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
Monday, 28 September 2015
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
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
Thursday, 27 August 2015
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.
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
Author: Ahmad N, Thomas GN, Gill P, Chan C, Torella F
Link to PubMed record
Tuesday, 18 August 2015
Growing our own: Supporting Trainee Advanced Nurse Practitioners
Read more here.
Monday, 17 August 2015
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
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
Thursday, 13 August 2015
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
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
Author: Ramavath AL, Geary N
Link to PubMed record
Monday, 10 August 2015
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
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
Friday, 7 August 2015
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
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
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