Citation: The Journal of Foot and Ankle Surgery. 2018, 57(1), 81-85
Author: Howard N, Cowan C, Ahluwalia R, Wright A, Hennessy M, Jackson G, Platt S
Abstract: A patient-specific letter was introduced to the consent process to observe the effect, if any, on information recall and satisfaction for patients undergoing elective foot and ankle surgery. The patients attending the clinic were written a personalized letter-this was a simple personalized letter that outlined their treatment options, the proposed management plan, likely treatment course, and the benefits, risks, and likely period required for recovery. The personalized letter system was compared with the 2 existing methods of consent process: signing for consent at their outpatient encounter at which they were scheduled for surgery and a separate consent clinic without the personalized letter. A total of 111 patients (87 females, 24 males) undergoing elective foot and ankle surgery were assessed on the day of surgery for recall of the procedure, risks, postoperative course, and satisfaction with the consent process. Patients receiving a personalized letter recalled more than those who had attended a routine preoperative consent clinic visit and significantly more than those who had provided consent at their last clinic visit. Patient satisfaction with the consent process was also greater in the personalized group. Our results suggest that the consent process is improved using routine preoperative consent clinics and, most notably, with patient-specific information to improve patient recall and satisfaction.
KEYWORDS: clinical governance; foot and ankle; informed consent; recall; risk management; risks; surgery
Link to PubMed record
Wednesday, 27 December 2017
Friday, 22 December 2017
WUTH publication: Machine learning enhanced virtual autopsy
Citation: Autopsy & case reports. 2017,7(4), 3-7
Author: O'Sullivan S, Holzinger A, Zatloukal K, Saldiva P, Sajid MI, Wichmann D
Abstract: KEYWORDS: Artificial Intelligence; Autopsy; Machine Learning; Magnetic Resonance Imaging; Metabolomics
Link to PubMed record
Author: O'Sullivan S, Holzinger A, Zatloukal K, Saldiva P, Sajid MI, Wichmann D
Abstract: KEYWORDS: Artificial Intelligence; Autopsy; Machine Learning; Magnetic Resonance Imaging; Metabolomics
Link to PubMed record
Tuesday, 19 December 2017
WUTH publication: Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial
Citation: Lancet. 2018, 391(10121), 668-678 [Epub 2017 Dec 14]
Author: Thwaites GE, Scarborough M, Szubert A, Nsutebu E, Tilley R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS, United Kingdom Clinical Infection Research Group (UKCIRG)
Abstract: BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.
METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.
FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).
INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.
FUNDING: UK National Institute for Health Research Health Technology Assessment.
Link to PubMed record
Author: Thwaites GE, Scarborough M, Szubert A, Nsutebu E, Tilley R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS, United Kingdom Clinical Infection Research Group (UKCIRG)
Abstract: BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.
METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.
FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).
INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.
FUNDING: UK National Institute for Health Research Health Technology Assessment.
Link to PubMed record
Friday, 1 December 2017
WUTH publication: An Outbreak of Pseudomonas Aeruginosa Infection Linked to a "Black Friday" Piercing Event
Citation: PloS Currents. 2017 Oct 16;9
Author: MacPherson P, Valentine K, Chadderton V, Dardamissis E, Doig I, Fox A, Ghebrehewet S, Hampton T, Mutton K, Sherratt C, McCann CM
Abstract: INTRODUCTION: Outbreaks linked to cosmetic piercing are rare, but can cause significant illness. We report the investigation and management of a point-source outbreak that occurred during a Black Friday promotional event in North West England.
METHODS: Outbreak investigation was led by Public Health England, and included active case finding among individuals pierced at a piercing premises between 25/11/2016 (Black Friday) and 7/12/2016. Detailed epidemiological, environmental (including inspection and sampling), and microbiological investigation was undertaken.
RESULTS: During the Black Friday event (25/11/2016), 45 people were pierced (13 by a newly-appointed practitioner). Eleven cases were identified (7 microbiologically-confirmed, 2 probable, and 2 possible). All cases had clinical signs of infection around piercing sites, and five required surgical intervention, with varying degrees of post-operative disfigurement. All confirmed and probable cases had a scaffold piercing placed with a guide bar by the newly-appointed practitioner. Pseudomonas aeruginosa, indistinguishable at nine-locus variable-number tandem repeat loci, was isolated from four of the confirmed cases, and from pre- and post-flush samples from five separate water taps (three sinks) in the premises. Water samples taken after remedial plumbing work confirmed elimination of Pseudomonas contamination.
DISCUSSION: Although high levels of Pseudomonas water contamination and some poor infection control procedures were identified, infection appeared to require additional exposure to an inexperienced practitioner, and the more invasive scaffold piercing. A proactive collaborative approach between piercers and health and environmental officials is required to reduce outbreak risk, particularly when unusually large events are planned.
Link to PubMed record
Author: MacPherson P, Valentine K, Chadderton V, Dardamissis E, Doig I, Fox A, Ghebrehewet S, Hampton T, Mutton K, Sherratt C, McCann CM
Abstract: INTRODUCTION: Outbreaks linked to cosmetic piercing are rare, but can cause significant illness. We report the investigation and management of a point-source outbreak that occurred during a Black Friday promotional event in North West England.
METHODS: Outbreak investigation was led by Public Health England, and included active case finding among individuals pierced at a piercing premises between 25/11/2016 (Black Friday) and 7/12/2016. Detailed epidemiological, environmental (including inspection and sampling), and microbiological investigation was undertaken.
RESULTS: During the Black Friday event (25/11/2016), 45 people were pierced (13 by a newly-appointed practitioner). Eleven cases were identified (7 microbiologically-confirmed, 2 probable, and 2 possible). All cases had clinical signs of infection around piercing sites, and five required surgical intervention, with varying degrees of post-operative disfigurement. All confirmed and probable cases had a scaffold piercing placed with a guide bar by the newly-appointed practitioner. Pseudomonas aeruginosa, indistinguishable at nine-locus variable-number tandem repeat loci, was isolated from four of the confirmed cases, and from pre- and post-flush samples from five separate water taps (three sinks) in the premises. Water samples taken after remedial plumbing work confirmed elimination of Pseudomonas contamination.
DISCUSSION: Although high levels of Pseudomonas water contamination and some poor infection control procedures were identified, infection appeared to require additional exposure to an inexperienced practitioner, and the more invasive scaffold piercing. A proactive collaborative approach between piercers and health and environmental officials is required to reduce outbreak risk, particularly when unusually large events are planned.
Link to PubMed record
Tuesday, 28 November 2017
WUTH publication: Care of patients undergoing weaning from mechanical ventilation in critical care
Citation: Nursing Standard. 2017, 32(13), 41-51
Author: Elliott S, Morrell-Scott N
Abstract: There are several reasons why mechanical ventilation - the use of an artificial device to assist a patient to breathe - may be initiated, for example to enable general anaesthesia for patients undergoing surgery, and for those with a compromised airway or respiratory failure. It is important that critical care nurses have the skills and knowledge to care for patients who are undergoing weaning from mechanical ventilation. This is to ensure that patients are weaned safely and as soon as possible, to improve their outcomes and avoid an increase in patient mortality and morbidity through complications that can arise such as airway trauma and ventilator-associated pneumonia. Furthermore, there are resource and cost implications of patients not being weaned as soon as possible.
KEYWORDS: critical care; critical care nursing; extubation; mechanical ventilation; mechanical ventilation weaning; respiratory failure
Link to PubMed record
Author: Elliott S, Morrell-Scott N
Abstract: There are several reasons why mechanical ventilation - the use of an artificial device to assist a patient to breathe - may be initiated, for example to enable general anaesthesia for patients undergoing surgery, and for those with a compromised airway or respiratory failure. It is important that critical care nurses have the skills and knowledge to care for patients who are undergoing weaning from mechanical ventilation. This is to ensure that patients are weaned safely and as soon as possible, to improve their outcomes and avoid an increase in patient mortality and morbidity through complications that can arise such as airway trauma and ventilator-associated pneumonia. Furthermore, there are resource and cost implications of patients not being weaned as soon as possible.
KEYWORDS: critical care; critical care nursing; extubation; mechanical ventilation; mechanical ventilation weaning; respiratory failure
Link to PubMed record
Friday, 24 November 2017
WUTH publication: Reducing the Rate of Abdominal Hysterectomies: Experience From a UK University Teaching Hospital
Citation: Journal of minimally invasive gynecology. 2017 Nov 14
Author: Minas V, Gul N, Aust T, Rowlands D
Abstract: KEYWORDS: abdominal hysterectomy; gynaecological surgery; laparoscopic hysterectomy; robotic hysterectomy; vaginal hysterectomy
Link to PubMed record
Author: Minas V, Gul N, Aust T, Rowlands D
Abstract: KEYWORDS: abdominal hysterectomy; gynaecological surgery; laparoscopic hysterectomy; robotic hysterectomy; vaginal hysterectomy
Link to PubMed record
Wednesday, 15 November 2017
WUTH publication: The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group
Citation: European journal of trauma and Emergency Surgery. 2018, 44(6), 877-82. [Epub 2017 Nov 13]
Author: Simpson G, Saunders R, Wilson J, Magee C
Abstract: INTRODUCTION: Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy.
METHODS: A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann-Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests.
RESULTS: One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80-96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality.
CONCLUSION: Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.
KEYWORDS: CRP; Elderly; Laparotomy; Mortality; Neutrophil/lymphocyte ratio
Link to PubMed record
Author: Simpson G, Saunders R, Wilson J, Magee C
Abstract: INTRODUCTION: Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy.
METHODS: A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann-Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests.
RESULTS: One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80-96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality.
CONCLUSION: Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.
KEYWORDS: CRP; Elderly; Laparotomy; Mortality; Neutrophil/lymphocyte ratio
Link to PubMed record
Dementia and Alzheimer’s
Relevant
articles from MA Healthcare journals to support your staff’s education and
practice
November
2017
Today 1 in 6 people over 80 are affected by dementia – 60% of these
being subsequently diagnosed with Alzheimer’s disease. As a condition that
progressively worsens over time, dementia has a significant emotional, social
and practical impact on not just the patient but also upon their family
members, friends and carers. NHS staff today need to be aware of the many
complex factors that are involved in the diagnosis and care of those affected.
This month MA Healthcare is raising awareness about the importance of meeting
the needs of people living with dementia and Alzheimer’s so they can receive
the best care the deserve with dignity and respect.
We have provided a list of relevant articles from MA Healthcare
journals dealing with this area, thereby providing your NHS staff with research,
information and tips that will support both their work and their patients.
Practice Nursing:
·
Communicating with people with dementia http://www.magonlinelibrary.com/doi/10.12968/pnur.2015.26.12.579
·
Transforming attitudes to dementia with a little
help from our friends http://www.magonlinelibrary.com/doi/10.12968/pnur.2016.27.8.395
British Journal Hospital
Medicine:
·
Understanding safe discharge of patients with
dementia from the acute hospital http://www.magonlinelibrary.com/doi/10.12968/hmed.2016.77.3.126
British Journal of
Community Nursing:
·
Sleep and dementia
Nursing and
Residential Care:
·
Continence care and dementia: practical advice
for care staff http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.8.450
·
Dementia is a disease and diseases can be
treated http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.8.464
British Journal of
Healthcare Management:
·
Neuroimaging in the assessment and treatment of
dementias http://www.magonlinelibrary.com/doi/10.12968/bjhc.2016.22.2.63
·
The needs of informal carers for people with
dementia http://www.magonlinelibrary.com/doi/10.12968/bjhc.2012.18.12.628
Nurse Prescribing:
·
Reducing anti-psychotic prescribing for care
home residents with dementia http://www.magonlinelibrary.com/doi/10.12968/npre.2017.15.10.504
Independent Nurse:
·
Assessing dementia
Practice Management:
·
Dementia: The path to a cure http://www.magonlinelibrary.com/doi/10.12968/prma.2017.27.7.16
British Journal of
Neuroscience Nursing:
·
Communication in end-of-life care for people
with dementia: an Admiral Nurse case study http://www.magonlinelibrary.com/doi/10.12968/bjnn.2017.13.2.70
·
Prevention of incontinence-associated dermatitis
in people with dementia http://www.magonlinelibrary.com/doi/10.12968/bjnn.2015.11.5.228
British Journal
of Healthcare Assistants:
·
Back to BACE: one approach to fighting
Alzheimer's http://www.magonlinelibrary.com/doi/10.12968/bjha.2017.11.1.10
·
Types of dementia: an introduction http://www.magonlinelibrary.com/doi/10.12968/bjha.2017.11.3.132
British Journal of
Nursing:
·
Perceptions and development needs of assistant
practitioners supporting individuals with dementia
·
Encouraging positive interactions in dementia
care http://www.magonlinelibrary.com/doi/10.12968/bjon.2016.25.21.1162
Friday, 10 November 2017
FAB Change Week
Monday is the first day of Fab Change Week. Why not make it your first day to change something?
The Academy of Fabulous Stuff https://fabnhsstuff.net/ is “a collaboration to ensure best practice examples, great ideas and service solutions are available to all” by “sharing all the fabulous things about the NHS. “
This week it encourages you to make a pledge to make a change, be it service improvement, staff well-being, patient safety or experience or anything you like!
You can make a pledge on their website here https://fabnhsstuff.net/fabchangeweek/add-pledges or on social media using the hashtag #FabChangeWeek
Ask your WUTH Fab ambassador Leanne Lockley for more details
Friday, 3 November 2017
Make a pledge to change!
Today is the first day of Fab Change Week. Why not make it
your first day to change something?
The Academy of Fabulous Stuff https://fabnhsstuff.net/ is “a collaboration to ensure best practice
examples, great ideas and service solutions are available to all” by “sharing
all the fabulous things about the NHS. “
This week it encourages you to make a pledge to make a
change, be it service improvement, staff well-being, patient safety or
experience or anything you like!
You can make a pledge on their website here https://fabnhsstuff.net/fabchangeweek/add-pledges
or on social media using the hashtag
#FabChangeWeek
Ask your WUTH Fab ambassador Leanne for more details
Dissections, cross sections and anatomical inspections
This week includes 2 awareness events in clinical support
National Pathology Week (6-12 November) celebrates the important
contribution pathologists make to healthcare, through a programme of events
aimed at people of all ages. Visit the Royal College of Pathologists website https://www.rcpath.org/discover-pathology/events-landing-page/national-pathology-week.html
which includes a competitions to win a £100 gift card and a £100 cash prize
Wednesday November 8th. is World Radiography Day. The date marks the anniversary of the
discovery of x-radiation by Wilhelm Roentgen in 1895., Visit the Society of Radiographers website for
more details about the day. https://www.sor.org/about-radiography/world-radiography-day
To take a look at slides, cross sections and thousands of
anatomical images, the LKS can help you
access Anatomy TV. Available to all WUTH staff and students on placement, you
can navigate through the anatomical structure. All you need is an Open NHS
Athens account.
To enquire about Anatomy TV, please ask a member of LKS
staff
WUTH publication:
Citation: The Bone & Joint Journal. 2017, 99-B(11), 1545-1551
Author: Makki D, Elgamal T, Evans P, Harvey D, Jackson G, Platt S
Abstract: AIMS: The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia.
PATIENTS AND METHODS: A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded. All patients with an arthroplasty at the time were evaluated for any prosthetic involvement.
RESULTS: The most common site of infection was the spine, which occurred in 28 patients (58%), and was associated with abscess formation in 16. Back pain was the presenting symptom in these patients, with a positive predictive value of 100%. A total of 24 patients had a total of 42 arthroplasties of the hip or knee in situ. Prosthetic joint infection occurred in six of these patients (25%). In five patients, the infection originated outside the musculoskeletal system. Three patients (6%) with MSSA septicaemia from a musculoskeletal sources died.
CONCLUSION: Amongst the musculoskeletal sources of MSSA septicaemia, the spine was the most commonly involved. We recommend an MRI scan of the whole spine and pelvis in patients with MSSA septicaemia with back pain, when the primary source of infection has not been identified or clinical examination is unreliable. Cite this article: Bone Joint J 2017;99-B:1545-51.
KEYWORDS: MRI scan; Musculoskeletal infection; Spinal infection; Staphylococcus aureus septicaemia
Link to PubMed record
Author: Makki D, Elgamal T, Evans P, Harvey D, Jackson G, Platt S
Abstract: AIMS: The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia.
PATIENTS AND METHODS: A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded. All patients with an arthroplasty at the time were evaluated for any prosthetic involvement.
RESULTS: The most common site of infection was the spine, which occurred in 28 patients (58%), and was associated with abscess formation in 16. Back pain was the presenting symptom in these patients, with a positive predictive value of 100%. A total of 24 patients had a total of 42 arthroplasties of the hip or knee in situ. Prosthetic joint infection occurred in six of these patients (25%). In five patients, the infection originated outside the musculoskeletal system. Three patients (6%) with MSSA septicaemia from a musculoskeletal sources died.
CONCLUSION: Amongst the musculoskeletal sources of MSSA septicaemia, the spine was the most commonly involved. We recommend an MRI scan of the whole spine and pelvis in patients with MSSA septicaemia with back pain, when the primary source of infection has not been identified or clinical examination is unreliable. Cite this article: Bone Joint J 2017;99-B:1545-51.
KEYWORDS: MRI scan; Musculoskeletal infection; Spinal infection; Staphylococcus aureus septicaemia
Link to PubMed record
Wednesday, 1 November 2017
Care of the Elderly
Relevant articles from MA Healthcare
journals to support your staff’s education and practice
October 2017
With the UK’s rapidly aging
population, healthcare professionals within the NHS are facing an increasing
number of complex health conditions relating to the health and care of elderly
people. The more common conditions affecting older patients are cardiovascular
disease, dementia, Alzheimer’s, diabetes, and cancer. Frailty is also a major
issue with the increase in the number of bone fractures resulting from falls
and accidents. Mental health is just as important, with loneliness and
isolation having an additional impact on the health of elderly people today.
This month
MA Healthcare is raising awareness about the importance of right care of the
elderly, so that they can receive the high-quality health and social care they
need in order to live happy and healthy lives.
We have
provided a list of relevant articles from MA Healthcare journals dealing with
this area, thereby providing your NHS staff with research, information and tips
that will support both their work and their patients.
Journal of Kidney Care:
·
CKD
and frailty: outcomes from a quality initiative for older patients
·
Achieving
the best results for older people on peritoneal dialysis
Practice Management:
·
Dementia:
The path to a cure
·
Caring
conversations
British Journal of Hospital Medicine:
·
Infection
in the older patient
·
Assessment
of frailty in the inpatient setting
British Journal of Community Nursing;
·
Preventing
falls in older people
·
Perspectives
on the risks for older adults living independently
British Journal of Neuroscience
Nursing:
·
Frail
older people shown to be at risk of traumatic brain injury
·
Communication
in end-of-life care for people with dementia: an Admiral Nurse case study
Nurse Prescribing:
·
Helping
people grow old gracefully
·
Polypharmacy
and older people
British Journal of Nursing:
·
Ensuring
the safe discharge of older patients from hospital
·
Student
nurses' perceptions of dignity in the care of older people
Practice Nursing:
|
·
A perfect storm: an elderly population,
increasing obesity and rises in diabetes and dementia
Gastrointestinal nursing:
·
Gastrointestinal issues in cystic fibrosis: a
lifetime of disease http://www.magonlinelibrary.com/doi/10.12968/gasn.2016.14.5.39
·
Older people and alcohol use
|
|
British Journal of Healthcare Assistants:
·
Advance care planning: the HCA's role
·
Bed bathing: how good cleaning turns into great care
Independent Nurse:
·
Post-polio syndrome: The legacy of a long-forgotten problem https://doi.org/10.12968/indn.2017.4.21
·
Malnutrition in the elderly
|
Monday, 30 October 2017
UpToDate extras
UpToDate now covers Anesthesiology! With 271 evidence summaries and 897 graphics, content covers surgical procedures and other interventions, pain management, opioid avoidance, blood transfusion, and postoperative critical care.
Access UpToDate via Cerner, via the intranet home page or via www.uptodate.com (for off-site access you'll need an OpenAthens account). If you register you can also get mobile access via the UpToDate app.
Access UpToDate via Cerner, via the intranet home page or via www.uptodate.com (for off-site access you'll need an OpenAthens account). If you register you can also get mobile access via the UpToDate app.
Friday, 20 October 2017
Book Club
As part of Fab Change Week 13-17th November 2017 your Library & Knowledge Service will be starting a Book Club. This initiative is in response to some feedback we have received during the launch of our lovely colourful comfy Library Lounge and has also been requested via Listening into Action huddles.
If you are interested in being part of this exciting initiative, made possible by collaboration with our Wirral Public Library colleagues, please come along to the McArdle Library on Wednesday 15th November between 11.00 and 12.00 to have a chat, find out how the Book Club will work, suggest a day and time (about four weeks later to allow time for reading) that would work for you and collect your copy of the first book “The Rosie Project” by Graeme Simsion. We know that with so many colleagues working shifts etc. that picking a day and time for the Club to happen is going to be the trickiest bit of the process, but let’s see what we can do. We are really hoping that there is a group of people who want to be part of Book Club on a regular basis. Let us know what you think.
If you are interested in being part of this exciting initiative, made possible by collaboration with our Wirral Public Library colleagues, please come along to the McArdle Library on Wednesday 15th November between 11.00 and 12.00 to have a chat, find out how the Book Club will work, suggest a day and time (about four weeks later to allow time for reading) that would work for you and collect your copy of the first book “The Rosie Project” by Graeme Simsion. We know that with so many colleagues working shifts etc. that picking a day and time for the Club to happen is going to be the trickiest bit of the process, but let’s see what we can do. We are really hoping that there is a group of people who want to be part of Book Club on a regular basis. Let us know what you think.
Thursday, 19 October 2017
Research / Library Drop-in Support session
Friday 20 October any time between 12-2pm
Library, Education Centre, APH
Have you any questions about research that need answering? If so, we are here to help.
· Where do I start?
· How should I undertake a literature search?
· What is a critical appraisal and how can I access tools to assist me to be more critical?
· What is the difference between research, audit and service evaluation?
· What approvals do I need?
Bespoke support and advice will be given.
If you are unable to attend on the day please email either the Library on WUTH.LKS@NHS.NET or the Research Department wih-tr.ResearchDepartment@nhs.net who will be happy to help.
Wednesday, 18 October 2017
Your Library Story: the winning entry
Congratulations to Graham Dawson for winning the Your Library Story competition with the below entry!
Library and Knowledge Service: From A to ZZZzzzzzzz
"An impromptu but confidential meeting in my shared office led me on the path to the Library and Knowledge Service Helpdesk. I was greeted with warmth and friendliness. The time is now to sort my niggle I thought. Unbeknown to them, over the next few minutes the Library and Knowledge Service staff would set in motion, the best year of sleep I’d had since I was a child.
My niggle you see, was the fact that I fell out of love with reading. The mobile phone had defeated the book mark. From a book a week before my teens, to whatever was necessary at University. Despite ‘resolutions’ here, impromptu book purchases there, nothing had reignited my love of reading.
“I’m after a book that isn’t too heavy, but will get me excited about reading again”, I was quickly directed to the aptly named ‘sit back and relax’ easy reading section. Despite having knowledge of the well know phrase, I started my pursuit of a good looking book cover. Less than a minute later, I was asked if I needed further help. Their help led me to completing a trilogy of crime fiction but most importantly led me to a year of good sleep. I had been reading from my mobile but the blue light that shone in my eyes into the early hours was making me immobile. I will admit I was addicted to my phone. Now with a book before bed, I will be asleep before my pillow touches my head.
I am a slow reader I will admit, so I found myself extending my loan on several occasions; this was never a problem or a chore to the team. So thank you to you, the Library and Knowledge Service team. Goodnight."
Library and Knowledge Service: From A to ZZZzzzzzzz
"An impromptu but confidential meeting in my shared office led me on the path to the Library and Knowledge Service Helpdesk. I was greeted with warmth and friendliness. The time is now to sort my niggle I thought. Unbeknown to them, over the next few minutes the Library and Knowledge Service staff would set in motion, the best year of sleep I’d had since I was a child.
My niggle you see, was the fact that I fell out of love with reading. The mobile phone had defeated the book mark. From a book a week before my teens, to whatever was necessary at University. Despite ‘resolutions’ here, impromptu book purchases there, nothing had reignited my love of reading.
“I’m after a book that isn’t too heavy, but will get me excited about reading again”, I was quickly directed to the aptly named ‘sit back and relax’ easy reading section. Despite having knowledge of the well know phrase, I started my pursuit of a good looking book cover. Less than a minute later, I was asked if I needed further help. Their help led me to completing a trilogy of crime fiction but most importantly led me to a year of good sleep. I had been reading from my mobile but the blue light that shone in my eyes into the early hours was making me immobile. I will admit I was addicted to my phone. Now with a book before bed, I will be asleep before my pillow touches my head.
I am a slow reader I will admit, so I found myself extending my loan on several occasions; this was never a problem or a chore to the team. So thank you to you, the Library and Knowledge Service team. Goodnight."
Monday, 9 October 2017
Your Library Story
It's Libraries Week and to celebrate we’re running a library competition! Tell us your library story to be in with a chance to win our goodie bag (includes chocolate, stationery and library goodies!).
Your story can be as long or short as you like and should be
about your use of the Library & Knowledge Service. You might want to include:
- How the library has made a difference to you
- Your favourite book or resource and why
- Why you love the library
- Any feedback about the service and how we can improve it
Your Library Story can be submitted via email (wuth.lks@nhs.net), on paper or as a Tweet (use #WUTHlibrarystory and be creative with your character limit!).
Competition closes 5pm on Friday 14th
October. The winner will be selected for
its fabulousness by the trust’s FAB Ambassador, Leeanne Lockley, and the winner
will be notified on Weds 18th October. Good luck!
Find out more at www.librariesweek.org.uk
or contact Victoria Treadway, Library & Knowledge Service Lead victoria.treadway@nhs.net.
Tuesday, 3 October 2017
WUTH publication: Concerns over: Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease
Citation: European Journal of Ophthalmology. Sept 28 [epub]
Author: Clearkin L
Link to PubMed record
Author: Clearkin L
Link to PubMed record
Wednesday, 27 September 2017
Macmillan Coffee Morning this Friday
Come and join us for a Macmillan Coffee Morning Event in the McArdle Library on 29th September 2017 between 11.00 a.m. and 2.00 p.m.
Please do:
Please do:
- make or bring cake to sell
- bring along any items you would like to donate for the raffle (these can be passed to Library staff as soon as you can)
- buy and eat cake
- buy and win with raffle tickets
- Celebrate with us when we announce how much we all raised for this great cause
Tuesday, 19 September 2017
WUTH publication: Twelve tips on how to compile a medical educator's portfolio
Citation: Medical Teacher. 2018, 40(2), 140-145. Epub 2017 Sep 17
Author: Dalton CL, Wilson A, Agius S
Abstract: Medical education is an expanding area of specialist interest for medical professionals. Whilst most doctors will be familiar with the compilation of clinical portfolios for scrutiny of their clinical practice and provision of public accountability, teaching portfolios used specifically to gather and demonstrate medical education activity remain uncommon in many non-academic settings. For aspiring and early career medical educators in particular, their value should not be underestimated. Such a medical educator's portfolio (MEP) is a unique compendium of evidence that is invaluable for appraisal, revalidation, and promotion. It can stimulate and provide direction for professional development, and is a rich source for personal reflection and learning. We recommend that all new and aspiring medical educators prepare an MEP, and suggest twelve tips on how to skillfully compile one.
Link to PubMed record
Author: Dalton CL, Wilson A, Agius S
Abstract: Medical education is an expanding area of specialist interest for medical professionals. Whilst most doctors will be familiar with the compilation of clinical portfolios for scrutiny of their clinical practice and provision of public accountability, teaching portfolios used specifically to gather and demonstrate medical education activity remain uncommon in many non-academic settings. For aspiring and early career medical educators in particular, their value should not be underestimated. Such a medical educator's portfolio (MEP) is a unique compendium of evidence that is invaluable for appraisal, revalidation, and promotion. It can stimulate and provide direction for professional development, and is a rich source for personal reflection and learning. We recommend that all new and aspiring medical educators prepare an MEP, and suggest twelve tips on how to skillfully compile one.
Link to PubMed record
WUTH publication: Post-operative C-reactive protein profile following abdominal wall reconstruction with transversus abdominis posterior components separation
Citation: International Journal of Surgery Case Reports. 2017, 40, 17-19
Author: Pearce A, Thornton L, Sutton PA, Walsh CJ
Abstract: INTRODUCTION: Abdominal wall reconstruction using posterior component separation with transversus abdominis release (AWTAR) produces a unique post-operative CRP profile, when compared to routine elective colorectal operations. Therefore, we aim to establish the normal post-operative C-reactive protein (poCRP) profile following AWRTAR and reduce the unnecessary invasive interventions in patients already at greater risk of septic complications.
METHODS: A retrospective analysis of daily poCRP levels was performed both for patients who underwent uncomplicated AWRTAR (n=12), and a comparator group of uncomplicated open right hemicolectomies (RH) matched for age and sex (n=24). All operations in both groups were performed by a single surgeon from 2013 to 2015.
RESULTS: The median (IQR) age was 62 (16) and 67 (16) years respectively, with a higher proportion of males to females in both groups (10:2 vs. 17:7). The poCRP profile follows an initial steep rise, peaking at day 2 followed by a gradual washout phase. The poCRP peak is significantly greater in the AWRTAR group compared to the RH group (274 [95%CI ±25] vs. 160 [95%CI±27]; p=0.0001), with a positive correlation between day 2 CRP levels and operative length (r=0.56).
CONCLUSIONS: We have demonstrated that uncomplicated AWRTAR provokes a significantly greater poCRP rise (>200) compared to that well described in the literature for uncomplicated open colectomy. As poCRP is an important marker of post-operative recovery with abnormally high levels associated with septic complications, these data should help clinicians interpret the post-operative clinical course after AWRTAR.
KEYWORDS: Abdominal wall reconstruction; CRP; Complications; Hernia; Post-operative; Transversus abdominis release
Link to PubMed record
Author: Pearce A, Thornton L, Sutton PA, Walsh CJ
Abstract: INTRODUCTION: Abdominal wall reconstruction using posterior component separation with transversus abdominis release (AWTAR) produces a unique post-operative CRP profile, when compared to routine elective colorectal operations. Therefore, we aim to establish the normal post-operative C-reactive protein (poCRP) profile following AWRTAR and reduce the unnecessary invasive interventions in patients already at greater risk of septic complications.
METHODS: A retrospective analysis of daily poCRP levels was performed both for patients who underwent uncomplicated AWRTAR (n=12), and a comparator group of uncomplicated open right hemicolectomies (RH) matched for age and sex (n=24). All operations in both groups were performed by a single surgeon from 2013 to 2015.
RESULTS: The median (IQR) age was 62 (16) and 67 (16) years respectively, with a higher proportion of males to females in both groups (10:2 vs. 17:7). The poCRP profile follows an initial steep rise, peaking at day 2 followed by a gradual washout phase. The poCRP peak is significantly greater in the AWRTAR group compared to the RH group (274 [95%CI ±25] vs. 160 [95%CI±27]; p=0.0001), with a positive correlation between day 2 CRP levels and operative length (r=0.56).
CONCLUSIONS: We have demonstrated that uncomplicated AWRTAR provokes a significantly greater poCRP rise (>200) compared to that well described in the literature for uncomplicated open colectomy. As poCRP is an important marker of post-operative recovery with abnormally high levels associated with septic complications, these data should help clinicians interpret the post-operative clinical course after AWRTAR.
KEYWORDS: Abdominal wall reconstruction; CRP; Complications; Hernia; Post-operative; Transversus abdominis release
Link to PubMed record
Thursday, 31 August 2017
WUTH publication: The BeSMART (Best Supportive Management for Adults Referred with Tonsillopharyngitis) multicentre observational stud
Citation: Annals of the Royal College of Surgeons of England. 2017, 99(7), 573-578
Author: Lau AS, Mamais C, McChesney E, Upile NS, Vaughan C, Veitch J, Abbas JR, Markey A, Brown NG, Evans M, Thomas J, Gaines M, Shehata Z, Wilkie MD, Leong SC
Abstract: Introduction Tonsillopharyngitis is the most common ear, nose and throat emergency admission, with 80,000 episodes recorded in England in 2015-2016. Despite this, there is a paucity of evidence addressing the supportive management of tonsillopharyngitis in inpatients. The aim of this retrospective multicentre observational study was to consider the Best Supportive Management for Adults Referred with Tonsillopharyngitis (BeSMART) in the inpatient setting, and to establish any associations between practice and outcomes. Methods Seven hospitals in North West England and North East Scotland participated in the study. Overall, 236 adult patients admitted with tonsillopharyngitis were included. The main outcome measures were interval to return to soft diet, length of stay (LOS), pain scores and readmissions. Results Women were more likely to seek professional help before presenting to secondary care (p=0.04). Patients admitted at the weekend were more likely to have a shorter LOS (p=0.03). There was no relationship between day of admission and seniority or specialty of the doctor initially seen. Prescription of corticosteroid, analgesia and a higher initial intravenous fluid infusion rate were not related to a shorter LOS. Conclusions This study is the first to yield valuable insights into the inpatient management of tonsillopharyngitis. This work represents part of an ongoing project to establish the evidence for common medical interventions for sore throat. Patient and professional surveys as well as a prospective interventional study are planned for the future.
KEYWORDS: Analgesia; Corticosteroid; Length of stay; Tonsillitis
Link to PubMed record
Author: Lau AS, Mamais C, McChesney E, Upile NS, Vaughan C, Veitch J, Abbas JR, Markey A, Brown NG, Evans M, Thomas J, Gaines M, Shehata Z, Wilkie MD, Leong SC
Abstract: Introduction Tonsillopharyngitis is the most common ear, nose and throat emergency admission, with 80,000 episodes recorded in England in 2015-2016. Despite this, there is a paucity of evidence addressing the supportive management of tonsillopharyngitis in inpatients. The aim of this retrospective multicentre observational study was to consider the Best Supportive Management for Adults Referred with Tonsillopharyngitis (BeSMART) in the inpatient setting, and to establish any associations between practice and outcomes. Methods Seven hospitals in North West England and North East Scotland participated in the study. Overall, 236 adult patients admitted with tonsillopharyngitis were included. The main outcome measures were interval to return to soft diet, length of stay (LOS), pain scores and readmissions. Results Women were more likely to seek professional help before presenting to secondary care (p=0.04). Patients admitted at the weekend were more likely to have a shorter LOS (p=0.03). There was no relationship between day of admission and seniority or specialty of the doctor initially seen. Prescription of corticosteroid, analgesia and a higher initial intravenous fluid infusion rate were not related to a shorter LOS. Conclusions This study is the first to yield valuable insights into the inpatient management of tonsillopharyngitis. This work represents part of an ongoing project to establish the evidence for common medical interventions for sore throat. Patient and professional surveys as well as a prospective interventional study are planned for the future.
KEYWORDS: Analgesia; Corticosteroid; Length of stay; Tonsillitis
Link to PubMed record
Friday, 25 August 2017
Wednesday, 16 August 2017
Out of hours access to the McArdle library is back!
Due to unforeseen circumstances we require you to call in to the library between 9am-4.30pm (Mon-Fri) to have your access re-enabled.
This process will take 5 minutes. Apologies for any inconvenience.
This process will take 5 minutes. Apologies for any inconvenience.
Monday, 7 August 2017
WUTH publication: Salivary duct carcinoma arising from the inferior turbinate
Citation: Journal of Surgical Case Reports. 2017(7). eCollection 2017 Jul.
Author: Vallabh N, Srinivasan V, Hughes D, Agbamu D
Abstract: Salivary duct carcinoma (SDC) is an uncommon, aggressive tumour, which carries a poor prognosis. SDC affects the major salivary glands, usually occurring in the parotid gland. A 76-year-old male patient presented with right-sided nasal obstruction and rhinorrhoea. A polypoidal mass was seen in the right inferior turbinate mimicking a benign neoplasm. Histological examination following wide excision led to a diagnosis of SDC. There are no therapeutic guidelines and management is based on experience with SDC of the major salivary glands. Given the aggressive nature and poor prognosis of the disease, it is a rare but important differential to consider in patients with unilateral nasal mass.
Link to PubMed record
Author: Vallabh N, Srinivasan V, Hughes D, Agbamu D
Abstract: Salivary duct carcinoma (SDC) is an uncommon, aggressive tumour, which carries a poor prognosis. SDC affects the major salivary glands, usually occurring in the parotid gland. A 76-year-old male patient presented with right-sided nasal obstruction and rhinorrhoea. A polypoidal mass was seen in the right inferior turbinate mimicking a benign neoplasm. Histological examination following wide excision led to a diagnosis of SDC. There are no therapeutic guidelines and management is based on experience with SDC of the major salivary glands. Given the aggressive nature and poor prognosis of the disease, it is a rare but important differential to consider in patients with unilateral nasal mass.
Link to PubMed record
Thursday, 3 August 2017
Learning & Development and Library & Knowledge Service Showcase events
Don't miss our Learning & Development and Library & Knowledge Service Showcase events which
highlight the training, services and support available to you
They are taking place on the following dates and times
Tuesday 8th August 1100-13.30 Elm House Training Room, Clatterbridge Hospital
Friday 11th August 11.00-14.00 Education Centre, Arrowe Park Hospital, Room 6a/6b
Tuesday 5th September 11.00-13.30 Elm House Training Room, Clatterbridge Hospital
Thursday 7th September 8.30-10.30 Education Centre, Arrowe Park Hospital, Room 6a/6b
Tuesday 12th September 11.30-14.00 Education Centre, Arrowe Park Hospital, Room 6a/6b
We look forward to seeing you
highlight the training, services and support available to you
They are taking place on the following dates and times
Tuesday 8th August 1100-13.30 Elm House Training Room, Clatterbridge Hospital
Friday 11th August 11.00-14.00 Education Centre, Arrowe Park Hospital, Room 6a/6b
Tuesday 5th September 11.00-13.30 Elm House Training Room, Clatterbridge Hospital
Thursday 7th September 8.30-10.30 Education Centre, Arrowe Park Hospital, Room 6a/6b
Tuesday 12th September 11.30-14.00 Education Centre, Arrowe Park Hospital, Room 6a/6b
We look forward to seeing you
Wednesday, 2 August 2017
WUTH publication: Altered theta oscillations in resting EEG of fibromyalgia syndrome patients
Citation: European Journal of Pain. 2018, 22(1), 49-57. Epub 2017 Jul 31.
Author: Fallon N, Chiu Y, Nurmikko T, Stancak A
Abstract: BACKGROUND: Fibromyalgia syndrome (FM) is a chronic pain disorder characterized by widespread pain, sleep disturbance, fatigue and cognitive/affective symptoms. Functional imaging studies have revealed that FM and other chronic pain syndromes can affect resting brain activity. This study utilized electroencephalographic (EEG) recordings to investigate the relative power of ongoing oscillatory activity in the resting brain.
METHODS: A 64-channel EEG was recorded at rest in 19 female FM patients and 18 healthy, age-matched, control subjects. The Manual Tender Point Scale (MTPS) examination was performed to quantify tonic pain and tenderness on the day of testing along with measures of mood, arousal and fatigue. Oscillations in delta, theta, alpha, beta and gamma frequency bands were analysed using Standardised Low-Resolution Brain Electromagnetic Tomography to evaluate sources of spectral activity throughout the whole brain.
RESULTS: FM patients exhibited greater pain, tiredness and tension on the day of testing relative to healthy control participants and augmented theta activity in prefrontal and anterior cingulate cortices. No significant differences were seen in other frequency bands. Augmented frontal theta activity in FM patients significantly correlated with measures of tenderness and mean tiredness scores.
CONCLUSIONS: The findings indicate that alterations to resting-state oscillatory activity may relate to ongoing tonic pain and fatigue in FM, and manifest in brain regions relevant for cognitive-attentional aspects of pain processing and endogenous pain inhibition. Enhanced low-frequency oscillations were previously seen in FM and other chronic pain syndromes, and may relate to pathophysiological mechanisms for ongoing pain such as thalamocortical dysrhythmia.
SIGNIFICANCE: Increased prefrontal theta activity may contribute to persistent pain in fibromyalgia or represent the outcome of prolonged symptoms. The findings point to the potential for therapeutic interventions aimed at normalizing neural oscillations, while further research utilizing quantitative analysis of resting EEG could benefit our understanding of fibromyalgia pathophysiology.
© 2017 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.
Link to PubMed record
Author: Fallon N, Chiu Y, Nurmikko T, Stancak A
Abstract: BACKGROUND: Fibromyalgia syndrome (FM) is a chronic pain disorder characterized by widespread pain, sleep disturbance, fatigue and cognitive/affective symptoms. Functional imaging studies have revealed that FM and other chronic pain syndromes can affect resting brain activity. This study utilized electroencephalographic (EEG) recordings to investigate the relative power of ongoing oscillatory activity in the resting brain.
METHODS: A 64-channel EEG was recorded at rest in 19 female FM patients and 18 healthy, age-matched, control subjects. The Manual Tender Point Scale (MTPS) examination was performed to quantify tonic pain and tenderness on the day of testing along with measures of mood, arousal and fatigue. Oscillations in delta, theta, alpha, beta and gamma frequency bands were analysed using Standardised Low-Resolution Brain Electromagnetic Tomography to evaluate sources of spectral activity throughout the whole brain.
RESULTS: FM patients exhibited greater pain, tiredness and tension on the day of testing relative to healthy control participants and augmented theta activity in prefrontal and anterior cingulate cortices. No significant differences were seen in other frequency bands. Augmented frontal theta activity in FM patients significantly correlated with measures of tenderness and mean tiredness scores.
CONCLUSIONS: The findings indicate that alterations to resting-state oscillatory activity may relate to ongoing tonic pain and fatigue in FM, and manifest in brain regions relevant for cognitive-attentional aspects of pain processing and endogenous pain inhibition. Enhanced low-frequency oscillations were previously seen in FM and other chronic pain syndromes, and may relate to pathophysiological mechanisms for ongoing pain such as thalamocortical dysrhythmia.
SIGNIFICANCE: Increased prefrontal theta activity may contribute to persistent pain in fibromyalgia or represent the outcome of prolonged symptoms. The findings point to the potential for therapeutic interventions aimed at normalizing neural oscillations, while further research utilizing quantitative analysis of resting EEG could benefit our understanding of fibromyalgia pathophysiology.
© 2017 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.
Link to PubMed record
Thursday, 27 July 2017
WUTH publication: The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema
Citation: The British Journal of Ophthalmology. 2017, 101(12), 1673-1678
Author: Denniston AK, Chakravarthy U, Zhu H, Lee AY, Crabb DP, Tufail A, Bailey C, Akerele T, Al-Husainy S, Brand C, Downey L, Fitt A, Khan R, Kumar V, Lobo A, Mahmood S, Mandal K, Mckibbin M, Menon G, Natha S, Ong JM, Tsaloumas MD, Varma A, Wilkinson E, Johnston RL, Egan CA, UK DR EMR Users Group
Abstract: AIM: To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery.
METHODS: Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system.
INCLUSION CRITERIA: eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy.
MAIN OUTCOME MEASURE: rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye.
RESULTS: 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01).
CONCLUSIONS: This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS: Cataract; Diabetic macular oedema; Diabetic retinopathy; Electronic medical record; Intravitreal therapy
Link to PubMed record
Author: Denniston AK, Chakravarthy U, Zhu H, Lee AY, Crabb DP, Tufail A, Bailey C, Akerele T, Al-Husainy S, Brand C, Downey L, Fitt A, Khan R, Kumar V, Lobo A, Mahmood S, Mandal K, Mckibbin M, Menon G, Natha S, Ong JM, Tsaloumas MD, Varma A, Wilkinson E, Johnston RL, Egan CA, UK DR EMR Users Group
Abstract: AIM: To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery.
METHODS: Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system.
INCLUSION CRITERIA: eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy.
MAIN OUTCOME MEASURE: rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye.
RESULTS: 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01).
CONCLUSIONS: This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS: Cataract; Diabetic macular oedema; Diabetic retinopathy; Electronic medical record; Intravitreal therapy
Link to PubMed record
Monday, 24 July 2017
WUTH publication: Perioperative Practices Concerning One Anastomosis (Mini) Gastric Bypass: A Survey of 210 Surgeons
Citation: Obesity Surgery. 2018, 28(1), 204-211
Author: Mahawar KK, Kular KS, Parmar C, Van den Bossche M, Graham Y, Carr WRJ, Madhok B, Magee C, Purkayastha S, Small PK
Abstract: BACKGROUND: There is currently little evidence available on the perioperative practices concerning one anastomosis/mini gastric bypass (OAGB/MGB) and no published consensus amongst experts. Even the published papers are not clear on these aspects. The purpose of this study was to understand various perioperative practices concerning OAGB/MGB.
METHODS: Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey. Only surgeons performing this procedure were included.
RESULTS: Two hundred and ten surgeons from 39 countries with a cumulative experience of 68,442 procedures took the survey. Surgeons described a large number of absolute (n = 55) and relative contraindications (n = 59) to this procedure in their practice. Approximately 71.0% (n = 148/208), 70.0% (n = 147/208) and 65.0% (n = 137/209), respectively, routinely perform a preoperative endoscopy, screening for Helicobacter pylori and ultrasound scan of the abdomen. A minority (35.0%, n = 74/208) of the surgeons used a constant bilio-pancreatic limb (BPL) length for all the patients with remaining preferring to tailor the limb length to the patient and approximately half (49.0%, n = 101/206) routinely approximate diaphragmatic crura in patients with hiatus hernia. Some 48.5% (n = 101/208) and 40.0% (n = 53/205) surgeons, respectively, do not recommend routine iron and calcium supplementation.
CONCLUSION: This survey is the first attempt to understand a range of perioperative practices with OAGB/MGB. The findings will help in identifying areas for future research and allow consensus building amongst experts with preparation of guidelines for future practice.
KEYWORDS: Cancer; Mini gastric bypass; Objections; Omega loop gastric bypass; One anastomosis gastric bypass; Perioperative practices; Single anastomosis gastric bypass
Link to PubMed record
Author: Mahawar KK, Kular KS, Parmar C, Van den Bossche M, Graham Y, Carr WRJ, Madhok B, Magee C, Purkayastha S, Small PK
Abstract: BACKGROUND: There is currently little evidence available on the perioperative practices concerning one anastomosis/mini gastric bypass (OAGB/MGB) and no published consensus amongst experts. Even the published papers are not clear on these aspects. The purpose of this study was to understand various perioperative practices concerning OAGB/MGB.
METHODS: Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey. Only surgeons performing this procedure were included.
RESULTS: Two hundred and ten surgeons from 39 countries with a cumulative experience of 68,442 procedures took the survey. Surgeons described a large number of absolute (n = 55) and relative contraindications (n = 59) to this procedure in their practice. Approximately 71.0% (n = 148/208), 70.0% (n = 147/208) and 65.0% (n = 137/209), respectively, routinely perform a preoperative endoscopy, screening for Helicobacter pylori and ultrasound scan of the abdomen. A minority (35.0%, n = 74/208) of the surgeons used a constant bilio-pancreatic limb (BPL) length for all the patients with remaining preferring to tailor the limb length to the patient and approximately half (49.0%, n = 101/206) routinely approximate diaphragmatic crura in patients with hiatus hernia. Some 48.5% (n = 101/208) and 40.0% (n = 53/205) surgeons, respectively, do not recommend routine iron and calcium supplementation.
CONCLUSION: This survey is the first attempt to understand a range of perioperative practices with OAGB/MGB. The findings will help in identifying areas for future research and allow consensus building amongst experts with preparation of guidelines for future practice.
KEYWORDS: Cancer; Mini gastric bypass; Objections; Omega loop gastric bypass; One anastomosis gastric bypass; Perioperative practices; Single anastomosis gastric bypass
Link to PubMed record
Friday, 21 July 2017
Wirral Postgraduate Medical Centre closure
The Trustees of Wirral Postgraduate Medical Centre have confirmed that they can no longer fulfil their charitable objectives and therefore has made the decision to relinquish their lease on the Postgraduate Centre at Clatterbridge and from 1 August 2017 the Centre will be closed.
Wirral University Teaching Hospital has had a long established and valued relationship with the Trustees of the Charity and has endeavoured to support Education and Library facilities within the Postgraduate Centre.
Support for existing users at the Postgrad Centre Clatterbridge will continue until the end of July 2017 and where requested, users have been offered alternative venues for education meetings, study days, support groups etc at both Clatterbridge and Arrowe Park sites. Throughout this process the Medical Education team has been in discussions with the Multi-disciplinary Team (MDT) Co-ordinator to ensure patient safety remains a priority.
For any future meeting requirements please contact the Education Centre Reception, Telephone No.0151 604 7365 (internal Ext 8600) or the Clinical Skills Centre 0151 604 7721 (internal ext 8644) at Arrowe Park. Meeting room information for the Arrowe Park site can also be found here. For rooms bookings at Elm House, Clatterbridge please contact the Learning & Development Team on 0151 482 7981.
From the 1st August the J. Aitken Library Resource Room will be relocating to a new interim home in the ‘Holly’ room in Radiotherapy at Clatterbridge Cancer Centre (CCC), before being re-housed in a more permanent location. As a result of this move, CCC staff will have more convenient access to library space and resources. WUTH and Wirral Community Trust (WCT) staff should access the McArdle Library at Arrowe Park and visit our webpages for all library needs. If you’re based at the Clatterbridge site and need access to books, journals or computers please contact the Library & Knowledge Service and they will be able to provide advice and support. If there are any further questions or comments please contact Library & Knowledge Service at lks.wuth@nhs.net or via ext. 8610. Staff can also like the Library & Knowledge Service Facebook page for updates.
WUTH and the Trustees thank all Wirral Postgraduate Centre Users for their loyal support over the years.
Monday, 17 July 2017
Friday, 14 July 2017
Oxford Medicine Online - new edition added!
The 2017 edition of the Oxford Handbook of Operative Surgery has now been added to the Oxford Medicines Online collection.
The Oxford Medicine Online collection gives you quick and easy access to the contents of over 200 books on a variety of clinical subjects.
Why should I use Oxford Medicine Online?
* Saves you time
If you waiting for a book to become available or can’t make it to the Library, you can access this book from wherever you normally access the internet.
* Easy-to-use functionality
The contents of the books are set out just like a web page. You can search for specific sections of the subject and filter your results.
* Images and videos
Included in the contents are over 40000 images and 750 videos which can help with your research, academic study or personal development.
How do I access Oxford medicine Online?
6 simple steps to access the collection
All you need is an Open Athens account (link here to helpsheet)
1. Go to http://www.evidence.nhs.uk
2. Select Journals and Database
3. Select ‘Login to OpenAthens’
4. Login with your Open Athens account user name and password
5. Select ‘Oxford Medicine Online’
6. Select ‘Browse all titles in your subscription
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