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
Friday, 23 October 2015
Monday, 12 October 2015
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.
Link to PubMed record.
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
KEYWORDS: Drugs; Macula; Retina; Treatment Medical
Link to PubMed record.
Friday, 9 October 2015
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.
Link to PubMed record
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
KEYWORDS: expectations; experiences; inpatient; pharmacy services
Link to PubMed record
Thursday, 8 October 2015
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.
Friday, 2 October 2015
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
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
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