Do you work for Wirral Community Trust?

Don’t forget that your Library & Knowledge Service can support you wherever you are working.

We offer:

ü  First Steps in Searching and Finding the Evidence sessions for individuals or groups

o   1 hour sessions

ü  Reflective Writing sessions for individuals or groups to support Nurse revalidation

o   1 hour session

ü  Training in Critical Appraisal skills so you can develop the skills to assess how robust and reliable original research is using appropriate tools

o   90 minute session

ü  Conduct Information searches with you on your chosen subjects

ü  Provide Print & electronic evidence resources to help you keep up-to-date

ü  Obtain journal articles & books for you

ü  Provide an Evidence Alerts service which alerts you to new innovations, improvements, best practice, news and evidence in your chosen areas of interest

ü  Support Journal Club activity which enables groups to present and critique relevant original research

ü  Offer 24 hour access to the library and its facilities, study space, computers and printers

We will come to you to provide support at a time and place that is convenient for you.

To find out more, request support or training please email mcardle.library@nhs.net or visit our website: http://www.wuth.nhs.uk/patients-and-visitors/services/l/library/

WUTH publication: Improving the handover and care of acute urological admissions

Citation: BMJ Quality Improvement Reports. 2015, 4(1)
Author: Bass E, Patel S
Abstract: The point at which a patient is most vulnerable during their journey through the hospital as an acute or emergency admission is the point at which they are transferred to the designated oncoming responsible team. Unsurprisingly, inadequate and incomplete clinical handovers have the potential for latter catastrophic consequences and are utterly avoidable. Recognising these facts, good clinical handover is an essential part of clinical governance and patient safety. Perhaps secondarily, clinical handover - especially when conducted with senior surgical personnel - can be a valuable learning tool for the surgical trainee. An complete audit loop was performed to assess the rate of handover and urology registrar involvement in acute urology periods in 2 month long periods as well as the rate of inadequate investigations and treatment. The interventions introduced included foundation doctor induction training in acute urology cases, an explanation of the importance of handover and a reflective look at ourselves and our approachability. As a result there were significant improvements in the rate of early registrar involvement and successful handover for patients admitted under our take. 

Link to PubMed record

WUTH publication: Treatment of tachycardia: bradycardia syndrome in a patient with obstructive sleep apnoea

Citation: BMJ Case Reports. 2015 April
Author: Lagan J, Saravanan P
Abstract: Obstructive sleep apnoea (OSAS) affects 4% of men and 2% of women aged 30-65 years. It is diagnosed in the presence of excessive daytime sleepiness and an apnoea-hypopnoea index (AHI) of ≥5 on polysomnography. Rhythm disturbances are common in OSAS and continuous positive airway pressure (CPAP) has been shown to be beneficial. We present a case of a patient with obesity, atrial fibrillation with fast ventricular response, significant nocturnal pauses (3.9 s) and tachycardiomyopathy. A polysomnography confirmed severe OSAS (AHI=64.25). CPAP improved bradycardia and allowed for the introduction of β-blockers. Subsequent Holter monitoring revealed better rate control with the longest pause of 2 s and the patient's left ventricular systolic function improved. CPAP prevented our patient from invasive treatment, allowed for rate control and improvement of tachycardiomyopathy. With such a high prevalence of OSAS, clinicians should be aware that CPAP may aid arrhythmia control.

Link to PubMed record

WUTH publication: A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit

Citation: Acute Medicine. 2015, 14(4), 159-164
Author: Smallwood N, Matsa R, Lawrenson P, Messenger J, Walden A
Abstract: The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant arriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

Link to PubMed record

New Nursing journal bundle

All staff and students have access to a new collection of nursing and midwifery journals, which includes key titles such as the British Journal of Nursing, British Journal of Community Nursing, Nurse Prescribing, Journal of Wound Care and British Journal of Midwifery.

This new bundle complements our existing nursing and midwifery resources, which will help to keep you up to date with practice, support your continuing professional development, and help you to gather evidence for your Revalidation portfolio. 

To access this journal bundle you need an OpenAthens account, which will allow you to log in to the MAG online website from work or from home. 

WUTH publication: Takotsubo cardiomyopathy case series: typical, atypical and recurrence

Citation: BMJ Case Reports. 2015
Author: Lagan J, Connor V, Saravanan P
Abstract: Takotsubo cardiomyopathy (TCM) is characterised by a transient left ventricular (LV) dysfunction, ECG changes that can imitate acute myocardial infarction and positive cardiac biomarkers in the absence of obstructive coronary artery disease. The exact pathogenesis of TCM is unclear but emotional or physical stress is a common denominator. We present three cases encompassing a spectrum of the disease: A typical TCM with apical LV dyskinesis, an atypical TCM with mid-ventricular regions affected and a TCM recurrence. Our cases show that TCM symptoms vary between individuals and may vary in the same patient. All our patients reported acute emotional stress prior to the onset of symptoms, had LV systolic dysfunction, positive cardiac biomarkers and non-obstructed coronary arteries. In all cases, LV systolic dysfunction eventually improved. TCM may account for 0.7-2.5% of acute coronary syndromes. It is more prevalent in the female population and can reoccur. Treatment is mainly supportive

Link to PubMed record

Explore England's prescribing data

Explore Open Prescribing.
Every month, the NHS in England publishes anonymised data about the drugs prescribed by GPs. But the raw data files are large and unwieldy, with more than 600 million rows. We're making it easier for GPs, managers and everyone to explore - supporting safer, more efficient prescribing.

WUTH publication: Atrial fibrillation during pregnancy: cardioversion with flecainide

Citation: British Journal of Hospital Medicine. 2015, 76(12), 720-1
Author: Lewis G, Currie P

Link to PubMed record

WUTH publication: Tolerability and Adherence Problems in Patients on a Stable Dose of Methotrexate: Results of a Multicentre Survey

Citation: Musculoskeletal Care. 2016, 14(3), 152-5. Epub 2015 Dec 8
Author: Robinson S, Gibson S, George E, Martin U, Heslop P, Wrightson H, Prowse P, Kalinowski M, Marshall D, Reed M, Adebajo A, Walker D
Abstract:  INTRODUCTION: Methotrexate is commonly used in patients with inflammatory arthritis. The aim of the present study was to ascertain the prevalence of side effects that patients on methotrexate were tolerating and to establish their adherence to the medication.
METHOD: A questionnaire was developed for completion by the healthcare professional with the patient, and piloted in one centre. The questionnaire was then used in six other centres, with the addition of a question about the attractiveness of stopping methotrexate treatment. Efficacy and toxicities were scored for severity on a 10-cm visual analogue scale (VAS). Adherence to the drug was also explored.
RESULTS: The prevalence of 'any side effect' ranged from 57% to 86%. The most frequent side effects were fatigue (53%); nausea (38%); mouth ulcers (23%) and hair loss (23%). Efficacy averaged 6.5 cm on the VAS. Results from the combined survey revealed that toxicity averaged 5.9 cm for fatigue, 4.8 cm for nausea, 4.4 for mouth ulcers, 3.9 cm for hair loss and 5.7 cm for 'other' side effects. 13.5% of patients revealed that they had forgotten to take the drug for an average of two weeks, and 25% for an average of 2.5 weeks in the previous year. Participants were more likely to reveal this to a nurse than a doctor.
CONCLUSION: Patients put up with a considerable number of side effects in order to benefit from methotrexate therapy. Adherence to this drug merits further study. Copyright © 2015 John Wiley & Sons, Ltd.

KEYWORDS: Methotrexate; adherence; side effects; tolerance

Link to PubMed record

WUTH publication: An Alternative Technique for External Fixation of Traumatic Intra-articular Fractures of Proximal and Middle Phalanx.

Citation: Techniques in hand & upper extremity surgery. 2015, 19(4), 163-167
Author: Kapur, Benjamin; Paniker, Jayanath; Casaletto, John
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