WUTH publication: Atropine sulphate: rescue therapy for pyloric stenosis.

Citation: BMJ Case Reports. 2012 Aug 2
Author: Owen RP, Almond SL, Humphrey GM
Abstract: Infantile hypertrophic pyloric stenosis (IHPS) is a common condition which presents with non-bilious vomiting and failure to thrive secondary to gastric outlet obstruction. In the UK, management is by fluid resuscitation followed by pyloromyotomy. Incomplete myotomy complicates 0.3% of cases necessitating further surgery and exposing the patient to further risk. Medical management of IHPS with antimuscarinics to promote pyloric relaxation is a well-described treatment modality that is used as first-line therapy in some countries. The use of this technique is limited by the need for extended hospital admission with parenteral nutrition administration. We describe a case of IHPS complicated by incomplete pyloromyotomy and subsequently managed successfully by atropine sulphate therapy.

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

WUTH publication: Penile metastases treated with partial glansectomy and adjuvant radiotherapy 5 years after an initial diagnosis of rectal cancer

Citation: BMJ Case Reports. 2013 Dec 5;2013
Author: McGuinness
Abstract: A 61-year-old man with recurrent rectal carcinoma was referred to the urology clinic with two penile lesions. These had negatively affected his quality of life and he underwent a radical circumcision and proximal glansectomy with reconstruction. This case report examines the clinical presentation and surgical treatment of rectal carcinoma metastasising to the penis.

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

WUTH publication: The impact of a new acute oncology service in acute hospitals: experience from the Clatterbridge Cancer Centre and Merseyside and Cheshire Cancer Network

Citation: Clinical Medicine. 2013, 13(6), 565-9
Author: Neville-Webbe
Abstract: The 2008 National Confidential Enquiry into Patient Outcomes and Death highlighted an urgent need to improve the quality, safety and efficiency of care for cancer patients following emergency presentation to acute general hospitals. A network-wide acute oncology service (AOS) was therefore commissioned and implemented on the basis of recommendations from the National Chemotherapy Advisory Group (NCAG). Through a continuous programme of raising awareness regarding both the role of the AOS and the necessity of early patient referral to acute oncology teams, we have been able to establish an AOS across all acute trusts in our cancer network. The network-wide AOS has improved communication across clinical teams, enabled rapid review of over 3,000 patients by oncology staff, reduced hospital stay, increased understanding of oncology emergencies and their treatment, and enhanced pathways for rapid diagnosis and appropriate referrals for patients presenting with malignancy of undefined origin (MUO). These achievements have been made by developing a network protocol book for managing common oncology emergencies, by introducing local pathways for managing MUO and by collaborating with palliative care teams to introduce local acute oncology (AO) multi-disciplinary team (MDT) meetings.

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

WUTH publication: C-reactive protein (CRP) responses in neonates with hypoxic ischaemic encephalopathy

Citation: Archives of Disease in Childhool. Fetal and neonatal edition. 2013 Nov 12
Author: Rath S, Narasimhan R, Lumsden C
Abstract: KEYWORDS: C-Reactive Protein, Hypoxic Ishaemic Encephalopathy, Intrapartum, Neonatal, Sepsis

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

NEW! Library Helpsheet for doctors undertaking exams

The Trust Library & Knowledge Service has produced a helpsheet to signpost freely available print and electronic resources to support those undertaking postgraduate medical exams.  You can find our whole range of helpsheets at http://www.whnt.nhs.uk/hrod/development/integratedlibraryservice/usingthelibrary/libraryhelpsheets/.

Now available! 3D anatomy for speech language pathology on Anatomy TV

Anatomy TV is now available to all staff until the end of March 2014, and includes 3D anatomy on speech language pathology.

This includes an in-depth focus on the anatomy of the head and neck. A 3D view of a head and neck model is accompanied by descriptive text and links to additional images.

Choos from nearly 100 clinical slides, anatomy illustrations, movies and animations to help explain mechanisms for a wide variety of functions, from articulation to swallowing.

Also included is a Patient Information section, containing information sheets, which can be edited to suit your particular requirements.

To access simply go to http://www.anatomy.tv and sign in using your NHS Athens account.

Please let us know what you think of this new resource.

Additional resources

Library Helpsheet created and available at http://www.whnt.nhs.uk/document_uploads/Library_Services/Helpsheet%20No.%2017_Anatomy%20TV.pdf

Evidence based information summaries from Dynamed available until December 2014!

All WUTH staff now have access to Dynamed until December 2014.  Dynamed provides over 3200 quick reference clinical topic summaries, designed for health care professionals to use at the point of need. 

How do I access Dynamed?

Go to dynamed.ebscohost.com  and select ‘Institutional users login here’, then select ‘Athens login’, then enter your NHS Athens username and password.  Find out more about an Athens account.

A Dynamed app is available for quick and easy access to evidence based clinical summaries via your mobile device (Blackberry/iPhone/iPad/Android).  Please contact the library for a mobile access code.

You may wish to watch this video on basic searching of Dynamed, or read this user guide.  You can also contact library staff for further support. 

Where can I give feedback about Dynamed?

Tell us what you think about this resource!  Please submit a Library Suggestion Form to give any feedback about Dynamed.

Further resources

If you would like to find out more about the range of health information resources and library services available to enhance your clinical and business decision-making please visit the Trust Library and Knowledge Service webpages at www.whnt.nhs.uk/library.

Additional resources

Dynamed provide two promotional kits to support institutional licences:

http://support.ebsco.com/knowledge_base/detail.php?id=4226

http://support.ebsco.com/knowledge_base/detail.php?id=4585

Dynamed helpsheets are available from the support section of the Dynamed website: http://support.ebsco.com/

Mobile access codes are available from the Librarians.  Distribution of mobile access codes will be monitored via a spreadsheet.  Instructions on how to set up mobile access are available on the S drive in Resources > Dynamed.  

WUTH publication: Osteochondral distal metatarsal allograft reconstruction: a case series and surgical technique

Citation: Foot and ankle international. 2013, 34(8), 1158-67
Author: Ajis A, Seybold JD, Myerson MS
Abstract:  BACKGROUND: Painful degenerative diseases of the metatarsophalangeal joints (MTPJs) are frequently progressive and difficult to treat. Traditional operative treatments such as debridement, distal metatarsal osteotomies, and arthroplasty present a unique set of complications, and pain and deformity may still occur. Osteochondral distal metatarsal allograft reconstruction (ODMAR) is presented as a salvage procedure, reserved for patients with significant bone loss or avascular necrosis in whom traditional interventions have failed or are inadequate to address the underlying joint deformity. METHODS: A retrospective review identified all ODMAR cases performed by the senior author over the past 10 years. Patient symptoms, satisfaction, and MTPJ range of motion were measured at each postoperative evaluation. Graft healing and subsequent degenerative changes at the MTPJ were observed at each visit with foot radiographs. The surgical techniques for both first and lesser metatarsal reconstructions are described. RESULTS: Six patients were identified with average follow-up interval of 36 months (range, 6-66). Preoperative diagnoses included infection (1), fracture (1), and avascular necrosis (4). Mean total arc of motion was 40 degrees (range, 30-50). All patients maintained viability of the allograft metatarsal head and joint space was normal or Kellgren-Lawrence grade 1 in 5 of 6 patients at final follow-up. All patients demonstrated osseous union of the metatarsal osteotomy site. No patients have undergone revision surgery to date. CONCLUSIONS: ODMAR is a safe and effective procedure for treatment of painful, degenerative conditions of the MTPJs. Further studies are required to determine the definitive indications and long-term outcomes for this procedure. LEVEL OF EVIDENCE: Level IV, retrospective case series. KEYWORDS: allograft, arthritis, forefoot disorders, metatarsal, necrosis, osteochondral

Link to Pubmed record

WUTH publication: Preoperative mapping of fistula in ano: a new 3D MRI based modelling technique

Citation: Colorectal Disease. 2013, 15(11), e699-701
Author: Day N, Earnshaw D, Salazar-Ferrer P, Walsh C
Abstract: AIM: We aimed to develop an intuitive, interactive, 3D MRI modelling technique to produce a 3D image of fistula in ano. METHOD: The 3D model is created from standard 2D MRI sequences to produce an image which is anatomically correct. Individual muscle and soft tissue layers are extracted from T1 weighted sequences and fistula pathology from STIR sequences, to produce two separate volumes. These are then fused using post processing software (Vitrea Workstation version 6.3) to generate a 3D model. RESULTS: The final 3D model is incorporated into a PDF file which has an integrated CAD viewer allowing the surgeon to rotate it in any direction during pre operative planning or whilst in theatre. CONCLUSION: As an adjunct to 2D MRI images and the associated radiology report, this model communicates better the fistula anatomy to the clinician and should be particularly useful in complex cases. This article is protected by copyright. All rights reserved.

Link to Pubmed record 

Consultation

The Trust Library & Knowledge Service is currently undertaking its annual review of subscription sources to ensure that we have access to the most appropriate titles, across a wide range of subjects, for Wirral University Teaching Hospital NHS Foundation Trust.

We subscribe to 100s of journals, either print or electronic. You can check which titles we have by consulting our print journal lists or by looking at the electronic titles via the Journals link on NICE Evidence Search. Please note you will need an NHS Athens account to access the full list of titles available to you.

Alternatively, please get in touch with us and we can send you a list of the journals available in your subject area.

If you have any comments about the range of titles available, or feel that there are any key journals missing, please let us know by Friday 1st November 2013. While we welcome any suggestions you may have for new titles, the final decision will be based on cost, ease of access and coverage of subjects.

We look forward to receiving your comments and suggestions.

WUTH publication: Postoperative range of motion trends following total ankle arthroplasty

Citation: Foot & ankle international, 2013, 34(5), 645-56
Author: Ajis A, Henriquez H, Myerson M
Abstract:
BACKGROUND: It is still unknown how ankle range of motion changes following total ankle arthroplasty. This study was undertaken to more accurately address patient expectations, guide postoperative rehabilitation, and improve our understanding of how ankle range of motion changes with time.
METHODS: 119 total ankle replacements of 3 different prosthetic designs from 1 surgeon were retrospectively examined and compared. Ankle dorsiflexion and plantar flexion ranges of motion were calculated and analyzed preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 1 year. The different ankle replacement systems were analyzed individually and together to determine whether trends were replicated.
RESULTS: No significant increase in ankle range of motion was found 6 months postoperatively (P = .75). Mean combined postoperative range of motion did not change significantly from 24.3 degrees at 1 year versus a preoperative mean of 22.7 degrees (P = .75). Mean dorsiflexion improved significantly at the 6-week postoperative stage by 5.5 degrees (P < .001), whereas plantar flexion only improved by 2.9 degrees (P = .06). Mean dorsiflexion improved from preoperative levels by 5.4 degrees (P = .001), whereas mean plantar flexion decreased by 3.7 degrees (P = .004).
CONCLUSIONS: We found no notable improvement in ankle range of motion after 6 months following total ankle arthroplasty. We also found a disproportionately higher increase in dorsiflexion compared with plantar flexion following surgery and an overall reduction in mean plantar flexion range compared with preoperative values. Notwithstanding this discrepancy, total mean ankle range of motion 1 year postoperatively was similar to preoperative values. Reasons for the discrepancy between dorsiflexion and plantar flexion are unclear.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.

KEYWORDS: ankle, arthroplasty, dorsiflexion, motion, physiotherapy, plantar flexion, range, rehabilitation, replacement, trend

Link to Pubmed record 

WUTH publication: Granulated sugar to reduce an incarcerated prolapsed defunctioning ileostomy

Citation: BMJ case reports. 2013 Feb 28
Author: Mohammed O, West M, Chandrasekar R
Abstract: This case report discusses the successful application of granulated sugar to reduce a prolapsed ileostomy thereby eliminating the need for an emergency surgery.

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

NEW YouTube videos to help you search for evidence

Edge Hill University have produced a series of instructional YouTube videos to help healthcare staff and students to navigate and search key online resources.  The videos include tips on undertaking a thorough literature search of the Medline database, and conducting an effective search in The Cochrane Library.

You can access a list of all the videos here: http://www.edgehill.ac.uk/lirc/resources/nhs-databases/guides/.

With thanks to Michelle Maden, Clinical Information Specialist at Edge Hill for sharing these videos.

WUTH publication: Comment on: Stanley D. (2012) Celluloid devils: a research study of male nurses in feature films. Journal of Advanced Nursing 68(11), 2526-2537.

Citation: Journal of Advanced Nursing. 2013, 69(9), 2141-2
Author: Pritchard MJ

Link to Pubmed record

WUTH publication: Factors with the management of incontinence and promotion of continence in older people in care homes

Citation: Journal of Advanced Nursing  2014, 70(3), 476-96
Author: Flanagan L, Roe B, Jack B, Shaw C, Williams KS, Chung A, Barrett J
Abstract:  AIM: Review of intervention studies of associated factors with incontinence as the primary outcome in older people in care homes to identify and inform practice and future research.
BACKGROUND: Incontinence is highly prevalent among care home populations. Previous reviews of descriptive and intervention studies have used urinary incontinence as the primary outcome.
DESIGN: Systematic review and narrative summary.
DATA SOURCES: Electronic searches of English empirical studies undertaken using MEDLINE and CINAHL from January 1966-May 2010. All relevant empirical designs were selected from MEDLINE highly sensitive search strings from the Cochrane Incontinence Review Group, modified to exclude surgical and pharmacological studies REVIEW METHODS: The PRISMA statement was followed and established methods for systematic review to produce a narrative summary.
RESULTS: Nine studies identified relating to associated factors with the management of incontinence in care homes. Factors included economic data, skin care, exercise studies, staff quality and prompted voiding adherence and the promotion of continence by the management of dehydration and incontinence.
CONCLUSION: Managing incontinence and promoting continence in care homes is complex, requiring time and cost-efficient management procedures to contain the problem and deliver quality, achievable care. When developing and designing systems of care in care homes, it is important to also recognize the impact of associated factors. As with any healthcare intervention programme, resources are required to implement the protocols. Economic evaluation studies are limited, with further studies warranted alongside preventative studies to maintain long-term continence in these populations.

Link to Pubmed record

WUTH publication: Regular observations: safe airway management.

Citation: British Journal of Nursing. 2013, 22(10), 554
Author: Pritchard MJ

Link to Pubmed record

Primal pictures

Now available: 3D anatomy models, images and videos

Anatomy TV (Primal Pictures) – is now available to all staff until the end of March 2014.

The subscription includes:

·         Human Anatomy Regional Series - Interactive 3D anatomy models, MRI sections, clinical slides, text and videos. 9 regional titles are included; Head & Neck, Spine, Shoulder, Hand, Thorax & Abdomen, Pelvis, Hip, Knee, Foot & Ankle.

·         Interactive Functional Anatomy - Covers the whole body with over 80 muscle function animations

To access simply go to http://www.anatomy.tv and sign in using your NHS Athens account.

Please let us know what you think of this new resource.

WUTH publication: Steroid induced central serous chorioretinopathy in giant cell arteritis

Citation: Case reports in ophthalmological medicine. 2013. Epub 2013 Jun 11.
Author: Grixti A, Kumar V
Abstract: Giant cell arteritis (GCA) is an ophthalmic emergency which requires early diagnosis and treatment with high dose systemic corticosteroids in order to prevent permanent visual loss. However, systemic corticosteroids have significant ocular side effects including cataract formation, raised intraocular pressure, and less commonly, central serous chorioretinopathy (CSCR). We report a case of visual loss secondary to CSCR complicating corticosteroid therapy in GCA. When assessing patients with systemic conditions such as GCA or other vasculitic process, who complain of visual loss which is getting worse on corticosteroid treatment, clinicians should consider other causes such as CSCR as part of the differential diagnosis. Extra caution should be exercised in such cases as increasing the dose of corticosteroids might aggravate CSCR resulting in further visual loss.

Link to Pubmed record

WUTH publication: Transconjunctival sutureless haptic fixation of posterior chamber IOL: a minimally traumatic approach for IOL rescue or secondary implantation

Citation: Retina (Philadelphia, Pa).2013, 33(3), 657-60
Author: Prasad S

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

Graded evidence based summaries on UpToDate

All WUTH members of staff have access to UpToDate, a tool to support clinical decision making. 

Access UpToDate via the WUTH intranet (select the UpToDate link in the ‘Clinical’ box) or via www.uptodate.com with your NHS Athens account. 

UpToDate has adopted the GRADE approach to classify both the strength of recommendation and the quality of the underlying information. Currently UpToDate includes more than 9,000 graded recommendations, and the process is ongoing. To view a topic's graded recommendations, simply click on the "Summary and Recommendations" button at the top of the outline.

Learn more about evidence-based medicine, as well as more in-depth instruction about the GRADE system, with the UpToDate interactive tutorial on grading available at www.uptodate.com/home/grading-tutorial.

WUTH publication: Transperineal template-guided saturation biopsy using a modified technique: outcome of 270 cases requiring repeat prostate biopsy.

Citation: BJU International, 2013 Jun,111(8), E365-73
Author: Ekwueme K, Simpson H, Zakhour H, Parr NJ
Abstract:  OBJECTIVES: To determine the incidence of prostate cancer (PCa), and pathological grade and location of PCa, using a modified transperineal template-guided saturation biopsy (TTSB). To compare the acute urinary retention (AUR) rate found using modified TTSB with that of published reports.
PATIENTS AND METHODS: A total of 270 consecutive patients with persistent clinical suspicion of PCa, despite a median (range) of 2 (1-6) sets of negative transrectal ultrasonography-guided biopsies, were enrolled and prospectively studied. All underwent modified TTSB avoiding the peri-urethral area at the base of the prostate under general anaesthesia. Statistical analysis was performed using binary logistic regression to determine the prebiopsy predictors of PCa and AUR.
RESULTS: The median (range) patient age was 64 (43-85) years, with a median (range) prostate-specific antigen (PSA) of 10 (1-114) ng/mL and median (range) prostate volume of 45 (17-106) mL. A mean (range) of 28 (16-43) cores were taken at modified TTSB. Prostate cancer was diagnosed in 54.8% (Gleason scores 6 in 27.7%, 7 in 43.2%, 8-10 in 29.1% of patients). The anterior third only was involved in 21%, the middle third in 6.8% and the posterior third in 8.7% of positive cases, although in 75% of positive cases there was some anterior involvement. Comparing uniquely anterior tumours with the 15.5% found uniquely in either the middle or posterior thirds, there was no significant difference between number of positive cores (2 vs 1, P = 0.091), maximum percentage core involvement (30 vs 17.5%, P = 0.315) and maximum tumour length (3.5 vs 2 mm, P = 0.092). Fourteen patients (5.2%) developed AUR. On multivariate analysis, PSA density (PSAD) and pre-TTSB PSA predicted PCa diagnosis, whilst prostate volume, prebiopsy PSA and PSAD predicted AUR.
CONCLUSIONS: Modified TTSB has a high cancer yield, especially in the anterior region, in patients with previously negative histology but onward suspicion of PCa. The modified TTSB technique provides a low risk of AUR without compromising cancer yield.

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

WUTH publication: The effect of bolus administration of tranexamic acid in revision hip arthroplasty.

Citation: Hip international, 2012 Nov-Dec; 22(6), 615-20
Author: Kazi HA, Fountain JR, Thomas TG, Carroll FA
Abstract: We assessed the efficacy of tranexamic acid in reducing transfusion requirements in patients undergoing revision hip arthroplasty. A prospective cohort study was designed comparing Tranexamic acid administration in 30 patients compared to 30 patients in a control group. Blood loss was measured in theatre, pre- and postoperative haemoglobin measurements were recorded and postoperative haemodynamic parameters were evaluated. The mean postoperative haemoglobin was 9.5 g/dl in the tranexamic acid group and 8.2 g/dl in the control group (p<0.01). The mean haemoglobin reduction was 2.7 g/dl in the tranexamic acid group and 3.4 g/dl in the control group (p = 0.47). Mean transfusion requirements were 2.76 units in the study group and 4.0 units in the control group (p = 0.49) and the frequency of transfusion was reduced (p = 0.032). Infected revisions showed no reduction in transfusion requirements with tranexamic acid administration (p = 0.25). There was a reduced frequency of transfusion in patients when revision was performed for aseptic loosening (p = 0.027). This group of patients may benefit from tranexamic acid administration.

Link to Pubmed record

Best Practice Day 21st June 2013

Best Practice Day 21^st June 2013 Education Centre, Arrowe Park Hospital

The Best Practice Day 2013 is a unique opportunity for staff to share innovation, best practice and service improvement from across the organisation.  Come along and find out more about the creative and innovative projects that are taking place across the organisation; maybe there’s something you could adopt in your own area.  Take advantage of the opportunity to network across sites and divisions, pick the brains of presenters and gather some valuable knowledge and learning.

Lunchtime & break refreshments will be available to purchase from the Time Out cafe.  All presenters, poster presentations and audience members will receive a certificate of participation.

To register your attendance, telephone the McArdle Library on 8610 or email us at mcardle.library@nhs.net.

To find out more, visit the Best Practice Day web page.

WUTH publication: Management of abductor mechanism deficiency following total hip replacement.

Citation: The bone & joint journal, 2013 Mar;95-B(3):343-7.
Author: Odak S, Ivory J
Abstract: Deficiency of the abductor mechanism is a well-recognised cause of pain and limping after total hip replacement (THR). This can be found incidentally at the time of surgery, or it may arise as a result of damage to the superior gluteal nerve intra-operatively, or after surgery owing to mechanical failure of the abductor muscle repair or its detachment from the greater trochanter. The incidence of abductor failure has been reported as high as 20% in some studies. The management of this condition remains a dilemma for the treating surgeon. We review the current state of knowledge concerning post-THR abductor deficiency, including the aetiology, diagnosis and management, and the outcomes of surgery for this condition.

Link to Pubmed record 

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

WUTH publication: Parr and colleagues' response to Tang and colleagues.

Citation: BMJ, 2013 Apr 16
Author: Parr NJ, Lucky MA, Rogers B

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

WUTH publication: The NHS working at weekends as it does during the week is a non-starter.

Citation: BMJ (Clinical Research Edition), 2013, Mar 26, 346
Author: Blair S

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

Celebrate international Womens day - with our free recommended resources

To celebrate international Womens day on the 8th of March we are linking to a series of recommended and favourite sites covering women and gender studies. http://lselibraryresearch.blogspot.co.uk/

In this first section: International Womens day resources.
A collection of special sites created by organisations to celebrate this event

Hear the One Woman Song from the UN

UN website
Has a history of the event, records of past days, news and basic facts and figures about women.

ILO puts the spotlight on sexual harassment. See their statement

Council of Europe Statements and files.

internationalwomensday.com is a global hub for sharing International Women’s Day information, events, news and resources. Find out about the history of the day and events in your area.
Follow it in real time on the Twitter section.
The resources section. has posters badges and online videos.

UK Government has released an interesting map showing its efforts to encourage female empowerment worldwide.
Goldman Sachs 10,000 women - photo site sharing the success stories of Women entrepreneurs worldwide.
Accenture have released research on what makes women happy in the workplace

TES- teaching guides for schools about Womens day

See our scoop.it guide http://www.scoop.it/t/women-and-gender-studies

Heather dawson

LSE

WUTH publication: Ankle Arthrodesis vs TTC Arthrodesis: Patient Outcomes, Satisfaction, and Return to Activity.

Citation: Foot and Ankle International, 2013, March 6th, epub ahead of print
Authors: Ajis A, Tan KJ, Myerson MS
Abstract: BACKGROUND: It is believed that patients with an ankle arthrodesis (AA) have better outcomes than after a tibiotalocalcaneal (TTC) arthrodesis due to preservation of subtalar motion. However, there are no studies comparing actual functional outcomes and patient satisfaction between AA and TTC arthrodesis. METHODS: We retrospectively analyzed patient satisfaction and functional outcomes of patients after an AA and TTC arthrodesis using a postal survey. A total of 173 patients who underwent TTC and 100 AA patients from 2002 to 2010 were identified with a minimum of 24 months follow-up. In all, 53 AA and 64 TTC arthrodesis patients were included in the study, with the remainder lost to follow-up. A return to activity questionnaire and SF-12 scores were used to compare functional outcomes. The mean follow-up time was 63 months.
RESULTS: Both groups showed good outcomes with a low visual analogue pain score (2.7 for AA and 2.8 for TTC), high satisfaction score (90.6% for AA and 87.5% for TTC), and return to work (77.4% for AA and 73.0% for TTC). In all, 84.6% of AA and 81.0% of TTC patients would have the surgery again. There were no significant differences between the 2 groups for these parameters. However, when asked if their desired activity level was met, fewer AA patients met their desired level (58.5% for AA and 66.5% for TTC, P = .02). AA patients were also more likely to feel their level was unmet due to the foot and ankle (85.6% for AA vs 25.7% for TTC, P < .001).
CONCLUSIONS: Both AA and TTC arthrodesis were associated with good functional outcomes and satisfaction. AA patients had higher postoperative activity expectations and were less likely to meet them. When they failed to meet these expectations, they were much more likely to attribute it to their operated ankle. We believe it is because of the different ways the 2 groups of patients are counseled preoperatively, which highlights the importance of managing patient expectations.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Link to Pubmed record

For more information about obtaining the full text of journal articles, please visit our Document / Book Supply service.

To view all WUTH publications please link here.

NHS Change Day – collective action to demonstrate how small changes can have a big impact

WHAT IS CHANGE DAY?

NHS Change Day – collective action to demonstrate how small changes can have a big impact

On the 13 March 2013 NHS Change Day will bring together the individual creativity, energy and innovative thinking of thousands of NHS staff from across clinical and non-clinical areas of work, in a single day of collective action to improve care for patients, their families and their carers.  The idea is to make a small change and make it every day practice.

Change Day is an NHS grassroots initiative devised and driven by emergent clinical and managerial leaders and improvement leaders, who want to make this call to action the single largest simultaneous improvement event in the NHS.

It is about galvanising and engaging the frontline in improvement, through individuals and teams pledging to make a change in their practice which will improve patient experience, clinical outcomes or spreading and adopting best practice and championing innovation. This will be a countrywide event and will coincide with Healthcare Innovation Expo at Excel in the same day.

The idea of NHS Change Day is create a mass movement of people working in the NHS demonstrating the difference they can make - by one simple act – and proving that we can make a big impact is possible when we work together in the NHS. Our initial aim was for 65,000 people to take part, 65 being the number of years the NHS has been in existence. To date we have over 90,000 supported pledges.

You can take part by going to the NHS Change Day website at http://www.changemodel.nhs.uk/changeday and make their pledge online, share you story of what happened, make a video clip, join in the discussions on the forum and become part of the growing list of active supporters and organisations taking part on the day.

Follow us on:

Twitter - #NHSchangeday

facebook.com/NHSchangeday

YouTube – http://www.youtube.com/user/NHSchangeDay

iTunes or at http://nhschangeday.podbean.com  

Access evidence based Dermatology topics via UpToDate

UpToDate content now covers all the major areas of dermatology, including medical dermatology, paediatric dermatology and procedural dermatology.  UpToDate’s graphics search also allows you to search for and download a range of dermatology images.

What is UpToDate?

UpToDate provides you with a summary of the latest evidence in your specialty or area of interest. It can be used as a tool to help you answer clinical questions quickly, increase your clinical knowledge, and improve patient care. A topic summary provides you with a synthesis of the literature, the latest evidence, and specific recommendations for patient care.

How can I access UpToDate?

You can access UpToDate via the WUTH intranet (click on the ‘UpToDate’ link in the Clinical box) or via www.uptodate.com with your Athens account.

Dermatology topics include:

·         Acne and rosacea
·         Bullous disease
·         Cosmetic dermatology
·         Cutaneous lymphoma
·         Dermatitis
·         Dermatologic diagnosis
·         Dermatologic surgery
·         Drug eruptions
·         Genodermatoses
·         Hair and scalp disease
·         Infections and infestations
·         Melanocytic lesions and disorders of pigmentation
·         Nonmelanoma skin cancer and related disorders
·         Other topics in dermatology
·         Papulosquamous disorders
·         Pediatric dermatology
·         Photodermatology
·         Skin and systemic disease
·         Urticaria and angioedema

You can register for an Athens account at www.evidence.nhs.uk.  For more information please contact the Integrated Library Service on extension 8610 or visit our webspages at www.whnt.nhs.uk/library. The library service can provide individual or group training on using UpToDate and a whole range of useful resources.  Please request training here.

Self Service Unit

Come and try our self service unit

Want to be able to borrow books at the weekend or late at night?

Want to return or renew materials?

Want to know what you have on loan and when the items are due back?

Try the self service unit today. Our friendly, helpful staff will show you how.

WUTH publication: Zinc induced damage to kidney proximal tubular cells: Studies on chemical speciation leading to a mechanism of damage.

Citation: Journal of Trace Elements in Medicine and Biology, 2013, 27(3), 242-8
Author: Sargazi M, Shenkin A, Roberts NB
Abstract: This study was carried out to investigate whether zinc can potentiate renal toxicity using monolayer cultures of kidney proximal tubular cells and if so to establish the chemical species and the mechanism involved. METHODS: Zinc was prepared as the citrate complex at pH 7.4 in phosphate buffered saline. Monolayers of kidney proximal tubular cells under standard cell culture conditions were exposed to zinc concentrations of 0, 5 10, 20, 50 and 100μmol/L. To assess cellular damage, thiazol blue (MTT) uptake, NAG and LDH release, DAPI staining and Tunel assay were used. Cytoprotective agents: trolox, cysteine, glutathione, ascorbic acid and sodium selenite were used to investigate if the damage was reversible. RESULTS: Incubation of kidney cells with zinc citrate showed a dose related reduction in cell viability (p<0.005) associated with cellular uptake of zinc ions. After 24h incubation with 100μmol/L Zn citrate, NAG release was not significantly different compared to the control whereas LDH increased 3 fold. DAPI staining showed apoptotic bodies within the cells confirmed by Tunel assay using flow cytometry. Electron microscopy showed significant morphological changes including loss of brush border, vacuolated cytoplasm and condensed nuclei. Trolox almost completely (>85±5%) and sodium selenite partially recovered (40±4%) the viability of cells exposed to Zn but no protection was observed with other cytoprotectants, e.g. glutathione, cysteine or ascorbic acid. In conclusion zinc can induce damage to kidney cells by a mechanism dependent on zinc ions entering the cell, binding to the cell organelles and disrupting cellular processes rather than damage initiated by free radical and ROS production.

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Final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis report)

The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, conducted by Robert Francis QC, was published on Wednesday 6 February 2013.  His Inquiry followed concerns about standards of care at the Trust, and an investigation and report published by the Healthcare Commission in March 2009.  Robert Francis has heard evidence from patients, their relatives and staff to inform his report and the 18 recommendations he makes.

Read the full report here.

The Guardian website gives a useful overview of the key recommendations from the report.

The Department of Health has published three reports to help embed effective governance and detect and prevent such serious failures occurring again: Review of Early Warning Systems in the NHS, Assuring the quality of senior NHS managers, The Healthy NHS Board.

Read the Care Quality Commission's response to the report here.

WUTH publication: Clinical outcomes of triamcinolone-assisted anterior vitrectomy after phacoemulsification complicated by posterior capsule rupture.

Citation: Journal of Cataract and Refractive Surgery, 2013, Jan 18
Author: Kasbekar S, Prasad S, Kumar BV
Abstract: PURPOSE: To compare the clinical outcomes in patients who had triamcinolone acetate-assisted anterior vitrectomy and patients who had anterior vitrectomy without triamcinolone acetate after phacoemulsification complicated by posterior capsule rupture and vitreous loss.
SETTING: Arrowe Park Hospital, Wirral, United Kingdom.
DESIGN: Retrospective consecutive case note review.
METHODS: Consecutive case notes of patients who had anterior vitrectomy assisted by triamcinolone acetonide (triamcinolone group) or without triamcinolone acetate (no-triamcinolone group) after posterior capsule rupture between January 2007 and January 2011 were identified and examined. Data recorded at the clinic visit preoperatively and 1 day and 3 months postoperatively were collated. Information recorded on the pro forma included visual acuity, ocular comorbidities, intraocular pressure (IOP), vitreous strands in the anterior chamber, and other adverse events.
RESULTS: No statistically significant difference was found in the visual acuity or IOP between 17 patients in the triamcinolone group and 34 patients in the no-triamcinolone group at any time point. Vitreous strands in the anterior chamber were noted in 1 patient in the triamcinolone group and 7 patients in the no-triamcinolone group. Cystoid macular edema (CME) was present in 3 patients in the no-triamcinolone group, including 1 patient with vitreomacular traction.
CONCLUSIONS: There was no significant increase in IOP after triamcinolone acetate-assisted anterior vitrectomy. Higher rates of CME and residual anterior chamber vitreous strands in the no-triamcinolone acetate group support the clinical use of triamcinolone acetate.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

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WUTH publication: Standardized definition of contamination and evidence-based target necessary for high-quality blood culture contamination rate audit.

Citation: Journal of Hospital Infection. 2013 Jan 9.
Author: Harvey DJ, Albert S

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New LEAF bulletin available

There is a new LEAF bulletin available.

NHS Line Managers Bulletin - is a fortnightly bulletin from NHS Employers which gives managers in the NHS practical tips, tools and advice on key workforce issues.

WUTH publication: A systematic review on the use of prophylactic mesh during primary stoma formation to prevent parastomal hernia formation.

Citation: Colorectal Disease, 2012, 14(8), 931-6.
Author: Shabbir J, Chaudhary BN, Dawson R
Abstract: AIM: Despite advances in surgical technique, parastomal herniation is common. This systematic review aims to assess the efficacy of prophylactic mesh at primary operation in reducing the incidence of parastomal hernia.
METHOD: Medline, EMBASE and CENTRAL were searched for relevant publications between January 1980 and January 2010. The search strategy included text terms and MESH headings for parastomal hernia, mesh and prevention and/or prophylaxis of hernia. No language restrictions were applied. Bibliographies from the papers requested in full were manually checked. All randomized controlled trials were included regardless of the language of publication. Results were extracted from the papers by two observers independently on a predefined data sheet. Disagreements were resolved by discussion. REVMAN 5 was used for statistical analysis.
RESULTS: Of 27 possible studies three randomized controlled trials fulfilled the criteria for systematic review, with a total of 128 patients (mesh 64, no mesh 64). The two study groups were well matched demographically. The incidence of parastomal hernia in the mesh group was 12.5% (8/64) compared with 53% (34/64) in the control group (P < 0.0001). There was no difference in mesh related morbidity in the two groups.
CONCLUSION: Although only three trials with 128 patients fulfilled the criteria for this systematic review, the data suggest that the use of prophylactic prosthetic mesh at the time of primary stoma formation reduces the incidence of parastomal hernia.

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