New Nursing journal bundle

All staff and students have access to a new collection of nursing and midwifery journals, which includes key titles such as the British Journal of Nursing, British Journal of Community Nursing, Nurse Prescribing, Journal of Wound Care and British Journal of Midwifery.

This new bundle complements our existing nursing and midwifery resources, which will help to keep you up to date with practice, support your continuing professional development, and help you to gather evidence for your Revalidation portfolio. 

To access this journal bundle you need an OpenAthens account, which will allow you to log in to the MAG online website from work or from home. 

WUTH publication: Takotsubo cardiomyopathy case series: typical, atypical and recurrence

Citation: BMJ Case Reports. 2015
Author: Lagan J, Connor V, Saravanan P
Abstract: Takotsubo cardiomyopathy (TCM) is characterised by a transient left ventricular (LV) dysfunction, ECG changes that can imitate acute myocardial infarction and positive cardiac biomarkers in the absence of obstructive coronary artery disease. The exact pathogenesis of TCM is unclear but emotional or physical stress is a common denominator. We present three cases encompassing a spectrum of the disease: A typical TCM with apical LV dyskinesis, an atypical TCM with mid-ventricular regions affected and a TCM recurrence. Our cases show that TCM symptoms vary between individuals and may vary in the same patient. All our patients reported acute emotional stress prior to the onset of symptoms, had LV systolic dysfunction, positive cardiac biomarkers and non-obstructed coronary arteries. In all cases, LV systolic dysfunction eventually improved. TCM may account for 0.7-2.5% of acute coronary syndromes. It is more prevalent in the female population and can reoccur. Treatment is mainly supportive

Link to PubMed record

Explore England's prescribing data

Explore Open Prescribing.
Every month, the NHS in England publishes anonymised data about the drugs prescribed by GPs. But the raw data files are large and unwieldy, with more than 600 million rows. We're making it easier for GPs, managers and everyone to explore - supporting safer, more efficient prescribing.

WUTH publication: Atrial fibrillation during pregnancy: cardioversion with flecainide

Citation: British Journal of Hospital Medicine. 2015, 76(12), 720-1
Author: Lewis G, Currie P

Link to PubMed record

WUTH publication: Tolerability and Adherence Problems in Patients on a Stable Dose of Methotrexate: Results of a Multicentre Survey

Citation: Musculoskeletal Care. 2016, 14(3), 152-5. Epub 2015 Dec 8
Author: Robinson S, Gibson S, George E, Martin U, Heslop P, Wrightson H, Prowse P, Kalinowski M, Marshall D, Reed M, Adebajo A, Walker D
Abstract:  INTRODUCTION: Methotrexate is commonly used in patients with inflammatory arthritis. The aim of the present study was to ascertain the prevalence of side effects that patients on methotrexate were tolerating and to establish their adherence to the medication.
METHOD: A questionnaire was developed for completion by the healthcare professional with the patient, and piloted in one centre. The questionnaire was then used in six other centres, with the addition of a question about the attractiveness of stopping methotrexate treatment. Efficacy and toxicities were scored for severity on a 10-cm visual analogue scale (VAS). Adherence to the drug was also explored.
RESULTS: The prevalence of 'any side effect' ranged from 57% to 86%. The most frequent side effects were fatigue (53%); nausea (38%); mouth ulcers (23%) and hair loss (23%). Efficacy averaged 6.5 cm on the VAS. Results from the combined survey revealed that toxicity averaged 5.9 cm for fatigue, 4.8 cm for nausea, 4.4 for mouth ulcers, 3.9 cm for hair loss and 5.7 cm for 'other' side effects. 13.5% of patients revealed that they had forgotten to take the drug for an average of two weeks, and 25% for an average of 2.5 weeks in the previous year. Participants were more likely to reveal this to a nurse than a doctor.
CONCLUSION: Patients put up with a considerable number of side effects in order to benefit from methotrexate therapy. Adherence to this drug merits further study. Copyright © 2015 John Wiley & Sons, Ltd.

KEYWORDS: Methotrexate; adherence; side effects; tolerance

Link to PubMed record

WUTH publication: An Alternative Technique for External Fixation of Traumatic Intra-articular Fractures of Proximal and Middle Phalanx.

Citation: Techniques in hand & upper extremity surgery. 2015, 19(4), 163-167
Author: Kapur, Benjamin; Paniker, Jayanath; Casaletto, John
Abstract: BACKGROUND: Intra-articular fractures of the proximal interphalangeal (PIP) joint are commonly treated with dynamic external fixation. Most commonly used is the Suzuki modification of the pins and rubber traction system (PRTS). There are a few other modifications of the PRTS external fixators. We present an alternative pin external fixator that is simple and effective.
METHODS: Under a suitable anesthesia and image intensification a true lateral view of the head of the proximal phalanx is obtained. A K-wire construct holds the affected digit out to length with the fracture reduced and Jurgan pin-balls hold the construct into position. Under image intensification the whole device is checked to ensure the joint and fracture is reduced and the joint is not over distracted. The PIP joint is also checked to ensure good range of motion. The device was checked in clinic at 1 week with radiographs. The wires are removed at 4 weeks followed by intensive hand physiotherapy.
RESULTS: Over 20 patients with intra-articular fractures of the proximal and middle phalangeal were treated with this technique. In all cases the fracture healed with good joint congruency. All patients achieved good range of motion of the PIP joint but with some restriction of full flexion (mean, 20 degrees). There was no loss of position or pin-site infections. There was good compliance with the treatment.
DISCUSSION: The main advantages of the technique we describe are: (1) the compact design, making it less cumbersome for the patient compared with other PRTS external fixators; (2) it is straightforward to assemble and the device is easy to adjust in clinic if there is any loss of reduction; (3) the pin-balls prevent sharp ends of the wire protruding causing morbidity to the patient; (4) there is less chance of loss of traction compared with traction devices using rubber bands. It is a dynamic device, which allows mobilization of the joints reducing stiffness

Link to PubMed record

New! First Steps in Searching for LKS web pages, Blog and Facebook

Library Training section in Help and Support on web pages

Request Information Skills Training

We deliver training to groups or individuals, at a time and in a location convenient to you. We can tailor the content of the sessions below to suit your requirements. Please contact us for more details.

First Steps in SearchingDo you need to take the first steps in understanding how to find evidence, for example to gain an overview of a clinical condition, treatment or for revalidation purposes?

•       How to find information and evidence via:

–      NICE Evidence Search

–      UpToDate

–      Dynamed

–      Google Advanced Search

Anyone can do it.

You can then go on to do:

Finding the Evidence Do you need to find the evidence (guidelines, journal articles etc.) to support your daily clinical practice, research or audit activities, to prepare for a presentation or teaching, or simply to keep up to date? On this session you’ll learn:

• How to develop a research or clinical question into an effective search strategy
• How to apply search techniques effectively (using AND/OR, wildcards, applying limits, using the thesaurus)
• Key health information resources (NICE Evidence, Pubmed, The Cochrane Library, Medline, CINAHL and other health databases)
• Searching Google effectively

Introduction to Critical Appraisal Do you need to develop your critical reading skills? Interested in finding out how to spot the strengths and weaknesses of research studies?

On this session you’ll learn:
• The benefits of critical appraisal 
• The key features of different study types
• How to apply critical appraisal techniques to a published piece of research
• How to access critical appraisal tools and resources to help you

WUTH publication: The introduction of an outpatient hysteroscopic polyp morcellation clinic at a district general hospital

Citation: Gynecological Surgery. 2015, 12(1) SUPPL. 1(S395-S396), 1613-2076
Author: Gillian S.; Alam M.
Abstract:  Background Endometrial polyps are a common hysteroscopic finding when investigating
women with abnormal uterine bleeding. They have been found in up to 40% of
symptomatic pre- menopausal women and are associated with menorrhagia, metrorrhagia,
intermenstrual bleeding and subfertility. They are also associated with post- menopausal
bleeding and found in women with malignant tissue changes.(1) In symptomatic women
who undergo polypectomy, it is reported that there is 75%-100% improvement. For
women who are asymptomatic , a polypectomy is recommended for those with risk
factors for endometrial cancer.(2) The introduction of hysteroscopic polyp morcellation
has allowed for a fast, safe and convenient procedure to remove polyps within an
outpatient setting. The use of small scopes, minimal dilatation and little or no local
anaesthetic has impoved the experience for patients and medical staff.(1) At Arrowe Park
Hospital we have introduced polyp morcellation using Hologic Myosure tissue removal
system and Aquilex fluid control system Methods Aim To review the implementation and
outcomes of a Myosure hysteroscopic polypectomy clinic within our outpatient
department performed by consultant and nurse practitioner Method A retrospective data
collection of patients who attended the clinic between September 2014 and May 2015
Results 28 patients were referred to the clinic. 4 patients had not undergone previous
hysteroscopy and were found not to have a polyp, 1 patient refused treatment and was
listed for general anaesthetic. 22 patients had successful polypectomy and 1 patient had
partial polypectomy due to loss of vision. All patients tolerated procedure well and left
clinic within 10 minutes of finishing. There were no complications during or following
polypectomy. 1 histology was reported as atypical hyperplasia, 21 were benign polyps,1
was benign fibroid Conclusions Myosure polypectomy is proving to be a fast, efficient,
safe and well tolerated procedure that is easily performed within an outpatient setting
allowing fast recovery and minimal disruption for patients.

WUTH publication: Conversion of abdominal hysterectomy to laparoscopic hysterectomy-the reverse paradigm. 5 year experience of a large UK district teaching hospital between 2010/11 and 2014/15

Citation: Gynecological Surgery. 2015, 12(1) SUPPL. 1(S471), 1613-2076
Author: Rowlands D.; Gul N.; Minas V.; King S.
Abstract: Background The EVALUATE study previously reported that for benign conditions and small moderatety enlarged uteri that vaginal hysterectomy was preferable to abdominal or
laparoscopic hysterectomy. And that laparoscopic hysterectomy is preferable to
abdominal. We have previously reported (RCOG World Congress 2015) that <8% of
hysterectomies performed in our unit in a sample size of 327 of 1258 hysterectomies
performed in our unit between 1/1/2010 and 31/12/14 would have been eligible for the
EVALUATE study. We postulate that this is as a consequence of less invasive treatments
such as endometrial ablation and the Mirena IUS. In the UK, despite evidence, the
majority of hysterectomies are still performed abdominally. We describe the difference
that a cultural attitude to laparoscopic surgery has had in reducing our abdominal
hysterctomy rates to under 10% . Methods Review of all hysterectomies performed at
Wirral University Teaching Hospital 1/1/2010 - 31/12/2010 and 1/1/2014 - 31/12/2014 by
type. There were no exclusions . Hysterectomies performed for ovarian cancer, cervical
cancer and high grade endometrial cancer are performed in the Regional Cancer Centre.
Results Results will show an extremely low abdominal hysterectomy rate which has
further fallen within this 5 year period as a consequence of training and education within
the unit. The unit has an inclusive approach towards safe laparoscopic surgery with an
ethos not to perform abdominal procedures wherever possible. With retirements, new
appointments, and education and traing we present results which we believe are
unparalleled in any other UK large hospital but demonstrate that with commitment
support and education we believe this is possible anywhere. Conclusions Abdominal
hysterectomy is in many cases an unnecessary major operation which can be succesfully
and safely achieved through minimal access surgery in almost all cases

WUTH publication: ANNALS EXPRESS: Validation of Serum Free Light Chain Reference Ranges in Primary Care Patients

Citation: Annals of Clinical Biochemistry. 2015 Nov 13
Author: Galvani L, Flanagan J, Sargazi M, Neithercut WD
Abstract: BACKGROUND: The demand for measurement of serum immunoglobulin free kappa (κ) and lambda (λ) light chains has increased. The κ:λ ratio is used to assist in diagnosis/monitoring of plasma cell disorders. The Binding Site reference range for serum free light chain (FLC) κ:λ ratios of 0.26-1.65 was derived from healthy volunteers. Subsequently a reference range of 0.37-3.1 for patients with chronic kidney disease (CKD) has been proposed. Elevated FLC concentrations and borderline raised FLC ratios also may be found in polyclonal gammopathies and with other non-renal illnesses. This assessment was conducted to validate the established FLC reference ranges in individuals from primary care.
METHOD: A total of 130 samples were identified from routine blood samples collected in primary care for routine biochemistry testing and eGFR calculation.
RESULTS: The median and range of κ:λ ratios found in each eGFR group used for CKD classification was higher than previously described. This was the case for individuals with normal or essentially normal renal function with eGFRs > 90, (0.58-1.76) and eGFR of 60-90 mL/min/1.73m², (0.71-1.93). Individuals with eGFR 15-30, (0.72-4.50) and eGFR <15ml/min/1.73m² (0.71-4.95) also had higher values when compared to the current renal reference range of 0.37-3.10.
CONCLUSIONS: Elevation of FLC-κ:λ ratios may occur in the absence of a reduced renal function shown by a normal eGFR and in the presence of reduced renal function by eGFR when comparing results with the established reference ranges. Explanations include choice of analytical systems or the presence of other concurrent non plasma cell illness

Link to PubMed record

‘New look’ Evidence Alerts

The Evidence Alerts service, delivered by the Library and Knowledge Service, has a new look.  We’ve added new topics to our collection of e-bulletins that aim to keep you up to date with new new innovations, improvements, best practice, news and evidence in your area of interest.

New topics include: leadership, health & wellbeing, integrated care and emerging technologies.

Find out more and subscribe here.

WUTH publication: A simple technique to achieve parallel transverse cuts in the scarf osteotomy

Citation: Annals of the Royal College of Surgeons of England. 2015, 97(3), 238-9
Author: Brookes-Fazakerley SD, Platt SR, Jackson GE

Link to PubMed record

WUTH publication: 'Rain chain' for ankle arthroscopy

Citation: Annals of the Royal College of Surgeons of England 2015, 97(5), 397
Author: Ramavath AL, Geary N

Link to PubMed record

WUTH publication: Where are we with RSV prophylaxis?

Citation: Archives of Disease in Childhood. Education and practice edition. 2016, 101(1), 38-42
Author: Caldwell NA, Townsend C
Abstract: Respiratory syncytial virus (RSV) is a predictable, seasonal disease with significant morbidity and mortality in children below 24 months. Prophylaxis, which decreases hospitalisation in those most vulnerable to the disease, has been available since 1998. Pharmacological prophylaxis is however, expensive and requires good infrastructure to deliver. It is out of reach for many patients in low-income and middle-income countries where mortality is highest. This article looks at the pathophysiology and risk factors for RSV. It also outlines what agents are currently available for prophylaxis and prevention.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
KEYWORDS: General Paediatrics; Immunisation; Infectious Diseases; Virology

Link to PubMed record

WUTH publication: An Alternative Technique for External Fixation of Traumatic Intra-articular Fractures of Proximal and Middle Phalanx

Citation: Techniques in Hand & Upper Extremity Surgery. 2015, 19(4), 163-7
Author: Kapur B, Paniker J, Casaletto J
Abstract: BACKGROUND: Intra-articular fractures of the proximal interphalangeal (PIP) joint are commonly treated with dynamic external fixation. Most commonly used is the Suzuki modification of the pins and rubber traction system (PRTS). There are a few other modifications of the PRTS external fixators. We present an alternative pin external fixator that is simple and effective.
METHODS: Under a suitable anesthesia and image intensification a true lateral view of the head of the proximal phalanx is obtained. A K-wire construct holds the affected digit out to length with the fracture reduced and Jurgan pin-balls hold the construct into position. Under image intensification the whole device is checked to ensure the joint and fracture is reduced and the joint is not over distracted. The PIP joint is also checked to ensure good range of motion. The device was checked in clinic at 1 week with radiographs. The wires are removed at 4 weeks followed by intensive hand physiotherapy.
RESULTS: Over 20 patients with intra-articular fractures of the proximal and middle phalangeal were treated with this technique. In all cases the fracture healed with good joint congruency. All patients achieved good range of motion of the PIP joint but with some restriction of full flexion (mean, 20 degrees). There was no loss of position or pin-site infections. There was good compliance with the treatment.
DISCUSSION: The main advantages of the technique we describe are: (1) the compact design, making it less cumbersome for the patient compared with other PRTS external fixators; (2) it is straightforward to assemble and the device is easy to adjust in clinic if there is any loss of reduction; (3) the pin-balls prevent sharp ends of the wire protruding causing morbidity to the patient; (4) there is less chance of loss of traction compared with traction devices using rubber bands. It is a dynamic device, which allows mobilization of the joints reducing stiffness.

Link to PubMed record

WUTH publication: UK AMD EMR USERS GROUP REPORT V: benefits of initiating ranibizumab therapy for neovascular AMD in eyes with vision better than 6/12

Citation: The British Journal of Ophthalmology. 2015, 99(8), 1045-50
Author: Lee AY, Lee CS, Butt T, Xing W, Johnston RL, Chakravarthy U, Egan C, Akerele T, McKibbin M, Downey L, Natha S, Bailey C, Khan R, Antcliff R, Varma A, Kumar V, Tsaloumas M, Mandal K, Liew G, Keane PA, Sim D, Bunce C, Tufail A, UK AMD EMR Users Group
Abstract: BACKGROUND/AIMS: To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy.
METHODS: Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections.
RESULTS: The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12.
CONCLUSIONS: All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
KEYWORDS: Drugs; Macula; Retina; Treatment Medical

Link to PubMed record.

On-site access to Dynamed

The Library & Knowledge Service is pleased to announce that if you are on site at Wirral University Teaching Hospital then you can access Dynamed via this link without having to log in.

WUTH publication: Inpatients' expectations and experiences of hospital pharmacy services: qualitative study

Citation: Health Expectations. 2015, 18(5), 1009-17
Author: Morecroft, Charles W; Thornton, David; Caldwell, Neil A
Abstract: INTRODUCTION: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services.
OBJECTIVE: To explore inpatients' expectations and experiences of hospital-based pharmacy services.
STUDY SETTING AND DESIGN: Face-to-face semi-structured interviews with inpatients admitted to acute medical wards of three NHS general hospitals.
PRINCIPAL FINDINGS: Seventy-four inpatients were interviewed: 37 were male with average age 73 years (age range of 19 -86 years). The predominate number of participants (62/74, 84%) being in the 65-80 years of age group. Thematic analysis of the data was driven by three themes; patients' expectations of the pharmacist's involvement in their treatment and care, the patients' experiences of any interaction that may have taken place and the patients' evaluation of their interaction with the pharmacist.
CONCLUSIONS: There was a dichotomy of expectations and opinions from patients about the role of hospital pharmacists and the services being provided. As pharmacists' roles are developing towards a patient-orientated model in which pharmacists have direct contact with patients and their care, it is important to ensure that patients are aware of these developments to help them maximize the benefit they derive from their country's health-care system.

© 2013 John Wiley & Sons Ltd.
KEYWORDS: expectations; experiences; inpatient; pharmacy services

Link to PubMed record

Try Dynamed Plus for free until 30th November!

The LKS has a free trial to Dynamed Plus until the end of November 2015.  This clinical decision support tool provides the usual quick-reference evidence summaries, but includes additional features such as calculators and images. 

If you’re on the WUTH network you can access Dynamed Plus here.  If you’re off-site you can use your Athens account to login here.

During the trial period you can also download the Dynamed Plus app which enables you to access all this content via your mobile device.  You can also receive updates to notify you of new evidence in your specialty. 

Please send your feedback on this resource to Victoria Treadway, Library and Knowledge Service Lead at Victoria.treadway@nhs.net or 8608.

For technical help and FAQs, see the Dynamed help page.

WUTH publication: An interesting case of an antihypertensive causing post-prostatectomy incontinence

Citation: BMJ Case Rep. 2015;2015
Author: Sarkar D, Kumar M
Abstract: A 70-year-old man underwent a laparoscopic radical prostatectomy with preservation of bladder neck for T3aN0R0 prostate cancer in December 2009, (Gleason 4+3, negative surgical margin). His postoperative prostate-specific antigen rose from 0.01 to 0.05 ng/mL over 19 months. He had salvage radiotherapy in May 2012. Following radiotherapy, his urinary control worsened and he needed to wear up to four pads per day. He was being considered for an artificial urinary sphincter placement. He was also taking doxazosin for hypertension, which was discontinued. After stopping the doxazosin, his urinary control improved and he did not require any further intervention. Doctors should be aware of the effect of α-blockers on the internal sphincter and the risk of incontinence in patients post-prostate cancer treatment.
 
Link to PubMed record

WUTH publication: Documentation of Focal Neurology on Patients with Suspected Cauda Equina Syndrome and the Development of an Assessment Proforma

Citation: The Open Orthopaedics Journal 2015, 31, (9), 390-4
Author: Mehta N, Garbera D, Kaye J, Ramakrishnan M
Abstract: OBJECTIVE: Cauda equina syndrome is a relatively rare condition with a disproportionately high medico legal profile. Definitive management involves prompt surgical decompression with outcome dependent on timing of surgery. Documentation of a comprehensive clinical and neurological assessment including examination of anal tone and perianal sensation is essential in reducing litigation and identifying patients requiring urgent surgical decompression. The aim of this study was to evaluate the documentation of focal neurology in patients with suspected cauda equina syndrome and devise an assessment proforma to use in the accident and emergency departments.
METHODS: A retrospective case note review was performed in all patients presenting to A&E with suspected cauda equina syndrome from January 2013 to March 2014. A full neurological examination was defined as having all modalities documented such as: MRC grade power, reflexes, sensory exam, vibration proprioception, anal tone & perianal sensation.
RESULTS: Sixty-nine patients with suspected cauda equina syndrome were identified with a median age of 44 (35-55) and a male to female ratio of 1:1.6. 4 patients (6%) had confirmed cauda equina syndrome and were transferred to a tertiary neurosurgical centre for further management. Only 2 patients (3%) had a complete neurological examination documented. 11 (16%) patients did not have any documentation of perianal sensation and 8 patients (12%) did not have documentation of anal tone.
CONCLUSION: Documentation of neurological was poor across our department. The introduction of an assessment proforma is proposed to increase documentation and optimise emergency department evaluation in these patients.
KEYWORDS: Assessment proforma; cauda equina syndrome; documentation; focal neurology; medico-legal

Link to PubMed record

WUTH publication: The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty

Citation: Indian Journal of Otolaryngology and head and neck surgery 2014 Dec;66(4):449-54
Author: Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V
Abstract: Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12-102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention.
KEYWORDS: Cartilage tympanoplasty; Middle ear surgery; Tympanic membrane retraction

Link to PubMed record

WUTH publication:

Citation: Haematologica. 2015, 100, 574-575
Author: Dixon L.
Abstract: Background: Sharing potentially devastating news with a patient is often considered the
most difficult task of a healthcare professional. The quality of the delivery of the bad
news can have a direct impact on patients' emotions and adjustment to the condition;
therefore doctors have a great responsibility. Aims: The main aim of this study was to
learn the theory behind breaking bad news and discover patients' perceptions of receiving
bad news in the haematology setting; including what they thought was done well and
areas that could be improved. The study was designed following the SPIKES protocol
because it comprises the basic principles and provides a structure. There is an ever
increasing amount of literature available surrounding this topic. Yet, there is a noticeable
lack of research concentrating on the experience from the patient's view. Methods: A
questionnaire was written based on the steps of the SPIKES model. The questions were
divided into sections. The first section, titled 'patient demographics', aimed to elicit
personal information without comprising anonymity. The next six sections represented the
six steps of the SPIKES model. There were a mixture of qualitative responses and
multiple choice answers; however the participants were always able to give qualitative
responses if they felt there were no multiple choice answers that represented their views.
The participants were asked the questions by interviewers, who documented their
answers. The interviewers were also available to explain the questions to the participants.
The questionnaire was attempted by 20 participants who were in/out patients at Arrowe
Park Hospital. The inclusion criteria for participation comprised a diagnosis of a
haematological malignant disease and treatment for the disease at this hospital.
Additionally, it was essential the patients gave voluntary and informed verbal consent.
Results: Due to help from the interviewers, all of the 20 questionnaires attempted were
completed and used in this study. The participants rated their experience: 55% said
'excellent'; 25% reported 'good'; 5% said 'satisfactory' and 15% stated 'poor'. 'Poor' was
rated more commonly by women and participants aged 45-64. Those who received their
diagnosis within the past few years tended to have a better consultation. The main
differences between the 'excellent' and 'poor' consultations include the doctor's sensitivity
and the patients having their understanding checked. Problem areas include only 35% of
patients were asked their existing knowledge and 85% of consultations failed to discuss
the impact of the diagnosis on daily life. Summary and Conclusions: Overall, most
patients were happy with their consultation. The areas patients particularly praised were
the set-up of the consultation and how sensitively the news was delivered. The knowledge
section was done well generally, however it showed the greatest difference between 'poor'
and 'excellent' consultations; therefore should be improved to standardise the experience.
Other areas patients felt needed improvement include the doctor determining the patient's
existing knowledge and what they would like to know. With a poorer prognosis, doctors
should work on reassurance and conveying hope. Most consultations could be improved
by the doctor exploring the effect of the diagnosis on other areas of the patient's life. This
study was limited by a small sample size and potential recall bias.

WUTH publication: Longitudinal studies are required

Citation: Journal of the Royal Society of Medicine. 2015, 108(6), 210
Author: Ahmad N, Thomas GN, Gill P, Chan C, Torella F

Link to PubMed record

Growing our own: Supporting Trainee Advanced Nurse Practitioners

The Library and Knowledge Service (LKS) has been supporting Trainee Advanced Nurse Practitioners (TANPs) for the last couple of years, to develop their evidence based practice and research skills, and to support their academic studies to master’s degree and beyond.

Read more here.

WUTH publication: Renal cell carcinoma presenting as an upper gastrointestinal bleeding

Citation: BMJ Case Reports. 2015 Aug 14
Author: Mohamed MO, Al-Rubaye S, Reilly IW, McGoldrick S
Abstract: An 80-year-old man presented with melaena and anaemia of 1 week duration. This was associated with shortness of breath and an indigestion-type pain for the preceding 8 weeks. General physical examination revealed epigastric tenderness, but an otherwise soft abdomen with no organomegaly. The patient had a gastroscopy, showing a polypoidal lesion in the second part of duodenum (D2) as the bleeding point, which was managed with epinephrine injection and endoclips. This was followed by CT of the abdomen, revealing a lobulated 8 cm mass arising from the lower pole of the right kidney and invading the duodenum. The case report aims to acknowledge the possibility of direct duodenal involvement in renal cell carcinoma, which is a rare occurrence.

Link to PubMed record

WUTH publication: A simple technique to achieve parallel transverse cuts in the scarf osteotomy

Citation: Annals of the Royal College of Surgeons of England 2015, 97(3), 238-9
Author: Brookes-Fazakerley SD, Platt SR, Jackson GE

Link to PubMed record

WUTH publication: 'Rain chain' for ankle arthroscopy

Citation: Annals of the Royal College of Surgeons of England 2015, 97(5), 397
Author: Ramavath AL, Geary N

Link to PubMed record

WUTH publication: Are we failing our trainees in providing opportunities to attain procedural confidence?

Citation: British Journal of Hospital Medicine (London). 2015, 76(2), 105-8
Author: Lagan J, Cutts L, Zaidi S, Benton I, Rylance J
Abstract: Practical procedures play a crucial role in clinical outcome. High proportions of Mersey trainees report a lack of procedural confidence despite the fact that the majority want to perform more procedures. Training has to be carefully analysed to address these shortcomings.

Link to PubMed record

WUTH publication: Altered Cortical Processing of Observed Pain in Patients With Fibromyalgia Syndrome

Citation: The journal of pain : official journal of the American Pain Society. Aug 2015, 16(8), 717-726
Author: Fallon, Nicholas; Li, Xiaoyun; Chiu, Yee; Nurmikko, Turo; Stancak, Andrej
Abstract:Fibromyalgia syndrome (FMS) is characterized by widespread chronic pain, fatigue, sleep
disorders, and cognitive-emotional disturbance. Patients with FMS exhibit increased
sensitivity to experimental pain and pain-related cues, as well as deficits in emotional
regulation. The present study investigated the spatiotemporal patterns of brain activations
for observed pain in 19 patients with FMS and 18 age-matched, healthy control
individuals using event-related potential analysis. Patients with FMS attributed greater
pain and unpleasantness to pain pictures, relative to healthy control participants. An
augmented late positive potential (LPP) component (>500 milliseconds) was found in
patients viewing both pain and nonpain pictures, and this amplitude difference in the LPP
covaried with perceived unpleasantness of pictures. Mid-latency potentials (250-450
milliseconds) demonstrated similar amplitude increases of positive potentials in the FMS
patient group. By contrast, the short-latency positive potential (140 milliseconds) was
reduced in patients with FMS relative to healthy control participants. Results suggest
amplitude increases to mid- to long-latency cortical activations in patients with FMS,
which are known to reflect emotional control and motivational salience of stimuli.
Patients with FMS demonstrate increased activations associated with pain and nonpain
pictures. The findings suggest that even innocuous, everyday visual stimuli with somatic
connotations may challenge the emotional state of patients with FMS. Our study points
toward the importance of cognitive-emotional therapeutic approaches for the treatment of
FMS. Copyright © 2015. Published by Elsevier Inc.

Link to PubMed record

WUTH publication: Radiological prevalence of degenerative arthritis of the first metatarsophalangeal joint.

Citation: Foot & ankle international. 2014 Dec;35(12):1277-81
Author: Howard N, Cowen C, Caplan M, Platt S
Abstract: BACKGROUND: The prevalence of osteoarthritis of the first metatarsophalangeal joint (MTPJ) has not been completely determined in a population-based study. The aim of the study was to determine the age- and gender-related prevalence of radiological first MTPJ arthritis.
METHODS: We analyzed 517 consecutive radiographs of adult patients who presented with acute foot injuries to the accident and emergency department over a 6-month period. Radiographs were assessed independently by 2 authors using the Hattrup and Johnson grading system for osteoarthritic changes in the first MTPJ.
RESULTS: The radiographic prevalence of MTPJ arthritis in our population was 25% (127/517). Overall incidence was higher in females, with 32% (85/269) of females affected in comparison to 18% (44/248) of males. Variance between the sexes was insignificant until the age of 60, at which point the prevalence rose to 66% (53/80) in females compared with 47% (18/38) in males of the same age.
CONCLUSIONS: The development of first MTPJ arthritis follows a typical pattern of degenerative arthritis, as shown in other joints, with increasing age being an important factor. The results of this study suggest that first MTPJ arthritis begins to appear in most cases in middle age and is significantly more apparent in females.
LEVEL OF EVIDENCE: Level III, comparative case series.

© The Author(s) 2014.
KEYWORDS: arthritis; degenerative; first metatarsophalangeal joint (MTPJ); radiological

Link to PubMed record

WUTH publication: An additional middle cuneiform?

Citation: Journal of Surgical Case Reports. 2015 Jul 29;2015(7).
Author: Brookes-Fazakerley SD, Jackson GE, Platt SR
Abstract: Additional cuneiform bones of the foot have been described in reference to the medial bipartite cuneiform or as small accessory ossicles. An additional middle cuneiform has not been previously documented. We present the case of a patient with an additional ossicle that has the appearance and location of an additional middle cuneiform. Recognizing such an anatomical anomaly is essential for ruling out second metatarsal base or middle cuneiform fractures and for the preoperative planning of arthrodesis or open reduction and internal fixation procedures in this anatomical location.

Link to PubMed record

WUTH publication: An unusual presentation of a retroperitoneal cyst

Citation: BMJ Case Rep. 2014;2014
Author: Sarkar D, Gulur D, Patel S, Nambirajan T
Abstract: A 34-year-old woman presented to the surgical assessment unit with severe right loin to groin pain. An ultrasound scan of the abdomen revealed a complex cyst in the right iliac fossa and a subsequent CT scan revealed a 7.5 cm retroperitoneal cystic lesion below the lower pole of the right kidney. The patient also had MRI of the kidneys, which confirmed the finding. The image showed the cyst was not attached to the kidneys and was clearly separate. She underwent a laparoscopic excision of the cyst. Histopathology revealed a cyst lined by a single layer of mucinous epithelium of endocervical type with foci of calcification and hyalinisation on the wall. The cyst was thought to be a benign cyst of Mullerian origin.

Link to PubMed record

Library users share their experience on our video

Our users wanted to share their experiences of using the library service. Our communications team put together a promotional video showcasing our library, and users describing our services and support. Watch the library video here.

WUTH publication: Safety and performance evaluation of a next-generation antimicrobial dressing in patients with chronic venous leg ulcers. Posted: Related Articles Safety and performance evaluation of a next-generation antimicrobial dressing in patients with chronic venous leg ulcers

Citation: International Wound Journal. Int Wound J. 2016 Aug;13(4):442-8. Epub 2015 Jun 21.
Author: Harding KG, Szczepkowski M, Mikosiński J, Twardowska-Saucha K, Blair S, Ivins NM, Saucha W, Cains J, Peters K, Parsons D, Bowler P
Abstract: The objective of this study was to investigate the safety and performance of AQUACEL™ Ag+ dressing, a wound dressing containing a combination of anti-biofilm and antimicrobial agents, in the management of chronic wounds. Patients (n = 42) with venous leg ulcers exhibiting signs of clinical infection were treated for 4 weeks with AQUACEL™ Ag+ dressing, followed by management with AQUACEL™ wound dressings for 4 weeks. Wound progression, wound size, ulcer pain and clinical evolution of the wound were assessed for up to 8 weeks. Adverse events were recorded throughout the study. AQUACEL™ Ag+ dressing had an acceptable safety profile, with only one patient discontinuing from the study, because of a non-treatment-related adverse event. After 8 weeks, substantial wound improvements were observed: 5 patients (11·9%) had healed ulcers and 32 patients (76·2%) showed improvement in ulcer condition. The mean ulcer size had reduced by 54·5%. Patients reported less pain as the study progressed. Notable improvements were observed in patients with ulcers that were considered to require treatment with systemic antibiotics or topical antimicrobials at baseline (n = 10), with a mean 70·2% reduction in wound area. These data indicate that AQUACEL™ Ag+ dressing has an acceptable safety profile in the management of venous leg ulcers that may be impeded by biofilm.

Link to PubMed record

WUTH publication: Management of Posterior Malleolar Fractures: A Systematic Review

Citation: Journal of Foot & Ankle Surgery. 2015 Jun 19
Author: Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S
Abstract: Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Although treatment of associated lateral and medial structures is well established, several controversies exist in the management of posterior malleolus fractures. We performed a systematic review of the current published data with regard to the diagnosis, management, and prognosis of posterior malleolus fractures. A total of 33 studies (8 biomechanical and 25 clinical) with >950 patients were reviewed. The outcome of ankle fractures with posterior malleolar involvement was poor; however, the evidence was not enough to prove that the size of the posterior malleolus affects the outcome. Significant heterogeneity was noted in the cutoff size of the posterior malleolar fragment in determining management. The outcome was related to other factors, such as fracture displacement, congruency of the articular surface, and residual tibiotalar subluxation. Indirect evidence showed that large fracture fragments were associated with fracture dislocations and ankle instability and, thus, might require surgical fixation. We have concluded that the evidence to prove that the size of the posterior malleolar affects the outcome of ankle fractures is not enough, and the decision to treat these fractures should be determined by other factors, as stated previously.

Link to PubMed record

WUTH Publication: Longitudinal studies are required.

Citation: Longitudinal studies are required.
J R Soc Med. 2015 Jun;108(6):210
Authors: Ahmad N, Thomas GN, Gill P, Chan C, Torella F

PMID: 26085558 [PubMed - in process]

Link to Pubmed record

WUTH Publication: Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta: conclusions from a short case series.

Citation: Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta: conclusions from a short case series.
Arch Gynecol Obstet. 2015 Feb;291(2):461-5
Authors: Minas V, Gul N, Shaw E, Mwenenchanya S
Abstract: PURPOSE: The management of women with abnormally invasive placenta remains one of the most challenging aspects of obstetric care. Various surgical and interventional radiological techniques have been developed to limit the risk of massive haemorrhage at caesarean section. Here we describe our experience with three such cases that required caesarean hysterectomy and were managed with prophylactic balloon catheterisation of the common iliac arteries. METHODS: The details of three cases that received prophylactic balloon catheterisation of the common iliac arteries for the surgical management of placenta accreta/percreta are presented. Observational conclusions from these cases as well as a review of the relevant literature are discussed. RESULTS: Our three cases required caesarean hysterectomy for suspected placenta accreta/percreta. The mean estimated blood loss was 3,333 ml. In one of the cases, we observed notable reduction in blood loss during occlusion of the common iliac arteries, as the balloons were deflated every 5 min to avoid lower limb ischemia. CONCLUSIONS: The cases presented here, and also our literature review, suggest that occlusion of the common iliac arteries appears to be more effective than, and as safe as the occlusion of the internal iliac arteries. Clinicians need to be aware of the potential risks and employ measures to prevent them. Further research is required to investigate the optimum length of occlusion and balance between reducing blood loss and risking ischemia of the limbs when occluding the common iliac arteries. PMID: 25178185 [PubMed - indexed for MEDLINE]

Link to PubMed record

UpToDate mobile app

A new demonstration video is now available on the help section of the UpToDate website for downloading and using the mobile app.

UpToDate provides evidence based summaries of clinical topics covering more than 20 specialties, as well as nearly 1,500 patient information topics, and more than 27,000 graphics, tables and videos available to download into presentations.  Use UpToDate as a starting point to gain a comprehensive overview of your topic.

Find out more about UpToDate and how to access it here.

WUTH Publication: Arthroscopic Evaluation of Impingement and Osteochondral Lesions in Chronic Lateral Ankle Instability.

Citation: Arthroscopic Evaluation of Impingement and Osteochondral Lesions in Chronic Lateral Ankle Instability.
Foot Ankle Int. 2015 Jun 1;
Authors: Odak S, Ahluwalia R, Shivarhatre DG, Mahmood A, Blucher N, Hennessy M, Platt S
Abstract: BACKGROUND: Anterolateral impingement associated with intra-articular synovitis, scarring, and fibrosis is a less recognized feature in patients with chronic lateral ankle instability. The aim of our study was to ascertain the incidence of intra-articular synovitis, osteochondral lesions (OCLs), impingement lesions (both intra- and extra-articular), and other associated pathologies in patients undergoing modified Broström-Gould ankle ligament reconstruction. METHODS: We performed a retrospective review of all patients who underwent arthroscopically assisted modified Broström-Gould ankle ligament reconstruction for symptomatic recurrent ankle instability. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Ankle arthroscopy was performed prior to reconstruction in all patients. Data were obtained from clinical and radiological records including magnetic resonance imaging scans. Arthroscopic findings were recorded in detail intraoperatively. A total of 100 patients (53 females and 47 males) with an average age of 37 years (range, 15-65 years) were reviewed over a 10-year period. RESULTS: Sixty-three patients (63%) had intra-articular synovitis mostly in the anterior and/or anterolateral compartment, which required arthroscopic debridement. Seventeen patients (17%) were found to have OCLs, and 12 (12%) patients had anterior bony impingement lesions. CONCLUSION: This study found a high incidence of anterior/anterolateral synovitis in patients with chronic lateral ankle instability. However, there was a relatively low incidence of anterior bony impingement lesions or OCLs in our series.
LEVEL OF EVIDENCE: Level IV, retrospective case series.
PMID: 26031851 [PubMed - as supplied by publisher]

Link to Pubmed record

Medline and PsycInfo now fully functional

The Medline and PsycInfo databases available via NICE Evidence are now fully functional.  Work had taken place to update the databases which resulted in some limit options being unavailable.  All limts are now available in all databases.

You can access the databases by visiting www.evidence.nhs.uk and selecting 'Journals and databases'.

BMA One Day Courses

http://bma.org.uk/about-the-bma/bma-library/library-courses 

The BMA Library runs a number of different one day courses aimed at all health care professionals.                Each course costs £160+VAT for BMA Members and £320+VAT for non-members.

Understanding Medical Statistics Workshop
This course will cover basic statistical concepts as used in papers, such as confidence intervals and p-values and communicate about statistics, particularly about risk and measures of risks.
Monday, 9 March
Monday, 12 October
Monday, 7 December

Analysing Medical Statistics Workshop
This course will introduce basic statistical analysis that will help delegates to plan and undertake their research, covering sampling and sample size estimation.
The trainers strongly recommend that anybody considering this course should first attend the Understanding Statistics Workshop.
Tuesday, 10 March
Tuesday, 13 October
Tuesday, 8 December

Critical Appraisal Skills Basic Workshop
Intensive overview of the skills needed and resources available for critical appraisal, and will provide ideas on how these can be used on return to the workplace.
Thursday, 19 March
Friday, 5 June
Thursday, 17 September

Critical Appraisal Skills Extended Workshop
Interactive and practical with advanced tips and advice. Delegates must have basic knowledge of evidence-based healthcare and be aware of the main resources.
Friday, 20 March
Monday, 29 June
Friday, 18 September

Research Methods Workshop
Detailed overview of the main quantitative research methods, what they are, when and how each method is applied, and how the resulting data are analysed and interpreted.
Monday, 8 June
Friday, 26 June

If you have any queries about our courses please email the Library Administrator, Euphemia Abraham - eabraham@bma.org.uk

Medline Bespoke Tutorial
We also offer an on-demand, by appointment only, one-to-one half day session to cover all the essentials of searching Medline using the OvidSP interface and can be tailored to your individual needs.
These tutorials are completely free for BMA Members. (The cost for Library Institutional Members is £80+VAT.)

To book a session please contact Helen Elwell on Tel: 020 7383 6582 or email: helwell@bma.org.uk

WUTH Publication: The treatment of penile carcinoma in situ (CIS) within a UK supra-regional network.

Citation: The treatment of penile carcinoma in situ (CIS) within a UK supra-regional network.
BJU Int. 2015 Apr;115(4):595-8
Authors: Lucky M, Murthy KV, Rogers B, Jones S, Lau MW, Sangar VK, Parr NJ
Abstract: OBJECTIVES: To review outcomes of the treatment of carcinoma in situ (CIS) of the penis at a large supra-regional penile cancer network, where centralisation has permitted greater experience with treatment outcomes, and suggest treatment strategies. PATIENTS AND METHODS: The network penile cancer database, which details presentation, treatment and complications was analysed from 2003 to 2010, identifying patients with CIS, with a minimum follow-up of 2 years, looking at treatments administered and outcomes. RESULTS: In all, 57 patients with mean (range) age of 61 (34-91) years were identified. In all, 18 were treated by circumcision only, 20 by circumcision and local excision (LE) and 19 by circumcision and 5-flurouracil (5-FU). The mean (range) follow-up was 3.5 (2-8) years. Of those treated by circumcision none subsequently developed CIS on the glans. For those who underwent circumcision + LE, five of 20 (25%) developed recurrence requiring further treatment. Of those treated by circumcision + 5-FU, 14/19 (73.7%) completely responded. Of the five incomplete responders, two had focal invasive malignancy at repeat biopsy. One incomplete responder underwent glansectomy and four grafting. No complete responders relapsed. Complications of 5-FU included significant inflammatory response in seven (36.8%), with two requiring hospital admission and one neo-phimosis (5.3%). CONCLUSION: This study suggests that patients undergoing circumcision for isolated CIS and complete responders to 5-FU may require only short-term follow-up, as recurrence is unlikely, whereas longer follow up is required for all other patients. However, numbers in this study are small and larger studies are needed to support this. An incomplete response to 5-FU dictates immediate re-biopsy, as it carries a significant chance of previously undetected invasive disease.
PMID: 25060513 [PubMed - indexed for MEDLINE]


Link to Pubmed record

WUTH Publication: Response to Dawson S, 'Blood culture contaminants', J Hosp Infect 2014, vol. 87, pp. 1-10.

Citation: Response to Dawson S, 'Blood culture contaminants', J Hosp Infect 2014, vol. 87, pp. 1-10.
J Hosp Infect. 2014 Oct;88(2):120
Authors: Shakeshaft M, Cunniffe J, Harvey D
PMID: 25218657 [PubMed - indexed for MEDLINE]

Link to Pubmed record

WUTH Publication: Early triaging using the Modified Early Warning Score (MEWS) and dedicated emergency teams leads to improved clinical outcomes in acute emergencies.

Citation: Early triaging using the Modified Early Warning Score (MEWS) and dedicated emergency teams leads to improved clinical outcomes in acute emergencies.
Clin Med. 2015 Jun 1;15(Suppl 3):s3
Authors: Patel A, Hassan S, Ullah A, Hamid T, Kirk H
PMID: 26026024 [PubMed - as supplied by publisher]

Link to Pubmed record

WUTH Publication: Management of migrated intravesical staples post laparoscopic colposuspension.

Citation: Management of migrated intravesical staples post laparoscopic colposuspension.
Urol J. 2014 Jul-Aug;11(4):1853
Authors: Floyd MS, Hughes D, Kutarski PW
PMID: 25194092 [PubMed - indexed for MEDLINE]

Link to Pubmed record

2015-2016 training prospectus published

The WUTH training prospectus 2015-16 has been published, signposting a whole range of development opportunities for WUTH staff.  There are a wide range of courses available across the organisation, from clinical skills to leadership and manegement.

You'll find the library training sessions outlined on pages 78-80.  Our sessions will teach you to find, retrieve and appraise information gathered from an ever expanding range of health related resources (both print and electronic formats). Used effectively this information can help to change clinical practice, support continuing education, research, service development and business decision making in a health service that requires evidence based practice.

WUTH Publication: Comment on 'Herpes zoster ophthalmicus reduction: implementation of shingles vaccination in the UK'.

Citation: Comment on 'Herpes zoster ophthalmicus reduction: implementation of shingles vaccination in the UK'.
Eye (Lond). 2014 Dec;28(12):1522-3
Authors: Clearkin L
PMID: 25190531 [PubMed - indexed for MEDLINE]

Link to Pubmed record

WUTH Publication: Altered cortical processing of observed pain in fibromyalgia syndrome patients.

Citation: Altered cortical processing of observed pain in fibromyalgia syndrome patients.
J Pain. 2015 May 12;
Authors: Fallon N, Li X, Chiu Y, Nurmikko T, Stancak A
Abstract: Fibromyalgia syndrome (FMS) is characterised by widespread chronic pain, fatigue, sleep disorders and cognitive-emotional disturbance. FMS patients exhibit increased sensitivity to experimental pain and pain-related cues, as well as deficits in emotional regulation. The present study investigated the spatio-temporal patterns of brain activations for observed pain in 19 FMS patients and 18 age-matched, healthy control subjects using event-related potential (ERP) analysis. Fibromyalgia patients attributed greater pain and unpleasantness to pain pictures relative to healthy control participants. An augmented late positive potential (LPP) component (>500 ms) was found in patients during both pain and non-pain pictures, and this amplitude difference in the LPP covaried with perceived unpleasantness of pictures. Mid-latency potentials (250-450 ms) demonstrated similar amplitude increases of positive potentials in the FMS patient group. By contrast, the short-latency positive potential (140 ms) was reduced in FMS patients relative to healthy control participants. Results suggest amplitude increases to mid-long latency cortical activations in FMS patients, which are known to reflect emotional control and motivational salience of stimuli.
PERSPECTIVE: FMS patients demonstrate increased activations for pain and non-pain pictures. The findings suggest that even innocuous, everyday visual stimuli with somatic connotations may challenge the emotional state of FMS patients. Our study points towards the importance of cognitive-emotional therapeutic approaches for the treatment of FMS.
PMID: 25979860 [PubMed - as supplied by publisher]

Link to Pubmed record

WUTH Publication: Epithelioid haemangioma: a rare cause of painful erections and sleep deprivation.

Ciation: Epithelioid haemangioma: a rare cause of painful erections and sleep deprivation.
Int Urol Nephrol. 2014 Sep;46(9):1747-50
Authors: Lucky MA, McGuinness LA, Floyd MS, Azhar U, Shanks JH, Li C, Shenjere P, Nonaka D, Robinson LQ, Parr NJ
Abstract: Epithelioid haemangioma of the penis is a rare condition which usually presents a solid single nodule. We report a case in a 43-year-old man who presented with painful erections and sleep disturbance with two palpable penile nodules. Magnetic resonance imaging with an artificially induced erection revealed these as individual lesions, and local excision was successfully undertaken. Pathological diagnosis of epithelioid haemangioma was confirmed with positive staining for CD31. Although rare, penile epithelioid haemangioma should be considered as a differential in an atypical penile mass. Induction in of an artificial erection prior to MRI can aid diagnosis and treatment is typically with surgical excision.
PMID: 24682864 [PubMed - indexed for MEDLINE]

Link to Pubmed record

WUTH Publication: Localised amyloidosis of the glans penis presenting as a painless lump with progression after 10 years.

Citation: Localised amyloidosis of the glans penis presenting as a painless lump with progression after 10 years.
Int Urol Nephrol. 2014 Sep;46(9):1737-9
Authors: Floyd MS, Glendinning J, Hiew K, Avram AM, Seneviratne R, Parr NJ
Abstract: Primary amyloidosis of the genitourinary tract is uncommon, and isolated invasion of the glans penis is exceptionally rare Degos et al. (Bull Soc Fr Dermatol Syphiligr 68:159, 1961). We report a case of localised amyloidosis of the glans penis in a 40-year-old presenting as an asymptomatic penile mass which changed after 10 years prompting treatment. We believe this to be the longest interval recorded between clinical occurrence and histological diagnosis of primary penile amyloidosis.
PMID: 24906425 [PubMed - indexed for MEDLINE]

Link to Pubmed record

WUTH Publication: Critical care in the emergency department: acute kidney injury.

Citation: Critical care in the emergency department: acute kidney injury.
Emerg Med J. 2016, 33(5), 361-5
Authors: Nee PA, Bailey DJ, Todd V, Lewington AJ, Wootten AE, Sim KJ
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 of AKI with reference to recent consensus guidelines on classification and treatment.
PMID: 25969433 [PubMed - as supplied by publisher]


Link to Pubmed record

Oxford Medical Handbooks are available to all WUTH staff and learners.  The collection is available online, meaning that you don’t need to come in to the library to use it. 

The Handbooks offer a convenient way for medical and nursing staff to access practical management advice that is portable and easily accessible.

Subjects covered include:

Anaesthetics

Cardiology

Cardiothoracic Surgery

Child and Adolescent Psychiatry

Clinical Medicine

Clinical Pharmacology and Therapeutics

Emergency medicine

Endocrinology and Diabetes

Forensic Psychiatry

Gastroenterology

Geriatric Medicine

Infectious Diseases

Intensive Care

Medical Dentistry

Medical Oncology

Medical Statistics and Methodology

Neurology

Nuclear Medicine

Obstetrics

Old Age Psychiatry

Oral and Maxillofacial Surgery

Otolaryngology (ENT)

Paediatric Surgery

Paediatrics

Palliative Medicine

Plastic Surgery

Psychiatry

Radiology

Renal Medicine

Respiratory Medicine and Pulmonology

Rheumatology

Surgery

Surgery

Urology

From an NHS computer:

To browse the Handbooks, visit the library catalogue, select the link to ‘Oxford Handbooks Online’ and log in with your OpenAthens account. 

From home:

Visit the Oxford Medicine Online webpage and log in with your OpenAthens account.

An OpenAthens account is required, please read this helpsheet for support with your OpenAthens account.

For technical support or to find out what ebooks are available in your specialty, please contact us.  

Work at NICE to implement the full functionality of Medline and PsycINFO databases is now completed.  Users of these databases should now be able to apply all available limits to their search, including date limits, language limits and age limits.  To access the databases and search for journal articles on your topic, please go to NICE Evidence at www.evidence.nhs.uk and select ‘Journals and databases’.  For training and assistance on searching for evidence please contact the Library and Knowledge Service. 

WUTH Publication: Omega-3 fatty acids do not suppress atrial fibrillation even in the "inflamed" heart.

Citation: Omega-3 fatty acids do not suppress atrial fibrillation even in the "inflamed" heart.
Int J Cardiol. 2015 Mar 20;187:445-446
Authors: Saravanan P, Calder PC, Davidson NC
PMID: 25841146 [PubMed - as supplied by publisher]

Link to Pubmed record

WUTH Publication: Treatment of tachycardia: bradycardia syndrome in a patient with obstructive sleep apnoea.

Citation: Treatment of tachycardia: bradycardia syndrome in a patient with obstructive sleep apnoea.
BMJ Case Rep. 2015;2015
Authors: Lagan J, Saravanan P
Abstract: Obstructive sleep apnoea (OSAS) affects 4% of men and 2% of women aged 30-65 years. It is diagnosed in the presence of excessive daytime sleepiness and an apnoea-hypopnoea index (AHI) of ≥5 on polysomnography. Rhythm disturbances are common in OSAS and continuous positive airway pressure (CPAP) has been shown to be beneficial. We present a case of a patient with obesity, atrial fibrillation with fast ventricular response, significant nocturnal pauses (3.9 s) and tachycardiomyopathy. A polysomnography confirmed severe OSAS (AHI=64.25). CPAP improved bradycardia and allowed for the introduction of β-blockers. Subsequent Holter monitoring revealed better rate control with the longest pause of 2 s and the patient's left ventricular systolic function improved. CPAP prevented our patient from invasive treatment, allowed for rate control and improvement of tachycardiomyopathy. With such a high prevalence of OSAS, clinicians should be aware that CPAP may aid arrhythmia control.
PMID: 25833907 [PubMed - as supplied by publisher]

Link to Pubmed record

NHS mental health apps library launched

NHS England has launched an initiative to help treat depression and anxiety and improve access to psychological therapies by unveiling the first ever directory of NHS-endorsed digital mental health services.  The Mental Health Apps Library features online tools, resources and apps that have a proven track record of effectiveness in improving mental health outcomes. The library is accessible through the NHS Choices platform.  

Health Foundation topic briefings

The Health Foundation has published a series of topic briefings on a range of NHS services the details of which are as follows:

·         Swimming against the tide? The quality of NHS services during the current parliament  This briefing summarises trends in the quality of NHS care in England since the 2010 general election.

·         Is mental health care improving? This overview uses the available data to assess the quality of health care services for people with mental health problems in England.

·         Is the NHS becoming more person-centred? This overview examines how the NHS in England has performed over this parliament in relation to indicators that reflect person-centred care.

·         Is the NHS getting safer? This overview considers how the NHS has performed over the current parliament in relation to patient safety.

·         Are people waiting longer for health care? This overview considers the performance of the NHS in England in providing timely access to health care during the current parliament.

·         How does the NHS compare with health systems in other countries? This overview looks at the use of international comparisons, and examines how the NHS compares with other countries’ health systems in a number of key areas. 

WUTH Publication: Contralateral acute lower limb ischaemia following total hip replacement in a patient with an endovascular abdominal aortic aneurysm repair.

Citation: Contralateral acute lower limb ischaemia following total hip replacement in a patient with an endovascular abdominal aortic aneurysm repair.
J Surg Case Rep. 2015;2015(3)
Authors: Brookes-Fazakerley SD, Thorpe P, Chan C, Jackson GE
Abstract: Total hip replacement (THR) is a common procedure to treat patients with a fractured neck of femur. Ipsilateral major vessel injury with acute lower limb ischaemia is a rare but potentially devastating complication. Contralateral acute limb ischaemia is unreported. We present the case of a contralateral, acute lower limb ischaemia following THR for a fractured neck of femur in the presence of an endovascular aortic aneurysm repair (EVAR) and femoro-femoral crossover grafts. We advise early vascular surgery consultation for patients undergoing THR with an EVAR stentgraft in situ to help minimize risks of peri- and postoperative graft occlusion and consequent acute lower limb ischaemia.
PMID: 25742966 [PubMed]

Link to Pubmed record

WUTH Publication: Takotsubo cardiomyopathy case series: typical, atypical and recurrence.

Citation: Takotsubo cardiomyopathy case series: typical, atypical and recurrence.
BMJ Case Rep. 2015;2015
Authors: Lagan J, Connor V, Saravanan P
Abstract: Takotsubo cardiomyopathy (TCM) is characterised by a transient left ventricular (LV) dysfunction, ECG changes that can imitate acute myocardial infarction and positive cardiac biomarkers in the absence of obstructive coronary artery disease. The exact pathogenesis of TCM is unclear but emotional or physical stress is a common denominator. We present three cases encompassing a spectrum of the disease: A typical TCM with apical LV dyskinesis, an atypical TCM with mid-ventricular regions affected and a TCM recurrence. Our cases show that TCM symptoms vary between individuals and may vary in the same patient. All our patients reported acute emotional stress prior to the onset of symptoms, had LV systolic dysfunction, positive cardiac biomarkers and non-obstructed coronary arteries. In all cases, LV systolic dysfunction eventually improved. TCM may account for 0.7-2.5% of acute coronary syndromes. It is more prevalent in the female population and can reoccur. Treatment is mainly supportive.
PMID: 25743867 [PubMed - in process]

Link to Pubmed record

WUTH Publication: Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data.

Citation: Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data.
J R Soc Med. 2014 Dec;107(12):483-9
Authors: Ahmad N, Thomas GN, Gill P, Chan C, Torella F
Abstract: OBJECTIVE: We describe the prevalence of major lower limb amputation across England and its relationship with revascularisation, patient demography and disease risk factors.
DESIGN: Retrospective cohort study.
SETTING: England 1 April 2003 to 31 March 2009.
PARTICIPANTS: Patients aged 50-84 years.
MAIN OUTCOME MEASURES: Age standardised prevalence rates were calculated using Hospital Episode Statistics as the numerator with census data as the denominator. The outcome measure 'amputation with revascularisation' was created if an amputation could be linked with a revascularisation. Logistic regression determined the odds of having an amputation with a revascularisation across England. Regression was performed unadjusted and repeated after controlling for demographic (age, sex, social deprivation) and disease risk factors (diabetes, hypertension, coronary heart disease, cerebrovascular disease, smoking).
RESULTS: There were 25,312 amputations and 136,215 revascularisations, and 7543 cases were linked. The prevalence rate per 100,000 (95% confidence intervals) for amputation was 26.3 (26.0-26.6) with rates significantly higher in Northern England (North: 31.7; 31.0-32.3, Midlands: 26.0; 25.3-26.7, South: 23.1; 22.6-23.5). The revascularisation rate was 141.6 (140.8-142.3) with significantly higher rates again in Northern England (North: 182.1; 180.5-183.7, Midlands: 121.3; 119.8-122.9, South 124.9; 123.9-125.8). The odds of having an amputation with a revascularisation remained significantly higher in the North (OR 1.22; 1.13-1.33) even after controlling demographic and disease risk factors.
CONCLUSIONS: There is a North-South divide in England for both major lower limb amputation and revascularisation. The higher odds of having an amputation with a revascularisation in the North were not fully explained by greater levels of deprivation or disease risk factors.
PMID: 25389229 [PubMed - indexed for MEDLINE]

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WUTH Publication:UK AMD EMR USERS GROUP REPORT V: benefits of initiating ranibizumab therapy for neovascular AMD in eyes with vision better than 6/12.

Citation: UK AMD EMR USERS GROUP REPORT V: benefits of initiating ranibizumab therapy for neovascular AMD in eyes with vision better than 6/12.
Br J Ophthalmol. 2015 Feb 13;
Authors: Lee AY, Lee CS, Butt T, Xing W, Johnston RL, Chakravarthy U, Egan C, Akerele T, McKibbin M, Downey L, Natha S, Bailey C, Khan R, Antcliff R, Varma A, Kumar V, Tsaloumas M, Mandal K, Liew G, Keane PA, Sim D, Bunce C, Tufail A, on behalf of UK AMD EMR Users Group
Abstract: BACKGROUND/AIMS: To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy.
METHODS: Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections.
RESULTS: The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12.
CONCLUSIONS: All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding.

PMID: 25680619 [PubMed - as supplied by publisher]

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