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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WUTH Publication: Unusual presentation of a scrotal tumour.

Citation: Unusual presentation of a scrotal tumour.
BMJ Case Rep. 2014;2014
Authors: Sarkar D, Parr NJ
Abstract:A 59-year-old man had a wide excision of the right-sided scrotal cancer in the neck of the scrotum. On dissection it became apparent that the tumour had developed a blood supply from the right spermatic cord. Histology revealed G2T2 squamous cell carcinoma. A biopsy from an abnormal skin area from the opposite groin reported chronic folliculitis. He underwent an ultrasound scanning of the groin and fine-needle aspiration, which did not show any suspicious features. Follow-up CT of the abdomen and pelvis after 6 weeks did not show any evidence of intra-abdominal lymphadenopathy. Another CT has been arranged within the next 3 months to confirm that the spread of the tumour does  not follow the pattern of a testicular tumour.

PMID: 24879734 [PubMed - indexed for MEDLINE]

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Wuth Publication: Are we failing our trainees in providing opportunities to attain procedural confidence?

Citation: Are we failing our trainees in providing opportunities to attain procedural confidence?
Br J Hosp Med (Lond). 2015 Feb 2;76(2):105-108
Authors: 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.
PMID: 25671476 [PubMed - as supplied by publisher]

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WUTH Publication: Ebola virus disease in Africa: epidemiology and nosocomial transmission.

Citation: Ebola virus disease in Africa: epidemiology and nosocomial transmission.
J Hosp Infect. 2015 Jan 20
Authors: Shears P, O'Dempsey TJ
Abstract
The 2014 Ebola outbreak in West Africa, primarily affecting Guinea, Sierra Leone, and Liberia, has exceeded all previous Ebola outbreaks in the number of cases and in international response. There have been 20 significant outbreaks of Ebola virus disease in Sub-Saharan Africa prior to the 2014 outbreak, the largest being that in Uganda in 2000, with 425 cases and a mortality of 53%. Since the first outbreaks in Sudan and Zaire in 1976, transmission within health facilities has been of major concern, affecting healthcare workers and acting as amplifiers of spread into the community. The lack of resources for infection control and personal protective equipment are the main reasons for nosocomial transmission. Local strategies to improve infection control, and a greater understanding of local community views on the disease, have helped to bring outbreaks under control. Recommendations from previous outbreaks include improved disease surveillance to enable more rapid health responses, the wider availability of personal protective equipment, and greater international preparedness.


PMID: 25655197 [PubMed - as supplied by publisher]

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WUTH publication: Radical cystectomy and pelvic lymphadenectomy with ileal conduit urinary diversion and abdominal wall reconstruction: an interesting case of multidisciplinary management.

Citation: International Medical Case Reports Journal. 2015 Jan 16;8:29-31
Author: Sofos, Stratos S, Walsh, Ciaran J, Parr, Nigel J, Hancock, Kevin
Abstract: The ileal conduit for urinary diversion after radical cystectomy is a well-described procedure. Furthermore, parastomal hernias, prolapse, stenosis, and retraction of the stoma have been reported as some of the more common complications of this procedure. The subsequent repair of parastomal hernias with a biological mesh and the potential of the conduit to "tunnel" through it has also been described. In this case report, we present a combined repair of a large incisional hernia with a cystectomy and a pelvic lymphadenectomy for invasive bladder cancer, with the use of a biological mesh for posterior component abdominal wall primary repair as well as for support to the ileal conduit used for urinary diversion.
KEYWORDS: biological mesh; incisional hernia; posterior component separation

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WUTH Publication:The use of hip radiographs in primary care: the inter-observer agreement of reporting native hip pathology.

Citation: The use of hip radiographs in primary care: the inter-observer agreement of reporting native hip pathology. Hip Int. 2014 May-Jun;24(3):290-4
Authors:Kenyon PJ, Perry D, Barrett M, Carroll FA, Thomas G
Abstract:INTRODUCTION: Plain radiographs are often the first line investigation in identifying the cause of hip pain, though they do not differentiate all morphologically normal and abnormal hips. Interpretation of radiographs is subjective, depending on the patient history and physical signs. A radiological report can be misleading and may lead to, unnecessary radiation exposure, a delay in referral and a delay to definitive treatment. This study was to investigate the inter-observer reliability in the reporting of plain radiographs.

METHODS: Sixty-one consecutive antero-posterior (AP) radiographs of native hips were identified that had been referred to one of the senior authors from the community with "hip pain". Images were anonymised within PACS (picture archiving and communication system) and reviewed by a consultant orthopaedic surgeon, two consultant musculoskeletal radiologists, one senior orthopaedic registrar and one senior radiology registrar. Each reviewer was given a pre-constructed proforma, and asked to report the radiographs.
RESULTS: There is a varying degree of 'agreement' for many of the commonly used terms on a hip radiograph. Agreement between all observers varied, by description, between 23.3% (CAM Lesion) to 93.3% (AVN). Multi-rater  agreement showed Kappa values ranging from 0.12 (poor) to 0.6 (moderate). Overall there were widespread inconsistencies, even amongst the most widely used terms.
CONCLUSION: There is variable agreement amongst musculoskeletal radiology and orthopaedic experts when analysing plain radiographs of the native hip. This has implications for utility of reporting and therefore treatment in the community setting.

PMID: 24500827 [PubMed - indexed for MEDLINE]

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UpToDate Anywhere

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.

WUTH now has a  subscription to UpToDate Anywhere, which means you can get:

• Free UpToDate mobile app for most leading devices

• Easy access to UpToDate by logging in from any computer with an internet connection

• Free continuing education credits (CME/CE/CPD) when you research a clinical question using UpToDate onsite or remotely – including on your mobile device

Registration is easy:

1. Access UpToDate via the WUTH staff webpages

2. Click on Log-in/Register in the top navigation bar of the UpToDate log-in page

3. Create a unique user name and password on the UpToDate Anywhere registration page

4. You are now registered and will receive a confirmation email with information about

installing the UpToDate Mobile App

Please note that Up to Date is an American resource. This is particularly important when using information on licensed indications, doses and treatment pathways. For UK advice please refer to the Medicines Formulary, the BNF or contact Medicines Information (OpenAthens details are required to access this resource).

Changes to McArdle Library Journal Subscriptions 2015

The Lancet

Message From NICE Evidence:


NICE and Elsevier have announced that access to The Lancet (electronic) will continue to be made available for a further 12 months (1 January 2015 – 31 December 2015). In order to secure equitable access to The Lancet we have had to negotiate the removal of access to the print version of the journal. You will no longer receive a print copy of The Lancet from 1 January 2015.



Nursing Standard



Unfortunately due to a substantial price increase the subscription to Nursing Standard has been cancelled from 1 January 2015. Please note that table of contents for this journal and other RCN published journals (including abstracts) are available from the RCN publishing website . The library can obtain full text articles via our inter-library loan service if required.

WUTH Publication: Nicorandil-associated ulceration of the gastrointestinal tract: side effects requiring surgical intervention.

Citation:Int J Colorectal Dis. 2015 Jan 13. [Epub ahead of print]
Nicorandil-associated ulceration of the gastrointestinal tract: side effects requiring surgical intervention.
Author:Shapey IM¹, Agbamu D, Newall N, Titu LV.Department of Colorectal Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Road, Wirral, Merseyside, CH49 5PE, UK, i.m.shapey@doctors.org.uk.

Link to Pubmed Record