacy of bilateral superficial cervical plexus block

Background Thyroid surgery is moderately painful, but is increasingly being considered as a day-case procedure. Bilateral superficial cervical plexus block (BSCPB) provides an adjuvant technique to facilitate this approach, but there is great evidential heterogeneity in randomised controlled trials (RCTs) about its use. Methods A systematic search, critical appraisal, and..

Published: 20/03/2018
Authors: Khirwadkar R

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Percutaneous Suprapubic Cystolitholapaxy

Floyd, MS Jr; Stubington, SR. (2018). Re: Percutaneous Suprapubic Cystolitholapaxy in Adult Patients with Previous Mitrofanoff Repair: Considerations for the Interventional Radiologist. Journal of Vascular and Interventional Radiology. 29 (2), 291

Published: 20/03/2018
Authors: Floyd Jr MS

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Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects

  Morton, JD. (2018). Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects. Plastic and Reconstructive Surgery. epub 18 Jan 

Published: 12/02/2018
Authors: Morton J

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Difficult airway update for ODPs: a quality improvement project

Management of the difficult airway requires familiarity with equipment and algorithms alongside well-rehearsed skills in their implementation. This demands effective collaboration between anaesthetists, ODPs and others, enabling successful execution of techniques in a crisis. NAP4 identified concerns including lack of education and training, inadequacy of skilled staff or equipment and..

Published: 12/02/2018
Authors: Jain N, Rodgers K

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How do junior anaesthetists manage the obese airway?

​ In 2014, it was estimated that 35% of men and 28% of women would be obese, rising to 47% and 36% respectively by 2025. Methods Based on the Society for Obese & Bariatric Anaesthetist's (SOBA) guidelines, we retrospectively collected data regarding airway management for obese patients undergoing emergency surgery. Results All patients (n = 49) had a BMI > 35. Thirty-seven..

Published: 12/02/2018
Authors: Khirwadkar R, Salvage G, Spilsbury Z

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Surgical trauma induces overgrowth in lower limb gigantism

Summary We describe an unclassified overgrowth syndrome characterised by unregulated growth of dermal fibroblasts in the lower limbs of a 35-year-old woman. A PIK3CA gene mutation resulted in lower limb gigantism. Below the waist, she weighed 117 kg with each leg measuring over 100 cm in circumference. Her total adiposity was 50%..

Published: 12/02/2018
Authors: Graham K

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Current practice in early management of neonatal respiratory distress syndrome

​ Hendriks, G; Stephenson, R; Yajamanyam, PK. (2017). Current practice in early management of neonatal respiratory distress syndrome: Is it evidence-based?  Archives of Disease in Childhood Fetal & Neonatal Edition. epub 23 Dec.

Published: 12/02/2018
Authors: Hendriks G

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A bifid reversed palmaris longus muscle causing median nerve compression in a child

​Letter. George, S. and Hassan, Z. (2018). A bifid reversed palmaris longus muscle causing median nerve compression in a child. Journal of hand surgery (European volume). Published online 10th January

Published: 01/02/2018
Authors: George S, Hassan Z

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Is management in school the key to quality improvement?

​National Paediatric Diabetes Audit results published in February 2017 for the first time show a significant improvement in diabetes control, with the median HbA1c nationally being 64.5 mmol/mol (8.1%), see Figure 1 (Royal College of Paediatric and Child Health [RCPCH], 2017). This exceeded the trajectory that was seen by our European colleges some..

Published: 04/01/2018
Authors: Thornton H

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Derivation and validation of a prognostic model for postoperative risk stratification of critically ill patients with faecal peritonitis

​Background: Prognostic scores and models of illness severity are useful both clinically and for research. The aim of this study was to develop two prognostic models for the prediction of long-term (6 months) and 28-day mortality of postoperative critically ill patients with faecal peritonitis (FP). Methods: Patients admitted to intensive care..

Published: 04/01/2018
Authors: Tridente A

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Critical care pharmacy workforce: UK deployment and characteristics in 2015

​Objective: Clinical pharmacists reduce medication errors and optimize the use of medication in critically ill patients, although actual staffing level and deployment of UK pharmacists is unknown. The primary aim was to investigate the UK deployment of the clinical pharmacy workforce in critical care and compare this with published standards...

Published: 04/01/2018
Authors: Barton G

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Video-assisted anal fistula treatment: a high volume unit initial experience

​ Introduction: Perianal fistulas are a common problem. Video-assisted anal fistula treatment is a new technique for the management of this difficult condition. We describe our initial experience with the technique to facilitate the treatment of established perianal fistulas. Methods: We reviewed a prospectively maintained database relating to consecutive patients undergoing..

Published: 04/01/2018
Authors: Appleton ND, Chadwick M, Cheung F, Kalaiselvan R, Nicholson J, Rajaganeshan R, Rout S, Samad A

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Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes: International Comparison Across Three Continents. Diabetes Care 2017;40:1034–1040

​Letter. Craig, M. E.; Prinz, N.; Thornton, H. et al. (2017). Response to Comment on Craig et al. Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes: International Comparison Across Three Continents. Diabetes Care 2017;40:1034–1040 . Diabetes Care . 40 (11), e168-169

Published: 04/01/2018
Authors: Thornton H

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0951: Frailty and functional status as decision factors regarding admission to critical care

INTRODUCTION Pressure on Critical Care (CC) services is significant, with a progressively more complex patient population with increasing comorbidities. Admission may be inappropriate if the patient is unlikely to benefit from it. Guidance published in the past may no longer reflect current practice [1–2]. Clinical frailty is associated with worse outcomes..

Published: 03/01/2018
Authors: Andrews FJ, Feeney J, Tridente A

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eP146: Development of digital video resources for goals of diabetes education: A UK structured education programme

Objective Goals of Diabetes Education is a structured educationprogramme that has been designed to enhance the knowledge, confi-dence and skills of all Children & Young People with Type 1 diabetes and contribute to their physical, social and emotional wellbeing. Introduced in 2016 in the UK this age related competency framework provides a scaffolding..

Published: 03/01/2018
Authors: Thornton H

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0058: Ventilator associated pneumonia: A Cheshire & Mersey critical care network pilot audit

INTRODUCTION Ventilator associated pneumonia (VAP) is an important Intensive Care Unit (ICU) associated infection. VAP is associated with increased mortality, length of stay & cost. ICUs should have standardised systems in place to monitor VAP rates1 . Currently there is no unifying definition of VAP & many of the current definitions in use..

Published: 03/01/2018
Authors:

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0063: Development of a clinical criteria for diagnosing and monitoring

INTRODUCTION It is estimated that ventilator-associated pneumonia (VAP) occurs in 10-20% of patients in intensive care1 . Despite advances in prevention strategies, there remains a lack of consensus on standard criteria for clinical diagnosis of VAP. Although surveillance programmes are available, questions remain about their suitability as a clinical diagnostic tool2 ...

Published: 03/01/2018
Authors:

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0820: A prognostic model for post-operative risk stratification of critically ill patients with faecal peritonitis

INTRODUCTION Prognostic models of illness severity are useful both clinically and for research purposes. A specific tool for prognostication in critically ill patients with faecal peritonitis is not available. OBJECTIVES We aimed to develop two prognostic models, for the prediction of 6 months and 28 day mortality of post-operative critically ill patients..

Published: 03/01/2018
Authors: Tridente A

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Book Review: Dupuytren Disease and Related Diseases The Cutting Edge

​Book review. Gill, P.; Shorollahi, K. (2017). Book Review: Dupuytren Disease and Related Diseases The Cutting Edge . Annals of plastic surgery . 79 (6), p532

Published: 03/01/2018
Authors: Gill P, Shokrollahi K

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Minding the gap: future challenges from acid attacks to mass casualty events

​Armed with an increased government mandate for charities to contribute more substantively to gaps in UK healthcare delivery, The Katie Piper Foundation’s overarching ambition to establish tangible rehabilitation for burns and scars outside of the acute hospital setting (and fulfilling as-yet-unrealised criteria of UK burn care standards, which have..

Published: 03/01/2018
Authors: Shokrollahi K

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Impact of operator volume for percutaneous coronary intervention on clinical outcomes: what do the numbers say?

​ Abstract: The impact of operator and centre volume on clinical outcomes and quality of care has been of considerable debate in recent years in a number of surgical- and procedural-based specialities. A relationship between higher volumes at both the institutional and operator levels and better clinical outcomes would at first..

Published: 03/01/2018
Authors: Rashid M

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655P: Safety of neoadjuvant/adjuvant chemotherapy for gastroesophageal cancers: A single cancer centre experience

Background: Neoadjuvant/adjuvant chemotherapy for gastroesophageal cancers leads to improvement in overall survival and is currently a standard practice. We performed a retrospective study at the Clatterbridge Cancer Centre to examine its safety and identify risk factors. Methods: Patients with gastroesophageal cancers who received cisplatin/5-FU based neoadjuvant and/or..

Published: 03/01/2018
Authors: Cave G

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A multi-centre audit of excess steroid use in 1176 patients with inflammatory bowel disease

​BACKGROUND: Corticosteroids are central to inducing remission in inflammatory bowel disease (IBD) but are ineffective maintenance agents. AIM: To benchmark steroid usage in British outpatients and assess factors associated with excess exposure. METHODS: We recorded steroid use in unselected IBD outpatients. Cases meeting criteria for steroid dependency or excess were..

Published: 03/01/2018
Authors: Bassi A

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Letter to the Editor re: Vieira et al. Abdominal wall endometriosis

​No abstract. Floyd M.S.and Baird A.D.. (2018). Letter to the Editor re: Vieira et al. Abdominal wall endometriosis. Journal of Clinical Urology . 11 (1), p62-63

Published: 03/01/2018
Authors: Floyd Jr MS

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Video Assisted Peri-anal Abscess Treatment (VPAT+) - Video Vignette

Abstract: We submit a video vignette describing how to perform a video-assistant peri-anal abscess drainage plus insertion of a draining seton. We have been using this technique within the NHS for two years successfully to manage acute perianal abscesses  Rajaganeshan, R. and Nicholson, J. A.. (2017). Video Assisted Peri-anal Abscess Treatment (..

Published: 02/01/2018
Authors: Nicholson J, Rajaganeshan R

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A European, Observational Study of Endocrine Therapy Administration in Patients With an Initial Diagnosis of Hormone Receptor-Positive Advanced Breast Cancer

Background: Despite guideline recommendations, reports suggest that a proportion of patients with hormone receptor (HR)-positive locally advanced or metastatic breast cancer (LA/MBC) might not receive endocrine therapy. The aims of this study were to estimate the proportion of postmenopausal patients with an initial (primary) diagnosis of HR-positive LA/..

Published: 02/01/2018
Authors:

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Re: Unusual intravesical foreign body

Extract We read with interest the recent case of an unusual intravesical foreign body reported by Bansal et al. (1). A case is presented of an 18 year old female who presented with lower tract symptoms and was found to have a supratrigonal fistula following self insertion of a plastic pen per..

Published: 22/12/2017
Authors: Floyd Jr MS, Omar A, Khattak AQ

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An endophytic squamous cell carcinoma of the distal phalanx masquerading as a bone cyst

Whittam, A; Hassan, Z. (2018). An endophytic squamous cell carcinoma of the distal phalanx masquerading as a bone cyst . Journal of Hand Surgery (European Volume). 43 (2), 210-211

Published: 22/12/2017
Authors: Whittam AM, Hassan Z

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Exploring pharmacist experiences of delivering individualised prescribing error feedback in an acute hospital setting

​ Highlights • Delivery of prescribing error feedback is valued by hospital pharmacists and considered sustainable • Pharmacists report altered prescribing behaviour and improved prescribing following receipt of feedback • Pharmacists report greater team-work and prescriber communication following delivery of feedback • Delivering prescribing error feedback can improve the self-confidence and self-worth of pharmacists Lloyd,..

Published: 20/12/2017
Authors: Lloyd M, Furlong NJ, Hardy KJ, O'Brien S

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Electrochemotherapy of unresectable cutaneous tumors with reduced dosages of intravenous bleomycin: analysis of 57 patients from the InspECT (International network for sharing practices of ElectroChemoTherapy) registry

​ Abstract BACKGROUND: Electrochemotherapy (ECT) is currently used to treat unresectable superficial tumors of different histotypes through the combination of cytotoxic chemotherapy and local application of electric pulses. In 2006, a collaborative project defined the ESOPE (European Standard Operating Procedures of Electrochemotherapy) guidelines to standardize the procedure. The International Network for Sharing..

Published: 20/12/2017
Authors: Liew S

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43: Management of acute low back pain in the ED: a systematic review

​ Abstract STUDY OBJECTIVE: There is no consensus on the management of low back pain in the ED and evidence suggests that these patients are likely to receive unwarranted imaging and inappropriate opioid prescription.The purpose of this study is to review the available literature pertaining to the clinical management of..

Published: 20/12/2017
Authors: Ashbrook J

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Postmenopausal craniofacial hyperhidrosis

Summary: Hyperhidrosis is a condition marked by excessive sweating, which can either be localized or generalized. Primary focal hyperhidrosis (PFH) can arise from the palms, plantar feet, axillae and also from the face and scalp. PFH primarily affects a younger population of children and young adults, with the majority presenting..

Published: 20/12/2017
Authors: Eustace K

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110 - Development of postoperative renal dysfunction and anaemia following an elective total knee replacement

​ The guidelines for the provision of anaesthesia services state that patients undergoing major joint replacement are often elderly, with co-existing medical conditions [1]. Peri-operative acute kidney injury is a leading cause of morbidity and mortality [2].  Methods  We conducted retrospective data collection of 194 patients who underwent an elective primary total knee replacement..

Published: 19/12/2017
Authors: Murray D, Fletcher J, Yoxall PF

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35 - Introduction of a learning checklist: a survey of trainees

Methods  Following the publication of an educational checklist in the RCoA Bulletin [1], we introduced an adapted checklist in our anaesthetic department as an aid to maximising the learning potential for trainees during operating lists. The checklist was incorporated into the induction packages for new anaesthetic trainees of all grades at..

Published: 19/12/2017
Authors: Kainth R

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Book Review: Deep Sternal Wound Infections

Mandal, A; Shokrollahi, K. (2017). Book Review: Deep Sternal Wound Infections . Annals of Plastic Surgery. 79 (3), 235

Published: 15/11/2017
Authors: Mandal A, Shokrollahi K

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A rare case of suspected perineal nodular induration

Abstract We read with interest the recent paper by Awad et al in which a rare case of perineal nodular induration (PNI) is reported and the surgical technique employed to remove the benign pseudotumour is described. The authors allude to the multiple names for perineal nodular induration (PNI) or biker’..

Published: 15/11/2017
Authors: Floyd Jr MS, Khattak AQ, Omar A

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Case Study: Clinical Governance and review of stroke data

Challenge To minimise delays to hyper-acute stroke unit (HASU) admission for all stroke patients. Solution We developed a system for checking and reviewing data. This governance process aims to help team members understand why there may be delays in getting patients to the stroke unit.   Hill, AM. (2017). Clinical Governance and..

Published: 13/11/2017
Authors: Hill AM

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False acute kidney injury alert due to model car fuel ingestion

Summary We report a case of accidental ingestion of model car fuel (Optifuel) resulting in an apparent elevation of serum creatinine of 274 µmol/L (3.1 mg/dL) as measured by the Jaffe (alkaline picrate) reaction, which resulted in an acute kidney injury (AKI) stage 3 alert being reported. Optifuel contains nitromethane, which..

Published: 29/09/2017
Authors: Powell D, Scholes D, Al-Jubouri M, Hassall L

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Autologous fat grafting for scars, healing and pain: a review

​ Introduction: Current guidelines suggest a multimodal approach to treating scars but there is no gold standard for treatment; however, there is exciting therapeutic potential for the use of autologous fat grafting (AFG). Functional and aesthetic improvements have been reported, including pain relief and scar quality improvement. Aims: To explore the..

Published: 26/09/2017
Authors: Riyat H, Touil L, Shokrollahi K

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Exploring the impact of feedback on prescribing error rates

​ Background Prescribing errors are prevalent in hospital settings with feedback identified as one potential error reduction strategy. Hospital pharmacists work alongside prescribers at ward level and are credible facilitators of prescribing error feedback. A formalised programme of pharmacist-led prescribing error feedback was designed and implemented  Objective To determine the impact..

Published: 17/08/2017
Authors: Lloyd M, O'Brien S, Hardy KJ, Furlong NJ

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FC1.9 Prospective pilot study evaluating the effectiveness of electrochemotherapy

​ Background Electrochemotherapy (ECT) is currently used to treat cutaneous and subcutaneous tumors of different histotypes. ECT combines cytotoxic drugs and the application of high-intensity electric pulses to increase cell permeability. In 2006, a multicenter European project (ESOPE, European Standard Operating Procedures of Electrochemotherapy) defined the guidelines for ECT application. To date,..

Published: 16/08/2017
Authors: Liew S

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Laparoscopic ventral mesh rectopexy for rectal prolapse using veritas mesh

​ Introduction Rectal prolapse and obstructive defecation syndrome are life altering conditions, common across the age spectrum. When previously considered unfit for open abdominal surgery, elderly patients have tended to undergo perineal procedures, known to have higher failure rates. The laparoscopic ventral mesh rectopexy (Lap-VMR) allows all patients to benefit from..

Published: 16/08/2017
Authors: Fretwell VL, Brannigan K, Downes C, Rajaganeshan R, Chadwick M

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Microcystic Adnexal Carcinoma

​ Opinion Statement Microcystic adnexal carcinoma (MAC) is a rare, slow-growing, infiltrative malignant tumour most commonly found on the head and neck. It often presents as a solitary skin-coloured or yellow papule, plaque or nodule. Ultraviolet radiation, immunosuppression and ionising radiation are possible risk factors. Clinical and histological differential diagnoses include..

Published: 15/08/2017
Authors: Aslam A

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Preoperative Site Marking: Are We Adhering to Good Surgical Practice?

​Objectives Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general..

Published: 15/08/2017
Authors: Bathla S, Chadwick M, Nevins EJ

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Book Review: Flaps and Reconstructive Surgery Second Edition

Whittam, AM; Shokrollahi, K. (2017). Book Review: Flaps and Reconstructive Surgery Second Edition . Annals of Plastic Surgery. 79 (1), 6

Published: 15/08/2017
Authors: Whittam AM, Shokrollahi K

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The effects of arthritis gloves on people with Rheumatoid Arthritis or Inflammatory Arthritis with hand pain: a study protocol for a multi-centre randomised controlled trial (the A-GLOVES trial).

​BACKGROUND: Arthritis gloves are regularly provided as part of the management of people with rheumatoid arthritis (RA) and undifferentiated (early) inflammatory arthritis (IA). Usually made of nylon and elastane (i.e. Lycra®), these arthritis gloves apply pressure with the aims of relieving hand pain, stiffness and improving hand function. However,..

Published: 19/06/2017
Authors: Hough Y

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Comparison of Control of Clostridium difficile Infection in Six English Hospitals Using Whole-Genome Sequencing

​Background.: Variation in Clostridium difficile infection (CDI) rates between healthcare institutions suggests overall incidence could be reduced if the lowest rates could be achieved more widely. Methods.: We used whole-genome sequencing (WGS) of consecutive C. difficile isolates from 6 English hospitals over 1 year (2013-14) to compare infection control performance. Fecal samples..

Published: 19/06/2017
Authors: Mortimer K

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Bullous pemphigoid and pemphigus vulgaris

​Autoimmune bullous diseases are characterised by blistering of the skin or mucous membranes. Blisters form due to the antibodies against structural skin components. The two most common bullous diseases are bullous pemphigoid and pemphigus vulgaris. Most of our epidemiological data comes from European studies. Estimates of the incidence of bullous ..

Published: 19/06/2017
Authors: Aslam A

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Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes

OBJECTIVE  Celiac disease (CD) has a recognized association with type 1 diabetes. We examined international differences in CD prevalence and clinical characteristics of youth with coexisting type 1 diabetes and CD versus type 1 diabetes only. RESEARCH DESIGN AND METHODS  Data sources were as follows: the Prospective Diabetes Follow-up registry (Germany/Austria); the..

Published: 06/06/2017
Authors: Thornton H

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Heel pressure ulcer prevention

​ Abstract In the period 2011 to 2015, St Helens and Knowsley Teaching Hospitals NHS Trust evaluated low-friction bootees (LFB) integrated into the care path for patients at-risk of heel pressure ulceration (hPU) in an initiative to reduce hospital acquired hPU related to friction and shear. In 2012, LFB were introduced and hPU reduced..

Published: 06/06/2017
Authors: Gleeson D

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Characteristics and outcome of patients according to the severity of peripheral oedema and breathlessness

​Introduction Heart failure is a common reason for hospital admission. Patients presenting with pulmonary and peripheral oedema may be seen as two ends of a spectrum with many patients presenting with a mixed picture. The purpose of the present analysis is to describe patient characteristics according to the severity of..

Published: 06/06/2017
Authors: Mohamed A

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The Katie Piper Foundation

Extract The Katie Piper Foundation was founded by Katie in December 2009, after she survived a brutal attack that led to her spending two months in the Burns Unit at the Chelsea and Westminster Hospital.  Shokrollahi, K. (2017). The Katie Piper Foundation: supporting burn survivors in the UK . Wounds UK. 13 (1), 104

Published: 06/06/2017
Authors: Shokrollahi K

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Bacterial agents of the discharging middle ear among children seen at the University of Nigeria Teaching Hospital, Enugu

​ INTRODUCTION: Discharging middle ear continues to be one of the commonest problems seen in the developing world. There is an ever growing need to carry out studies periodically to determine the common bacterial agents responsible for discharging otitis media and their antibiotic sensitivity especially in set-ups characterized with minimal laboratory..

Published: 01/06/2017
Authors:

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Association between age and access to immediate breast reconstruction

​ Background National guidelines state that patients with breast cancer undergoing mastectomy in England should be offered immediate breast reconstruction (IR), unless precluded by their fitness for surgery or the need for adjuvant therapies. Methods A national study investigated factors that influenced clinicians' decision to offer IR, and collected data on..

Published: 24/05/2017
Authors:

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The implementation of the Vessel Health and Preservation framework

​ Abstract Vascular access is an important component of health care but is not without associated risks, some of which can be life-threatening. The Vessel Health and Preservation (VHP) framework was developed with the intention of providing frontline staff with a resource to assist in assessing and selecting the best vascular..

Published: 24/05/2017
Authors: Weston V

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Surgical Determinants of Patient-Reported Outcomes

Background This national prospective cohort study compared the patient-reported outcomes of breast cancer patients undergoing postmastectomy autologous reconstruction to those who had breast implants, in terms of aesthetic appearance; levels of psychological, physical, and sexual well-being; and overall satisfaction. Methods Of 5063 women who underwent immediate reconstruction (n = 3349) or delayed reconstruction (..

Published: 18/05/2017
Authors:

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Phototherapy and photochemotherapy for polymorphic light eruption desensitization

Aslam, A; Fullerton, L; Ibbotson, SH. (2017). Phototherapy and photochemotherapy for polymorphic light eruption desensitization: a five-year case series review from a university teaching hospital . Photodermatology, Photoimmunology & Photomedicine. epub 11 May 

Published: 18/05/2017
Authors: Aslam A

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P427 Quality of life and outcomes following video assisted anal fistula treatment

Aim Video assisted anal fistula treatment (VAAFT) is a novel technique. We performed a prospective longitudinal study with the aim of evaluating outcomes and how quality of life was affected with this treatment. Method Patients undergoing VAAFT were entered into a prospective database. A longitudinal study design was employed. Data..

Published: 17/05/2017
Authors: , Rout S, Scott M, Samad A, Chadwick M, Rajaganeshan R

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Book Review: A Practical Guide on Operative Technique and Peri-Operative Management

Defty, C; Shokrollahi, K. (2017). Book Review: A Practical Guide on Operative Technique and Peri-Operative Management . Annals of Plastic Surgery. 78 (5), e4

Published: 17/05/2017
Authors: Defty C, Shokrollahi K

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P.PO.57 Management of placenta praevia

​ Introduction  Placenta praevia is associated with significant fetal and maternal morbidity and mortality. Careful management and compliance with evidence-based local guidelines is imperative to optimise both fetal and maternal outcomes. Methods  Women diagnosed with placenta praevia were retrospectively recruited from two neighbouring hospitals in North West England from a 6-month..

Published: 17/05/2017
Authors: McCallin K, D'Costa D, , Harrison S

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Initial UK experience with transversus abdominis muscle release

​ Introduction Large, complicated ventral hernias are an increasingly common problem. The transversus abdominis muscle release (TAMR) is a recently described modification of posterior components separation for repair of such hernias. We describe our initial experience with TAMR and sublay mesh to facilitate abdominal wall reconstruction. Methods The study is a..

Published: 16/05/2017
Authors: , , Scott M

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Straight to CT delivers earlier first definitive treatment

Background  The National Optimal Lung Cancer Pathway (NOLCP) recommends performing a CT scan before a patients first appointment in a rapid access suspected lung cancer clinic. A local audit in 2014 at our hospital which receives over 350 two week rule suspected lung cancer referrals per year found that less than 50% of..

Published: 16/05/2017
Authors: Malhotra P, Murphy P, Dawson C, Hunt N, Hendry J

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Specialist community diabetes team

​Aim To identify appropriateness and reasons for home visits in people with diabetes referred from a local Clinical Commissioning Group (CCG) to Knowsley Community Diabetes Team. Methods The case records of all patients referred for a home visit from Knowsley CCG (population 161,000) over a 16 month period were examined. Results Seventy..

Published: 10/05/2017
Authors: Wooding A, Garnett I, Timm L

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Effect of academic detailing on insulin prescribing: a before and after study

​Abstract Introduction and aims Insulin is a high risk medication with prescribing errors potentially compromising patient care. The aim of the study was to assess the impact of educational outreach on insulin prescribing in a hospital setting. Methods Insulin prescribing was prospectively audited over a four week period. Hospital pharmacists..

Published: 28/04/2017
Authors: Hart A, Lloyd M, Furlong NJ, Hardy KJ

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The 2017 International Joint Working Group recommendations of the Indian College of Cardiology

​ Abstract There have been no published recommendations for the management of low-risk chest pain in emergency departments (EDs) across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in EDs. Risk stratification of patients utilizing an accelerated diagnostic protocol has..

Published: 28/04/2017
Authors: Kataria H

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Neurocognitive Function of School-aged HIV-infected Children in Enugu, Nigeria

​ Abstract Background Evidence has shown neurocognitive problems often exist among human immunodeficiency virus (HIV)-infected children. There are limited data for children in Nigeria. Methods This was a cross-sectional study of 100 school-aged perinatally HIV-infected children seen in the paediatric HIV clinic and age/sex-matched controls from the general paediatric clinic...

Published: 28/04/2017
Authors:

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Meta-analysis of biomarkers predicting risk of malignant progression in Barrett's oesophagus

​Abstract Background Barrett's oesophagus is a precursor to the development of oesophageal adenocarcinoma. This study sought to clarify the role of genetic, chromosomal and proliferation biomarkers that have been the subjects of multiple studies through meta-analysis. Methods MEDLINE, Embase, PubMed and the Cochrane Library were searched for clinical studies assessing..

Published: 28/04/2017
Authors: Altaf K, Hickey L, Kaul A

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An excellent year in Liverpool

​ Aseri, S. (2016). An excellent year in Liverpool . Transmitter. Autumn, p18.

Published: 27/04/2017
Authors: Aseri S

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Severe co-trimoxazole-induced hypoglycaemia

​ Summary A 69-year-old man presented to the emergency department with lower respiratory tract infection and febrile neutropaenia. He was recently discharged following a 50-day hospital stay with newly diagnosed microscopic polyangiitis, complicated by pulmonary haemorrhage and severe renal dysfunction requiring renal replacement therapy, plasma exchange and immunosuppression (cyclophosphamide and methylprednisolone)...

Published: 26/04/2017
Authors: Conley TE

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Book Review: Reconstructive Lymph Vascular Surgery

​ Gurusinghe, D; Shokrollahi, K. (2017). Book Review: Reconstructive Lymph Vascular Surgery . Annals of Plastic Surgery. 78 (4), 364

Published: 26/04/2017
Authors: Gurusinghe D

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Five-year local recurrence for breast cancer: The presentation of our local data

​Background Breast cancer is the most common cancer in women, affecting 1 in 8 worldwide. Overall survival has now reached 80% at 5 years, with improved targeted therapy. Although a large amount of data is collected for national audit, in the UK local recurrence rate is largely unknown.  Methods Retrospective analysis of prospectively collected..

Published: 25/04/2017
Authors: Clifford R, Antoniadis S, Chagla LS

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Simple reconstructive techniques for conservative breast cancer surgery

Background Patients undergoing breast conservation surgery (BCS) for cancer may benefit with the defect reconstruction using simple techniques to obtain optimal cosmetic & oncological outcome. Aim To determine feasibility simple oncoplastic level 2 reconstruction as a day case. Material and Methods A prospective series of patients eligible for BCS & likely to have..

Published: 25/04/2017
Authors: Jois RHS,

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Specific mutations in KRAS codon 12

​ Background Activating mutations in KRAS have been suggested as potential predictive and prognostic biomarkers. However, the prognostic impact of specific point mutations remains less clear. This study assessed the prognostic impact of specific KRAS mutations on survival for patients with colorectal cancer. Methods Retrospective review of patients KRAS typed for..

Published: 24/04/2017
Authors: Clifford R

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Risk of lymphoma in patients exposed to antitumour necrosis factor therapy

​Abstract Objectives  Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma compared with the general population. There are concerns that tumour necrosis factor inhibitors (TNFi) may exacerbate this risk. However, since the excess risk of lymphoma in RA is related to the cumulative burden of inflammation, TNFi may..

Published: 24/04/2017
Authors: Abernethy R

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Relationship between exposure to tumour necrosis factor inhibitor therapy

​Abstract Objectives  Patients with rheumatoid arthritis (RA) are at increased risk of myocardial infarction (MI) compared with subjects without RA, with the increased risk driven potentially by inflammation. Tumour necrosis factor inhibitors (TNFi) may modulate the risk and severity of MI. We compared the risk and severity of MI in..

Published: 24/04/2017
Authors: Abernethy R

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Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess

​Introduction Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). Materials and Methods A prospective..

Published: 14/03/2017
Authors: Jain Y, Javed M, Singh S, Rout S, , Rajaganeshan R

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Electrochemotherapy in the treatment of metastatic malignant melanoma: A prospective cohort study by InspECT

​ Background Electrochemotherapy (ECT) is an effective local treatment for cutaneous metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. The aim of this study was to investigate the effectiveness of ECT in cutaneous metastases of melanoma and to identify factors which affect (..

Published: 14/03/2017
Authors: Pritchard-Jones R, Liew S

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Individualised Expert Feedback is Not Essential

​Objective To determine whether unsupervised video feedback (UVF) is as effective as direct expert feedback (DEF) in improving clinical skills performance for medical students learning basic surgical skills—intravenous cannulation, catheterization, and suturing. Background Feedback is a vital component of the learning process, yet great variation persists in its quality,..

Published: 14/03/2017
Authors: Whitehead IJ

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Apert syndrome: A consensus on the management of Apert hands

Introduction Apert Syndrome is a congenital condition characterised by primary craniosynostosis, midfacial malformations and complex symmetrical malformations of the hands and feet. The hands demonstrate one of the most complex collections of congenital upper limb deformities, posing a significant challenge for the paediatric hand surgeon. This study examines the extant..

Published: 14/03/2017
Authors: Mishra A, McArthur P

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Case Report of Lichen Planopilaris Occurring in a Pediatric Patient Receiving a Tumor Necrosis Factor α Inhibitor and a Review of the Literature

Abstract A 12-year-old girl with extended oligoarthritis treated with adalimumab presented with a short history of a progressive cutaneous eruption involving the legs and scalp. Physical examination and histologic results were consistent with lichen planopilaris. The adalimumab was discontinued. She received treatment with topical clobetasol propionate and the majority of..

Published: 14/03/2017
Authors: Walsh ML

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To treat or not to treat? the efficacy of oral paracetamol for delayed closure of the ductus arteriosus; A case report

​ Background and aims  Female infant was born at 29 weeks gestation. At one month of life this baby was self ventilating in air but having frequent profound desaturations requiring stimulation. These did not improve with blood transfusion nor anti reflux therapy. Weight gain was also suboptimal. Echocardiography demonstrated a large haemodynamically..

Published: 14/03/2017
Authors: Brophy H, Bentur H, Abdelaziz M

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DP12 Angioinvasive lympho matoid papulosis: a raresubtype easily mistaken for a high-gradeangioinvasive lymphoma

​Abstract A 59-year-old woman presented with painful ulceration on her chin. She described that it began as a nodule that then ulcerated. On examination she had a well-defined area of ulceration measuring 2 x 2 cm with haemorrhagic crust resembling eschar. There was no lymphadenopathy. She was treated with prednisolone and the..

Published: 14/03/2017
Authors: Walsh ML

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PWE-146 Is A Nurse-Led Computerised HCC Surveillance System Effective?

​Introduction  Hepatocellular carcinoma (HCC) accounts for 90% of liver cancers and has a growing incidence of HCC worldwide. In 2013, liver cancer accounted for 2% of all cancers with an incidence of 5,413 new cases. 90–95% of cases of HCC arise in cirrhosis and non-cirrhotic chronic Hepatitis B.1 Outcomes are poor with a median survival..

Published: 14/03/2017
Authors: Priestley S, Ashton K, Jones J, Fox M

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The incidence of cancer in patients with rheumatoid arthritis

​Objective To explore the influence of TNF inhibitor (TNFi) therapy and rituximab (RTX) upon the incidence of cancer in patients with RA and prior malignancy. Methods The study population comprised RA subjects with a prior malignancy reported to the UK national cancer registers, recruited to the British Society for Rheumatology..

Published: 14/03/2017
Authors: Abernethy R

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Protecting vulnerable skin from moisture-associated skin damage

Abstract The skin, the body's largest organ, has several functions. Its barrier role can be undermined if it is in contact with urine, faeces and other sources of excess moisture; overhydration can also increase the likelihood of injury from friction through contact with clothing, incontinence pads or bed linen. If..

Published: 14/03/2017
Authors: Simon D

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Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis

​ BACKGROUND: Radial artery occlusion (RAO) may occur posttransradial intervention and limits the radial artery as a future access site, thus precluding its use as an arterial conduit. In this study, we investigate the incidence and factors influencing the RAO in the current literature. METHODS AND RESULTS: We searched MEDLINE and..

Published: 09/03/2017
Authors: Rashid M

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Laser significantly improved a debilitating lymphaticovenous malformation: a case report

Abstract​ Lymphaticovenous malformations are rare congenital anomalies leading to oozing, ulceration and recurrent infections. They are managed by a specialist multi-disciplinary team with compression garments, symptomatic treatments and options such as percutaneous sclerotherapy and debulking procedures. Limited literature exists on the use of laser to seal the lymphatic vesicles. We..

Published: 09/03/2017
Authors: Defty C

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Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT)

​Javed, MA. et. al. (2016).Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT). Techniques in Coloproctology . 20 (12), 871-873.

Published: 02/03/2017
Authors: Javed M, Singh S, Fowler H, Jain Y, Scott M, Rajaganeshan R

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Goals of diabetes education: A national UK structured self-management education programme

​Objective: Goals of Diabetes Education is a structured education programme that was originally developed in 1996 in Denmark. It was translated and first published in the UK in 2012 to fulfil the requirements of the Paediatric Diabetes Best Practice Tariff. This original structured educational framework has been updated and enhanced following the..

Published: 24/02/2017
Authors: Thornton H

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Effectiveness of a pressure-relieving mattress

Abstract Between the 10 May and 18 July 2016, St Helens and Knowsley Teaching Hospitals NHS Trust conducted a small, non-controlled evaluation set out to assess the performance of the Apex Pro-care Auto pressure-relieving mattress in an acute stroke ward. Seven patients, assessed as being at medium-to-high risk of developing a pressure ulcer (..

Published: 23/02/2017
Authors: Gleeson D

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Relationship between transcutaneous bilirubin

​ Background Transcutaneous bilirubin (TcB) consists of the skin-deposited bilirubin. Free bilirubin represents the protein-unbound bilirubin (UB) that is able to pass into the tissues. We aimed to describe the relationship UB-TcB and study the passage of UB into the skin. Methods We prospectively enrolled 194 neonates and we measured TcB, UB,..

Published: 23/02/2017
Authors: Tridente A

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Discrepancies between biopsy

​Armstrong A; Hart-Pinto, A; Sharma, N; Hassan, Z. (2016). Discrepancies between biopsy and formal excision histology of non-melanoma skin cancer. Journal of plastic, reconstructive and aesthetic surgery (JPRAS). 69 (12), 1714-1716

Published: 23/02/2017
Authors: Hart-Pinto AD, Sharma N, Hassan Z

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Coblation Assisted Procedures

​ Objectives  To assess the clinical effectiveness of coblation assisted upper airway procedures in patients with snoring and sleep apnea. Methods  This study was conducted at the ENT Department of St Helens and Knowsley Teaching Hospitals NHS Trust, United Kingdom. Fifty-six consecutive patients who underwent upper airway procedures were included in..

Published: 23/02/2017
Authors: Saleem Y

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Excess steroid use in IBD

Background Corticosteroids are the cornerstone of induction of remission in active IBD but are limited in their ability to maintain remission, and are associated with significant side effects. ECCO defines appropriate steroid use and recommends an exit strategy for steroid dependent patients. Data to support the utility of clinical and..

Published: 21/02/2017
Authors: Bassi A

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A rare cause of mucositis

​ Trehan, P; Pang, E; Khirwadkar, N; Alsharqi, A; Parslew, R. (2016). A rare cause of mucositis . Clinical and Experimental Dermatology. 41 (8), 951-952

Published: 21/02/2017
Authors: Pang E

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P054: Electrochemotherapy in the treatment

Aims  Electrochemotherapy (ECT) is an effective local treatment for cutaneous metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. The aim of this study was to investigate the effectiveness of ECT in cutaneous metastases of melanoma and to identify factors which affect (..

Published: 21/02/2017
Authors: Liew S, Pritchard-Jones R

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The significance of extramural venous invasion

Background and aims Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes and prognosticators in patients with R1 resection of rectal cancer. Material and..

Published: 21/02/2017
Authors: Ormsby N, Bermingham HN,

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Implementation of regional anaesthesia service

​Background and Aims Regional anaesthesia (RA) allows awake surgery on the upper limb. Avoidance of general anaesthesia (GA) may lead to faster recovery times, reduced costs and improved patient satisfaction. We recently introduced a RA service for day case plastic surgery patients to allow awake surgery. We have performed a..

Published: 21/02/2017
Authors: Mukhtar K

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Age should hold no boundaries for young people

Abstract Diabetes can be diagnosed at any age in childhood. Children and young people (CYP) must be empowered to develop knowledge and self-caring skills with the aim of independence by the time they transfer to young adult services. The percentage of CYP achieving excellent diabetes control has increased from 15.8% in 2012/13..

Published: 21/02/2017
Authors: Thornton H, Seagrave V

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Child abuse in Pakistan

​Abstract Aims: Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects of abuse can be profound and life altering for both victims and the victims’ own children. There is substantial literature from High Income Countries about signs of abuse but a dearth of data..

Published: 21/02/2017
Authors: Maul KM

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Management of pretibial lacerations: How patients' well-being is affected by their management

​Background: Pretibial lacerations remain one of the commonest problems in plastic surgery. There is still no evidence of superiority of either a conservative or surgical approach for their management, nor any documentation regarding patients' performance following each approach. Methods: We conducted a retrospective study of all patients treated for pretibial..

Published: 17/02/2017
Authors: , Kelsey C, Khan I

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Critical care in the Emergency Department: organ donation

​ Abstract: Organ transplantation is associated with improved outcomes for some patients with end-stage organ failure; however, the number of patients awaiting a transplant exceeds the available organs. Recently, an extended role has been proposed for EDs in the recognition and management of potential donors. The present review presents an illustrative..

Published: 17/02/2017
Authors: Bonney S, Nee PA, Andrews FJ

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Response to Letter Regarding ‘Pregnancy Following Bariatric Surgery—Medical Complications and Management’

​Narayanan, RP; Syed, AA.. (2016).Response to Letter Regarding ‘Pregnancy Following Bariatric Surgery—Medical Complications and Management’. Obesity Surgery. 16 (12), 3008.

Published: 17/02/2017
Authors:

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Prediction of malignant progression of Barrett’s oesophagus

Abstract Background Barrett’s Oesophagus (BO) is a precursor for Oesophageal Adenocarcinoma (OAC). Currently, there are no biomarkers in clinical practice that predict the malignant progression in BO. We sought to clarify the effectiveness of common genetic aberrations as potential biomarkers through a systematic review and meta-analyses.  Methods MEDLINE, EMBASE..

Published: 17/02/2017
Authors: Altaf K, Hickey L, Kaul A

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VL flaps are not ALT flaps

​ Extract We read the paper from Kaminsky, Li, Copeland-Halperin, and Miraliakbari (Kaminsky et al, 2015) on the vastus lateralis (VL) free flap for lower extremity Gustilo grade III reconstruction with interest; however, we feel that this paper could be better in mapping the real versatility of the VL flap given the..

Published: 17/02/2017
Authors: El-Gawad A

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Biweekly Viscosupplementation Regimen for Knee Osteoarthritis

Abstract Osteoarthritis is the most common form of arthritis in the Western world, causing disabling symptoms in 10% of people older than 55 years. Hyaluronic acid injections can reduce osteoarthritic pain but require three to five doses administered weekly. This preliminary study aims to assess the efficacy of a more flexible viscosupplementation..

Published: 17/02/2017
Authors: Munir U, Teanby D

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The Laser Test Patch

Extract Laser practitioners, manufacturers and indemnity providers are variably sold on the concept of a laser test patch before full treatment of patients with lasers. But what is the purpose of a test patch, how is a test patch objectively defined, what makes a test patch different from a full..

Published: 17/02/2017
Authors: Shokrollahi K

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Using Stroke Sentinel Audit Data to drive quality improvement

    Hill, AM. (1 Feb 2017). Using Stroke Sentinel Audit Data to drive quality improvement. Royal College of Physicians Commentary Magazine

Published: 01/02/2017
Authors: Hill AM

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Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient

​ INTRODUCTION: Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss..

Published: 30/01/2017
Authors: Samsudin A

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Unexpected encounters with ureters

Ureteric injuries are as common as 0.5-3% and are frequently missed.Delayed diagnosis can occur in upto 15% patients and can lead to serious morbidity such as fistula formation, peritonitis, loss of renal function and is a frequent cause of medico legal litigation. The common sites of ureteric injury are at..

Published: 23/12/2016
Authors: Thomas A

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Beyond

​The progress in scientific and medical knowledge has been fascinating over the last few decades and has had a noticeable impact on the most recent clinical practice. However, not every patient benefits from this progress in the same way; European and North American data are there to prove how senior..

Published: 23/12/2016
Authors:

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Case study: Using SSNAP data to improve stroke services

Extract Being admitted with a suspected stroke can be stressful and bewildering for stroke patients and their families. A simple way to alleviate this and provide high quality stroke care is to try to ensure that patients who have had a suspected stroke are admitted to a specialist ward, and..

Published: 29/11/2016
Authors: Hill AM

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067 Improving access to same-day initial therapy assessment with later working patterns

Introduction Early initial multi-disciplinary therapy assessment following stroke admission is important to establish baseline function, engage patients and families, manage expectations and set realistic rehabilitation and treatment goals. Bray et al established that there are significant variations in assessment time according to time of admission and day of admission. We..

Published: 21/11/2016
Authors: Hill AM

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085 Standardising quoted post-thrombolysis bleeding complication rates using the Heidelberg Bleeding Classification

Introduction Intracerebral haemorrhage is one of the most feared complications of delivering thrombolysis therapy. Variable complication rates are quoted for symptomatic haemorrhage post-thrombolysis, reflecting difficulty establishing whether the extent of haemorrhage, or the original infarction was responsible for the eventual outcome. National datasets such as the Stroke Sentinel National..

Published: 21/11/2016
Authors: Hill AM

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Is the ISAN score valid against stroke datasets with high levels of completeness?

Parallet Session 2A: High Scoring Abstract Introduction In 2015, Smith et al analysed the Stroke Sentinel National Audit Programme dataset to produce a risk assessment tool for predicting 7 and 30 day mortality and the prevalence of stroke associated pneumonia (SAP). In our study we analysed our Trust’s stroke population over the..

Published: 21/11/2016
Authors: Hill AM

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A literature review and summary of capsular contracture: An ongoing challenge to breast surgeons and their patients

Abstract Capsular contracture is a significant difficulty where implants are used in both breast augmentation and breast reconstruction surgery. This report reviews the published literature focusing on factors and techniques that reduce the incidence of this complication, as well as evaluating the available treatment options for patients who have developed..

Published: 27/10/2016
Authors: ,

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The development of a stroke unit simulation model to reconfigure an inpatient stroke unit

Summary Our team developed a mathematical simulation of a stroke unit, allowing us to demonstrate the optimal size and configuration for a stroke unit. The model utilised existing known inputs: including the number of strokes, stroke ‘mimics’, TIAs, and optionally the presence of medical outliers on the stroke unit. For..

Published: 27/10/2016
Authors: Hill AM

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Development of a graphical dashboard for real-time analysis of Sentinel Stroke National Audit Programme (SSNAP) data

Summary The Stroke Sentinal National Audit Programme Dataset contains valuable operational data but is limited by its lag time to reporting. We have developed a realtime data dashboard which enables SSNAP data to be used to study the performance of our unit live. Data is entered onto the dashboard by..

Published: 27/10/2016
Authors: Hill AM

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Pregnancy Following Bariatric Surgery—Medical Complications and Management

Abstract Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12–24 months to reduce..

Published: 27/10/2016
Authors:

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Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital, Enugu

Abstract Background Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children. Objective To determine the prevalence of ear-related problems among children presenting at the Paediatric..

Published: 27/10/2016
Authors:

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Retained surgical drain after total knee arthroplasty: An eight-year follow-up

Abstract Case This report describes a patient in whom the intra-articular portion of a suction drain broke during total knee arthroplasty. The broken portion of the drain could not be removed, but the patient experienced no major complications over an eight-year follow-up period. Conclusion The presence of a retained surgical..

Published: 27/10/2016
Authors: Gheorghiu D, Teanby D

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The influence of booking body mass index

​Introduction Obesity is a major public health concern with over half of childbearing aged women overweight or obese in the UK. Maternal obesity carries numerous maternal and fetal complications during pregnancy and is a risk factor for anaesthesia related mortality. The incidence of complications such as caesarean section (CS), preeclampsia,..

Published: 26/10/2016
Authors: Anwar A, Yoxall PF

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The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis

​ Abstract The biochemical response to ursodeoxycholic acid (UDCA)—so-called “treatment response”—strongly predicts long-term outcome in primary biliary cholangitis (PBC). Several long-term prognostic models based solely on the treatment response have been developed that are widely used to risk stratify PBC patients and guide their management. However, they do not..

Published: 26/10/2016
Authors: McLindon J

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An audit cycle reviewing the offer of HIV testing

​Objectives To determine if the offer of an HIV test at a community sexual health clinic adhered to national guidelines (Offer of HIV testing 97% BASHH). In the first audit cycle (October 2014) the offer of an HIV test (84%) failed to comply with national guidelines. In addition, the uptake of HIV testing..

Published: 26/10/2016
Authors: Botchey SA,

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An audit reviewing Intrauterine contraceptive fitting

​Objectives To ensure that contraceptive fitting at a community sexual health clinic meets the auditable standards suggested by the FSRH clinical standards committee. Standards (FSRH clinical standards committee auditable outcomes) (1) The proportion of sexually active women offered sexually transmitted infection screening requesting intrauterine contraception (IUC). [Auditable standard 97%] (2) The proportion of..

Published: 10/10/2016
Authors: , Annuar N, Botchey SA

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The importance of frailty

​Introduction Demand for Critical Care (CC) is increasing but admission may be inappropriate if the patient is unlikely to survive. Consequently, published guidance may no longer reflect current practice [1-2]. Clinical frailty evaluation scores have recently been shown to be associated with increased mortality in patients already admitted to CC [3]...

Published: 10/10/2016
Authors: Tridente A

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Gastroschisis: Overview of epidemiology and management trends

​Introduction  A rise in incidence of gastroschisis has been reported. We investigated the incidence in our unit.  Methods  In a retrospective series; maternal case notes of all gastroschisis patients diagnosed in utero at a single NHS centre over a 6-year period were reviewed (n = 14).  Results  Gastroschisis was diagnosed in 14 fetuses,..

Published: 07/10/2016
Authors: Pankaja S

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Communication within an intensive care setting

​Introduction The ability to communicate well with patients and their relatives is a fundamental clinical skill in intensive care medicine and central to good medical practice. Communication at the bedside, even when the patient is unconscious or sedated, may often be recalled by critical care survivors and can impact upon..

Published: 07/10/2016
Authors: , Fuller A

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Correctly diagnosing death

​Introduction Around 50% of deaths in the UK occur in hospital, giving a total of around 250 000 in 2013 [1]. The responsibility of confirmation and documentation of these deaths rests across all specialties of hospital doctor. The Academy of Medical Royal Colleges (AMRC) released a consensus guideline in 2008 aiming to standardise this process [2]. Guidance..

Published: 07/10/2016
Authors: Webber A, ,

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Infusion medication concentrations in UK’s critical care areas

​Abstract Following two studies done in 2007 and 2009, a follow-up of the adherence to the suggested guidelines on drug standardisation has been performed with a suggestion for future standards that can be achieved, to complement the recently published Carter report. The Intensive Care Society (ICS) introduced recommendations for infusion concentrations of 16..

Published: 06/09/2016
Authors: Barton G

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Admission to critical care

Introduction Critical Care (CC) services are in increasing demand but published guidance for triaging admissions may no longer reflect current practice [1-2]. Exercise tolerance and clinical frailty assessment may have a role in assessing patients (pts) referred to CC [3]. We aimed to establish the impact of frailty and other factors..

Published: 16/08/2016
Authors: Bolton N, , England L, Feeney J, Tridente A, Wilkinson K

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Platelet function analysis utilising the PFA-100

​ Introduction Sepsis is known to be associated with impaired platelet function (1). The PFA-100 (Siemens Healthcare, Dade International, Miami, Fla., USA) is a device in which a citrated whole blood sample is aspirated through an aperture coated with agonists inducing platelet activation. Platelet aggregation leads to occlusion of the aperture and..

Published: 16/08/2016
Authors: Bolton N, , Bonney S, Tridente A, Nee PA

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Reduction in tidal volumes for ventilated patients

​ Introductions Over 60 % of patients admitted to an Intensive Care Unit (ICU) will require Endotracheal Tube (ETT) intubation and mechanical ventilation. The aim was to perform an audit of ventilation regimes in critically ill patients admitted to Whiston Hospital. Its main objectives were to evaluate the current management of ventilated patients..

Published: 10/08/2016
Authors: Fuller A,

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The impact of Karnofsky performance scale

​ Introductions Karnofsky performance scale (KPS) [1] is being widely to describe patients’ functional status. Correlation between poor functional levels and adverse outcomes has been found. KPS is used in decision making surrounding starting aggressive therapy. We evaluated the impact of KPS on long term renal & patient survival in AKI patients, receiving ..

Published: 10/08/2016
Authors: Tridente A

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Comparison of mortality scores

​ Introduction Burn injuries are amongst the most severe physical and psychological insults a patient can experience and morbidity is extensive with variable mortality. Studies have repeatedly confirmed factors associated with high mortality, which include increasing age, extent of burn and presence or absence of inhalational injury. Predicting mortality from burns..

Published: 10/08/2016
Authors: Howarth O, Davenport K, , Raftery S

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Outcomes of patients

​ Introduction Palliative oncology patients are admitted to critical care not uncommonly, outcomes are variable and often difficult to predict. We sought to observe Intensive care unit (ICU) and hospital outcomes of palliative oncology patients, in relation to demographic, disease and organ failure criteria. Methods Retrospective review of the electronic database..

Published: 09/08/2016
Authors: Tridente A

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Emotion sharing: implications for trainee doctor well-being

​Farley, S; Manger, J. (2016). Emotion sharing: implications for trainee doctor well-being​ . Medical Education. 50 (8), 798-800.​

Published: 25/07/2016
Authors: Manger J

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Combined infection training

Abstract This commentary discusses the recent pioneering overhaul of training for UK doctors wishing to pursue a career in the infection specialities. Changes include the introduction of new curricula that embrace increased collaboration between the laboratory-based and clinical specialties and a broad-based infection training period, named ‘Combined Infection Training’, which..

Published: 25/07/2016
Authors: Sunny S

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Book Review: Review of Plastic Surgery

​ Touil, L; Shokrollahi, K. (2016). Book Review: Review of Plastic Surgery​ . Annals of Plastic Surgery. 77 (2), 140.​

Published: 25/07/2016
Authors: Touil L, Shokrollahi K

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Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects

​​ Abstract More than 30 years have passed since the first case series was published regarding the phenomenon of secondary intention healing in relation to lid margin defects. Despite the fascinating results, the technique has not gained widespread support. This study looks at a series of 34 marginal lower lid defects allowed to..

Published: 21/07/2016
Authors: Morton J

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Use of Video Laryngoscopy forRapid Sequence Induction

​Excerpt Video laryngoscopy (VL) is a novel method of achieving endotracheal intubation and there is evidence to show that visualistation of larynx can be improved using VL for rapid sequence induction (RSI). Ahmad, H; Jahan, S; Yusaf, M; Aseri, S. (2016). Use of Video Laryngoscopy for Rapid Sequence Induction​ . Journal of..

Published: 21/07/2016
Authors: Aseri S

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Early Detection of Epidemic GII-4 Norovirus Strains

​ Abstract Noroviruses are endemic in the human population, and are recognised as a leading cause of acute gastroenteritis worldwide. Although they are a highly diverse group of viruses, genogroup-II genotype-4 (GII-4) noroviruses are the most frequently identified strains worldwide. The predominance of GII-4 norovirus strains is driven by the periodic..

Published: 19/07/2016
Authors: Trainor E

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Critical care in the emergency department: acute kidney injury

​ Abstract Acute kidney injury (AKI) is common among emergency department patients admitted to hospital. There is evidence of inadequate management of the condition leading to adverse outcomes. We present an illustrative case of AKI complicating a gastrointestinal disorder in an older adult. We discuss the clinical presentation, assessment and management..

Published: 19/07/2016
Authors: Bailey DJ, Nee PA, , Todd V

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Tolvaptan for Heart Failure

​ Abstract The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure (HF). However, there is paucity of evidence guiding its use, and lack of evidence of its long term efficacy. Our objectives are to perform a systematic review of studies examining tolvaptan's effects..

Published: 19/07/2016
Authors: Tridente A

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Diabetic kidney disease in routine clinical care

​ Aim To examine the impact of service re-design on management and 10-year outcomes in diabetic kidney disease in a real world setting. Methods We established a highly structured, nurse-led diabetic kidney clinic to deliver consistent evidence-based care processes (blood pressure control (BP), glycaemic control (HbA1c), renin-angiotensin-aldosterone (RAAS) blockade, lipid-lowering..

Published: 19/07/2016
Authors: Hardy KJ, O'Brien S

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Absence of Flexor Carpi Radialis

​ Purpose We present an extremely rare anatomical variation of unilateral flexor carpi radialis (FCR) absence. This rare anatomical variation posed a clinical dilemma to us and we highlight the importance of the surgeon being aware of this anatomical variation of an important structure both as a reconstruction tool and as..

Published: 19/07/2016
Authors: Sofos S

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Reintubation following planned extubation

​ Introduction Studies indicate reintubation rates following planned extubation to be between 10-20% in the general ICU population. There is evidence that extubation failure and reintubation can worsen outcome, with studies suggesting ICU mortality rates of between 25-50% in these patients. Objectives To establish how our failed extubation rate and subsequent..

Published: 19/07/2016
Authors: Whitmore D, Mahambrey T

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Peri- and post-operative management of the “high-risk” surgical patient

​ Introduction In 2011, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published a report, “Knowing the Risk,” [1] which reviewed data regarding peri-operative management of the high risk surgical population and subsequently produced recommendations in aim to improve outcomes in this patient population. Of particular focus, recommendations included; clear documentation..

Published: 19/07/2016
Authors: Bridge L, Winslow L

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Obstructive uropathy secondary to bilateral ureteroinguinoscrotal herniation

O, Feyisetan; Floyd, MS Jr, Samsudin, A. (2016). Obstructive uropathy secondary to bilateral ureteroinguinoscrotal herniation​ . International Brazilian journal of urology. 42 (3), 621-622.​

Published: 19/07/2016
Authors: Feyisetan O, Floyd Jr MS, Samsudin A

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Recurrent life-threatening haemoptysis

​ Abstract A bleeding vertebral artery pseudoaneurysm is a rare cause of haemoptysis. Pseudoaneurysm can arise due to radionecrosis from previous radiotherapy in the base of skull and neck region and may present with haemoptysis many years later. It is important to be aware of this entity in the work-up of..

Published: 19/07/2016
Authors: Hartley JL

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Skin involvement in Dupuytren's disease

Oskrochi, Y; El-Gawad, A. (2016). Re: Wade R, Igali L and Figus A. Skin involvement in Dupuytren's disease​ The Journal of Hand Surgery (European Volume). 41 (6), 667-668​

Published: 19/07/2016
Authors: El-Gawad A

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Tips and tricks of ureteroscopy - Part I

​ Abstract Ureteroscopy is fast becoming the first line treatment option for the majority of urinary tract stones. Ureteroscopy training can be performed in a variety of ways including simulation, hands on ureteroscopy courses and supervised operative experience. We report an “expert consensus view” from experienced endourological surgeons, on all aspects..

Published: 19/07/2016
Authors: Samsudin A

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An unusual presentation of a vesicouterine fistula

​ Abstract A 26-year-old female presented with a history of cyclical incontinence following a ventouse assisted delivery. Initial investigations revealed an endometrial deposit in her bladder, which following further investigations revealed a vesicouterine fistula necessitating formal open repair. Floyd, MS; Abbas, G; Connolly, S; Gana, HB; McCabe JE. (2016). An unusual presentation..

Published: 19/07/2016
Authors: Floyd Jr MS, Connolly S, Gana HB, McCabe JE

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A full time regional ortho-plastic unit; initial results

​ Sargazi, N; El-Gawad, A; Narayan, B; Bell, D; Shanks, L; Nayagam, S; Graham K. (2015). A full time regional ortho-plastic unit; initial results​ . Journal of plastic, reconstructive & Aesthetic surgery: JPRAS. Published online 31st December

Published: 19/07/2016
Authors: Bell D, Graham K

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The Introduction of Standard Operating Procedures

​ Abstract United Kingdom (UK) burn units face substantial new obstacles in delivering high quality care because of the advent of full-shift working patterns, cross-specialty cover arrangements, and increased trainee turnover. Junior trainees rely heavily on senior colleagues, who may not be readily accessible. The authors therefore proposed the introduction of..

Published: 19/07/2016
Authors: Lymperopoulos NS, Wilkinson D, Shokrollahi K

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UK service level audit of insulin pump therapy

​ Aim To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151). Methods All centres in the UK, providing pump services to children and young people were invited to participate in an..

Published: 19/07/2016
Authors: Furlong NJ

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The Discrete Scar in Prominent Ear Correction

​ Introduction  Various postauricular incision sites can be used for prominent ear correction depending on technique and surgeon preference. No study has previously looked at the most aesthetic (least visible) location for the postauricular scar. We investigated the visibility of various scar locations on the posterior ear from a third person..

Published: 19/07/2016
Authors: Shokrollahi K, Javed M

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Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes

​ Objective  First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods ..

Published: 19/07/2016
Authors: Rashid M

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The prominent antihelix and helix

​ Background Classic teaching of ear anatomy in the context of otoplasty states that if the antihelical fold is more prominent than the helical fold after surgery then the ear is “overcorrected.” We set out to explore the role of the antihelix in normal ear anatomy, its relevance to aesthetic perceptions..

Published: 19/07/2016
Authors: Shokrollahi K

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Ovarian hilar proliferations

​ Aims To describe four cases of incidentally detected microscopic ovarian hilar Sertoli cell proliferation, a phenomenon that, as far as we are aware, has not been previously reported, and to discuss the differential diagnosis of these lesions. Methods and results The proliferations occurred in women aged 35–62 years, and were composed..

Published: 19/07/2016
Authors: Hasan NU

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Book Review: Practical Skin Surgery

​ Yao, S. (2016). Book Review: Practical Skin Surgery​ . Annals of Plastic Surgery. 76 (3), 262.

Published: 19/07/2016
Authors: Yao S

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Book Review: Hair Restoration, An Issue of Facial Plastic Surgery Clinics of North America

​ Jordan, DJ; Shokrollahi, K. (2016). Book Review: Hair Restoration, An Issue of Facial Plastic Surgery Clinics of North America​ . Annals of Plastic Surgery. 76 (4), 370​

Published: 19/07/2016
Authors: Shokrollahi K

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Validation of a classification system

​ OBJECTIVE Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. DESIGN, SETTING AND PARTICIPANTS One hundred case scenarios of patients who died in an ICU were..

Published: 19/07/2016
Authors: McCairn AJ, Mahambrey T

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Assessment of diabetes knowledge

​ Abstract In the UK, approximately 12–25% of all hospital inpatients have diabetes, although most are admitted for other health problems. People with diabetes often have a prolonged hospital stay compared to people without the condition, often as a result of suboptimal inpatient management of their diabetes. During in-depth interviews conducted in..

Published: 19/07/2016
Authors: Cardwell J, Hardy KJ

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P211 Impact of door-to-radiograph time on pneumonia management

​ Introduction  Pneumonia continues to be associated with significant mortality.1 The diagnostic gold standard remains the Chest X-Ray (CXR). Quality indicators such as door-to-antibiotic or door-to-radiograph time are monitored as surrogate outcome measures. Objective  To assess the impact of CXR availability at first clinician contact in cases where initial antibiotics were..

Published: 19/07/2016
Authors: Varia R, Ashton A

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Assessing the diagnostic accuracy

​ Background  The British Thoracic Society guidelines (2015) on the investigation and management of pulmonary nodules recommend the use of two risk prediction tools to assess the likelihood of malignancy in solid pulmonary nodules (Brock model following initial CT and the model described by Herder et al. following PET-CT). Management strategies are..

Published: 19/07/2016
Authors: Malhotra P

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P244 The impact of “Seven Day working”

​ Abstract St Helens and Knowsley NHS trust (STHK) have re designed the acute pathway for medical admissions. Investment in Consultant numbers has allowed the Acute Medical Admissions (MAU) team and the speciality teams to provide robust Consultant input to their areas Monday to Sunday. Speciality Consultants have been released from..

Published: 19/07/2016
Authors: Twite S, Stockton P, Malhotra P

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Long term outcomes in acute kidney injury patients

​ Introduction and Aims Acute kidney injury (AKI) affects 40% of critically ill patients with UK data reporting 5% needing renal r​eplacement therapy (RRT). Hospital mortality is reported as being up to 60%. We sought to evaluate renal and long term patient survival outcomes in AKI patients receiving RRT on our ICU.    Methods..

Published: 19/07/2016
Authors: Tridente A

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Obstructive Azoospermia

​ Extract A 25-year old male presented with primary infertility. He and his partner had been trying to conceive for over 12 months despite normal gynecological investigations. There was no history of chronic respiratory disease, infections, sexual dysfunction, genetic abnormalities, trauma or illicit substance use. Secondary sexual characteristics were normal. Physical examination..

Published: 19/07/2016
Authors: Floyd Jr MS, Connolly S, Gana HB

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Cash direct: Increasing patient choice and access to LARC

​ Background/introduction  Busy lifestyles and women’s continued need and desire for reliable methods of contraception, has led to the development of ‘CaSH Direct’ which offers LARC assessments and procedures at times that are convenient to women but without the need for multiple visits to. Aim(s)/objectives  CaSH Direct..

Published: 19/07/2016
Authors: Marshall J, Taylor A

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P118. Improving breast services – It's in the DNA

​ Introduction All breast referrals must be seen within 2 weeks. The sheer volume of referrals from primary care makes this a challenging target to achieve. It is therefore extremely important that clinics are utilised appropriately and that every effort is taken to minimise non-attendance. Current hospital policy is to re-appoint all..

Published: 19/07/2016
Authors: Chagla LS

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A two nipple technique

​ Abstract We describe a novel approach to reconstruction of the superiorly placed hypoplastic nipple areola complex (NAC) with the aim of retaining sensation of the nipple and avoiding scars on the upper pole of the breast. We used this novel approach for a 38 year old lady with right sided Poland..

Published: 19/07/2016
Authors: Koshy O, Veliky M

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Acute Urinary Retention in a Female

​ Extract 56 years old female smoker presented with recurrent urinary tract infections but no hematuria. Pelvic exam revealed an indurated area on the anterior vaginal wall. Magnetic resonance imaging (MRI) revealed a suspicious area around the urethra which was thought to be tumor extension from a bladder cancer. Rigid cystoscopy demonstrated..

Published: 19/07/2016
Authors: , Floyd Jr MS, Khattak AQ

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Unexpected medical undergraduate simulation training (UMUST)

​ Background Preparing medical students with the skills necessary to deal with emergency situations as junior doctors can be challenging due to the complexities of creating authentic ‘real life’ experiences in artificial environments. The following paper is an evaluation of the UMUST (Unexpected Medical Undergraduate Simulation Training) project; a high-fidelity simulation..

Published: 19/07/2016
Authors: Bennett N

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Tips and tricks of ureteroscopy - Part II

​ Abstract Our “tips and tricks” focuses on all aspects of upper tract endourology and we hope these will be of use to all trainees and consultants who perform ureteroscopy. We report an “expert consensus view” from experienced endourological surgeons, on all aspects of advanced ureteroscopic techniques, with a particular focus..

Published: 19/07/2016
Authors: Samsudin A

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Youssef’s syndrome

  Floyd, MS; Gana, HBY; McCabe, JE. (2016). Letter to the editor re: ‘Youssef’s syndrome: should MRI be the first line investigation?’​ . Journal of Clinical Urology. 9 (2), 135-136

Published: 19/07/2016
Authors: Floyd Jr MS, Gana HB, McCabe JE

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Hypofractionated radiotherapy versus conventionally fractionated radiotherapy

​ Background Patient-reported outcomes (PROs) might detect more toxic effects of radiotherapy than do clinician-reported outcomes. We did a quality of life (QoL) substudy to assess PROs up to 24 months after conventionally fractionated or hypofractionated radiotherapy in the Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP) trial...

Published: 19/07/2016
Authors: Malik Z

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Impact of the introduction of National Institute for Health and Care Excellence (NICE) guideline NG3

​ Aims NICE updated its guidance on diabetes in pregnancy in February 2015. The changes included recommending cut-off values for diagnosing gestational diabetes (GDM) and lowering the target pre-prandial glucose levels from

Published: 19/07/2016
Authors: Bujawansa S, McNulty S, Wilkinson P, Michaels S, Pankaja S

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Microbiological spectrum of clinically infected foot ulcers

​ Aims Infection is common in diabetes foot ulcers and early judicious use of antibiotics is important to reduce complications. The choice of initial antibiotic should be based on local microbiological flora. The aim of this study was to determine the microbiological spectrum of clinically infected foot ulcers in patients with..

Published: 19/07/2016
Authors: Ball R

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Vasopressin, steroids and epinephrine

​ The use of vasopressin and steroids in addition to epinephrine during the resuscitation of patients suffering an in-hospital cardiac arrest is associated with an improved neurological outcome. Rehnberg, J.V.; Nee, P. (2015). Vasopressin, steroids and epinephrine and neurologically favourable survival after in-hospital cardiac arrest​ . Journal of the Intensive Care Society. 16 (1), 77..

Published: 19/07/2016
Authors: Nee PA

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Pharmacokinetic considerations and dosing strategies of antibiotics

​ Abstract The treatment of sepsis remains a significant challenge and is the cause of high mortality and morbidity. The pathophysiological alterations that are associated with sepsis can complicate drug dosing. Critical care patients often have capillary leak, increased cardiac output and altered protein levels which can have profound effects on..

Published: 19/07/2016
Authors: Barton G

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Evaluating an alternating mattress on an elderly rehabilitation ward

​ Abstract Pressure ulcer prevention is a primary requirement for the NHS. Robust nursing procedures and the provision of pressure-relieving equipment is vital in meeting this requirement. However, the Department of Health also regards making considerable financial savings as a fundamental requirement. There is a firm clinical consensus among national and..

Published: 19/07/2016
Authors: Gleeson D

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International genome-wide meta-analysis

​ Abstract Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We..

Published: 19/07/2016
Authors: McLindon J

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Flap or graft: The best of both in nasal ala reconstruction

​ Summary The area of the nose immediately medial to the nasofacial groove is a common site for relatively small but penetrating basal cell carcinomas (BCCs). Although larger lesions may necessitate formal subunit reconstruction, smaller lesions pose a considerable dilemma. Full-thickness skin grafts (FTSGs) often result in an unsightly contour defect...

Published: 19/07/2016
Authors: Morton J

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The UK plastic surgery sentinel lymph node biopsy service

​ Abstract It has been well established that the incidence of melanoma in the UK continues to rise, and that earlier detection leads to overall improved survival. Amongst several prognostic features, primary tumour thickness and regional lymph node status are accepted as the most important.1 Since it was first introduced in 1990..

Published: 19/07/2016
Authors: Brackley P, Yao S

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Low-resolution CT attenuation correction images

​ Objective To review new incidental findings detected on low-resolution CT attenuation correction (CTAC) images acquired during single-photon emission CT-CT myocardial perfusion imaging as an extension to our initial study. Methods CTAC images acquired as part of myocardial perfusion imaging performed using single-photon emission CT at four UK nuclear medicine centres..

Published: 19/07/2016
Authors: Howes A

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Urinary proteomic profiling in severe obesity

​ Introduction Obstructive sleep apnoea (OSA) is common in obesity and is associated with cardiovascular and metabolic complications. Continuous positive airway pressure (CPAP) in OSA may lead to physiological changes reflected in the urinary proteome. The aim of this study was to characterise the urinary proteome in severely obese adult subjects..

Published: 19/07/2016
Authors: Hardy KJ

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Comparison of the reconstruction trochanteric antigrade nail (TAN)

​ Abstract Reverse oblique intertrochanteric fractures have unique mechanical characteristics and are often treated with intramedullary implants. We compared the outcomes of the reconstruction trochanteric antegrade nail (TAN) with the proximal femoral nail antirotation (PFNA). Between July 2008 and February 2014, we reviewed all patients with reverse oblique intertrochanteric fractures treated at our..

Published: 19/07/2016
Authors: Matar HE, Lipscombe S, Gudena R

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Primary cutaneous myxoid spindle cell squamous cell carcinoma

​ Summary A 72-year-old woman presented to the plastic surgery outpatient department with a nodular lesion to her shin. This nodule had increased in size, but was slow growing. The patient had a history of sun-damaged skin. On visual examination, the lesion was thought to be a naevus or basal cell..

Published: 19/07/2016
Authors: Khan I

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Preparedness and training in staff responding to a burns disaster

​ Abstract Effective disaster response is preceded by effective disaster planning, and insufficient staff training has been identified as a problem in the preparation of hospitals for major incidents. Despite this, little is known about the exact levels of training doctors and nurses responding to a disaster receive. The authors conducted..

Published: 19/07/2016
Authors: May J

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Improving rehabilitation after critical illness

​ Purpose Patients recovering from critical illness may be left with significant muscle mass loss. This study aimed to evaluate whether a 6-week program of enhanced physiotherapy and structured exercise (PEPSE) and an essential amino acid supplement drink (glutamine and essential amino acid mixture [GEAA]) improves physical and psychological recovery. Materials..

Published: 19/07/2016
Authors: Jones C, McCairn AJ

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Proximal femur giant solitary plasmacytoma of bone: lessons learnt

​ Solitary skeletal Plasmacytoma is a malignant plasma cell tumour that accounts for 3–5% of all monoclonal gammopathies. It presents as a single lytic lesion with clonal plasma cells in the vertebrae, ribs or pelvis, with low or no serum or urine M-protein. Bone marrow is not consistent with multiple myeloma, however,..

Published: 19/07/2016
Authors: Matar HE, Gudena R

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Managing acute severe ulcerative colitis in the hosptialised setting

​ Abstract Ulcerative colitis affects approximately 146 000 people in the UK and is the most common form of inflammatory bowel disease. The majority of patients will have uncomplicated disease, but around 1 in 10 patients will develop acute severe colitis. Despite modern medical management, colectomy rates of 27% and mortality rates of 1% are still reported...

Published: 19/07/2016
Authors: McClements D

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Pilot study of video assisted anal fistula treatment

​ Abstract Introduction Video-assisted anal fistula treatment (VAAFT) is a minimally invasive, sphincter-preserving procedure with low morbidity. It was the aim of this prospective study to analyse both the feasibility and preliminary results of video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair for anal fistula. Method  The procedure involves..

Published: 19/07/2016
Authors: Ormsby N, Rajaganeshan R

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PTU-233 Transanal haemorrhoidal dearterialization (THD) and targeted mucopexy for haemorrhoids

​ Introduction  This study aims to evaluate the efficacy of transanal haemorrhoidal dearterialization and Mucopexy (THD+Mpx) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome. Method  Two hundred and fifteen patients affected by Grade II (27, 13%), III (145, 69%) and IV (39, 18%) symptomatic haemorrhoidal disease..

Published: 19/07/2016
Authors: Ormsby N, Singh S, Chadwick M, Scott M, Samad A, Rajaganeshan R

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PTH-306 R1 rectal cancer: an analysis of survival

​ Introduction  Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes of patients with R1 resection of rectal cancer. Method  Retrospective study of all patients..

Published: 19/07/2016
Authors: Ormsby N, Chadwick M, Samad A, Scott M, Rajaganeshan R

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PWE-410 Initial UK experience with transversus abdominus muscle release

​ Introduction  Large complicated ventral hernias are an increasingly common problem following laparotomy and particularly laparostomy. Moreover, they are often seen in patients with significant co-morbidities who may have or need to have stomas. Repair with bridging is associated with high recurrence rates and makes surgical risk unattractive. The transversus abdominis..

Published: 19/07/2016
Authors: Scott M

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PWE-336 Outcomes of colorectal cancer resections in patients with multiple co-morbidities and advanced tumours

​ Introduction  Comorbid patients with advanced tumours constitute a rapidly growing segment of patients undergoing colorectal cancer resection, but their outcomes remain understudied and under-reported. Our aims were to analyse outcomes of high risk patients with advanced tumours undergoing curative colorectal resections compared with a similar cohort 2 decades younger. Method  Data..

Published: 19/07/2016
Authors: Garry J, Ormsby N, Scott M, Samad A, Rajaganeshan R

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PWE-374 Is ct colonoscopy ready for prime time as first line investigation for high risk patients?

​ Introduction   With CT virtual colonoscopy (CTVC) emerging as a widely available sensitive tool in the investigation of GI pathology, we changed our practice, and are now investigating patients presenting in our “one stop – 2 week rule” gastroenterology clinic with lower GI symptoms with a flexible sigmoidoscopy followed by a CTVC on..

Published: 19/07/2016
Authors: Bennett B, Bassi A

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EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma

​ Purpose Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized melanoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery and pathology. The aim of this document is to provide guidelines for nuclear..

Published: 19/07/2016
Authors: May J

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Clearing the field: A novel device to assist microsurgeons

​ Abstract We describe an innovative technique which uses a synergistic approach to maintain a static, clear and dry field and allow the optimal microsurgical repair of neurovascular structures. Jordan, DJ; Jeevan, R; Koshy, O. (2015). Clearing the field: A novel device to assist microsurgeons​ . Journal of plastic, reconstructive & aesthetic surgery: JPRAS. 68 (12), 1766..

Published: 19/07/2016
Authors: Koshy O

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The implementation of a blood conservation strategy

​ I​ntroduction Patients admitted to intensive care units (ICUs) are commonly affected by anaemia, which is contributed to by iatrogenic blood loss from diagnostic testing, with potential risks of increasing transfusion requirements and negative effect on outcomes. Recently published guidelines make several recommendations for the management of anaemia and red..

Published: 19/07/2016
Authors: Tridente A, Bonney S, Nee PA

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The FICE course and qualification - experience from the Cheshire and Merseyside group

​ Introduction The utility of echocardiography for assessing the critically ill patient has long been recognised. The Focused Intensive Care Echocardiography (FICE) training pathway is endorsed by the Intensive Care Society of the UK. Candidates attend a full day course consisting of lectures and practical sessions. Subsequently, every candidate is required..

Published: 19/07/2016
Authors: Bolton N, Rogers G, Booker K, Mohammed A, Mahendran V, Tridente A

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A master stroke or recipe for heartache?

​ Background Intra-operative fluid management technologies (FMT) have been identified as a high impact intervention by the Department of Health. This is due to savings from reduced complication rates, improved utilisation of critical care resources and reduced length of stay for patients undergoing major procedures when FMT are used. The trust..

Published: 19/07/2016
Authors: Hughes E, Yoxall PF, Waits R

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Effect of CPAP on arterial stiffness

​ Background Obstructive sleep apnoea (OSA) may independently increase cardiovascular risk in obesity. Although there is evidence that arterial stiffness is altered in OSA, knowledge of these effects with continuous positive airway pressure (CPAP) in severe obesity (body mass index (BMI) ≥ 35 kg/m2) is limited. This study aimed to explore how..

Published: 19/07/2016
Authors: Hardy KJ

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Localization techniques for guided surgical excision of non-palpable breast lesions

​ Background Breast cancer is the most common form of cancer and the second leading cause of death amongst women in Europe. Amongst five invasive cancers per 1000 women detected in screening, 2.7 were < 15 mm in diameter; and others reported that over one third of excised breast lesions were clinically occult. The challenge..

Published: 19/07/2016
Authors: Jois RHS,

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Efficacy and Safety of a Biweekly Viscosupplementation Regimen

​ Abstract Osteoarthritis is the most common form of arthritis in the Western world, causing disabling symptoms in 10% of people older than 55 years. Hyaluronic acid injections can reduce osteoarthritic pain but require three to five doses administered weekly. This preliminary study aims to assess the efficacy of a more flexible viscosupplementation..

Published: 19/07/2016
Authors: Munir U, Teanby D

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Postoperative shoulder function

​ Abstract Reported complications of neck dissection surgery have included decreases in shoulder muscle power and range of motion, drooping shoulder, and shoulder pain. We conducted a cross-sectional study to assess postoperative shoulder function following three different types of neck dissection surgery that were performed at Aga Khan University Hospital and..

Published: 19/07/2016
Authors:

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Challenging ipsilateral hip and segmental diaphyseal femur fractures

​ Description Patients with hip fractures very rarely have hip osteoarthritis (OA), with published data suggesting an inverse relationship between hip fractures and hip OA. In fact, hip OA is found to be protective against intracapsular fractures but increases the risk for extracapsular fractures. This is related, in part, to the..

Published: 19/07/2016
Authors: Matar HE, El-Hosh S, Attar FG

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Book Review: An issue of Clinics in Plastic Surgery

​ Jordan, D. (2015).  Book Review: An issue of Clinics in Plastic Surgery April 2014 . Annals of Plastic Surgery. 74 (5), p519  

Published: 19/07/2016
Authors:

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Axillary lymph node dissection

​ Page, F; Nelson, K; et al. (2015).  Axillary lymph node dissection: Do you know your boundaries?  Journal of Plastic, Reconstructive and Aesthetic Surgery. 68 (4), p597-599

Published: 19/07/2016
Authors: Nelson K

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Discrete Scar in Prominent Ear Correction

​ Introduction Various postauricular incision sites can be used for prominent ear correction depending on technique and surgeon preference. No study has previously looked at the most aesthetic (least visible) location for the postauricular scar. We investigated the visibility of various scar locations on the posterior ear from a third person..

Published: 19/07/2016
Authors: Shokrollahi K

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Bladder reconstruction: The past, present and future (review)

​ Abstract Ileal conduit urinary diversion is the gold standard treatment for urinary tract reconstruction following cystectomy. This procedure uses gastrointestinal segments for bladder augmentation, a technique that is often associated with significant complications. The substantial progression in the fields of tissue engineering and regenerative medicine over the previous two decades..

Published: 19/07/2016
Authors: Khattak AQ

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Diabetes education through adult learning

​ Abstract Patient education is acknowledged to be the cornerstone of effective self-management in people with chronic conditions such as diabetes. While the effects of patient education in terms of biophysical endpoints such as HbA1c are well studied, its effects on quality of life (QOL) and other non-biophysical outcomes are..

Published: 19/07/2016
Authors: Cardwell J, Hardy KJ, O'Brien S

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Peripheral T-cell lymphoma

​ Abstract A 70-year-old Caucasian gentleman presented with a four-month history of a rapidly enlarging skin tumor on his right lower abdomen, episodes of night sweats and generalized pruritus. No other relevant medical or drug history was found. Clinical examination revealed a large 16 by 13 centimeters fungating tumor on his right lower..

Published: 19/07/2016
Authors: Sharma N, Tappin J, Ngan K

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Lichen planus pigmentosus-inversus

​ Abstract A 50-year-old Caucasian woman presented with a four-month history of asymptomatic, linear hyperpigmentation along the skin creases on the left side of her neck, right axilla and groins. No preceding trigger factor was reported and she had no relevant medical or drug history. Clinical examination revealed multiple, well-demarcated hyperpigmented..

Published: 19/07/2016
Authors: Ngan K, Sharma N

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Management of extensive facial burns

​ Abstract Perioral facial burns have a high propensity to formation of microstomia and numerous prosthetic devices have been described that can be used postoperatively to address this problem. We introduce a novel device, the Whiston Buccal Prosthesis, which is used intraoperatively and in the early postoperative period and it acts..

Published: 19/07/2016
Authors: , Shokrollahi K, Sofos S, Tehrani H,

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Multiple foreign bodies of long duration in adult vagina

​ Introduction  Foreign bodies of long duration are not unusual in adult vagina. Several published in literature involve children, especially pre-pubertal girls often related to curiosity. Variety of objects have been retrieved ranging from tampons, sex toys, forgotten pessaries, pens, pencil tops, bottles, aerosol caps, fruits, vegetables and packets containing illicit..

Published: 19/07/2016
Authors: Dhannapuneni JS, , Srivastava N

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Haultain's procedure

​ Introduction  Acute uterine inversion is rare but life threatening emergency in the third stage of labour. Prompt recognition and immediate management is the key to saving the patient's life. Traditional management options involve immediate manual replacement with or without hydrostatic pressure. When unsuccessful, surgical correction using Huntington and Haultain's procedures..

Published: 19/07/2016
Authors: Amma JS, Morgan PR, Dhannapuneni JS

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Opsoclonus-myoclonus syndrome

​ Introduction Opsoclonus-myoclonus syndrome is a rare autoimmune syndrome usually seen in children and very rarely in adults. It typically presents with a triad of opsoclonus, myoclonus and ataxia, and is most often associated with a tumor or after an infection or vaccination. Around half of all adult cases are paraneoplastic..

Published: 19/07/2016
Authors: Forsyth L

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Peri-operative practice in knee arthroscopy

​ Abstract Knee arthroscopy is one of the commonest elective day case orthopaedic procedures performed worldwide. The incidence of this procedure is 9.9 per 10,000 in England [1]. Day surgery of such a high volume usually has a highly standardized regime of care, however a survey of Swedish and German Orthopaedic surgeons on knee..

Published: 19/07/2016
Authors: Pydisetty R

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Neutrophil to lymphocyte count ratio

​ Objectives  Early identification of patients with blood stream infection (BSI), especially bacteraemia, is important as prompt treatment improves outcome. The initial stages of severe infection may be characterised by increased numbers of neutrophils in the peripheral blood and depression of the lymphocyte count (LC). The neutrophil to LC ratio (NLCR)..

Published: 19/07/2016
Authors: Nee PA, Vardhan M

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Reconstructive outcomes of Mohs surgery compared with convention

​ Abstract Established in 2012, the Mersey Regional Centre for Mohs Surgery is the first UK Mohs service to be led by a Mohs trained Plastic & Reconstructive surgeon. We evaluate the resection requirements and reconstructive techniques of our patient group and compare their surgical outcome to that which would have been gained..

Published: 19/07/2016
Authors: Wain R, Tehrani H

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A Novel Cadaveric Simulation Program in Urology

​ Objective To evaluate the urology human cadaver training program developed by the British Association of Urological Surgeons. Design This prospective, observational comparative study recruited urology residents, with different levels of experience, in 2 sessions of a 3-day modular cadaveric operative urology training. Participants performed various procedures on fresh-frozen cadaveric specimens, as..

Published: 19/07/2016
Authors: McCabe JE

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Hemiarthroplasty for Hallux Rigidus

​ Abstract Hallux rigidus is a progressive osteoarthritic condition affecting the first metatarsophalangeal joint that causes pain and stiffness, with a marked reduction in dorsiflexion. Joint arthrodesis has previously been the standard treatment of hallux rigidus; however, new surgical techniques have evolved and first metatarsophalangeal joint hemiarthroplasty is now a viable..

Published: 19/07/2016
Authors: Gheorghiu D, Ballester J

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Risk of malignancy in pulmonary nodules

​ Objectives Clinical prediction models assess the likelihood of malignancy in pulmonary nodules detected by computed tomography (CT). This study aimed to validate four such models in a UK population of patients with pulmonary nodules. Three models used clinical and CT characteristics to predict risk (Mayo Clinic, Veterans Association, Brock University)..

Published: 19/07/2016
Authors: Malhotra P

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Treatment of keloid scars

​ Abstract Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but..

Published: 19/07/2016
Authors: Tehrani H

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Audit reviewing contraceptive methods

​ Background Regular review of contraceptive methods in HIV positive women is important to help prevent on-toward drug interaction and un-intended pregnancies. The British HIV Association (BHIVA) recommends all HIV positive women not on therapy be offered all forms of available contraception and those on therapy to avoid certain hormonal combinations...

Published: 19/07/2016
Authors: Rimmer K, Pilkington L, Quayle P

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Early prediction model for delirium

​ Rationale Delirium incidence in intensive care unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention. Purpose To develop and validate a model based on data available at ICU admission to predict delirium development during a patient’s complete ICU stay and..

Published: 19/07/2016
Authors: Jones C

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Risk of solid cancer in patients

​ Background  Patients with rheumatoid arthritis (RA) have an increased risk of certain solid cancers, in particular lung cancer, compared to the general population. Treatment with tumour necrosis factor (TNF) inhibitors (TNFi) may further enhance this risk. Objectives  To compare the risk of solid cancer in patients with RA treated with..

Published: 19/07/2016
Authors: Abernethy R

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Serum urate and obstructive sleep apnoea

​ Abstract Obstructive sleep apnoea (OSA) may increase the risk of hyperuricaemia and predispose to gout. The evidence for the effects of OSA on serum urate in severe obesity is limited. This study investigated whether OSA was associated with serum urate in severe obesity and whether continuous positive airway pressure (CPAP)..

Published: 19/07/2016
Authors: Hardy KJ

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The Mersey Burns App

​ Introduction  ‘Mersey Burns App’ is a smartphone/tablet application that aids in the assessment of total burn surface area (TBSA) and calculation of fluid resuscitation protocols in burns. This paper presents two studies assessing the speed and accuracy of calculations using Mersey Burns (App) in comparison with a Lund and..

Published: 19/07/2016
Authors: Barnes J, Pritchard-Jones R, McArthur P, Shokrollahi K,

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Investigation and management of pulmonary nodules

​ SUMMARY OF RECOMMENDATIONS This guideline is based on a comprehensive review of the literature on pulmonary nodules and expert opinion. Although the management pathway for the majority of nodules detected is straightforward it is sometimes more complex and this is helped by the inclusion of detailed and specific recommendations and..

Published: 19/07/2016
Authors: Malhotra P

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Do we practice what we preach

​ Background & Aims There is a lack of conclusive long-term studies evaluating risk and benefit in the surgical management of patients who show a complete pathological response following radiotherapy in rectal cancer. The trend in practice is becoming increasingly conservative. We questioned whether increased age and/or comorbidity influenced management when..

Published: 19/07/2016
Authors: Ormsby N, Rajaganeshan R

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Third International Intensive Aftercare Conference

​ ABSTRACT The third international conference on intensive care unit (ICU) diaries and intensive aftercare took place in Norrköping, Sweden, on 28 November 2013. The conference was organized by Carl Bäckman and colleagues, Vrinnevi Hospital and NOFI, and represented by Sissell Storli. More than 100 clinicians from across Europe and the USA..

Published: 19/07/2016
Authors: Jones C

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Melanoma mimic in epidermolysis bullosa simplex

​ Abstract Epidermolysis bullosa (EB) simplex (EBS) is a mechanobullous disease characterized by blistering, typically of the hands and feet, following friction or minor trauma. A less well-recognized phenomenon in this condition is the sudden development of atypical naevi. We report the case of a 27-year-old hairdresser with a clinical diagnosis..

Published: 19/07/2016
Authors: Sharma N, Ellison J, Walsh ML

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The ADMIN-ICU survey

​ Objectives  There is little evidence and few guidelines to inform the most appropriate dosing and monitoring for antimicrobials in the ICU. We aimed to survey current practices around the world. Methods  An online structured questionnaire was developed and sent by e-mail to obtain information on local antimicrobial prescribing practices for..

Published: 19/07/2016
Authors: Barton G

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How should I structure my Post-ICU Clinic?

​ Ranzani, OT; Jones, C. (2015).  How should i structure my Post-ICU Clinic? from early goal rehabilitation to outpatient visits . Minerva Anestesiologica. 81 (8), 832-834    

Published: 19/07/2016
Authors: Jones C

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Intra-arterial vasodilators

​ Objectives The aim of this study is to review the available literature on the efficacy and safety of agents used for prevention of RAS. Background Different vasodilator agents have been used to prevent radial artery spasm (RAS) in patients undergoing transradial cardiac catheterization. Methods We included studies that evaluated any..

Published: 19/07/2016
Authors: Rashid M

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Haematological considerations in urology

​ ​Abstract Deep venous thrombosis (DVT) remains a serious and common complication of surgical procedures and is therefore an issue of importance for all urologists. In the UK, pulmonary embolism (PE) following DVT in hospitalised patients causes 32,000 deaths each year. DVT and PE represent the outcome of venous thromboembolism (VTE). The..

Published: 19/07/2016
Authors: Floyd Jr MS, McCabe JE

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Pericyazine for schizophrenia

​ Background Pericyazine is a 3-cyano-10 (3-4'-hydroxypiperidinopropyl) phenothiazine. It is overall pharmacologically similar with chlorpromazine, though particularly sedating. Dopamine receptor subtype analysis has not been performed for pericyazine, but the drug appears to induce greater noradrenergic than dopaminergic blockade. Compared to chlorpromazine, pericyazine reportedly has more potent antiemetic, antiserotonin, and..

Published: 19/07/2016
Authors: Matar HE

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Antibiotic prophylaxis during dental procedures

​ Abstract The average age of patients presenting for total joint arthroplasty is decreasing. The number of primary and revision arthroplasty procedures performed in the UK, Europe and USA is increasing annually. As number of procedures performed increases, the life expectancy of our patients and therefore the in vivo duration of..

Published: 19/07/2016
Authors: Pydisetty R

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Penile ulceration

​ Abstract Penile ulceration is a rare side effect of treatment with nicorandil for the management of angina pectoris. To our knowledge, there have been six reported cases in the literature: Yap et al. reported a case series of three in 20101, Kinney et al. reported two cases in 20102 and Birnie et..

Published: 19/07/2016
Authors: Ellison J, McCabe JE

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Analysis of prolonged jaundice

​ Background and aims  Prolonged neonatal jaundice is a common presentation in newborns and rarely requires intervention; however it is important to rule out sinister causes such as biliary atresia. The outcome of this study was to analyse the demographics of infants presenting with prolonged jaundice, investigations undertaken and results of..

Published: 19/07/2016
Authors: Bentur H

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Plastic and reconstructive Mohs Surgery

​ Comparisons between Mohs micrographic surgery (MMS) and conventional excision (CE) have been made in the past, in particular relating to tumour recurrence rates; however, there are no comparative studies of reconstructive outcomes between these two methods in the current literature. We compared the reconstructive techniques and histological findings of our..

Published: 19/07/2016
Authors: Wain R, Tehrani H

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Mohs micrographic surgery

​ Microcystic adnexal carcinoma (MAC) is a locally aggressive tumour with a propensity for perineural and perivascular invasion, resulting in a high recurrence rate even with wide surgical margins (Leibovitch I, Huilgol SC, Selva D et al. Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol 2005; 52: 295-300). We..

Published: 19/07/2016
Authors: Tehrani H

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Communication with patients with tracheostomy

​ Introduction and Aims  Ventilated patients in ITU (intensive treatment unit) tend to be challenging to communicate with, especially patients who are being weaned. These patients usually have tracheostomy in situ and use means such as writing or letter boards to communicate. The situation becomes complex in patient groups that have..

Published: 19/07/2016
Authors: Shokrollahi K

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Postoperative Patient-Controlled Analgesia

​ The latissimus dorsi has been the workhorse flap in breast reconstruction for several decades. The flap has a high reliability but is becoming less frequently used because of the recognized limitations of this flap. These disadvantages include functional impairment such as reduced shoulder mobility and strength. The rate of seroma..

Published: 19/07/2016
Authors: Iqbal A, Shaaban H

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Centralising acute stroke services

​ Morris and colleagues did not discuss how substantial financial investment in services affected their results. The London stroke strategy was supported by an additional £23m (€28.8m; $37.3m) in funding.2 The cost improvement programme highlighted the need for an extra £13m investment in hyperacute stroke units to provide the imaging and..

Published: 19/07/2016
Authors: Hill AM

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An isolated digital lipoblastoma

​ Abstract This report presents a girl with a lipoblastoma of a finger presenting as a macrodactyly. Documented inflammation of the digit at birth raises suspicion of neo-adipogenesis, which is recognised in lipomas. This case highlights a rare site for lipoblastomas and explores a potential aetiopathogenesis. Vaiude, P; Husein, B; Hurrell,..

Published: 19/07/2016
Authors: McArthur P

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Intravenous antibiotic administration practices

​ INTRODUCTION Antibiotics are the curative therapy in the management of sepsis. A point prevalence study in 2007 showed that 51 % of patients on Intensive Care Units worldwide were deemed to have sepsis with 71 % receiving antibiotics. Pharmacokinetic/pharmacodynamic (pk/pd) data suggest that some parameters such as volume of distribution and renal clearance..

Published: 19/07/2016
Authors: Barton G

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Early prediction of delirium

​ INTRODUCTION Delirium incidence in Intensive Care Unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention. We developed and validated an early ICU delirium prediction model. OBJECTIVE To develop and validate a model based on data available at ICU admission to predict..

Published: 19/07/2016
Authors: Jones C

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The admin-ICU survey

​ INTRODUCTION Antibiotic choice and dosing is one of the cornerstones of infection management in intensive care. Recent research demonstrates variability in antimicrobial pharmacokinetics in the critically ill. There is little evidence to which is the most appropriate dosing, administration and monitoring strategy. OBJECTIVES To determine current practices in antimicrobial dosing,..

Published: 19/07/2016
Authors: Barton G

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Lung protective ventilation

​ INTRODUCTION In 2013 Futier et al. published work showing that a lung protective ventilation strategy with low tidal volumes for patients undergoing elective major abdominal surgery was associated with improved clinical outcome and reduced healthcare utilisation. It is established within intensive care that protective ventilation strategies are best practice, however until..

Published: 19/07/2016
Authors: Angus W, Glennon K, Mahambrey T, Miller T

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Treatment options for management of gout

​ Lee, WP; Mavinamane, S. (2014).  Treatment options for management of gout . GM: Midlife & Beyond. 44 (9), 39-42  

Published: 19/07/2016
Authors: Mavinamane S

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Low-resolution CT attenuation correction images

​ Objective To review new incidental findings detected on low-resolution CT attenuation correction (CTAC) images acquired during single-photon emission CT (SPECT-CT) myocardial perfusion imaging (MPI) and to determine whether the CTAC images had diagnostic value and warrant reporting. Methods A multicentre study was performed in four UK nuclear medicine departments. CTAC..

Published: 19/07/2016
Authors: Howes A

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Diagnostic accuracy of MRI scanning

​ Introduction and Objectives To assess the accuracy of pre-biopsy MRI in detecting prostate cancer prior totransperineal template guided sector (TPTS) prostate biopsies. Materials and Methods Patients undergoing TPTS biopsy for diagnostic purposes (previous negative TRUS biopsies with persisting clinical suspicion of prostate cancer) were included in this prospective analysis. Patients..

Published: 19/07/2016
Authors: McCabe JE

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Foleys in a nutshell

​ Introduction and Objectives  Dr. Frederic Eugen Basil Foley, best known to modern urologists as the man whose name attached to the self-retaining balloon catheter, the commonest urethral catheter ever used.  Materials and Methods  Dr Foley was an American Urologist, from St. Cloud, Minnesota (5th April, 1891 - 24th March, 1966). He studied..

Published: 19/07/2016
Authors: McCabe JE

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Dopamine agonists and monoamine oxidase B inhibitors

​ Background Whether initial treatment for Parkinson's disease should consist of levodopa, dopamine agonists, or monoamine oxidase type B inhibitors (MAOBI) is uncertain. We aimed to establish which of these three classes of drug, as initial treatment, provides the most effective long-term control of symptoms and best quality of life for..

Published: 19/07/2016
Authors: Abrams J, Ashley S, Steiger M

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Transfusion and haemoglobin changes in primary THR

​ Joint replacement surgery causes a significant burden on national blood stocks accounting for approximately 10% of hospital transfusions [1]. Allogenic blood transfusions are associated with increased morbidity and mortality [2]. There is a wide variation in transfusion rates in UK trusts, for primary total hip replacement (THR), with a reported national average of 25% [3]...

Published: 19/07/2016
Authors: Raftery S, Yoxall PF

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Labour epidural efficacy

​ The aim of our audit was to establish the efficacy of our labour epidurals by assessing the height of the block we achieved whist the epidural was in use and the requirements for ‘top up’ boluses. Following the initial audit we introduced a standardised loading dose to prevent disconnection from..

Published: 19/07/2016
Authors: Yoxall PF

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Vertical scar skin pattern

​ Abstract Immediate breast reconstruction following mastectomy has become increasingly common. Skin-sparing mastectomies (SSM) and risk reducing mastectomies are becoming more commonly performed.1–3 Where radiotherapy is not anticipated, implant-based reconstruction may be performed. One problem associated with implant-based reconstructions has long been lower pole coverage and support. A number of techniques..

Published: 19/07/2016
Authors: Iqbal A

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Care of children and young people

​ Background and aim  Deliberate Self-harm (DSH) affects 1 in 15 young people and remains one of top 5 causes of acute hospital admissions in UK. We looked at children attending hospital with DSH to assess their pathways of care and discharge outcomes. We also looked to see if any trends emerged in their..

Published: 19/07/2016
Authors: Aziz M, Bentur H

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Utilising the MTP plantar fat

​   Touil, LL; Lindsay, KJ; Anderson, K; Bell, D. (2015).  Utilising the MTP plantar fat: A novel approach in Syme's amputation . Journal of Plastic, Reconstructive and Aesthetic Surgery. 68 (1), 126-129.

Published: 19/07/2016
Authors: Touil L, Bell D

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Radical cystectomy and pelvic lymphadenectomy

​ Abstract The ileal conduit for urinary diversion after radical cystectomy is a well-described procedure. Furthermore, parastomal hernias, prolapse, stenosis, and retraction of the stoma have been reported as some of the more common complications of this procedure. The subsequent repair of parastomal hernias with a biological mesh and the potential..

Published: 19/07/2016
Authors: Sofos S

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Positron emission tomography

​ Introduction  Positron Emission Tomography (PET) is an important tool in the evaluation of pulmonary nodules. A number of risk prediction tools attempt to discriminate between benign and malignant nodules. Herder et al previously demonstrated an improvement in performance of the Mayo risk prediction tool when information regarding FDG avidity was..

Published: 19/07/2016
Authors: Malhotra P

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Haemoptysis with a normal chest X ray

​ Introduction Haemoptysis is a red-flag symptom for lung cancer, but there is no consensus on how to investigate patients with haemoptysis and a normal chest X-ray. We sought to determine the yield of CT and bronchoscopy in this patient population in patients attending two hospitals in Northern England. Methods Patients..

Published: 19/07/2016
Authors: Malhotra P

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Exacerbation of COPD

​ Abstract A shortcut review was carried out to establish whether a normal partial pressure of carbon dioxide (pCO2) on a venous blood sample could be used to rule out hypercarbia. Eleven studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type,..

Published: 19/07/2016
Authors: Woods M

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Trends in clinical variables and outcome

​ Introduction  Patients admitted to intensive care following surgery for faecal peritonitis present particular challenges in terms of clinical management and risk assessment. Collaborating surgical and intensive care teams need shared perspectives on prognosis. We aimed to determine the relationship between dynamic assessment of trends in selected variables and outcomes. Methods ..

Published: 19/07/2016
Authors: Tridente A

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Phenotypic factors associated with outcome

​ Introduction Patients admitted to intensive care following surgery for faecal peritonitis present particular challenges in terms of clinical management and risk assessment that require close collaboration between surgical and intensive care teams [1]. We aimed at establishing whether dynamic assessment of trends in selected variables may be associated with outcomes, and..

Published: 19/07/2016
Authors: Tridente A

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Successful implementation of a medical emergency team

​ Introduction A medical emergency team (MET) was introduced in our institution in January 2012 to provide timely response to the needs of acutely ill inpatients and cardiac arrest calls. The MET assesses the patient and prescribes a management plan for the responsible team to follow; promptly stabilising and transferring patients to..

Published: 19/07/2016
Authors: Elmore J, Mahambrey T, Tridente A, Varia R

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Critically ill patients with faecal peritonitis

​ Introduction Faecal peritonitis (FP) is a common cause of sepsis and admission to the ICU [1]. We report a review of all patients admitted to our ICU over 5 years with FP. The aim was to define the clinical characteristics, outcomes and risk factors for mortality in ICU patients with FP. Methods..

Published: 19/07/2016
Authors: Tridente A

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Long-term renal and survival outcomes

​ Introduction Acute kidney injury (AKI) affects 40% of critically ill patients, with UK data reporting 5% needing renal replacement therapy (RRT). Hospital mortality is reported as being up to 60%. We sought to evaluate renal and long-term patient survival outcomes in AKI patients receiving RRT on our ICU. Methods Data were collected from..

Published: 19/07/2016
Authors: Tridente A

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Re-examining the role of whole body Bone Scan

​ Introduction Current BAUS guidelines for staging prostate cancer include a radionuclide bone scan and MRI or CT of the pelvis/prostate. MRI has a higher sensitivity for detecting skeletal metastasis than bone scan. The aim of our study was to evaluate the incidence of metastasis to the appendicular skeleton in..

Published: 19/07/2016
Authors: Feyisetan O, McCabe JE

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Does time of transfer from critical care to the general wards affect anxiety? A pragmatic prospective cohort study

​ Objectives To examine prospectively the impact of transfer time on patient anxiety. Design A pragmatic prospective cohort study. Setting 14 bed adult intensive care unit (ICU) in a National Health Service teaching hospital trust in the United Kingdom. Methods Critically ill patients staying on the ICU for at least 24 hours and..

Published: 19/07/2016
Authors: McCairn AJ, Jones C

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Breast conserving surgery

​ Abstract The increasing incidence of breast cancer and advances in detection of small, impalpable cancers presents increasing challenges for the modern breast surgeon. Accurate localization and excision with adequate oncological margins to reduce loco-regional recurrence rates whilst minimizing volume deficit and maximizing aesthetics remains the “gold standard.” We review the..

Published: 19/07/2016
Authors:

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The Chicken Hand

​ Yao, SZJ; Iqbal, A; Bell, D. (2014).  The Chicken Hand: A training model for hand surgery . Journal of Plastic, Reconstructive and Aesthetic Surgery,. 67 (8), e214-16

Published: 19/07/2016
Authors: Yao S, Iqbal A, Bell D

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SAT0130 Rheumatoid Arthritis Related Interstitial Lung Disease

​ Background  Rheumatoid arthritis (RA) is associated with interstitial lung disease (ILD). This is linked with an increased risk of early death from respiratory failure. There is debate on the relative safety of different disease modifying anti rheumatic drugs (DMARDs) in RA-ILD. Objectives  We have examined the effect of a range..

Published: 19/07/2016
Authors: Dawson J

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A Model To Assess The Cost Of Flare In Ulcerative Colitis (UC)

​ Introduction  Disease flare in ulcerative colitis (UC) can result in substantial cost implications to the NHS. While the costs associated with treatment and management of UC are well-documented, estimates of the cost of flare are lacking. A cost analysis was performed to construct a model to estimate the costs associated..

Published: 19/07/2016
Authors: Bassi A

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OP0037 Pulsed Cyclophosphamide in the Treatment

​ Background  There is little evidence base to guide clinicians in the management of patients with rheumatoid arthritis (RA) related interstitial lung disease (ILD). In the subgroup who have rapidly deteriorating respiratory function, pulsed cyclophosphamide has been advocated but no assessment of its efficacy has been published. The British Rheumatoid InterstitiaL..

Published: 19/07/2016
Authors: Dawson J

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OP0254 Association between Steroid Therapy and Survival

​ Background  Clinically relevant interstitial lung disease (ILD) is present in approximately 5% of patients with rheumatoid arthritis (RA). Traditionally, oral steroids have been used to treat this manifestation of RA, but no evidence base exists to support this. Indeed, concern has been raised that such an approach might be associated with..

Published: 19/07/2016
Authors: Dawson J

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BI26 Disseminated cutaneous Mycobacterium chelonae...

​ We report a rare case of disseminated cutaneous Mycobacterium chelonae and phaeohyphomycosis occurring in an immunocompromised patient, a 67-year-old man who developed a rash while on intravenous teicoplanin for Charcot joint osteomyelitis. The rash became widespread over the course of 2 months despite discontinuation of his antibiotics. On initial examination, he..

Published: 19/07/2016
Authors: Hickey S, Forsyth L

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CD14 The use of alitretinoin for chronic hand eczema

​ Alitretinoin is specifically licensed for adults with severe chronic hand eczema that has not responded to potent topical steroids. Severe disease is defined by the Physician's Global Assessment (PGA) and a Dermatology Life Quality Index (DLQI) of > 15. Our aim was to assess compliance to NICE guidance (National Institute for Health..

Published: 19/07/2016
Authors: Walsh ML

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CPC06 rare case of cutaneous collagenous vasculopathy

​ We report the case of a 76-year-old woman who presented with a 2-year history of a slowly extending, asymptomatic rash. It had started off on her anterior knees, extending to her arms and trunk. She reported prominence of her rash over the summer months and felt systemically well. Medically she..

Published: 19/07/2016
Authors: Ellison J

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P04 Trophic ulceration secondary to carpal tunnel syndrome

​ A 56-year-old man presented with a 3-month history of nontraumatic painful ulceration affecting his left hand. He described numbness and pins and needles affecting his left hand with minimal altered sensation affecting his dominant right hand. He has a past medical history of myocardial infarction and is a nonsmoker with..

Published: 19/07/2016
Authors: Ngan K

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P188 Sudeck's atrophy

​ Case history A 49-year-old woman with Type 2 diabetes for 17 years, diabetic retinopathy and sensory neuropathy presented with a 2week history of left forefoot, plantar ulcer and cellulitis. Peripheral pulses were palpable; clinically and radiologically there was no osteomyelitis. Wound swab revealed methicillin resistant Staphyloccus aureus (MRSA), Group B Streptococcus and..

Published: 19/07/2016
Authors: Keigan S, Mohsin N

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A64 (P310) Outpatient parenteral antibiotic therapy (OPAT)

Aims  To determine the benefits of OPAT in diabetes foot infections. Methods This was a retrospective study of consecutively initiated OPAT in patients with diabetes foot infections. Patients initiated on OPAT in a multidisciplinary diabetes foot clinic and inpatients discharged from a diabetes inpatient ward between April 2011 and May 2013 and..

Published: 19/07/2016
Authors: , Hardy KJ, Keigan S, Lewis A,

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Epiglottic Hypoplasia

​ ABSTRACT Non-syndromic hypoplasia of the epiglottis presenting without symptoms at middle age is an extremely rare entity. We report a 50 years female who presented with oral ulcers and incidentally was found to have an asymptomatic rudimentary epiglottis and thickened bilateral aryepiglottic folds forming an inverted funnel shaped supraglottis protecting the..

Published: 19/07/2016
Authors: Muddaiah A

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Recovery post ICU

​ Summary Many ICU patients struggle to recovery following critical illness and may be left with physical, cognitive and psychological problems, which have a negative impact on their quality of life. Gross muscle mass loss and weakness can take some months to recover after the patients’ Intensive Care Unit (ICU) discharge,..

Published: 19/07/2016
Authors: Jones C

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G264 Mentoring for Paediatricians

​ Aims  Mentoring has been shown to be important for personal and professional development of doctors. This study aimed to assess the current awareness of and demand for mentoring amongst paediatricians in the UK. This will enable appropriate development and targeting of resources and support, in addition to assisting paediatricians in..

Published: 19/07/2016
Authors: Garr R

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G417(P) Unexplained multiple rib fractures

​ Background  We describe the unusual case of a three month old girl who developed six posterior rib fractures whilst an inpatient on a paediatric ward with a paroxysmal cough. Causality of rib fractures detected in children include non-accidental injury, bone fragility and trauma. A serious case review investigates the contributory..

Published: 19/07/2016
Authors: Aziz M

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Reduction in self-harming behaviour

​ Abstract No psychotropic drug is specifically licensed for the management of emotionally unstable borderline personality disorder. Prescribing ‘off-label’ places additional responsibilities on the prescriber and may increase liability if there are adverse effects. This case report describes a patient with borderline personality disorder who was started on zuclopenthixol decanoate with..

Published: 19/07/2016
Authors: Javed S

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Multifocal calcifying fibrous tumor at six sites in one patient

​ Abstract Calcifying fibrous tumors (CFT) are rare benign tumors. They usually affect children and young adults and the incidence is equal in males and females. The usual clinical presentation is that of a painless mass. A computed tomography scan typically reveals a well-demarcated calcified lesion. CFT usually presents as a..

Published: 19/07/2016
Authors: Kelly S, Pinto M

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Emergency colorectal cancer: Primary care input

​ Introduction Higher morbidity and mortality is seen in patients with colorectal cancer (CRC) who present as an emergency. A study was performed to assess the pre-admission symptoms experienced by such patients, and time taken to referral. Method A retrospective analysis of all CRC patients presenting as an emergency to a..

Published: 19/07/2016
Authors: Rajaganeshan R, Scott M

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Correlation and diagnostic accuracy of CT in the acute surgical

​ Aim  CT in the acute surgical presentation has significantly increased with technological advancement and availability. Emergency CT is reported by the on call radiologist of varying seniority. We undertook a retrospective study to compare the correlation with the initial senior clinicians' diagnosis and the eventual laparotomy findings.  Method Retrospective data..

Published: 19/07/2016
Authors: Rajaganeshan R, Wellens T

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Is clinical examination alone becoming obsolete in modern surgic

​ Aim Computed Tomography (CT) is the radiological investigation of choice for the majority of acute surgical admissions with abdominal pain. Accuracy has been repeatedly reported at over 95% in studies since 2002. A retrospective analysis was performed to compare a senior clinician's bedside diagnosis with that of emergency CT. Method Retrospective review..

Published: 19/07/2016
Authors: Rajaganeshan R, Wellens T

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Loop colostomy and loop ileostomy complications

​ Aim The formation of a loop stoma is common practice in emergency and elective surgery, but has a profound effect on patient well-being, particularly if complications arise. In our District General Hospital we investigated and compared morbidity outcomes for patients who had loop stomas formed over a 1-year period. Methods..

Published: 19/07/2016
Authors: Chadwick M

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Rheumatoid arthritis-related interstitial lung disease

​ Objectives The prevalence of interstitial lung disease (ILD) in RA is ∼5%. Previous work identified increasing age, active articular disease and articular damage as risk factors for RA-associated ILD (RA-ILD). The roles of high-resolution CT (HRCT) and lung function testing in defining the nature and extent of pulmonary involvement have recently..

Published: 19/07/2016
Authors: Dawson J

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Pseudoangiomatous stromal hyperplasia

​ INTRODUCTION Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast lesion that can be mistaken for angiosarcoma or fibroadenoma. This rare condition generally tends to present as a palpable mass in premenopausal women which can be seen on mammogram and ultrasound alike. The pathological findings tend to be of a thickening..

Published: 19/07/2016
Authors: Barker D,

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Squamous cell carcinoma and vitiligo

​ Ultraviolet radiation predisposes to the development of nonmelanoma skin cancer (NMSC). Melanin safeguards the skin against this. This leads one to conjecture that patients with vitiligo are at a higher risk of developing skin malignancies. However, despite the lack of protective melanin and increased oxidative stress due to epidermal hydrogen..

Published: 19/07/2016
Authors: Hindle E

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Great improvement in acute pancreatitis care

​ Introduction The British Society of Gastroenterologists (BSG) updated guidelines on the management of acute pancreatitis in2005.This audit aimed to improve acute pancreatitis care in accordance with those guidelines. Methods An initial audit of all 39 patients with acute pancreatitis in October-December 2011 was undertaken. Improvements were made through arranging group teaching..

Published: 19/07/2016
Authors: Maitra D

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Education greatly improves AMT scoring

​ Introduction The best practice tariff (BPT) for fragility hip fracture applies to patients aged 60 years and over admitted with a fractured neck of femur (NOF). It awards 1335 per case provided several criteria are met including completion of pre and post-operative abbreviated mental test (AMT). Our fractured NOF pathway prompted AMTscoring,..

Published: 19/07/2016
Authors: Gudena R, Allsup S

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ROLL after neo adjuvant treatment

​ Neo-adjuvant chemo & hormone therapy is very effective in reducing the size of the primary breast cancer: this may result into a substantial response, hence the need to localise a non-palpable lesion. A variety of localisation techniques are used to target surgical removal of these subclinical lesions i.e., Wire marker,..

Published: 19/07/2016
Authors: Jois RHS, Harris O,

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Medical Emergency Team

​ Abstract In January 2011 a multidisciplinary hospital-wide medical emergency team (MET) was introduced at Whiston Hospital replacing the previous cardiac arrest team. The primary aim of this new rapid-response service was to improve early identification and management of deteriorating patients, with a reduction in unplanned intensive care (ICU) admissions, cardiac arrest..

Published: 19/07/2016
Authors: Elmore J, Mahambrey T

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Obstructive sleep apnea

​ Abstract Obstructive sleep apnea is associated with obesity and metabolic syndrome, leading to greater cardiovascular risk. Severely obese patients with obstructive sleep apnea may still be at risk of adverse health outcomes, even without previous cardiovascular disease. Pulse wave analysis non-invasively measures peripheral pulse waveforms and derives measures of haemodynamic..

Published: 19/07/2016
Authors: Hardy KJ

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Compression gloves in hand osteoarthritis

​ Background/Purpose Compression gloves are used in Hand Osteoarthritis (HOA) to reduce pain (day and/or night), stiffness and improve hand function. A systematic review identified only two trials (sample sizes n= 2 and 5), with inconclusive results [1]. The commonest compression gloves provided in the UK are Isotoner gloves. The aim was..

Published: 19/07/2016
Authors: Hough Y

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Outpatient anti epileptic drug prescribing errors

​ Purpose Prescription errors are a common and potentially hazardous problem and may cause patient harm. This review evaluates all new anti-epileptic drug (AED) outpatient prescriptions over one year and reviews the subject literature. Methods A 12-month retrospective review of all outpatient prescriptions of AEDs within a large Children's Hospital. Copies..

Published: 19/07/2016
Authors: Bentur H

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Anaplastic large cell lymphoma

​ Abstract Systemic anaplastic large cell lymphoma (ALCL) is a distinct disease classification provisionally sub-divided into ALCL, Anaplastic Lymphoma Kinase (ALK)+ and ALCL, ALK− entities. More recently, another category of ALCL has been increasingly reported in the literature and is associated with the presence of breast implants. A comprehensive review of..

Published: 19/07/2016
Authors: Shokrollahi K

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Rheumatoid arthritis related interstitial lung disease

​ Background/Purpose Interstitial Lung Disease (ILD) is the commonest manifestation of lung disease in Rheumatoid Arthritis (RA) and the only complication reported to be increasing in prevalence, accounting for 6% of all RA deaths. High resolution computed tomography (HRCT) confirmed 25% of RA patients had radiological evidence of ILD. This study examines..

Published: 19/07/2016
Authors: Dawson J

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Delirium sedation and analgesia

​ Abstract Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation..

Published: 19/07/2016
Authors: Jones C

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Clinical Prediction Models

​ Background  Management of solitary pulmonary nodules (SPNs) depends critically on the pre-test probability of malignancy. Several quantitative prediction models have been developed using clinical and radiological criteria. Three models include CT criteria (Mayo, Veterans Association, Brock University) with a fourth model (Herder) incorporating FDG avidity on CT-PET scan in addition...

Published: 19/07/2016
Authors: Jones C

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Retracting the ear

​ Jeevan, R; Lymperopoulos, NS and James, MI. (2014).  Retracting the ear: A hands-free approach . Journal of Plastic, Reconstructive and Aesthetic Surgery. 67 (2), e65-66    

Published: 19/07/2016
Authors: Lymperopoulos NS

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Using surrogate markers

​ McNulty, SJ and Williams, P. (2014).  Bad medicine: using surrogate markers . BMJ. 348 (Published online 10th March).    

Published: 19/07/2016
Authors: McNulty SJ, Williams P

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The Liverpool experience

​ Objective To assess the clinical outcomes and treatment costs of a regional adult burn service in northwest England. Methods We retrospectively reviewed data on a five year cohort of 1075 patients treated by the Mersey Regional Burn Service between 2006 and 2010 to obtain age-stratified mortality estimates based on the lethal area 50 (LA50)..

Published: 19/07/2016
Authors: Lymperopoulos NS

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Lymphopenia as a predictor of bacteremia

​ Introduction  Bloodstream infection (BSI) is associated with a reduction in circulating lymphocytes. Lymphopenia has been proposed as an early marker of BSI in pyrexial adults in the emergency department (ED) setting [1]. The aim of this study was to compare lymphocyte count with conventional markers in patients presenting to the ED..

Published: 19/07/2016
Authors: Nee PA

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Patients with haematological malignancies

​ Introduction  Critical care (CC) admission has traditionally been viewed as likely to result in a poor outcome for immune-compromised haemato-oncological (HO) patients [1,2]. Recent studies have challenged such views [3,4]. We recently reported results from a cohort of HO patients admitted to CC, showing the pAO2/FiO2 (P/F) ratio to be..

Published: 19/07/2016
Authors: Tridente A

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Organisational changes in service provision

​ Introduction  Demand for critical care (CC) resources is constantly increasing in the face of limited availability. Guidance for triage exists but may no longer reflect current practice [1,2]. We previously identified nonmedical and medical factors (comorbidities, physiological derangement and functional status) as predicting likelihood of admission of referred patients to CC [3..

Published: 19/07/2016
Authors: Tridente A

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Recalibration of the delirium prediction model

​ Purpose Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients. Methods A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea..

Published: 19/07/2016
Authors: Jones C

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Mohs surgery service

​ Summary Mohs Micrographic Surgery (MMS) is the current ‘gold-standard’ for excision of a number of cutaneous lesions and provides a valuable addition to a skin cancer service. The Mersey Regional Centre for Mohs Surgery is the first MMS service in the UK to be led by an MMS trained Plastic..

Published: 19/07/2016
Authors: Tehrani H

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Frozen section in skin cancer surgery

​ Prowse, P; May, J; Morton, J. (2014).  Frozen section in skin cancer surgery: Is the technique obsolete? Journal of Plastic, Reconstructive and Aesthetic Surgery. 67 (3), 414-15.

Published: 19/07/2016
Authors: May J, Morton J

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Diverticular perforation

​ Abstract An 81-year-old woman with stage 4 chronic kidney disease (focal segmental glomerulosclerosis) requiring steroids and immunosuppression with mycophenolate mofetil presented with left iliac fossa (LIF) pain, anorexia and rectal bleeding with mucus. Examination and investigations revealed no pyrexia, LIF tenderness, supraclavicular subcutaneous emphysema or leucocytopenia. An erect chest x-ray (figure 1)..

Published: 19/07/2016
Authors: Chadwick M

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Association between immunosuppressive therapy and relative risk

​ Background RA is associated with clinically relevant interstitial lung disease (ILD) in around 5% of patients. A variety of immunosuppressive agents have been advocated in patients with RA-ILD, with very little evaluation of their comparative effectiveness. We have examined the influence of a range of immunosuppressives (ISP) on mortality in a..

Published: 19/07/2016
Authors: Dawson J

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Association Between Biologic Therapy and Survival

​ Background RA is associated with clinically relevant interstitial lung disease (ILD) in approximately 5% of patients. Concern has been expressed over the use of biologic therapies in patients with RA-ILD, with several reports of disease progression and death from accelerated respiratory failure. We have examined the association between different biologic therapies..

Published: 19/07/2016
Authors: Dawson J

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Obstructive sleep apnoea in obese women

​ Background Recent studies have highlighted an association between gout and obstructive sleep apnoea (OSA), reflecting shared risk factors with increasing body weight associated with gout and OSA. However, intermittent episodes of hypoxia in OSA may lead to purine breakdown and increase uric acid levels, potentially contributing to hyperuricaemia. This study..

Published: 19/07/2016
Authors: Hardy KJ

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Association between steroid therapy and survival

​ Background Clinically relevant interstitial lung disease (ILD) is present in approximately 5% of patients with RA. Traditionally, oral steroids have been used to treat this manifestation of RA, but no evidence base exists to support this. Indeed, concern has been raised that such an approach might be associated with increased mortality..

Published: 19/07/2016
Authors: Dawson J

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Drug-induced interstitial lung disease

​ Abstract Drug-induced interstitial lung disease (ILD) is a rare but potentially fatal complication from the disease modifying drugs that we use for rheumatological conditions. Clinical presentation, prevalence and screening for MTX pneumonitis will be focussed upon. Diagnostic criteria for hypersensitivity pneumonitis will be reviewed. The talk will also give an..

Published: 19/07/2016
Authors: Dawson J

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Uropathogen profiles and antimicrobial resistance

INTRODUCTION & OBJECTIVES Urinary tract infections are a core aspect of urological practice and occupy a large component of infections treated in primary care. The rise of antimicrobial resistance poses a challenge to clinical practice and raises the morbidity and mortality from urinary tract infections. The volume of urinary tract infections,..

Published: 19/07/2016
Authors: McCabe JE

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Sedation in mechanically ventilated adults

​ Abstract The use of sedative and analgesic dugs is essential in intensive care. The lowest effective doses should be used for the shortest period of time in order to limit the risk of serious complications. Daily interruption of sedation (DIS) is one strategy that has been shown to reduce overall..

Published: 19/07/2016
Authors: Nee PA

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Intra Urethral Human Papillomavirus Related Warts

​ Iskander, M; Patrick, N; Mistry, R. (2014).  Intra Urethral Human Papillomavirus Related Warts Following Urinary Tract Instrumentation . Urology Journal. 11 (2), 1491.  

Published: 19/07/2016
Authors: Mistry R

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Audit of insulin pump therapy

​ Aims The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first UK-wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the..

Published: 19/07/2016
Authors: Furlong NJ

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Basal cell carcinoma

​   Pinto, R; Mavinamane, S. (2014). Basal cell carcinoma: diagnosis and management. GM: Midlife & Beyond. 44 (5), 33-35  

Published: 19/07/2016
Authors: Mavinamane S

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Low dietary sodium

​ Abstract  In a meta-analysis that investigated the effects of dietary sodium restriction in diabetes nephropathy, although blood pressure fell, there were significant increases in plasma renin and aldosterone levels. In this article, we hypothesise that in diabetic nephropathy, ACE-I or ARB treatment attenuates any rise in RAS hormones that might..

Published: 19/07/2016
Authors: Hardy KJ, O'Brien S

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Ulcerating metastatic inguinal lymphadenopathy

​ Sadri, A; Touil, L; Liew, SW; Brackley, P; Koshy, O. (2014).  Salvage of ulcerating metastatic inguinal lymphadenopathy using the inferior pedicled TRAM flap . Journal of Plastic, Reconstructive & Aesthetic Surgery. 67 (5), E138-9  

Published: 19/07/2016
Authors: Touil L, Liew S, Brackley P, Koshy O

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Anterior abdominal wall 'peritoneal recess'

​ Background Chronic abdominal pain is a well-known cause of prolonged morbidity and patient frustration. Often it is managed symptomatically with high recurrence rate and no definite treatment. Material and Methods We present here a new potential space named as ‘Peritoneal Recess’ inside the abdomen which was found during diagnostic laparoscopy..

Published: 19/07/2016
Authors: Samad A

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Johans as knot pusher

​ Background The base of appendix can be secured by stapling or with endoloops. The authors have reported the use of Johan forceps as endoloop pushers for laparoscopic appendicectomy. Objectives A feasibility study of safety and cost effectiveness of using Johan forceps as endoloop pushers for laparoscopic appendicectomy. Material and Methods..

Published: 19/07/2016
Authors: Kaul A

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Urinary proteomics

​ Introduction Obstructive sleep apnoea (OSA) is a common complication of obesity and can have a substantial negative impact on a patient's quality of life and risk of cardiovascular disease. In this study, discovery profiling of urinary peptides was performed by capillary electrophoresis- mass spectrometry (CE-MS) in obese subjects with and..

Published: 19/07/2016
Authors: Hardy KJ

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Epidural bolus requirements

​ Introduction In our department, we use both continuous infusion and programmed intermittent bolus techniques for labour epidural management. As a service evaluation project, we decided to assess the number of additional boluses which were required with each of these techniques. Methods We retrospectively examined the clinical records of 97 women who..

Published: 19/07/2016
Authors: Yoxall PF

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Anterior abdominal wall 'peritoneal recess'

​ Background No clear guidelines exist about management of chronic abdominal pain. We present here a new potential space named as ‘Peritoneal Recess’ inside the abdomen which was found during diagnostic laparoscopy performed to look for the cause of recurrent abdominal pain. Material and Methods A middle aged patient presented with..

Published: 19/07/2016
Authors: Samad A

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Acquired haemophilia A

​ Jacob, A; Mavinamane, S. (2014).  Acquired haemophilia A as a cause of recurrent bleeding episodes in the elderly . British Journal of Hospital Medicine. 75 (5), 294-95.    

Published: 19/07/2016
Authors: Mavinamane S

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Adjuvant bevacizumab in patients with melanoma

​ Background Bevacizumab, a monoclonal antibody that targets VEGF, has shown restricted activity in patients with advanced melanoma. We aimed to assess the role of bevacizumab as adjuvant treatment for patients with resected melanoma at high risk of recurrence. We report results from the preplanned interim analysis. Methods We did a..

Published: 19/07/2016
Authors: Marshall E

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Retinopathy of prematurity

​ Objectives  To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment. Design  National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009–2011. Setting  161 (94%) neonatal units in England. Population  Infants born below 32..

Published: 19/07/2016
Authors: Amegavie L

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Stillbirth

​ Abstract Stillbirth rates both in the UK and worldwide are extremely high. This reflective case study is centred on my first experience at caring for a bereaved couple who lost their baby boy, stillborn, at 27 weeks gestation. Whilst causes of stillbirth are often multi-factorial and unexplained, this reflection aims to..

Published: 19/07/2016
Authors: Stott S

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Nodal recurrence of cutaneous malignant melanoma

​ Summary We report the case of an 84-year-old woman who had a nodal recurrence of melanoma 45 years after the primary diagnosis of an extremity cutaneous melanoma. It is believed to be the longest disease-free latency period reported between primary melanoma diagnosis and recurrence to date. Late recurrences of melanoma are..

Published: 19/07/2016
Authors: Liew S

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Boardless skin meshers?

​ May, J; Sadri, A; James, I; Shokrollahi, K. (2014).  Cost savings in plastic surgery: Boardless skin meshers? Burns. 40 (4), 780-81  

Published: 19/07/2016
Authors: May J, Shokrollahi K

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The IBD-control questionnaire

​ Introduction  Routine capture of reliable, patient-centred health status measures for IBD has not become part of standard practice. The IBD-Control questionnaire is a short (13 item), generic patient-reported outcome measure which we developed to support routine care.1 Methods  To further define performance in varied settings, we undertook: (A) A prospective study..

Published: 19/07/2016
Authors: Collins B, Bassi A

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Nurse led one stop upper GI clinics are safe and allow rapid assessment of patients

​ Introduction  Meeting 2 week referral targets presents a challenge to many hospitals. Commonly patients are seen in clinic prior to investigation with resultant additional delays in time to investigation. Nurse led one stop clinics where patients undergo clinical assessment and endoscopic and/or radiological assessment on the same day have the..

Published: 19/07/2016
Authors: Williams S, Ashall B, Cave G, Bassi A

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Clinic Outcomes For Unselected Patients

​ Introduction  There is a well-established role of specialist nurses in on-going management of chronic diseases in specialist clinics. With the reduction in junior doctor hours, advanced nurse clinicians (ANC) are taking on increasing complex medical roles. We aimed to evaluate the effectiveness of ANC in managing unselected new patients (NP)..

Published: 19/07/2016
Authors: McClements D, McLindon J, Chandy R, Priestley S, Fox M, Theis V, Dobson J, Bassi A

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Use of epidural blood patch

​ Background Epidural blood patch (EBP) is viewed as the "gold standard" treatment for headaches caused by accidental dural puncture (ADP), although it is not supported by strong evidence [1]. The mechanism of action is also poorly understood. Moreover, the success of EBP in treating headaches due to labour epidural related ADP..

Published: 19/07/2016
Authors: Yoxall PF

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Radical nephrectomy

​ Abstract A 65-year-old man presented with a rapidly enlarging pre-auricular lump, with pruritis and contact bleeding. The patient was referred to dermatology due to the high index of suspicion for malignancy. Following excision of the lump and histological analysis it was found to be a metastasis from renal cell carcinoma...

Published: 19/07/2016
Authors: Mistry R

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Improve outcomes for upper GI cancer patients

​ Siddique, K; Holmes, J; Kaul, A. (2013).  Lean initiative to develop managed clinical network to improve outcomes for upper GI cancer patients in Saint Helens & Knowsley . European Journal of Cancer,. 49 (Suppl 2), S592  

Published: 19/07/2016
Authors: Holmes J, Kaul A

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Breast cancer recurrence after ROLL lumpectomy

​ Background Very few literatures are available on the long term outcomes after Radioguided Occult Lesion Localisation (ROLL) guided lumpectomy for non palpable invasive breast cancer. We previously published a recurrence of 1.9% with median follow up of 33 months. This is the first observation reporting after a Ten year experience with ROLL...

Published: 19/07/2016
Authors: Jois RHS, Carini S, Harris O, Thind R, Desmond S, Ray A, Chagla LS, Bulgasim N,

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Stainless Steel Suture Technique

Proflavine wool with silk ‘tie-overs’ is used commonly to secure a skin graft. Our new strategy employs a surgical steel wire suture that can be twisted down to secure the graft without the need for multiple ties. Figure 1A shows the graft over the defect, and Figures 1B and 1C..

Published: 19/07/2016
Authors: Shokrollahi K, Sofos S

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The Critical Care Management of the Burn Patient

​ Abstract Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies...

Published: 19/07/2016
Authors: Mahambrey T, Shokrollahi K

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Effective ventilation during cardiac arrest

​ INTRODUCTION Despite ALS training, management of the airway during in-hospital cardiac arrests often appears poorly performed by the non-anaesthetist. OBJECTIVES To assess the competency of junior doctors airway skills in the cardiac arrest scenario. METHODS We conducted an assessment of foundation year 1 (FY1) doctors´ management of the airway in a..

Published: 19/07/2016
Authors: Young S, Bolton N,

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Time of transfer from critical care

​ INTRODUCTION Night time transfer from critical care to the general wards is associated with increased hospital mortality and transfer from critical care areas to the general ward between 22:00 and 07:00 should be avoided whenever possible1. In addition the timing of transferring a patient from the critical care unit to the general..

Published: 19/07/2016
Authors: McCairn AJ, Wood J, Jones C

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CORTRAK device in itu

​ INTRODUCTION The cortrak enteral access system (EAS) allows real time tracking of a NG tube tip, supposedly abolishing the need for x-ray confirmation of nasogastric tube (NGT) position. With the use of an electromagnetic transmitting stylet inserted within the NG tube and a receiver unit placed over the patient's xiphisternum,..

Published: 19/07/2016
Authors: Sharma N

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Stroke mimics - A case of viral encephalitis

​ Introduction Stroke causes significant morbidity and mortality. In the UK it accounts for up to 11% of deaths annually, with over 56,000 deaths occurring in England and Wales in 1999. Stroke typically presents with focal neurological deficits including speech disturbance and limb weakness, consistent with vascular territory involved. However, in some cases, this..

Published: 19/07/2016
Authors: Mavinamane S

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The masquerade of myasthenia gravis

Objective Myasthenia gravis is an autoimmune condition characterised by fatigable muscle weakness. It may present as a bulbar palsy and can mimic a cerebrovascular event. We report a case of myasthenia gravis presenting in a 69 year old which initially presented as stroke. Case presentation A 69 year old male was admitted..

Published: 19/07/2016
Authors: Mavinamane S

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Acquired haemophilia A in an elderly patient

​ Background Acquired haemophilia A is a rare condition that can have potentially life-threatening consequences. We report a case of acquired haemophilia A in an elderly patient who had presented to hospital with recurrent bleeding episodes. Case presentation A 73 year old female nursing home resident with advanced dementia and previous stroke..

Published: 19/07/2016
Authors: Mavinamane S

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Proton pump inhibitors

​ Objective Proton pump inhibitor (PPI) prescribing has increased dramatically over recent years and has significant cost implications. It is estimated that up to two-thirds of PPI prescriptions are inappropriate and costs the National Health Service approximately 100 million in unnecessary PPI prescribing. PPIs are associated with serious adverse effects including clostridium..

Published: 19/07/2016
Authors: Mavinamane S

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Primary Squamous Cell Carcinoma of the Nipple

​ Abstract There has been only one documented case in the English literature with the diagnosis of primary Squamous Cell Carcinoma (SCC) of the nipple; we present a further case of a primary SCC of the nipple, thus raising awareness to the skin or breast specialist of this possible presentation for..

Published: 19/07/2016
Authors: Tehrani H, Lymperopoulos NS, Sofos S,

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Mental and physical disability after sepsis

​ Sepsis remains a major cause of admissions to Intensive Care Units (ICU) and has a high mortality rates and significant morbidity in survivors. There are physical, cognitive and psychological sequelae from severe sepsis that have a negative effect on the patients’ health related quality of life in the longer term..

Published: 19/07/2016
Authors: Jones C

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Tubal occlusion in new infertility patients

​ Objective 100% of women with risk factors for tubal occlusion should be offered diagnostic laparoscopy. Background NICE CG 156 (February 2013) recommendation 62 suggests that if any woman has comorbities that would lean towards tubal occlusion, that diagnostic lap should be offered. A paper with regards to cost-effectiveness of tubal patency tests by Verhoeve..

Published: 19/07/2016
Authors: Omar M, Langton J

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Management of acute confusion

​ Abstract This article discusses the management of acute confusion and aggression in patients with infections of the central nervous system (CNS). The issues discussed are applicable to the management of acute confusion of any cause and the principles of care apply to all confused patients. The article addresses many of..

Published: 19/07/2016
Authors: Jones C

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Genotype-guided dosing of warfarin

​ BACKGROUND The level of anticoagulation in response to a fixed-dose regimen of warfarin is difficult to predict during the initiation of therapy. We prospectively compared the effect of genotype-guided dosing with that of standard dosing on anticoagulation control in patients starting warfarin therapy. METHODS We conducted a multicenter, randomized, controlled..

Published: 19/07/2016
Authors: Nicholson T

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CURBO2–65 better correlation than CURB65

​ Introduction  For patients admitted to hospital with pneumonia, CURB65 (confusion, Urea>7, Respiratory Rate>30 and Blood Pressure

Published: 19/07/2016
Authors: Disney A, Molugu C, Singer A, Stockton P

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CURBO2–65 superior to CURB-65

​ Introduction and Objectives  Community Acquired Pneumonia (CAP) accounts for a significant proportion of hospital admissions and is a common cause of mortality and morbidity in UK. CURB-65 is recommended by BTS and widely used to stratify patients according to severity and guide initial treatment (1). As oxygen is not part of..

Published: 19/07/2016
Authors: Singer A, Disney A, Lewis A, Molugu C, Stockton P

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Dedicated pneumonia follow up clinic

​ Background  It is routine clinical practice, based on British Thoracic Society recommendations, to arrange a clinical review and chest x-ray approximately 6 weeks following an episode of pneumonia in most patients. However there is a paucity of published evidence to support or refute this practice. Objective  To determine the clinical and..

Published: 19/07/2016
Authors: Komrower D, Malhotra P, Shanker V, Stockton P, Twite S

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V-DimERS study

​ Hypothesis  The risk of Venous Thromboembolism (VTE) including Pulmonary Embolism (PE) increases proportionately with the level of d-dimers. Introduction  The risk of PE/VTE is low when the values of d-dimers are below the reference range (1) (5000. Each group was analysed by separate individual. Data was collected by selecting only those..

Published: 19/07/2016
Authors: Fisher G, Hirons B, Hughes D, Molugu C, Raftery S

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Managing suspected pulmonary embolism

​ Background  We observed a high number of patients admitted with suspected pulmonary embolism (PE) via our acute medical unit. After positive diagnosis, they remained as inpatients until their International Normalised Ratio (INR) was in range resulting in long lengths of stay - Median (range) 7 (0 to 52) days. Recently, there has been..

Published: 19/07/2016
Authors: Varia R

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'CURE-CAP'

​ Introduction  The annual incidence of Community acquired pneumonia (CAP) is 5–11/1000. Between 22% and 42% require admission to hospital. Wide variation exists in the management of CAP despite guidelines issued by the British Thoracic Society (BTS). Care bundles have been shown to improve outcomes through standardisation of care in other diseases as well..

Published: 19/07/2016
Authors: Varia R

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A case of collapse

​ Abstract We describe the case of a woman who presented with seemingly non-specific symptoms, including collapse, but through examination was eventually revealed to have an unusual, potentially fatal, but treatable neurological condition. We share some thoughts on the process of diagnosis, the difficulty of diagnosing a rare disease and the..

Published: 19/07/2016
Authors: Williams P

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Berlin definition for acute respiratory distress syndrome during

​ Purpose A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to evaluate BD validity in early childhood. A..

Published: 19/07/2016
Authors: Tridente A

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DIEP flap breast reconstruction

​ Background The popularity of the DIEP flap has increased over the last decade. However, there is little information regarding the transfusion rates of this complex procedure. The current study reports the transfusion rates in patients who underwent DIEP flap reconstruction in our unit with an attempt to correlate significant blood..

Published: 19/07/2016
Authors: , Graham K, Koshy O, Lymperopoulos NS, Sofos S

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Fractures of the shaft of humerus

​ Abstract  Humeral shaft fractures account for 1–3% of all fractures. Non-surgical management with functional bracing is arguably the standard of care for most humeral shaft fractures. It results in high union rates and in general the outcome is excellent. Surgical management is indicated in some cases, such as open fractures, polytrauma,..

Published: 19/07/2016
Authors: Kumar V, Rathinam M

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Rheumatoid arthritis-related pulmonary fibrosis

​   Ennis, H; Dawson, J et al. (2014).  HLA-DRB1 associations with rheumatoid arthritis-related pulmonary fibrosis . Scandinavian Journal of Rheumatology. 43 (1), 75-76    

Published: 19/07/2016
Authors: Dawson J

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Diffusion of responsibilities

​   McNulty, SJ and Williams, P. (2014).  A call to reduce diffusion of responsibilities . BMJ. 348 (Published online 19th February).    

Published: 19/07/2016
Authors: McNulty SJ, Williams P

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An epidemiological survey of the GenOSept cohort

​ Introduction Faecal peritonitis (FP) is a common cause of sepsis and admission to the intensive care unit (ICU). The Genetics of Sepsis and Septic Shock in Europe (GenOSept) project is investigating the influence of genetic variation on the host response and outcomes in a large cohort of patients with sepsis..

Published: 19/07/2016
Authors: Tridente A

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Serum creatinine and estimated glomerular filtration rate

​ OBJECTIVE  Fasting is not routinely recommended for renal function tests, despite the known effects of cooked meat on creatinine. We therefore studied variation in creatinine and estimate glomerular filtration rate (eGFR) following a standardised cooked meat meal in 80 subjects: healthy volunteers, diabetes patients with chronic kidney disease (CKD) stages 1 & 2, 3A, 3..

Published: 19/07/2016
Authors: Hardy KJ, O'Brien S

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Pathologic Response of Breast Cancer

​ Background:  Neo-adjuvant chemotherapy is being increasingly used for breast cancer. MRI is used for assessing tumour response. Literature on correlation of pathologic response and MRI response is scanty. Aim:  Can a pre-operative MRI predict pathologic response of breast cancer to neo-adjuvant chemotherapy? Methods:  A consecutive series of patients with invasive..

Published: 19/07/2016
Authors: , Jois RHS, Harris O, Pennick M

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Managing the axilla

​ Background:  Data suggest neoadjuvant chemotherapy (NAC) can downstage the axilla in up to 40% of breast cancers, yet there is no consensus regarding timing and extent of axillary surgery post NAC. Sentinel lymph node biopsy (SLNB) after NAC is also debated. We performed a literature review and suggest an algorithm for..

Published: 19/07/2016
Authors: Pennick M

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Latissimus Dorsi (MSLD) and Latissimus Dorsi (LD) flap breast

​ Introduction:  The Muscle Sparing Latissimus Dorsi (MSLD) flap utilizes only the lateral segment of the muscle containing the descending branch of the thoracodorsal artery with its thoracodorsal artery perforators to supply the skin paddle and fascial components of the flap. The aim of this study was to determine the postoperative..

Published: 19/07/2016
Authors: , Shaaban H, , Iqbal A

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Hyperostosis

​ Abdelaziz, M; John, CM. (2013).  Hyperostosis: an under-recognized complication of prostaglandin infusion . Acta Paediatrica. 102 (5), e192  

Published: 19/07/2016
Authors: Abdelaziz M

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Book Review

​ Sofos, SS and Shokrollahi, K. (2013).  Book Review: Laser and IPL Technology in Dermatology and Aesthetic Medicine . Annals of Plastic Surgery. epub 12th June  

Published: 19/07/2016
Authors: Sofos S, Shokrollahi K

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Deep Vein Thrombosis

​ Abstract We describe a rare case of deep vein thrombosis (DVT) in children, highlight the importance of early diagnosis of rare disease with potential complications. In a 5 year old boy presented with persistent leg pain without any obvious cause. Detailed investigation led to diagnosis of DVT. As there are common..

Published: 19/07/2016
Authors: Aabideen K, Ogendele M, Ahmad I, Amegavie L

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Delivery of Parenteral Nutrition

​ Introduction  Recent report by NCEPOD into hospital care of patients receiving parenteral nutrition (PN) suggested that only 19% adult patients had PN care that was considered to represent good practise. An initial audit (retrospective audit over six months) in our hospital suggested lack of quality control at the point of initiation..

Published: 19/07/2016
Authors: Whittingham C, Bassi A

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FRAX analysis

​ Background  Bone health is a significant problem with over 300,000 patients presenting with fragility fractures to hospitals in the UK each year resulting in 20% mortality and 50% disability. FRAX and Q fracture are two fracture risk-assessment tools available to use in the UK. FRAX is an important tool to assess 10-year fracture..

Published: 19/07/2016
Authors: Tayal V, Abernethy R, Clewes A, Dawson J, O'Rourke T

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Lung function tests and high resolution computed tomography

​ Background  Rheumatoid arthritis (RA) is associated with clinically relevant interstitial lung disease (ILD) in approximately 5% of patients. The natural history of the association has been shown to be poor: in a previous study mean survival was 3 years from diagnosis of RA-ILD [1]. The importance of high resolution computed tomography (HRCT) of..

Published: 19/07/2016
Authors: Dawson J

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Assessing the cardiovascular risk burden

​ Background  Rheumatoid arthritis (RA) is associated with the increased risk of cardiovascular (CV) mortality and morbidity. There are recommendations by European League against Rheumatism (EULAR) and National Institute for Health and Clinical Excellence (NICE) to include assessment of cardiovascular, osteoporosis, infection and depression risks annually. One of the ways CV..

Published: 19/07/2016
Authors: Patel V, , Abernethy R, Dawson J, Clewes A, Novak J, Cox A, Williams J, O'Rourke T

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Assessing osteoporosis risk

​ Background  Osteoporosis is a major cause of morbidity in patients with RA. It leads to fragility fractures frequently associated with disability, mortality and major financial and social impact. There is no clear guidance regarding when to screen for Osteoporosis in these group of patients who are at high risk compared..

Published: 19/07/2016
Authors: , Patel V, Abernethy R, Dawson J, Clewes A, Novak J, Cox A, Williams J, O'Rourke T

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Setting up the ventilator

​ Background We aimed to see if patients were being set up on the ventilator appropriately, with a tailored ventilation strategy including evidence based tidal volumes. Methods A quality improvement project of patients receiving mechanical ventilation (MV) on the ICU over a 6 month period. Patients admitted for organ donation and those..

Published: 19/07/2016
Authors: , McBeath K,

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Laparoscopic versus Open Hysterectomy

​ Background  Endometrial carcinoma accounts for 5% of cancers in women in the UK and is the second most common gynaecological cancer. Obesity is associated with a two- to fivefold increase in the risk of endometrial cancer in both pre and postmenopausal women. Overweight and obese patients have an increased risk of..

Published: 19/07/2016
Authors: Tildesley R, Gilliland J, Dearden D, Kundodyiwa T

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Sexual and Reproductive Healthcare

​ Objective  The Faculty of Sexual and Reproductive Healthcare (FSRH) became an established branch of the Royal College of Obstetrics and Gynaecology (RCOG) in 1993. Although this is a relatively new specialty the practise of genito-urinary medicine is not a new concept. Current sexual health practices are rooted in traditions that took..

Published: 19/07/2016
Authors: Purlackee S

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Metastatic Vulval Crohn's Disease

​ Background  Crohn’s disease is a chronic granulomatous, inflammatory disorder and may have intestinal/extra intestinal manifestations. Vulval involvement is an uncommon extra intestinal manifestation of Crohn’s disease. It is not uncommon to encounter diagnostic dilemmas in vulval lesions. We present a case of abnormal vulval lesions due to..

Published: 19/07/2016
Authors: Idama TO, Myagerimath R

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Body Mass Index >40 and Pregnancy

​ Objective  Review current practice in pregnancy management of women with obesity at a DGH. Method  Retrospective case-note survey of over 70% of women with a booking BMI > 40. Results  The UK prevalence of women with a known BMI ≥ 35 at any point in pregnancy is approximately 38 500 a year. The Health Survey for England..

Published: 19/07/2016
Authors: Suttenwood HSL, Srivastava N, Ramachandran N

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Bleeding in Early Pregnancy

​ Objectives  Bleeding in early pregnancy (BEP) creates a significant workload for the emergency department (ED) as women seek help out of hours when other specialist services are closed. Turnover of doctors and nurses is high, ED staff are anxious not to miss an ectopic pregnancy and women attend seeking an..

Published: 19/07/2016
Authors: Graham S, Rao S, Moorcroft LK

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Chronic Adnexal Torsion

​ Introduction  Acute adnexal torsion diagnosis is challenging because clinical evaluation and imaging studies are often nonspecific. There are an additional population of women who present with mild, nonspecific symptoms or an incidental finding of an adnexal mass. These cases may represent a failed diagnosis of acute torsion, or perhaps the..

Published: 19/07/2016
Authors: Ramachandran N

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Hydrothermal Ablation

​ Introduction  Heavy menstrual bleeding (HMB) has major impact on a woman’s quality of life. Interventions should aim to improve this rather than focusing on menstrual blood loss. Up to 60% of women with HMB undergo hysterectomy within 5 years of referral to a gynaecologist. Several ablative techniques have been developed to..

Published: 19/07/2016
Authors: Myagerimath R,

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Ovarian Hyperstimulation Syndrome

​ Background  Ovarian Hyperstimulation Syndrome (OHSS) is characterised by presence of multiple luteinized cysts within the ovaries leading to ovarian enlargement. It is commonly associated with assisted fertility treatment. Spontaneous OHSS is an extremely rare event in natural conceptions although a few cases have been described in association with multiple or..

Published: 19/07/2016
Authors: , Mackin D, , Tempest N

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Rescue Cerclage in MCDA Twin Pregnancy

​ Introduction  Around one-third of twin pregnancies in the UK are monochorionic. After single fetal death in a monochorionic pregnancy, the risk to the surviving twin is high and management of such pregnancies is complex. We report a case of rescue cerclage in MCDA twin pregnancy with a view to salvage..

Published: 19/07/2016
Authors: Cording V, Idama TO, Myagerimath R

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Glucose Tolerance Test

​ Introduction  Diabetes is a disorder of carbohydrate metabolism requiring immediate lifestyle changes. Over 650 000 women give birth in England and Wales each year with 2–5% of these women being diabetic. Approximately 87.5% of pregnancies complicated by diabetes are due to gestational diabetes mellitus (GDM) that is dependent on various factors. GDM is associated..

Published: 19/07/2016
Authors: Albert S, , Myagerimath R

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Round Ligament Varicosity in Pregnancy

​ Introduction  Round ligament varicosity (RLV) is an important clinical entity that has not been reported extensively. The incidence of RLV is unknown. It may be easily mistaken for inguinal hernias in gravid patients because these conditions have similar presentations. Distinguishing between varicosities and hernias is critical to avoid performing unnecessary..

Published: 19/07/2016
Authors: Idama TO, Myagerimath R

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External Cephalic Version

​ Background  The term breech trial renewed interest in the procedure of external cephalic version (ECV). It is now recommended that ‘ECV should be discussed and offered to all women with uncomplicated breech presentation at term’. Objective  To assess the outcome of ECV in our clinical setting. Methods  This was a..

Published: 19/07/2016
Authors: Idama TO

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GLP-1 Treatment

​ Abstract Glucagon-like peptide 1 (GLP-1) agonist treatment in type 2 diabetes typically improves glycaemic control and results in weight loss. The National Institute for Health and Clinical Excellence (NICE) continuation criteria are that at six months patients must have achieved at least a 3% reduction in weight and an 11mmol/mol (1%) reduction in..

Published: 19/07/2016
Authors: Keigan S, Wessels L, O'Brien S, Hardy KJ

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3-Dimensional Model

​ Abstract The European Working Time Directive and streamlined training has led to reduced training time. Surgery, as an experience-dependent craft specialty is affected more than other medical specialties. Trainees want to maximize all training opportunities in the clinical setting, and having predeveloped basic skills acquired on a simulated model can..

Published: 19/07/2016
Authors: Graham K, Hassan Z

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Nonmelanoma Skin Tumors

​ Abstract Introduction: The formation of cutaneous carcinoma has been shown to rely on neovascularization, with angiogenesis being implicated in the invasive process of skin malignancy and metastasis. To date, studies of angiogenesis have generally been limited to in vitro, animal (often murine), or postexcision histopathologic models. Methods: To demonstrate the..

Published: 19/07/2016
Authors: McArthur P, Tehrani H

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Mental and Physical disability

​ Abstract Sepsis remains a major cause of admissions to Intensive Care Units (ICU) and has a high mortality rates and significant morbidity in survivors. There are physical, cognitive and psychological sequelae from severe sepsis that have a negative effect on the patients' health related quality of life in the longer..

Published: 19/07/2016
Authors: Jones C

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Post-ICU burden for patients and relatives

​   Jones, C. (2013).  What's new on the post-ICU burden for patients and relatives? . Intensive Care Medicine. 39 (10), 1832-35.  

Published: 19/07/2016
Authors: Jones C

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Stage 1B Cutaneous Melanoma

​ Question:  Sentinel Lymph Node Biopsy (SLNB) has been advocated as part of the diagnostic and prognostic process in the 2010 updated guidelines for management of cutaneous melanoma. However, there remains some discrepancy in practice across the UK regarding offering SLNB in patients with 1B melanoma (ulceration or mitotic rate ≥1/mm2). Methods: ..

Published: 19/07/2016
Authors: Yao S, Brackley P

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Primary Cutaneous Melanoma

​ Question:  Most current international guidelines for the management of primary cutaneous melanoma stage pT2 and above recommend excisional surgery with a minimum of 2 cm radial margins. However recent systematic reviews suggest that wider excision margins offer no better local disease control than narrow ones. The latest Cochrane review recommended a..

Published: 19/07/2016
Authors: Brackley P,

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Folic Acid Supplementation vs Placebo

​ Abstract Methotrexate (MTX) is the first-line systemic agent in the treatment of chronic plaque psoriasis (CPP). We undertook a prospective, double-blind, randomized controlled trial in CPP patients treated with MTX to examine the effects of daily folic acid supplementation vs. placebo on MTX efficacy, nausea and serum homocysteine levels. Fifty..

Published: 19/07/2016
Authors:

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Mechanically Ventilated Adult Patients

​ Abstract The combined use of daily interruption of sedation and a nursing-implemented sedation protocol targetting light sedation does not reduce duration of mechanical ventilation in adult ICU patients. Keough, J; Nee, P. (2013).  Daily interruption of sedation and nursing-implemented sedation protocol in mechanically ventilated adult patients . Journal of the Intensive Care..

Published: 19/07/2016
Authors: , Nee PA

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Pocket Guide to Plastic Surgery

​ Abstract There are a number of handy pocket guides in plastic surgery that can help residents, trainees, and medical students to gain consolidated and concise information. We have reviewed 5 of the more popular pocket guides in plastic surgery with a view to assist the discerning buyer to choose the pocket..

Published: 19/07/2016
Authors: Hassan Z, Shokrollahi K

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Trends in the use of bilateral mastectomy

​ Objectives  For healthy women at high risk of developing breast cancer, a bilateral mastectomy can reduce future risk. For women who already have unilateral breast cancer, removing the contralateral healthy breast is more difficult to justify. We examined trends in the number of women who had a bilateral mastectomy in..

Published: 19/07/2016
Authors:

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Patients' Perceptions of Cosmetic Surgery

​ Nassab, R. (2013).  Commentary on: Patients' Perceptions of Cosmetic Surgery at a Time of Globalization, Medical Consumerism, and Mass Media Culture: A French Experience . Aesthetic Surgery Journal. 33 (6), 886-7

Published: 19/07/2016
Authors:

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Delayed Discharge

​ Aim:  To assess both the rate and the reasons for delayed discharge in Day case inguinal hernia and groin repair in a busy consultant-led day-case unit over an 18 month period. Method:  Retrospective analysis of the records of 235 patients who underwent inguinal hernia/groin repair over an 18-month period took place...

Published: 19/07/2016
Authors: Scott M

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Becoming an orthopaedic surgeon

​ Aim:  National training numbers (NTN) in Trauma and Orthopaedics (T&O) in the UK are highly competitive. In 2011 there were 565 applicants for 115 positions. This study aims to assess the academic achievements of candidates successful in gaining an NTN and how building a successful portfolio affected their work-life balance. Methods:  A..

Published: 19/07/2016
Authors: Purlackee S

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Pseudo-herniation of small bowel

​ Introduction:  A new potential space named as ‘Peritoneal Recess' was found during diagnostic laparoscopy performed to look for the cause of recurrent abdominal pain. Case Report:  A middle aged patient presented with chronic abdominal pain without any obvious cause. All her investigations including small bowel studies were normal; however a..

Published: 19/07/2016
Authors: , Samad A

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Texas sharp shooter

​   McNulty, SJ; Williams, P. (2012).  If you’re going to Vegas, watch out for the Texas sharp shooter . . ..  BMJ. Published online 21st December  

Published: 19/07/2016
Authors: Williams P, McNulty SJ

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Rotaglide+ total knee replacement

​ Purpose Mobile-bearing knee replacements were introduced as an alternative to their fixed-bearing counterparts. Movement of the polyethylene insert relative to the tibial tray has been shown to decrease contact stresses, wear and polyethylene-induced osteolysis. The aim of this study is to compare outcomes between mobile and fixed-bearing surfaces of the..

Published: 19/07/2016
Authors: ,

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Otoplasty

​ Shokrollahi, K. (2013).  Otoplasty awake and in the prone position-a new perspective . Annals of Plastic Surgery. 70 (1), 1-3

Published: 19/07/2016
Authors: Shokrollahi K

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Split-Thickness Skin Grafts

​ INTRODUCTION: Significant controversy surrounds the effectiveness of negative pressure wound therapy although it has been in use for decades. Although many clinicians favor this modality in relation to its practicality, ease of use especially in complex wounds, it has faced the same challenges as other dressings in relation to evidence..

Published: 19/07/2016
Authors: Shokrollahi K

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Prescribing Errors in Patients

​ Objective  To evaluate the prevalence, type and severity of prescribing errors observed between grades of prescriber, ward area, admission or discharge and type of medication prescribed. Design  Ward-based clinical pharmacists prospectively documented prescribing errors at the point of clinically checking admission or discharge prescriptions. Error categories and severities were assigned..

Published: 19/07/2016
Authors: Lloyd M

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Model of Care

​ Thornton, H. (2013).  Which model of care will deliver the improvements we seek?  Journal of Diabetes Nursing. 17 (1), 18-19  

Published: 19/07/2016
Authors: Thornton H

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Merkel cell carcinoma

​   Tehrani, H; Iqbal, A; Hancock, K. (2013).  Merkel cell carcinoma of the hallux: A case report . European Journal of Plastic Surgery. 36 (1), 63-64  

Published: 19/07/2016
Authors: Tehrani H, Iqbal A,

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Central Venous Sinus Thrombosis

​ Objectives:  To describe the predisposing factors clinical presentation, neuroimaging, management and outcome in a cohort of children with cerebral sinus venous thrombosis (CVST).  Methods:  Retrospective analysis of case notes of patients up to 17 years of age with a diagnosis of CVST, between January 1997 to December 2009 in a tertiary hospital. Results: ..

Published: 19/07/2016
Authors: Clarke R, Ismail N

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Post Traumatic Stress Disorder

​ Jones, C. (2013).  Post Traumatic Stress Disorder – The critical care effect . Australian Critical Care. 26 (1), p4-5  

Published: 19/07/2016
Authors: Jones C

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Brown Bowel Syndrome

​ Brown bowel syndrome, as described by Stamp and Evans (1987), is a rare disorder of lipofuscin accumulation in intestinal smooth muscle which has been described in association with vitamin E deficiency. Asher, C and Mavinamane, S. (2013).  Brown Bowel Syndrome . British Journal of Hospital Medicine. 74 (2), 111 

Published: 19/07/2016
Authors: Asher C, Mavinamane S

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Combined Carbon Dioxide Laser

​ Background:  Basal cell carcinomas (BCCs) are often seen by general practitioners, plastic surgeons, and dermatologists in the outpatient setting. Photodynamic therapy (PDT) and CO2 laser when used as monotherapy have been successfully used to treat small BCC, with greatest success in the superficial histological subtype but have limitations compared to..

Published: 19/07/2016
Authors: Shokrollahi K

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Robot-assisted Laparoscopic Nissen Fundoplication

​ Introduction:  Gastroesophageal reflux disease (GERD) has been the main health concern in the last few years, both in term of quality of life and symptomatology and also causing longterm health concern like cancer. In our current practice laparoscopic Nissen fundoplication is the most commonly performed operative procedure for reflux disease...

Published: 19/07/2016
Authors: Pushdary KH

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Pseudoherniation of Small Bowel

​ Abstract A middle-aged patient presented with intermittent chronic abdominal pain without any obvious cause. Computed tomography detected a hernia (presumed to be the cause of the patient's symptoms) without any obvious lump on examination. A laparoscopy was performed to repair the hernia. This revealed a left-sided unilateral 'peritoneal recess' at..

Published: 19/07/2016
Authors: , , Samad A

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Calcium Replacement in Hypocalcaemia

​ Introduction The aim of the study is to examine the efficacy of calcium replacement in patients with hypocalcaemia in the ICU. Hypocalcaemia affects between 15 and 50% of admissions to the ICU. Methods Adjusted calcium results

Published: 19/07/2016
Authors: Chatha H,

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PREDELIRIC

​ Introduction Delirium is a serious and frequent disorder in ICU patients. The aim of this study was to internationally validate the existing Prediction of Delirium ICU (PREDELIRIC) model to predict delirium in ICU patients. Methods A prospective multicenter cohort study was performed in eight ICUs in six countries (Table 1). The 10..

Published: 19/07/2016
Authors: Jones C

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National Insulin Pump Audit

​ Introduction The National Insulin Pump Audit is a joint funded project by Diabetes UK, ABCD and the JDRF. As the Cheshire and Merseyside expert reference group for this audit we present the preliminary results for adult patients. Aims The first national audit of insulin pump therapy in the UK. Methods..

Published: 19/07/2016
Authors: Furlong NJ

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Bilateral Arytenoid Keratosis

​ KEY POINTS We present a rare case of bilateral arytenoid keratosis and concomitant oral leukoplakia in a 52 year old smoker and drinker with an acute hoarse voiceSmoking and alcohol are well known aetiological risk factors for the development of keratosis Laryngeal keratosis is a premalignant mucosal change Laryngeal keratosis is..

Published: 19/07/2016
Authors: Qureshi EH, Saleem Y

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Inpatients with Diabetes

​ Aim:  UK management of inpatients with diabetes is suboptimal. Previously, we found diabetes knowledge to be lacking amongst ward staff nurses. We hypothesised that final year student nurses should know about diabetes management and our aim was to test diabetes knowledge in such students to determine whether low knowledge amongst..

Published: 19/07/2016
Authors: O'Brien S, , Cardwell J, Hardy KJ

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Diabetes Foot Ulceration

​ Aims:  The presence of foot ulceration is associated with increased morbidity and mortality. This study aimed to determine the factors associated with mortality among patients with foot ulcers attending a multidisciplinary diabetes foot clinic. Methods:  All patients reviewed consecutively in a multidisciplinary diabetes foot clinic with new foot ulceration between 1..

Published: 19/07/2016
Authors: Hart-Pinto AD, Beeharry D, Hardy KJ,

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Recurrent Foot Ulceration

​ Aims:  To identify risk factors for recurrent foot ulceration (RFU) among people with diabetes attending a multidisciplinary diabetes foot clinic. Methods:  All consecutively reviewed patients in amultidisciplinary diabetes foot clinic with newfoot ulceration over an 18-month period were included in this retrospective, observational study. Patients with Charcot neuroarthropathy were excluded...

Published: 19/07/2016
Authors: Hart-Pinto AD, Beeharry D, Hardy KJ,

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Healthcare Assistants Lack the Knowledge

​ Aim:  Much healthcare for people with diabetes is delivered by healthcare assistants (HCAs). We interviewed inpatients with diabetes following discharge from hospital and they raised concerns about HCAs’ understanding of diabetes.Given the enhanced role of HCAs in recent years it is essential they know how to manage inpatients with..

Published: 19/07/2016
Authors: , Cardwell J, Hardy KJ, O'Brien S

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Inpatient Diabetes Care

​ Aim:  Inpatient diabetes care is a burden on NHS resources. National inpatient audits identify areas of poor management but do not provide insight into underlying causes to fix the problems. Our aim was to explore the experiences of inpatients with diabetes, identify reasons for mismanagement and investigate these further. Methods: ..

Published: 19/07/2016
Authors: O'Brien S, , Cardwell J, Hardy KJ

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Guidelines and Inpatient Diabetes Nurse Specialists

​ Aim:  Diabetes specialist nurses (DSNs) have a vital role in enabling people to self-manage and in supporting non-specialist staff. Our research has identified low diabetes knowledge amongst ward nurses and students, but this may not be problematic if DSNs bridge the gap. Here, we surveyed ward nurses to determine their ..

Published: 19/07/2016
Authors: Cardwell J, , Hardy KJ, O'Brien S

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National Insulin Pump Audit (Paediatric)

​ Introduction:  The National Insulin Pump Audit is a joint funded project by Diabetes UK, ABCD and JDRF. As the Cheshire and Merseyside expert reference group for this audit we present the preliminary results for paediatric (children and young persons, CYP) patients. Aims:  This is the first national audit of insulin..

Published: 19/07/2016
Authors: Furlong NJ

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Tragedy of the Commons

​ McNulty, SJ. (2013).  The tragedy of the commons for the NHS? . BMJ. 346 (Published online 16th April).  

Published: 19/07/2016
Authors: McNulty SJ

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Laser Doppler Imaging

​ Abstract This review article discusses the use of laser Doppler imaging as a clinimetric tool to determine burn depth in patients presenting to hospital. Laser Doppler imaging is a very sensitive and specific tool to measure burn depth, easy to use, reliable and acceptable to the patient due to its..

Published: 19/07/2016
Authors: Gill P

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Recurrent lentigo maligna melanoma

​ Abstract There are various types and combinations of coexisting cutaneous neoplasms which have been documented in the past but are uncommon. In this report we describe a case of basal cell carcinoma (BCC) colonised by recurrent lentigo maligna melanoma. A review of the literature has established the coexistence of lentigo..

Published: 19/07/2016
Authors: Ahmad F, Brackley P, Hassan Z

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Zone I Flexor Tendon Injuries

​ Eighty-two patients who were treated by suture repair for Zone I flexor tendon injuries over a ten-year period were identified, to determine the incidence of post-operative surgical complications and subsequent re-operations. Eighty-five percent of patients completed 12 weeks follow-up post-surgery. Of these patients almost all had good to excellent outcome in..

Published: 19/07/2016
Authors: Bidwai AS, Feldberg L

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Proactive Improvement Strategy Checklist

​ Aims:  Laparoscopic cholecystectomy has been widely accepted as a day case procedure but many trusts struggle to attain this. Techniques have been described to reduce pain and immediate/early complications from surgical and anaesthetic perspectives. We evaluated our theatre practices, targeting areas of improvement, to create and implement a "Proactive..

Published: 19/07/2016
Authors: Mann K, Graham M, Purlackee S, Ray A, Kaul A, Kuduvalli P

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Immunological Faecal Occult Blood Testing

​ Introduction Current investigation for patients with colorectal symptoms without overt rectal bleeding is undertaken by colonoscopy or by flexible sigmoidoscopy and barium enema. A large majority of patients do not have colorectal cancer. There exists no instant, objective measure to discriminate patients who are likely to have colorectal cancer and..

Published: 19/07/2016
Authors: Kaul A

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Primary Squamous Cell Carcinoma

​ Abstract There has been only one documented case in the English literature with the diagnosis of primary Squamous Cell Carcinoma (SCC) of the nipple; we present a further case of a primary SCC of the nipple, thus raising awareness to the skin or breast specialist of this possible presentation for..

Published: 19/07/2016
Authors: , Lymperopoulos NS, Sofos S, Tehrani H,

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The Postauricular Fascia

​ Abstract In recent times, there has been evolving interest in the fascial structure of the ear, especially in relation to otoplasty techniques. Although the fascial tissues used in these procedures are referred to as "postauricular/retroauricular fascia," the sparse anatomical studies that exist use this terminology to describe what is..

Published: 19/07/2016
Authors: Shokrollahi K

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Metastatic Skin Cancers

​ Abstract In the absence of distant disease simultaneous skin cancer metastasis to neck and axillary lymph nodes necessitates both an axillary and neck en block lymphadenectomy. A combined ipsilateral neck and axillary lymph node dissection should involve an in-continuity dissection through the cervicoaxillary canal for optimal lymphatic and oncological clearance...

Published: 19/07/2016
Authors: , Shaaban H

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Farewell

​ Jones, C. (2013).  Farewell to a beloved grandfather . Intensive Care Medicine. Published online 14th May

Published: 19/07/2016
Authors: Jones C

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Obstructive sleep apnoea

​ Introduction:  Obstructive sleep apnoea (OSA) is associated with obesity, hypertension and cardiovascular disease. Arterial stiffness has been proposed as a marker of cardiovascular disease risk. We determined whether severely obese patients with newly diagnosed OSA without previous cardiovascular disease have increased arterial stiffness compared with BMI-matched controls. Methods:  72 patients(35 females),..

Published: 19/07/2016
Authors: Hardy KJ

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Book Review

​ Molajo, A and Shokrollahi, K. (2013).  Book review: aesthetic breast surgery, concepts, and techniques . Annals of Plastic Surgery. 71 (1), 12  

Published: 19/07/2016
Authors: Molajo A, Shokrollahi K

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ROLL failure rates

​ Background:  We have used Radioisotope Occult Lesion Localization (ROLL) of breast lesions at our unit since 2002. Literature reports failure rates of 4 - 10% for Wire Guided Localisation (WGL). Ours is the first reporting of the difficulties with ROLL (UK) and lessons learnt from it. Method:  A consecutive series of patients underwent..

Published: 19/07/2016
Authors: , Carini S, Harris O, Thind R, Desmond S, Jois RHS

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Impact of a Ward Pharmacy Technician

​ The impact of clinical pharmacists in terms of intervening in drug therapy and reducing medication errors to improve patient outcomes has been described. In addition, pharmacy technicians have in part enabled the expansion of clinical pharmacy services by taking a more active role in patient care such as undertaking patients’..

Published: 19/07/2016
Authors: Brancaleone CP, Brough S

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Cosmetic surgery growth

​ Background:  Over the past 10 years, there has been significant fluctuation in the yearly growth rates for cosmetic surgery procedures in both the United States and the United Kingdom. Objectives:  The authors compare cosmetic surgical procedure rates in the United Kingdom and United States with the macroeconomic climate of each region..

Published: 19/07/2016
Authors:

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Diabetic Medicine

​   Nair, S; Hardy, KJ; Wilding, JPH. (2012).  Reply to Camargo et al. Diabetic Medicine . 29 (8), 1086-87  

Published: 19/07/2016
Authors: Hardy KJ

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Human Bite

​ Pettitt, DA; Molajo, A; and McArthur, P. (2012).  A Human Bite . BMJ . Published online 17th July  

Published: 19/07/2016
Authors: McArthur P, Molajo A

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Burn Depth Analysis

​ Shokrollahi, K. (2012).  Photography and the mobile phone camera: A good method for burn depth analysis with implications for remote assessment . Burns. 38 (3), 459  

Published: 19/07/2016
Authors: Shokrollahi K

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Purple Urine Bag

​ Asher, C; Mavinamane, S. (2012).  A case of purple urine bag syndrome . European Geriatric Medicine. 3 (3), 179-80  

Published: 19/07/2016
Authors: Asher C, Mavinamane S

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Secondary care costs in oesophagogastric cancer

​ Introduction  Published data describing the scale, profile and determinants of healthcare resource use for oesophago-gastric cancer (OGC) are scarce, particularly for the UK. The National Cancer Plan (2000) encouraged greater use of imaging for staging and increased use of oncological therapies but the major modalities of palliation and curative surgery have..

Published: 19/07/2016
Authors: Bassi A

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Salvage Anal Cancer Surgery (SACS)

​ Introduction:  2004 NICE guidance on anal carcinomas advised treatment by specific multidisciplinary teams (MDTs). The National Peer Review Programme recommended each cancer network have a single anal carcinoma MDT and single salvage surgery centre. We present the results of this service. Methods:  A retrospective case note audit was performed of all..

Published: 19/07/2016
Authors: Liew S

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Metformin and alcohol

​ Overend, L; Hardy, K. (2012).  Metformin and alcohol . Practical Diabetes. 29 (6), 229-30  

Published: 19/07/2016
Authors: Overend L, Hardy KJ

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Colorectal Cancer Risk

​ Abstract We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10−10), 11q13.4 (rs3824999,..

Published: 19/07/2016
Authors: Abbas M, Marshall E

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Medical Innovation

​ Sofos, S; McArthur, P; Shokrollahi, K et al. (2012).  Medical Innovation - A Starting Point for Plastic Surgeons . Annals of Plastic Surgery. Published online 8th August 2012.   

Published: 19/07/2016
Authors: McArthur P, Shokrollahi K, Sofos S

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Metal Ion Levels

​ Abstract Plasma levels of cobalt and chromium ions and Metal Artefact Reduction Sequence (MARS)-MRI scans were performed on patients with 209 consecutive, unilateral, symptomatic metal-on-metal (MoM) hip arthroplasties. There was wide variation in plasma cobalt and chromium levels, and MARS-MRI scans were positive for adverse reaction to metal debris (ARMD)..

Published: 19/07/2016
Authors: Malek S

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White Out

​ Extract A patient in their mid-40s presented with a history of worsening dyspnoea. The patient had neurofibromatosis type 1 and had previous spinal surgery for kyphoscoliosis. A chest x-ray showed a right sided ‘white out’, thought to be a pleural effusion (figure 1A). CT thorax showed a thoracic scoliosis with..

Published: 19/07/2016
Authors: Tack G, Wide J, Stockton P

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Skin lesion in axilla

​ Invasive lobular carcinoma (ILC) of breast is known to present with atypical clinical findings in the breast, making it difficult to diagnose. It is also known to have unusual sites of metastases arising de novo or in patients treated for known ILC. Skin lesion in axilla could be a cutaneous..

Published: 19/07/2016
Authors: Sripadam R

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Rituximab

​ Patel, V; Dawson, J and Patel, P. (2012).  Comment on: Non-infectious pulmonary toxicity of rituximab: a systematic review . Rheumatology. Published online 4th September

Published: 19/07/2016
Authors: Dawson J, Patel V

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Delivery Room Resuscitation

​Background In 2011, on the basis of clinical research studies, the Resuscitation Council (UK) recommended that term infants should be resuscitated initially in room air, and preterm infants in blended oxygen guided by pulse oximetry. Aims We aimed to examine whether UK hospitals follow the Resuscitation Council 2011 (UK) guidelines and how..

Published: 19/07/2016
Authors: Whitby TM

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Right Inguinoscrotal Swelling

​ Myxofibrosarcoma of the spermatic cord is a rare condition. We present an unusual case of a 69-year-old gentleman who presented to the emergency department on two occasions with a right inguinoscrotal swelling. We will explore the diagnostic difficulties encountered and subsequent management. We will also highlight the importance of histological..

Published: 19/07/2016
Authors: , , Brougham K, McCabe JE

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Interprofessional Simulation-Based Education (IPSE)

​ Summary Interprofessional simulation-based education (IPSE) is becoming an increasingly popular educational strategy worldwide within undergraduate healthcare curricular. The purpose of the literature review was to examine qualitative, quantitative and mixed/multi-method research studies featuring undergraduate IPSE. A literature review was conducted using CINAHL, MEDLINE, and PsycINFO databases from January 1999 to..

Published: 19/07/2016
Authors:

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TA/T1 Transitional Cell Carcinoma

​ Omar, A; Amirzqadah, P; Khattak, A; Gana, H; Chisholm, N; Jacob, N. (2012).  Ten weeks versus 6 weeks maintenance intravesical instillation of mitomycin-C for prevention of recurrence of TA/T1 transitional cell carcinoma of the bladder: A retrospective study in a single institution. Urology. 80 (3 (Supplement)), pS217-18  

Published: 19/07/2016
Authors: Amirzadah P, Chisholm N, Gana HB, Khattak AQ, Omar A, Jacob N

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Barium Aspiration

​ A 70-year-old lady underwent a barium swallow for investigation of dysphagia and unfortunately aspirated a large quantity of contrast material, which dramatically illuminated the airspaces (Figure 1A). The patient received supportive care, chest physiotherapy and prophylactic antibiotics. Varatharaj, A; Roome, C; Allsup, S. (2012).  Barium aspiration . QJM: An International Journal of..

Published: 19/07/2016
Authors: Allsup S, Roome C, Varatharaj A

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CT Scout Topograms

​ Objective Guidelines for the diagnosis and management of new presentations of urolithiasis recommend performing both X-Ray Kidney-Ureter-Bladder (XR-KUB) and CT Kidney-Ureter- Bladder (CT-KUB). We assessed the sensitivity of the CT scout topogram compared with XR-KUB in the detection of urinary tract calculi. Methods  Patients that underwent both XR-KUB and CT-KUB..

Published: 19/07/2016
Authors: Massey G, , McCabe JE,

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Mobile lithotripsy service

​ Objective The introduction of Extracorporeal Shockwave lithotripsy (ESWL) in the 1980s revolutionised the treatment of urinary stones. ESWL is a popular treatment option due to the low risk of morbidity and the reported good rates of stone clearance. Mobile lithotripters offer an ESWL service for DGH populations at a fraction..

Published: 19/07/2016
Authors: , McCabe JE, , Samsudin A

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Preoperative Fasting Time

​ Jameel, SA; Kataria, C. (2012).  Audit of preoperative fasting time . British Journal of Anaesthesia. 109 (3), 479P-480P  

Published: 19/07/2016
Authors: Jameel SA, Kataria C

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Red Cell Utilization

​ Yoxall, PF; Mayhew, D. (2012).  Red cell utilization in revision hip surgery and attempting to reduce utilization using a standardized dose of tranexamic acid and appropriate cell salvage . British Journal of Anaesthesia. 109 (3), 475P-476P  

Published: 19/07/2016
Authors: Mayhew D, Yoxall PF

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​ Huisman, MG; Audisio, RA et al. (2012).  The predictive ability of timed “Up & Go” in oncogeriatric surgical patients . European Journal of Surgical Oncology. 38 (9), 769-70  

Published: 19/07/2016
Authors:

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Safe Surgical Monitoring

​ Abstract It is often difficult to apply traditional ECG electrodes on patients with extensive burns due to a large operative site, compromise of sterility, the fact that traditional placement would be within the operative site or because stick-on pads cannot stick due to prep solution, bleeding and other factors. We..

Published: 19/07/2016
Authors: Shokrollahi K, Sofos S, Tehrani H,

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Blunt Carotid Artery Injury

​ Objective To highlight a rare cause of Horner's syndrome, and to review the management of blunt carotid artery injury. Method Literature search via PubMed for related articles. Results Horner's syndrome and blunt carotid artery injury are rare phenomena; sexual asphyxia as a cause has not previously been reported. This case..

Published: 19/07/2016
Authors: Galli F, Muddaiah A, Banigo A

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Patients With Tracheostomy

​ Introduction and aims Ventilated patients in ITU (intensive treatment unit) tend to be challenging to communicate with, especially patients who are being weaned. These patients usually have tracheostomy in situ and use means such as writing or letter boards to communicate. The situation becomes complex in patient groups that have..

Published: 19/07/2016
Authors: Shokrollahi K

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Button-Over-Nail Technique

​ Abstract The "button over the nail" is the most commonly used technique in order to re-insert the flexor digitorum profundus tendon into the distal phalanx in the management of Zone 1 injuries. Recent evidence in the literature has highlighted an associated morbidity with the technique. In this study, 37 patients were identified..

Published: 19/07/2016
Authors: Bidwai AS, Feldberg L

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Functional Antibody Assay

​ Background and Aim  Recurrent respiratory tract infection (RTI) is a frequent presenting complaint in the general paediatric clinic. Children are often tested to screen for possible underlying immunodeficiency and Cystic Fibrosis. We aim to evaluate the indications for performing functional antibody assay (FAA) and how the results affected our clinical ..

Published: 19/07/2016
Authors: Collier JJ, Ho DKK, Abdelaziz M, John CM

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Renal Replacement Catheter Placement

​ BACKGROUND.  This audit was conducted in response to work conducted by Kam et al¹ analysing tracer uptake from adjacently positioned central venous catheters (CVC) and haemofiltration (HF) lines. They found that if the CVC was positioned less than 2cm distal to the tip of the HF catheter, or proximal to..

Published: 19/07/2016
Authors: Lyons MW, Miller T

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Out of Hours Admission

​ INTRODUCTION.  Recent evidence suggests that patients admitted to hospitals in the UK over the weekend have an increased risk of death when compared to those admitted during the week[1]. Likewise, for intensive care admissions, studies suggest that mortality seems to be worse for patients admitted both out of hours[2] and..

Published: 19/07/2016
Authors: , Harvey E, Downes C,

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Topical Negative Pressure Therapy

​ Abstract Research into topical negative pressure therapy (TNPT) started in 1989 with Dr Louis Argenta and Prof Michael Morykwas of Wake Forest University School of Medicine in North Carolina, USA. In 1997, Morykwas and Argenta concluded that TNPT both enhanced granulation tissue formation and helped bacterial clearance, through the actions of negative..

Published: 19/07/2016
Authors: , Saedi F, McArthur P

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Surviving the Intensive Care

​ Abstract Patients recovering from critical illness may suffer from physical, psychological, and cognitive problems that have a negative impact on their health-related quality of life. To ensure that patients return as close as possible to their previous physical and mental health, their rehabilitation needs should be assessed and an appropriate..

Published: 19/07/2016
Authors: Jones C

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Our Man in Havana

​ Varatharaj, A. (2012).  The lesson of Dr Hasselbacher from Our man in Havana . Clinical Medicine, Journal of the Royal College of Physicians. 12 (5), 492

Published: 19/07/2016
Authors: Varatharaj A

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Managing Myocardial Infarction

​ Embolic myocardial infarction is an uncommon but increasingly recognised complication of infective endocarditis. This complication has a high mortality rate and is deemed a relative contraindication to thrombolytic therapy. The present article describes an episode of acute myocardial infarction associated with infective endocarditis. Systemic thrombolytic therapy was administered, which resulted..

Published: 19/07/2016
Authors: Overend L

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Hodgkin's Disease

​ Purpose:  Published literature from India on HD in children is scant. This comprehensive review of published and grey literature was conducted to understand the current management and outcome of childhood HD in India. Methods:  A search of MEDLINE and EMBASE was carried out. The search was limited to studies published..

Published: 19/07/2016
Authors: Aabideen K

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Raynaud’s Phenomenon

​ Abstract Raynaud’s phenomenon of the nipple is an unusual cause of severe nipple pain. Precipitants for Raynaud’s phenomenon of the nipple are known to be cold temperatures, caffeine, and emotional stress. Nipple pain is quoted as the most common cause of cessation of breastfeeding. It is important that..

Published: 19/07/2016
Authors: McGuiness N, Cording V

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Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

​ Abstract Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective for obese patients with type 2 diabetes mellitus (T2DM) because they concomitantly target obesity and dysglycaemia. Considering the high prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with T2DM, we determined the impact of 6 months’ GLP-1 RA therapy on..

Published: 19/07/2016
Authors: Furlong NJ

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Reconstructive Limb Surgery

​ The British Association of Plastic Reconstructive and Aesthetic Surgeons Reconstructive Limb Surgery Course represents part 5 of the its Advanced Educational Courses. This article reports the highlights and contents of the course. Molajo, A. (2012).  Course Review: Reconstructive Limb Surgery . Annals of Plastic Surgery. Published online 13th December  

Published: 19/07/2016
Authors: Molajo A

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Pilonidal sinus

​Abstract Occupationally acquired inter-digital pilonidal sinuses are seldom seen and typically found on the hands of hair dressers. Sheep shearing has traditionally been believed to be a cause of inter-digital pilonidal sinuses; although in reality it is infrequently so with only two previously reported cases in 1951 and 1966. We present a..

Published: 19/07/2016
Authors: ,

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Diabetes Legacy Plan

​ Thornton, H. (2012).  A diabetes legacy plan for children and young people . Journal of Diabetes Nursing. 16 (1), 18  

Published: 19/07/2016
Authors: Thornton H

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Management of Hyperglycaemia

​ Chandrasekara, H; Brough, C; Goenka, N; Somauroo, J and Hardy, K. (2012).  Management of hyperglycaemia in people with acute coronary syndromes (NICE Clinical Guideline 130): uncertainty persists . Practical Diabetes. 29 (1), 9-11

Published: 19/07/2016
Authors: Hardy KJ

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Critical Care

​ Abstract Inadequate resuscitation of major haemorrhage is an important cause of avoidable death in severely injured patients. Early recognition of blood loss, control of bleeding and restoration of circulating volume are critical to the management of trauma shock, and transfusion of blood components is a key intervention. Vital signs may..

Published: 19/07/2016
Authors: Bonney S, Mahambrey T, Nee PA

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Re-audit of Multidisciplinary Management

​ Patients are at risk of hypothermia (core body temperature

Published: 19/07/2016
Authors: Kuduvalli P

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Obesity and in-hospital Cardiac Arrest

​ Resuscitation of the obese presents numerous challenges. It is known that obesity can affect the airway, ventilation and haemodynamics. At present however, Resuscitation Council (UK) guidelines do not suggest modified Advanced Life Support for the obese patient. A large study based on American Heart Association (AHA) data suggested that obesity..

Published: 19/07/2016
Authors: Shelton C, Williams A, Kuduvalli P

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Impalpable Breast Cancer

​ Background:  The detection of impalpable breast cancer lesions is on the rise due to mass population screening. Radio-guided occult lesion localisation (ROLL) has recently been used in the management of early lesions while sentinel lymph node biopsy (SLNB) has been used to detect occult lymph node metastases. In order to..

Published: 19/07/2016
Authors: Herbert J, , Chagla LS, Desmond S, Galea M, Harris O, Ray A, Thind R, Jois RHS

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Sentinel lymph node biopsy

​ Background:  Sentinel lymph node biopsy (SLNB) is an established method of assessing axillary node status in women with early breast cancer. The primary aim of SLNB is to understand lymph node status with minimal morbidity. Current practice is to offer completion axillary clearance for those women with metastases in sentinel..

Published: 19/07/2016
Authors: Galea M, Jois RHS, Swaminathan V, Chagla LS, Thind R, Harris O, Desmond S,

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Decontamination

​ Introduction An audit to assess the compliance of decontamination of bedside computer keyboards by medical staff on an ICU. The topic was used for audit as previously identified by the hospital infection control department as the worst-performing area on 'clean trace' scoring, and had been a regular topic of discussion..

Published: 19/07/2016
Authors: Disney A,

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Anaesthesia and orphan disease: Phocomelia - a lesson from the past

​ Mukhtar K; Jayaseelan S; Allsop E (2012)  Anaesthesia and orphan disease: Phocomelia - a lesson from the past . European Journal of Anaesthesiology. Published online 5 April 2012   

Published: 19/07/2016
Authors: Allsop E, Jayaseelan S, Mukhtar K

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Visible and non visible haematuria

​ Introduction & Objectives In the UK investigation of patients presenting with any form of haematuria is now accepted practice and patients are often referred to be seen urgently within 2 weeks, with financial penalties imposed if these targets are not met. We set out to ascertain the proportion of patients presenting with..

Published: 19/07/2016
Authors: McCabe JE

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Facial Nerve Branches

​ Lymperopoulos, N; Lappas, D; Gisakis, I; Juszczyk, A; Karkanevatos, A and Iqbal, A. (2012).  Anatomical variations in facial nerve branches in a mediterranean population - A cadaver study . European Archives of Oto-Rhino-Laryngology. 269 (4), 1385

Published: 19/07/2016
Authors: Iqbal A, Lymperopoulos NS

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Gastrointestinal Stromal Tumours

​ Dimitrakakis, G; Stamou, D; Sofos, SS; Dimitrakaki, IA. (2012).  eComment. Gastrointestinal stromal tumours . Interactive Cardiovascular and Thoracic Surgery. 14 (4), 499

Published: 19/07/2016
Authors: Sofos S

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Breast Reconstruction

​ Wallace C; Shokrollahi K. (2012).  Thoracodorsal or Internal Mammary Recipient Vessels for Microvascular Breast Reconstruction? . Annals of Plastic Surgery. 68 (5), 536  

Published: 19/07/2016
Authors: Shokrollahi K

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Mobile Phone Camera

​ Shokrollahi K. (2012).  Photography and the mobile phone camera: A good method for burn depth analysis with implications for remote assessment . Burns. 38 (3), 459  

Published: 19/07/2016
Authors: Shokrollahi K

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Twitter for Plastic Surgeons

​ Saedi F; Nassab RS; Shaaban H. (2012).  Twitter for Plastic Surgeons.  Plastic & Reconstructive Surgery. 129 (5), 893e-94e   

Published: 19/07/2016
Authors: , Saedi F, Shaaban H

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Collagen Scaffolds

​ Abstract The term tissue engineering is the technology that combines cells, engineering and biological/synthetic material in order to repair, replace or regenerate biological tissues such as bone, muscle, tendons and cartilage. The major human applications of tissue engineering are: skin, bone, cartilage, corneas, blood vessels, left mainstem bronchus and..

Published: 19/07/2016
Authors: , , ,

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Chondrogenic

​ Abstract Chondrogenesis is a vital part of adult life, as cartilage is important not only for articulation of joints but also maintenance functions of the body. Chondrogenesis is a five way process of intricate events controlled by specific genes and cell-cell interactions which has been documented over recent years. This..

Published: 19/07/2016
Authors: Griffin M, ,

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Chondrogenesis

​ Abstract Conditions affecting cartilage through damage or age-related degeneration pose significant challenges to individual patients and their healthcare systems. The disease burden will rise in the future as life expectancy increases. This has resulted in vigorous efforts to develop novel therapies to meet current and future needs. Due to the..

Published: 19/07/2016
Authors: , , ,

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Self-referral

​ Background:  Nurse Advice Lines have been a long accepted practice in Rheumatology. At St. Helens Hospital we expanded this to a Therapy Advice Line, and noticed an increasing tendency for self referral by our patients. From working parties on management of Early RA and Stable RA we emphasized our self..

Published: 19/07/2016
Authors: Clayton AM, Griffiths AE, Clewes A, Lynch M, Abernethy R, Dawson J

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Nasopharyngeal Aspirate Cost-analysis Review

​ Introduction  SIGN recommends rapid virological testing for RSV. There was a perception that in the absence of laboratory confirmation, infants were being increasingly investigated and treated to cover for bacterial pneumonia. Method  A cost analysis comparing two periods when NPA was routinely done and when it was not done was..

Published: 19/07/2016
Authors: Strong JS, Whitby TM

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Tissue Glue

​ Teo, I; Lam, W; Bell, D. (2012).  Practical tips for using tissue glue . Journal of Wound Care. 21 (5), 234-235   

Published: 19/07/2016
Authors: Bell D

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V-Y Flap

​ Summary  This case report demonstrates a modification of the so-called ‘Extended V-Y Flap’ used to simultaneously reconstruct a defect involving the upper lip, floor of nose and alar rim following tumour excision. We hope that this case serves as a reminder of the versatility of the V-Y flap in the..

Published: 19/07/2016
Authors: Morton J,

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Plastic Surgery apps

​ Molajo, A; Vaiude, P; Benson, A. (2012).  ‘iReconstruct’: Clinically relevant plastic surgery apps . Journal of Plastic, Reconstructive & Aesthetic Surgery. 65 (6), 838-39  

Published: 19/07/2016
Authors: Benson A, , Molajo A

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Turner Syndrome

​ Abstract Advances in reproductive medicine using oocyte donation have made it possible for women with Turner syndrome (TS) to achieve successful pregnancies. These pregnancies carry substantial fetal and maternal risks, with hypertensive disorders or pregnancy and fetal growth restriction common, and an increased risk of aortic dissection, sometimes fatal, for..

Published: 19/07/2016
Authors: , Brockbank A

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Neck Swelling

​ Sinha, IP; Stickland, A; John, CM. (2012).  A child with neck swelling . BMJ. 344 (7860), e3171   

Published: 19/07/2016
Authors: John CM

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Perinatal Mortality

​ Ekekwe, GO; Anorlu, R. (2012).  Perinatal mortality and associated risk factors at Lagos University Teaching Hospital . BJOG: An International Journal of Obstetrics and Gynaecology. 119 (Suppl s1), 51   

Published: 19/07/2016
Authors: Ekekwe GO

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Pregnant woman with thrombophilia

​ Ekekwe, GO; Tempest, N; Rao S. (2012).  Pregnant woman with thrombophilia presenting with massive rectus sheath and pelvic haematoma: A case report . BJOG: An International Journal of Obstetrics and Gynaecology. 119 (Suppl s1), 78   

Published: 19/07/2016
Authors: Tempest N, Ekekwe GO, Rao S

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Gitelman's syndrome

​ Ekekwe, GO; Rao, S. (2012).  Gitelman's syndrome in pregnancy: A case report . BJOG: An International Journal of Obstetrics and Gynaecology. 119 (Suppl s1), 28-29   

Published: 19/07/2016
Authors: Ekekwe GO, Rao S

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Post Fracture Fixation

​ In spite of the widespread availability of image intensifier for fracture fixation and storage of images on a radiological computer system, routine check radiography is still a common practice. This is even so in situations with no clear indications such as fall or increasing patients' discomfort. Idowu, OK; Menakaya, CU;..

Published: 19/07/2016
Authors: Idowu OK,

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Intensive Care Diaries

​ Background  Relatives of patients recovering from critical illness are at risk of developing posttraumatic stress disorder. Objectives  To test whether providing a diary to intensive care patients and their relatives reduces the level of symptoms related to posttraumatic stress disorder in the relatives. Methods  Observational study of close family members..

Published: 19/07/2016
Authors: Griffiths RD, Jones C

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UK Radical Cystectomy Audit

​ Background:  UK Urologists have been able to submit radical cystectomy data to the BAUS complex operations database since 2004. In 2011 the datasets were overhauled and a web based system launched. We present an analysis of this newly submitted data. It is hoped that by collecting this data we can gain a..

Published: 19/07/2016
Authors: Fowler S, , McCabe JE

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Rheumatoid Arthritis

​ OBJECTIVES: To compare the risk of keratinoctye skin cancer (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) in patients treated for rheumatoid arthritis (RA) compared with the general population, and to determine whether anti-tumour necrosis factor (TNF) therapy exacerbates this risk. METHODS: Patients with RA enrolled in the British..

Published: 19/07/2016
Authors: Abernethy R

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Validating Imagine-S

​ Purpose  To validate a virtual reality simulator suitable for training Interventional Radiology (IR) skills. Task Analysis (TA) was employed to create a detailed description of a Liver Biopsy procedure, from which critical procedure steps (CPS) were identified. Engineers and computer scientists used the TA and CPS to build a simulator..

Published: 19/07/2016
Authors: Sinha A

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CS gas

​ Kain, N; Mishra, A; James, MI. (2010).  Exposure to CS gas: Guidance needed on secondary effects of CS gas on staff . BMJ. 340 (7745), 494 ​

Published: 19/07/2016
Authors: Kain N, Mishra A,

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Pleural Drain Insertion

​ Nazareth, DS; Prakash, A; Blayney, S; Stockton, P. (2010).  Pleural drain insertion and management in a UK hospital . American Journal of Respiratory and Critical Care Medicine. 181 (Meeting Abstracts)  

Published: 19/07/2016
Authors: Blayney S, Prakash A, Nazareth DS, Stockton P

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Community Acquired Pneumonia

​ Nazareth, DS; Tack, G; Maher, F; Patrick, S; Stockton, P. (2010).  Community acquired pneumonia: Improvements in hospital management in a UK NHS hospital . American Journal of Respiratory and Critical Care Medicine. 181 (Meeting Abstracts), D25

Published: 19/07/2016
Authors: Maher F, Nazareth DS, Patrick S, Stockton P, Tack G

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Cheshire and Merseyside Critical Care

​ Background The intravenous route is the most common route of drug administration on critical care units. Intravenous drug administration can be particularly hazardous on critical care due to complex drug regimes, multiple concurrent infusions and the unstable nature of patients. In response to 800 incidents, the National Patient Safety Agency (NPSA)..

Published: 19/07/2016
Authors: Barton G

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Inflammatory Osteoarthritis

​ Abstract We report the case of a 51-year-old woman who presented with an inflammatory flare of osteoarthritis of the small joints of her hands occurring in a temporal relationship with the commencement of Arimidex, prescribed to reduce systemic oestrogen levels to treat breast cancer. Following the cessation of Arimidex and..

Published: 19/07/2016
Authors: Williams S

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Insulin Errors

​ McNulty, SJ; Lewis, A; Hardy, KJ. (2010).  Reducing insulin errors . BMJ. 341 (7782), 1065.   

Published: 19/07/2016
Authors: Lewis A, Hardy KJ, McNulty SJ

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Acute ortic Valvular Regurgitation

​ Abstract A 40-year-old man with Wegener's granulomatosis with renal and ocular involvement was admitted with symptoms of fever, malaise and cough not responding to oral antibiotics. On initial assessment, he had patchy consolidation but was also found to have a new cardiac murmur. He was mildly anaemic. Within 2 days of..

Published: 19/07/2016
Authors: Clewes A

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Homodigital Subcutaneous Flap

​ Hold, P; Tehrani, H and Feldberg, L. (2010).  The homodigital subcutaneous flap for soft tissue coverage of the dorsum of the finger: a case series . Hand. 5 (4), 458-60  

Published: 19/07/2016
Authors: Tehrani H, Feldberg L

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Beware SLEAZE tactics

​ Capewell, S and Capewell, A. (2011).  Denialism in public health: Beware SLEAZE tactics . BMJ. 342 (7790), 188  

Published: 19/07/2016
Authors: Capewell A

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Missile launch pad

​ Abstract Vehicle airbags significantly reduce vehicle occupant injuries and fatalities in road accidents. However, a number of injuries are recognised as being directly attributable to airbag deployment. The majority of these are blunt injuries due to the high force of airbag deployment and include ocular injuries, burns, chest trauma and,..

Published: 19/07/2016
Authors: Emecheta IE

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Glucagon-like peptide-1 analogues

​ A 58 year old woman attends a diabetes clinic with type 2 diabetes of seven years’ duration and no history of macrovascular disease. She is obese (body mass index 37), but says she eats a healthy diet and describes this. Her blood pressure is 134/78 mm Hg, and she has microalbuminuria, but normal renal..

Published: 19/07/2016
Authors: Hardy KJ

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A boy with a painful arm

​ A healthy 8 year old boy, with no history of surgery or medical conditions, presented to the accident and emergency department with severe pain in his right arm after falling off a four foot wall. He had a painful, tender, and swollen right elbow, which he was hesitant to move. The..

Published: 19/07/2016
Authors: McArthur P

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Skill of interpreting imperfect investigations

​ Shuster suggests that clinicians should direct their efforts away from encouraging a deeper understanding of statistics towards searching for better investigations that will give a definitive answer, yes or no.1 To strive for a test that is 100% sensitive and specific, with a 100% positive and negative predictive value, though admirable, is..

Published: 19/07/2016
Authors: McNulty SJ, Williams S

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Pump Advanced Carbohydrate Education programme

​ Abstract Enabling patients to have a say in the design and delivery of local health services is a key priority in the NHS. The St Helens and Knowsley Teaching Hospitals NHS Trust diabetes team aimed to set up a peer support group for people with type 1 diabetes to aid in..

Published: 19/07/2016
Authors: Cardwell J, Furlong NJ, Hardy KJ, Wessels L, O'Brien S

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Accidental staggered paracetamol overdose

​ Abstract Paracetamol is one of the most commonly used drugs both over the counter and on prescription. Liquid paracetamol is available over the counter all over the world. Most commonly available concentrations are 120 mg/5 ml and 250 mg/5 ml. Many parents and healthcare professionals assume that doses available in different countries..

Published: 19/07/2016
Authors: Sills J, Aabideen K

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Carcinoma with Unknown Primary

​ Abstract Widespread metastatic disease with no obvious primary on initial investigations is a diagnostic challenge often encountered by radiologists. Carcinoma of unknown primary origin (CUP) forms a heterogeneous group of cancers constituting approximately 3-5% of new cancers and amongst the top 10 causes of cancer-related deaths worldwide. A radiologist is often..

Published: 19/07/2016
Authors: , Marshall E, Thind R

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Secondary Breast Cancers

​ Background:  Occurrence of metastatic disease to breast (secondary breast cancer) in both women and men is rare, constituting 0.5-6% of breast malignancy. In addition to systematic history taking and clinical examination, early diagnosis of secondary breast cancer demands vigilance by radiologists to distinguish subtle disparities between much commoner primary breast..

Published: 19/07/2016
Authors: Kulkarni T, , Jois RHS, Harris O, Thind R

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ROLL Lumpectomy

​Background  Occult breast lesions are being successfully targeted by means of Radioactive-guided Occult Lesion Localization (ROLL). Several reports demonstrate suitability of ROLL technique to excise non-palpable breast lesions with immediate advantages. Aim  Evaluation of long-term outcomes after ROLL guided lumpectomy for early breast cancer. Materials and methods  A consecutive series..

Published: 19/07/2016
Authors: , Chagla LS, Desmond S, Harris O, Poonawala S, Thind R, Jois RHS

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Prediction of Non Sentinel Nodal Metastases After Positive Sentinel Lymph Node Biopsy for Early Breast Cancer – Burney Breast Unit Experience

Background: Sentinel lymph node biopsy (SLNB) is an established method of assessing axillary node status in women with early breast cancer. The primary aim of SLNB is to understand lymph node status with minimal morbidity. Current practice is to offer completion axillary clearance for those women with metastases in sentinel..

Published: 19/07/2016
Authors: Galea M, Jois RHS, Swaminathan V, Chagla LS, Thind R, Harris O, Desmond S,

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Using Stroke Sentinel National Audit Data To Deliver Organisational Change - A keynote speech to the NI Stroke Forum

  Hill, AM. (2016). Using Stroke Sentinel National Audit Data To Deliver Organisational Change - A keynote speech to the NI Stroke Forum. 5th NIMAST Northern Ireland Stroke Conference. 17 May

Published: 17/05/2016
Authors: Hill AM

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Challenging Hunt on Strokes (Letter)

  Hill, AM. (2016). Challenging Hunt on Strokes (Letter). The Times. 17 January. 

Published: 17/01/2016
Authors: Hill AM

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060 The development of a stroke unit simulation model to reconfigure an inpatient stroke unit

Summary Our team developed a mathematical simulation of a stroke unit, allowing us to demonstrate the optimal size and configuration for a stroke unit. The model utilised existing known inputs: including the number of strokes, stroke ‘mimics’, TIAs, and optionally the presence of medical outliers on the stroke unit. For..

Published: 24/10/2015
Authors: Hill AM

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Oral Presentation: Development of a graphical dashboard for real-time analysis of Stroke Sentinel National Audit (SSNAP) data

Summary The Stroke Sentinal National Audit Programme Dataset contains valuable operational data but is limited by its lag time to reporting. We have developed a realtime data dashboard which enables SSNAP data to be used to study the performance of our unit live. Data is entered onto the dashboard..

Published: 23/10/2015
Authors: Hill AM

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Centralising acute stroke services: study confounded by financial investment

Extract Morris and colleagues did not discuss how substantial financial investment in services affected their results.1 The London stroke strategy was supported by an additional £23m (€28.8m; $37.3m) in funding.2 The cost improvement programme highlighted the need for an extra £13m investment in hyperacute stroke units to   Hill, AM. (2014). Centralising..

Published: 23/09/2014
Authors: Hill AM

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St Helens Community Staff

Atrial Fibrillation and Stroke: State-of-the-art and future directions

Introduction Stroke is a major complication of atrial fibrillation (AF). About 25% of ischaemic stroke are cardio-embolic in origin; AF is the most common cause of those.1 Nonvalvular AF carries a 5-fold increased risk of stroke,2 while AF related to mitral stenosis increases the risk of stroke by 20-fold.3 The attributable..

Published: 31/10/2023
Authors: Elsheikh S, Hill AM, Irving G, Abdul-Rahim A

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P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

Published: 25/04/2023
Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

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P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty SJ, Bujawansa S, Cardwell J, Hardy KJ

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P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Balafshan T, Cardwell J, Hardy KJ

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Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Background The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths..

Published: 22/12/2022
Authors: Irving G

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

Published: 27/10/2022
Authors: Westall S, Narayanan RP, Irving G, Hardy KJ

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General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic

Abstract With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main..

Published: 16/05/2022
Authors: Irving G

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...

Published: 20/04/2022
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Hardy KJ

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Association between household air pollution and nasopharyngeal pneumococcal carriage in Malawian infants (MSCAPE)

Background Household air pollution from solid fuels increases the risk of childhood pneumonia. Nasopharyngeal carriage of Streptococcus pneumoniae is a necessary step in the development of pneumococcal pneumonia. We aimed to assess the association between exposure to household air pollution and the prevalence and density of S pneumoniae carriage among..

Published: 24/01/2022
Authors: Dherani M

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Putting Down Roots

St Helens is ahead of the curve when it comes to health and social care integration and it has the momentum to stay there, explains Mark Palethorpe Palethorpe, M. (2021). Putting Down Roots. Municipal Journal. Suppl 8 July (.), 10-11

Published: 08/07/2021
Authors: Palethorpe M

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Evaluation of a 'drop box' doorstep assessment service

Abstract The COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being..

Published: 29/03/2021
Authors: Tinsley A, Whittaker C, Cox SJ

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Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

Abstract: COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed..

Published: 29/03/2021
Authors: Irving G

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The MRCGP Recorded Consultation Assessment: time to drop 10 minutes as standard?

Extract Why do we continue to examine GP trainees at 10 minutes when the RCGP itself has called for longer GP consultations? The recently announced changes to the MRCGP in response to the COVID-19 pandemic has seen the replacement of the Clinical Skills Assessment (CSA) with the Recorded Consultation Assessment (RCA).1..

Published: 28/01/2021
Authors: Irving G

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P300 The role of FMT in reducing hospital admissions and length of stay

Introduction Clostridium difficile infection (CDI) is the most common healthcare associated infection in the NHS with 12,275 cases reported in England in 2018/19. Recurrent Clostridium Difficile infection (rCDI) is an increasingly common problem; the recurrence rate is approximately 20% after a first episode and 45–60% after a second episode of C difficile infection, with..

Published: 21/01/2021
Authors: Baig D, McClements D

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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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John Holden: an appreciation

Dr John Holden was known to many within the RCGP for his work on the quality agenda, GP training, clinical audit, Fellowship by Assessment, Membership by Assessment, past Council membership, Provost of Mersey Faculty, and as a recipient of the President’s Medal. John tragically passed away in a fall..

Published: 23/12/2019
Authors: Cox SJ

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Exploring the impact of pharmacist-led feedback on prescribing behaviour: A qualitative study

Background Prescribing errors occur frequently in hospital settings. Interventions to influence prescribing behaviour are needed with feedback one potential intervention to improve prescribing practice. Doctors have reported a lack of feedback on their prescribing previously whilst the literature exploring the impact of feedback on prescribing behaviour is limited. Objectives To..

Published: 16/01/2019
Authors: O'Brien S

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Exploring hospital pharmacists’perceptions of their medication communication with prescribers

Abstract Prescribing errors are common and problematic in hospital settings in the UK. Pharmacists have been described as integral in the interception of prescribing errors, with effective medication communication between pharmacists and prescribers important to resolve and optimize prescribing outcomes. However, poor communication between healthcare professionals, including pharmacists and prescribers,..

Published: 16/05/2018
Authors: O'Brien S

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Practising humility: how philosophy can inform general practice

​Note. Murphy, C. (2017). Practising humility: how philosophy can inform general practice. British journal of general practice . 67 (665), p561

Published: 03/01/2018
Authors: Murphy C

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Exploring pharmacist experiences of delivering individualised prescribing error feedback in an acute hospital setting

​ Highlights • Delivery of prescribing error feedback is valued by hospital pharmacists and considered sustainable • Pharmacists report altered prescribing behaviour and improved prescribing following receipt of feedback • Pharmacists report greater team-work and prescriber communication following delivery of feedback • Delivering prescribing error feedback can improve the self-confidence and self-worth of pharmacists Lloyd,..

Published: 20/12/2017
Authors: Lloyd M, Furlong NJ, Hardy KJ, O'Brien S

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International variations in primary care physician consultation time

Objective  To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. Design and outcome measures  This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish,..

Published: 10/11/2017
Authors: Holden JD

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Introducing community integrated nursing teams

​ Abstract The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated,..

Published: 15/08/2017
Authors: O'Brien S

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22 controlled trials in Education for Primary Care 1990–2015 (letter)

​Holden, JD. (2017). 22 controlled trials in Education for Primary Care 1990–2015. Education for Primary Care . 11 (May ), 1-2

Published: 01/06/2017
Authors: Holden JD

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Which cuff should I use?

Objective To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. Data sources MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. Eligibility criteria Cross-sectional, randomised and cohort..

Published: 03/11/2016
Authors: Irving G

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Interventions to increase or decrease the length of primary care physicians' consultation

Background Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average consultation lengths differ. These differences may be due to self selection. This is the first update of the original review. Objectives To assess the effects of interventions to alter the length..

Published: 25/08/2016
Authors: Irving G

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Unusual staphylococcal toxic shock syndrome

Abstract Diagnosis of nonmenstrual staphylococcal toxic shock syndrome (TSS) is often challenging. A female medical colleague had a rare entity, a staphylococcal pharyngitis complicated by TSS. The diagnosis was confirmed by isolation of tst-positive Staphylococcus aureus in throat culture and by identification of a specific Vbeta2 expansion pattern of her..

Published: 19/07/2016
Authors: Fletcher C

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Exploring attitudes and opinions of pharmacists toward delivering prescribing error feedback

Background Prescribing error (PE) rates have been extensively reported in the literature. Various interventions at reducing PEs have been studied with some success, yet PEs continue to be a challenge for the health care system. Prescriber feedback has been proposed as one mechanism to reduce PEs in seminal studies. Pharmacists..

Published: 19/07/2016
Authors: O'Brien S

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Formalized prescribing error feedback from hospital pharmacists

Abstract Doctors have reported a lack of awareness of their prescribing errors with lack of feedback considered a system failure. This article summarizes the views of hospital doctors about receiving formal prescribing error feedback from ward-based pharmacists.  Lloyd, M; Watmough, SD; O'Brien, SV; Furlong, N; Hardy, K. (2015). Formalized prescribing error..

Published: 19/07/2016
Authors: O'Brien S

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Role models in primary care education

​ Abstract Role models are widely acknowledged in medicine, but they have received much less attention than the other two essential elements of effective medical education, planned and organised teaching, and structured experiences. This may be the result of not distinguishing between what students and trainers are taught and what they..

Published: 19/07/2016
Authors: Holden JD

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Music: A better alternative than pain?

​ Holden, R and Holden, J. (2013).  Music: A better alternative than pain? . British Journal of General Practice. 63 (615), 536  

Published: 19/07/2016
Authors: Holden JD

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A64 (P310) Outpatient parenteral antibiotic therapy...

Aims  To determine the benefits of OPAT in diabetes foot infections. Methods This was a retrospective study of consecutively initiated OPAT in patients with diabetes foot infections. Patients initiated on OPAT in a multidisciplinary diabetes foot clinic and inpatients discharged from a diabetes inpatient ward between April 2011 and May 2013 and..

Published: 19/07/2016
Authors: Hodgkins P, McGrail P, O'Hanlon S

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Don’t Shoot the Messenger

​ Cox, S; Holden, J. (2013).  Don't shoot the messenger: The problem of whistleblowing in general practice . British Journal of General Practice. 63 (611), 291  

Published: 19/07/2016
Authors: Cox SJ, Holden JD

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Feeding the Beast

​ Foulkes et al suggest that the ePortfolio software should be developed to make the process of documenting and reporting the progress of trainees easier and quicker. Holden, J; Cox, S; Breach, M; Hargreaves, S; van Dessel, M; Hyde, S; White, J; Parr, H; Clarke, C;. (2013). Educational Supervision for GP Trainees:..

Published: 19/07/2016
Authors: Breach M, Clarke C, Cox SJ, Hargreaves SA, Holden JD, Hyde S, Parr H, Van Dessel M, White J

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Time Efficiency Principle

Abstract The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make..

Published: 19/07/2016
Authors: Holden JD

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Writing therapy

​ Mugerwa, S and Holden, JD. (2012).  Writing therapy: A new tool for general practice?  British Journal of General Practice. 62 (605), 661-63  

Published: 19/07/2016
Authors: Holden JD, Mugerwa S

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Revalidation

Abstract The start of revalidation for doctors in the United Kingdom in 2012, based on Good Medical Practice1 and a conclusion by annual appraisal that a doctor is ‘up-to-date and fit to practice’, raises important issues for educational leaders in primary care. These include consideration of the purpose of revalidation; what..

Published: 19/07/2016
Authors: Holden JD, Cox SJ, Hargreaves SA

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Chronic Heart Failure Guidelines

Introduction A number of international guidelines have been developed to support primary care clinicians improve the quality of care for patients with chronic heart failure at the end of life. The objective of this study was to undertake a systematic evaluation of such guidelines in relation to end-of-life care. Methods..

Published: 19/07/2016
Authors: Edwards J, Holden JD

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Cancer Diagnosis in Primary Care

​ Irving, G and Holden, J. (2013).  Measures of promptness of cancer diagnosis in primary care . British Journal of Cancer. 108 (10), 2186  

Published: 19/07/2016
Authors: Holden JD

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Sexual Health Services

​ Background   Teenage pregnancy rates in the UK are the highest in Western Europe. Causes of teenage pregnancies are multifaceted with complex interplay of social, lifestyle and wider determinants influencing risk. Improving access to sexual health services through community services is an important factor in attempting to tackle this issue, but..

Published: 19/07/2016
Authors: Forster S, Olsen JR

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Eldercare

Holden, J. (2012).  What's the alternative? . Health Service Journal. 27th September, p32-33   

Published: 19/07/2016
Authors: Holden JD

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Cancer Prognosis

Background:  General practitioners are probably asked regularly about the prognosis for patients with cancer. There is no readily available source of information on the accuracy of their estimates. Objective:  To discover studies that have reported general practitioners estimates of prognosis. Methods:  A search for studies of estimates of prognosis in..

Published: 19/07/2016
Authors: Holden JD, Wooff E

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15 Minute Consultations

​ Irving, GJ; Holden, J. (2012).  15 minute consultations as standard benefit patients and GPs . BMJ. 344 (7862), 31-32  

Published: 19/07/2016
Authors: Holden JD

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Ideas for appraisal

​ Holden, J. (2010).  Ideas for appraisal . Education for primary care. 21 (5), 324-326  

Published: 19/07/2016
Authors: Holden JD

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Alcohol Problems

Objective:  To describe the pattern of diagnosis of 368 patients with alcohol problems in one general practice in northwest England. Methods:  Records were searched retrospectively, and notes were made prospectively from 1996, of all patients who either admitted to drinking more than 50 units per week (men) or 35 units per week (women), or..

Published: 19/07/2016
Authors: Holden JD, Tatham D, Wooff E

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Significant Events

BACKGROUND Patient safety is a key issue in primary care. Significant event analysis (SEA) is a long established method of improving safety. In 2004, SEA was introduced as part of the Quality and Outcomes Framework (QOF) of the new general medical services (GMS) contract. AIM To review SEAs submitted for the..

Published: 19/07/2016
Authors: Cox SJ, Holden JD

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Poor Performance

BACKGROUND The detection, assessment, and management of primary care poor performance raise difficult issues for all those involved. Guidance has largely focused on managing the most serious cases where patient safety is severely compromised. The management of primary care poor performance has become an increasingly important part of primary care..

Published: 19/07/2016
Authors: Cox SJ, Holden JD

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Exploring attitudes and opinions of pharmacists toward delivering prescribing error feedback

Background Prescribing error (PE) rates have been extensively reported in the literature. Various interventions at reducing PEs have been studied with some success, yet PEs continue to be a challenge for the health care system. Prescriber feedback has been proposed as one mechanism to reduce PEs in seminal studies. Pharmacists..

Published: 19/07/2016
Authors: Furlong NJ, Hardy KJ, Lloyd M, O'Brien S

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Formalized prescribing error feedback from hospital pharmacists

Abstract Doctors have reported a lack of awareness of their prescribing errors with lack of feedback considered a system failure. This article summarizes the views of hospital doctors about receiving formal prescribing error feedback from ward-based pharmacists. Lloyd, M; Watmough, SD; O'Brien, SV; Furlong, N; Hardy, K. (2015). Formalized prescribing error..

Published: 19/07/2016
Authors: Furlong NJ, Hardy KJ, Lloyd M, O'Brien S

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After Achilles

Extract Contrary to the view that ‘using time as a diagnostic tool’ is ‘sloppy and idle’ and that general practice has ‘floundered’ as a result of such unhelpful phrases, we consider that general practice has struggled to provide a robust evidence base to confirm or refute the value of time..

Published: 01/05/2016
Authors: Irving G

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The AGREE Reporting Checklist is useful for assessing the quality of clinical practice guideline development

Extract At least two systematic reviews of national and international clinical practice guidelines have used the AGREE tools (I and II). Both found that no guideline was perfect and highlighted the same key problems—a lack of applicability and stakeholder involvement. These domains relate to … Irving, G. (2016). The AGREE Reporting..

Published: 12/04/2016
Authors: Irving G

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Do you understand how your health system works?

Extract As family doctors we should be thinking about how our healthcare system works and how we can shape it. We share responsibility for the distribution of limited resources not only as healthcare professionals, but also as patients and taxpaying citizens. But how much do we know about how the..

Published: 05/11/2015
Authors: Irving G

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Adjustment and adaptation in patients with chronic heart failure at the end of life

  Irving, G 2015, 'Adjustment and adaptation in patients with chronic heart failure at the end of life', PhD thesis, University of Liverpool, Liverpool.

Published: 02/09/2015
Authors: Irving G

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The meaning of suffering in patients with advanced progressive cancer

Background There is a lack of research into suffering and what it means to the individual patient with advanced cancer and its importance in end of life care. Aims To explore the concept of suffering and distress by eliciting what individual patients with advanced cancer perceived as suffering and how..

Published: 01/09/2015
Authors: Irving G

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Pharmacological agents for the prevention of vestibular migraine

Background Vestibular migraine is a common cause of episodic vertigo. Many preventive treatments have been proposed for this condition, including calcium antagonists, beta‐blockers, antidepressants, anticonvulsants, selective 5‐HT1 agonists, serotonin antagonists and non‐steroidal anti‐inflammatory drugs (NSAIDs). Objectives To assess the effects of pharmacological agents for the prevention of..

Published: 21/06/2015
Authors: Irving G

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Colchicine for Pericarditis

Background Pericarditis is the inflammation of the pericardium, the membranous sac surrounding the heart. Recurrent pericarditis is the most common complication of acute pericarditis, causing severe and disabling chest pains. Recurrent pericarditis affects one in three patients with acute pericarditis within the first 18 months. Colchicine has been suggested to be..

Published: 28/08/2014
Authors: Irving G

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Cardiovascular disease and cancer compete for the outcome of death

Extract Life is a game of multiple competing risks, and problems arise when we forget that death is a single, non-repetitive event usually attributable to one cause.1 Doctors often consider issues of competing risks when caring for patients with multimorbid chronic disease. For example, it’s not uncommon for a..

Published: 19/08/2014
Authors: Irving G

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From patient uncertainty to WHO policy in two years

Abstract Clinical encounters in daily practice can provide a fertile ground for identifying uncertainties that require further investigation. Addressing such uncertainties by undertaking a Cochrane review can be a rewarding educational process and result in important contributions to health care policy. This paper describes the experiences of a UK GP..

Published: 10/03/2014
Authors: Irving G

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Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists...

Published: 02/12/2013
Authors: Irving G

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Chronic heart failure guidelines: Do they adequately address patient need at the end-of-life?

Introduction A number of international guidelines have been developed to support primary care clinicians improve the quality of care for patients with chronic heart failure at the end of life. The objective of this study was to undertake a systematic evaluation of such guidelines in relation to end-of-life care. Methods..

Published: 03/10/2013
Authors: Irving G, Holden JD

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NAPCRG 2012: reflections from across the pond

Extract The 40th annual meeting of the North American Primary Care Research Group (NAPCRG) was held in New Orleans from 1–5 December 2012. As early-career family doctors from the UK we were keen to explore primary care research from around the world. With delegates from North America and Europe to the antipodes..

Published: 01/08/2013
Authors: Irving G

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Measures of promptness of cancer diagnosis in primary care

Extract Sir, In their discussion Lyratzopoulos et al (2003) make the crucial point that they were not able to examine whether prolonged values of either the primary care interval or the number of pre-referral consultations were either justifiable or preventable. We also wish to question the widely held assumption that optimum..

Published: 01/05/2013
Authors: Irving G, Holden JD

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Global health: time for full integration into GP education

Extract Postgraduate medical training no longer sufficiently prepares UK doctors for the challenges of the 21st century. In 2010, an Independent Commission on the Education of Health Professionals, published in The Lancet, described a ‘mismatch between present professional competencies and the requirements of an increasingly interdependent world’.1 Globalisation, fuelled by a..

Published: 01/05/2013
Authors: Irving G

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The John Henry effect

Extract The “Ballad of John Henry” tells of the legendary black American steel pin driver, John Henry, who swung a huge nine pound hammer driving railroad spikes on the Chesapeake and Ohio railway in the 1870s.1 John Henry was renowned for his strength among his fellow workers and could drive..

Published: 02/04/2013
Authors: Irving G

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The time-efficiency principle: time as the key diagnostic strategy in primary care

Abstract The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make..

Published: 27/03/2013
Authors: Irving G, Holden JD

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VdGM: Vasco da Gama Movement

Extract The Vasco da Gama Movement is delighted to announce that it is participating in the organization of the World Preconference, which will be carried out in Prague on 24–25 June 2013, prior to the Wonca World Conference. The event is organized in partnership with the Rajakumar Movement (Asia-Pacific Region), the Waynakay..

Published: 01/03/2013
Authors: Irving G

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Dismantling Lord Moran’s ladder: the primary care expert generalist

Extract It is over 50 years since Lord Moran suggested that GPs were doctors who have fallen off the specialist ladder.2 Then, two-thirds of early career GPs would have preferred to have been specialists.2 Today Lord Moran’s ladder lives on. General practice is still not a first career choice for..

Published: 01/01/2013
Authors: Irving G

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Long-term protective effects of hepatitis A vaccines. A systematic review

Objective Data on duration and long-term protective effects of hepatitis A vaccines (HepA) have not been reviewed using a systematic approach. Our objective is to provide a comprehensive review of evidence on the duration of protection achieved by HepA, which is needed for revising existing vaccine policies. Limitations in data..

Published: 17/12/2012
Authors: Irving G

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Global health in the UK's GP postgraduate curriculum

Extract Jennifer Hall and colleagues (Aug 25, p 728) highlight an apparent lack of global health content in UK postgraduate curricula. The Curriculum Development Committee of the UK's Royal College of General Practitioners (RCGP) is currently exploring whether more explicit language about global health issues should appear in the GP postgraduate curriculum...

Published: 10/11/2012
Authors: Irving G

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Do GPs really provide 47 minutes a year for the patient?

Extract The recently published RCGP report on medical generalism brings into focus the need for GPs to spend more time with patients to deliver high quality generalist care. Historically, the figure of 47 minutes a year for the patient has been widely cited and discussed as a summary statistic for the..

Published: 01/08/2012
Authors: Irving G

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Hepatitis A immunisation in persons not previously exposed to hepatitis A

Background In many parts of the world, hepatitis A infection represents a significant cause of morbidity and socio‐economic loss. Whilst hepatitis A vaccines have the potential to prevent disease, the degree of protection afforded against clinical outcomes and within different populations remains uncertain. There are two types of hepatitis..

Published: 11/07/2012
Authors: Irving G, Holden JD

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15 minute consultations as standard benefit patients and GPs

Extract Spence claims that increasing appointments to 15 minutes would reduce availability, limit access, and jeopardise safety with an unknown effect on the quality of patient care. We have offered 15 minute appointments as standard in our practice for eight years with huge benefits for our patients and us. Irving, G; Holden,..

Published: 01/06/2012
Authors: Irving G

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Calling time on the 10-minute consultation

Extract In their editorial, Silverman and Kinnersley present a strong case for moving on from the 10-minute consultation. In 2011 an electronic ‘consultation length’ survey of all UK GP trainees (ST1–ST4) was undertaken by the RCGP Associates in Training committee. One of the key questions within the electronic survey was, ‘..

Published: 01/05/2012
Authors: Irving G

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A pause for thought: reflections on the 2011 SAPC Annual Conference

Extract The 41st Annual Scientific Meeting of the Society for Academic Primary Care (SAPC) was held in Bristol. A packed and varied programme,1 together with excellent organisation, brought people together to share ‘breaking news’ in primary care teaching and research. However, conferences are about more than dissemination of new work...

Published: 31/10/2011
Authors: Irving G

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Can generalism help revive the primary healthcare vision?

Extract It is more than 30 years since the World Health Organization (WHO) called for a paradigm-shift to a model of primary healthcare: a vision of creating ‘Health for All’ through ‘putting people at the centre of health care’.1 Since then, we have seen significant advances in health and healthcare. People..

Published: 03/10/2011
Authors: Irving G

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Academic General Practice Training in the UK-what is it All about?

Abstract Academic GPs have made significant contributions to the care of many millions of patients through research in primary care populations. They have also been instrumental in the development of community-based undergraduate medical education. Here, we explore what academic GP training involves and why all associates in training should have..

Published: 01/09/2010
Authors: Irving G

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Depression in advanced cancer

Purpose Depression is one of the most common psychiatric diseases seen in patients with advanced cancer. It is not only an independent predictor of poor survival in advanced cancer but also reduces quality of life, reduces compliance with treatment and prolongs hospitalization. Yet all too often depression is under diagnosed..

Published: 01/08/2010
Authors: Irving G

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The educational benefits of a federation of four training practices

No abstract available. Hargreaves, S; Irving, G; Holden, J. (2010). The educational benefits of a federation of four training practices. Education for Primary Care. 21 (2), 114-115

Published: 31/03/2010
Authors: Irving G, Holden JD

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The Prevalence of Depression in People with Cancer

This chapter contains sections titled: Prevalence of Depression in Cancer Patients Depression by Cancer Type Depression in Advanced Cancer and Palliative Care Demoralization Conclusions References   Massie, MJ; Lloyd-Williams, M; Irving, G; Miller, K. (2010). The Prevalence of Depression in People with Cancer. In: Kissane, DW; Maj, M; Sartorius, N Depression and..

Published: 03/03/2010
Authors: Irving G

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Knowsley Community Staff

GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19

Abstract Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can..

Published: 17/05/2023
Authors: Shuker K, Tridente A

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Tales from the Menopause Clinic: A multidisciplinary approach to patient care in women with a breast cancer diagnosis

Abstract We chose to focus my project on urogenital symptoms, as so many women are affected by the impact of lack of oestrogen on urogenital tissue quality despite available treatment options. There are various non-hormonal treatment options available on prescription to manage vasomotor symptoms. These include SSRIs and SNRIs, gabapentin,..

Published: 09/10/2021
Authors: Rostron S

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Can we prevent hospital admissions for diabetes?

Aim To identify reasons for presentation at the emergency department and identify methods to avoid hospital admission in patients from a single Clinical Commissioning Group (CCG). Methods We examined the case records of all patients with diabetes specific emergency admissions from Knowsley CCG area to Aintree University Hospital over a 12..

Published: 10/05/2017
Authors: Merriman M

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The NHS health check programme in England: a qualitative study

​ Abstract Despite an extensive evidence-base linking patterns of health with social determinants, recent public health policy has emphasized 'lifestyle diseases' and risk factor modification through behavioural and pharmacological intervention. In England, one manifestation of this has been the launch of the National Health Service Health Check programme. This paper reports..

Published: 19/07/2016
Authors: Cushing J, Panter L

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Primary Care Management of Patients

​ Aims:  Evidence-based management of patients with IGR is essential in reducing the incidence of Type 2 diabetes. The estimated adult prevalence of IGR is 2.3%. Without intervention, the majority of IGR patients are likely to develop Type 2 diabetes within five–10 years. A clinical audit was conducted to identify current practice in the..

Published: 19/07/2016
Authors: Conrad D, McNulty S

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Social Marketing

​ Abstract Social marketing appears to offer a structured approach to the delivery of public health interventions. It uses the principles of marketing to understand health-related behaviour and tailor appropriate and effective interventions to population subgroups. Whilst commercial marketing capitalises on current demand for a tangible benefit, social marketing relies on..

Published: 19/07/2016
Authors: Morris P

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The Liverpool Lung Project Primary Care Implementation Programm

Background More than 90% of people diagnosed with lung cancer in the UK die within a 5-year period. The poor survival is partly linked with late diagnosis often at an advanced stage when various treatment options are less efficacious. The cornerstone of early diagnosis includes prompt identification of high risk individuals,..

Published: 19/07/2016
Authors: Ashton M, Hughes J, Mimnagh C

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Future lung cancer risk

Background Lung cancer continues to be the leading cause of cancer death worldwide. The disease is predominantly common among elderly patients, thus likely to be preceded or accompanied by multiple comorbid conditions. Whilst many studies have reported association between pulmonary diseases and lung cancer occurrence, the role of other chronic..

Published: 19/07/2016
Authors: Ashton M, Hughes J, Mimnagh C

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Management of functional constipation in childhood

​ Abstract Functional constipation is a common childhood condition. In the majority of cases the constipation develops as a result of a complex weave of factors including specific triggers, e.g. reduced fluid intake following a viral infection or periods of restricted access to the toilet. The passage of large painful..

Published: 19/07/2016
Authors: Rogers J

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Achilles Tendon

​Abstract Fluoroquinolone antibiotics have been widely used for over 25 years. Their key adverse effect is tendinopathy. A 76-year-old woman developed bilateral Achilles tendinopathy on the fourth day of fluoroquinolone use. Her doctor advised her to complete the course; however, she went on to sustain bilateral tendoachilles rupture. The patient undertook..

Published: 19/07/2016
Authors: Lewis T

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Halton Community Staff

Much to celebrate

The author discusses topics related to midwifery in Great Britain as of December 2019. Topics covered include the need for choice and access for all women in every area, the establishment of Women's and Children's Services Partnership Boards, and the appointment of England's first Chief Midwifery Officer Professor Jacqueline Dunkley-Bent. Casey-Hardman,..

Published: 23/12/2019
Authors: Casey-Hardman C

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Child population dental preventive programme

​Introduction  An evaluation was undertaken to measure the dental health of five cohorts of 5-year-old children living in Halton and St Helens, each cohort having had a different length of time they were exposed to a population dental prevention programme before their fifth birthday. Method  The dental health of each..

Published: 19/07/2016
Authors: Kearney-Mitchell P, Kellett L, Rice A

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Tackling compression therapy in the community

​Abstract The use of compression bandaging in venous leg ulcers has been acknowledged as ‘best practice’ for some time now, but these wounds remain a serious management problem in many patients with pain, excess exudate, limb swelling and poor mobility all affecting their quality of life. Wound care in general,..

Published: 19/07/2016
Authors: Moore K

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Outbreak of Measles

​Abstract From 1 January to 30 June 2012, 359 confirmed and 157 probable cases of measles were reported in Merseyside, England. The most affected age groups were children under five years and young adults from 15 years of age. Most cases have been sporadic. There have been few outbreaks in nurseries; however, no outbreaks have been..

Published: 19/07/2016
Authors: Mason R

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Prescription for challenging times

​ Forde, C. (2012).  Efficiency: Prescription for challenging times . Health Service Journal . 122 (6291), 30-31  ​

Published: 19/07/2016
Authors: Forde C

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Health Visiting Support Staff

​Abstract Community nursery nurses (CNNs) and health visiting assistants (HVAs) are increasingly working and supporting health visitors (HVs) within clinical settings. The acute shortage of HVs and increased workloads has resulted in routine services normally provided by HVs, such as detection/screening for postnatal depression, no longer being offered. A..

Published: 19/07/2016
Authors: Osborn T

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C Difficile Relapses

Abstract Nurses face several challenges in caring for patients with recurrent episodes of C difficile in the community. This article reports on the development of a clinical pathway to meet the needs of older patients and their families.  Wynne, S. (2012).  Managing C difficile relapses in the community . Nursing Times . 109 (27), 15-17.

Published: 19/07/2016
Authors: Wynne S

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Chronic low back pain

Abstract Chronic low back pain (CLBP) is a condition that causes individuals considerable distress. It also presents a significant challenge to the health service and is often viewed by clinicians as frustrating to manage. The purpose of the present paper is to explore the experiences of individuals in the immediate..

Published: 19/07/2016
Authors: Miller J, Timson D

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Patient Experiences

Abstract Loco-regional recurrence after radical primary treatment of oral cancer is associated with poor prognosis and major patient and carer distress. The patient's psychosocial response to recurrence is underreported in the literature. This is one of the few papers to address in detail this stage in a patient's cancer journey...

Published: 19/07/2016
Authors: Griffiths MJ

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Dental Health

Introduction  Dental access centres (DACs) were introduced in England at the turn of the twenty-first century in response to a growing problem of access to NHS dental services. DACs were expected to offer NHS dental care primarily to those patients that were unwilling or unable to attend 'high street' dental..

Published: 19/07/2016
Authors: Kearney-Mitchell P, Milsom KM, Tickle M

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North West Boroughs Community Health Staff

Always consider a differential and a multidisciplinary approach to the foot

Conference Abstract The Multidisciplinary Diabetes Foot Clinic manages patients primarily with neuropathic or neuroischaemic ulcers or Charcot arthropathy. The following are cases that did not fit the classical picture, requiring involvement in the wider multidisciplinary team to diagnose and treat the underlying condition. A 76-year-old gentleman with persistent bilateral plantar..

Published: 18/04/2021
Authors: Sullivan H, Furlong NJ, Pendlebury H

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The development of a diabetes screening service for the homeless population in St Helens

Aim To screen members of the homeless community in St. Helens for diabetes, and offer advice, support, diabetic eye screening and diabetic foot screening for those with diabetes, following two diabetes-related deaths in this population in 2018. Method(s) The Teardrops Hub staff promoted the drop in service to their service..

Published: 07/10/2020
Authors: Pendlebury H, Bujawansa S, Cardwell J

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Setting up a total contact casting service within a diabetes foot ulcer service

Aims The National Institute for Health and Care Excellence (NICE) recommend total contact casting (TCC) for neuropathic ulceration in the diabetic foot. The St Helens and Knowsley Hospitals Trust, Diabetes Team, determined the feasibility of starting and developing a TCC service within their diabetes foot ulcer service. Method The type..

Published: 07/10/2020
Authors: Pendlebury H, Furlong NJ, Sullivan H

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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: 07/10/2020
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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Perceived problem areas in diabetes do not correlate with levels of anxiety and depression

Background and Aim 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. Methods..

Published: 07/10/2020
Authors: Westall S, Narayanan RP, Langan E, Gallagher CG, Bujawansa S, McNulty S, Furlong NJ, Cardwell J, Hardy KJ

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The Effectiveness of Digital Health Interventions in the Management of Musculoskeletal Conditions

Background Musculoskeletal conditions are the second greatest contributor to disability worldwide and have significant individual, societal, and economic implications. Due to the growing burden of musculoskeletal disability, an integrated and strategic response is urgently required. Digital health interventions provide high-reach, low-cost, readily accessible, and scalable interventions for large patient populations..

Published: 08/06/2020
Authors: Hewitt S, Sephton R

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Engaging public and patients to develop a website to assist people to remain in or return to work

Purpose Musculoskeletal conditions are the second biggest cause of absenteeism in the UK representing 28.2 million working days lost per annum. Current literature suggests that work issues are generally insufficiently addressed in primary healthcare and there is little evidence that evaluates any existing workplace interventions in this setting. To address this..

Published: 01/05/2020
Authors: Sephton R, Bannon C, Cunneely M, Poole A

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A community‐based, two‐week structured education programme

Aims To determine the effectiveness of a community‐based structured education programme for Type 2 diabetes, measuring Hba1c and weight change over a four month period. ‘Diabetes and You’ is a structured education programme delivered by a specialist nurse and dietitian across Knowsley. Methods Participants were recruited between January and..

Published: 26/06/2019
Authors: Gallagher CG

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G361(P) Local vs. regional pathway and cost-implications

​ Aims  Henoch-Schonlein purpura (HSP) is an IgA mediated commonest systemic vasculitis with risk of long-term renal involvement. The regional pathway (Alder Hey) recommends a sixmonth nurse led follow-up with stratification of children into either Standard Pathway (SP) or Proteinuria Pathway (PP) at one week after presentation with PP cohort at..

Published: 16/08/2017
Authors: Viswanathan RK, Woon E, Basavaraju JA

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A questionnaire to identify patellofemoral pain in the community

​Background Community-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community. Methods Study designs: comparative study and cross-sectional study. Study..

Published: 10/10/2016
Authors: Sephton R, Hough E, James J

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Patellofemoral pain in the community

​ Background Community-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community. Methods Study designs: comparative study and cross-sectional study. Study..

Published: 19/07/2016
Authors: Sephton R

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Case 5: non-healing traumatic wound colonised with MRSA

​ Abstract A traumatic wound colonised with MRSA failed to respond to topical antimicrobial dressings. Following the combined use of octenilin Wound Gel and octenilin Wound Irrigation Solution, the MRSA was removed in 4 weeks, the necrotic tissue was debrided and the wound started healing. Simon, D. (2016). Case 5: non-healing traumatic wound colonised..

Published: 19/07/2016
Authors: Simon D

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Case 9: heavily exuding, malodorous, necrotic pressure ulcer

​ Abstract In this case, the necrotic tissue was so hard it was not possible to categorise the ulcer. Octenilin products were able to debride the necrotic tissue, so that the wound depth could be determined. After 4 weeks, the wound was covered with granulation tissue, improving the patient's quality of life...

Published: 19/07/2016
Authors: Simon D

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Case 10: venous leg ulcer that was significantly impairing quality of life

​ Abstract This heavily exuding, sloughy ulcer was so painful that the patient had difficulty tolerating any physical contact with it. After treatment, pain levels subsided, so that she was better able to tolerate dressing changes, could sleep in her own bed instead of a chair, and started compression therapy. Simon,..

Published: 19/07/2016
Authors: Simon D

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How to improve the community care of leg ulcer patients

​ Abstract Venous leg ulcers make up a considerable part of the community nurse’s workload and the gold standard treatment is multilayered compression bandaging applied to cleansed and debrided lower limbs. The author of this piece looks at the background to leg ulcer development; as well as how to assess..

Published: 19/07/2016
Authors: Simon D

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Diagnosing osteomyelitis in diabetes foot ulceration

​ Aims Although osteomyelitis is a common complication of diabetes foot ulceration (DFU), it presents a diagnostic challenge. The aim of this study was to determine the diagnostic modality used to confirm osteomyelitis in patients with DFU. Methods This was a retrospective observational study of patients with DFU complicated by osteomyelitis...

Published: 19/07/2016
Authors: Pendlebury H

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Gelling fibrous silver dressing

​ Abstract Choosing the correct dressing is often key to moving a wound along the healing trajectory, with its ability to deal with problems such as pain, excess exudate production and inflammation being crucial to the healing outcome. Infection is also a serious problem in many wounds and this article looks..

Published: 19/07/2016
Authors: Forster E

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Practical Prescribing

​ Synopsis This book provides prescribing advice for medical and non-medical prescribers caring for adult patients with common musculoskeletal problems. It will be particularly useful for non-medical practitioners, including independent physiotherapy and podiatry prescribers. Reference is made to current prescribing law and accountability, and the principles of safe prescribing are clearly..

Published: 19/07/2016
Authors: Sephton R, Dawson J

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Post-operative Tracheal Extubation Practices

​ Jameel, S; Kataria, C. (2012).  Survey of post-operative tracheal extubation practices at a district general hospital . Anaesthesia. 67 (S2), 51  

Published: 19/07/2016
Authors: Jameel SA, Kataria C

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Journals and Conferences

​ Mabvuure N; Griffin M; Hindocha S. (2012).  The value of medical student specific journals and surgical conferences to future surgeons . International Journal of Surgery. 10 (3), 167-68  

Published: 19/07/2016
Authors: Griffin M,

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Mohs Surgeons

​   Tehrani H; Sofos S; McPhail J; Brackley P (2012)  A Novel Training Model for Mohs Surgeons . Dermatologic Surgery. Published online 6 Feb 2012   

Published: 19/07/2016
Authors: , Brackley P, Sofos S, Tehrani H

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