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

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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.

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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

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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

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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.

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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.

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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

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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.

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