Citation: Journal of Surgical Case Reports. 2017 Apr 4
Author: Vallabh N, Srinivasan V, Hughes D, Agbamu D
Abstract: Ancient schwannomas are benign, slow-growing tumours derived from the neural sheath. They are characterized by degenerative changes which are not seen in the common schwannoma. An unusual case of ancient schwannoma of the sublingual space is reported to highlight the diagnostic challenge that this tumour presents. A 49-year-old male patient presented with an 8-month history of a right-sided neck swelling, palpable in the anterior part of the submandibular triangle. Pre-operative imaging showed a non-enhancing mass in the sublingual space spilling into the submandibular triangle, consistent with a plunging ranula. Fine needle aspiration cytology was inconclusive. However, histopathology of the lesion confirmed the diagnosis of an ancient schwannoma, which is seldom found in the sublingual space.
Link to PubMed record
Tuesday, 2 May 2017
Thursday, 27 April 2017
Now recruiting! Trust-wide Randomised Chocolate Trial
If you like the idea of testing the effects of chocolate consumption, come along and take part in a Randomised Chocolate Trial in celebration of International Clinical Trials Day 2017! The Research Department and Library & Knowledge Service will be co-hosting this fun event to highlight the importance of research in healthcare and to help participants understand how clinical trials work.
Friday 19th May 2017
Seminar Rooms A/B, Clinical Skills, Arrowe Park
Drop in any time between 12pm and 2pm
Seminar Rooms A/B, Clinical Skills, Arrowe Park
Drop in any time between 12pm and 2pm
No need to book, just turn up – and bring your colleagues with you. The results of our trial will be published after the study. All participants will be entered into a free prize draw to win… more chocolate!
Wednesday, 26 April 2017
McArdle Library
Please note that the McArdle Library will be staffed until 5.00 p.m. on Friday 28/4/17 and will next be staffed on Tuesday 2/5/17. 24 hour access is currently not available but we hope to have a resolution soon.
Wednesday, 19 April 2017
New e-books for all WUTH staff
New e-books for all WUTH staff
All WUTH Athens account holders now have access to
Community and Public Health titles including:
·
Public Health and Epidemiology at a Glance
from the hugely popular ‘At A Glance’ series
·
Health communication : from
theory to practice - introduces existing challenges and areas of interest in
health communication
·
The Routledge Handbook of Planning for Health
and Well-Being - case studies of good
practice from around the globe.
You can access these titles and more from the Library
& Knowledge Service catalogue. http://arrowe.cirqahosting.com/
All you need is your Open Athens account.
Contact the Library and Knowledge Service for details on
accessing the catalogue and registering for an Open Athens account.
Wednesday, 12 April 2017
WUTH publication: Avoiding Radical Surgery in Elderly Patients With Rectal Cancer Is Cost-Effective
Citation: Diseases of the colon and rectum. 2017, 60(1), 30-42
Author: Rao C, Sun Myint A, Athanasiou T, Faiz O, Martin AP, Collins B, Smith FM
Abstract: BACKGROUND: Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes.
OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy.
DESIGN: Decision analytical modeling and a Markov simulation were used to model long-term costs, quality-adjusted life-years, and cost-effectiveness after watch and wait and radical surgery. Sensitivity analysis was used to investigate the effect of uncertainty in model parameters.
SETTINGS: A third-party payer perspective was adopted.
PATIENTS: Patients included in the study were a 60-year-old male cohort with no comorbidities, 80-year-old male cohorts with no comorbidities, and 80-year-old male cohorts with significant comorbidities.
INTERVENTIONS: Radical surgery and watch-and-wait approaches were studied.
MAIN OUTCOME MEASURES: Incremental cost, effectiveness, and cost-effectiveness ratio over the entire lifetime of the hypothetical patient cohorts were measured.
RESULTS: Watch and wait was more effective (60-year-old male cohort with no comorbidities = 0.63 quality-adjusted life-years (95% CI, 2.48-3.65 quality-adjusted life-years); 80-year-old male cohort with no comorbidities = 0.56 quality-adjusted life-years (95% CI, 0.52-1.59 quality-adjusted life-years); 80-year-old male cohort with significant comorbidities = 0.72 quality-adjusted life-years (95% CI, 0.34-1.76 quality-adjusted life-years)) and less costly (60-year-old male cohort with no comorbidities = $11,332.35 (95% CI, $668.50-$23,970.20); 80-year-old male cohort with no comorbidities = $8783.93 (95% CI, $2504.26-$21,900.66); 80-year-old male cohort with significant comorbidities = $10,206.01 (95% CI, $2762.014-$24,135.31)) independent of patient cohort age and comorbidity. Consequently, watch and wait was more cost-effective with a high degree of certainty (range, 69.6%-89.2%) at a threshold of $50,000/quality-adjusted life-year.
LIMITATIONS: Long-term outcomes were derived from modeled cohorts. Analysis was performed for a United Kingdom third-party payer perspective, limiting generalizability to other healthcare contexts.
CONCLUSIONS: Watch and wait is likely to be cost-effective compared with radical surgery. These findings strongly support the discussion of organ-preserving strategies with suitable patients.
Link to PubMed record
Author: Rao C, Sun Myint A, Athanasiou T, Faiz O, Martin AP, Collins B, Smith FM
Abstract: BACKGROUND: Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes.
OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy.
DESIGN: Decision analytical modeling and a Markov simulation were used to model long-term costs, quality-adjusted life-years, and cost-effectiveness after watch and wait and radical surgery. Sensitivity analysis was used to investigate the effect of uncertainty in model parameters.
SETTINGS: A third-party payer perspective was adopted.
PATIENTS: Patients included in the study were a 60-year-old male cohort with no comorbidities, 80-year-old male cohorts with no comorbidities, and 80-year-old male cohorts with significant comorbidities.
INTERVENTIONS: Radical surgery and watch-and-wait approaches were studied.
MAIN OUTCOME MEASURES: Incremental cost, effectiveness, and cost-effectiveness ratio over the entire lifetime of the hypothetical patient cohorts were measured.
RESULTS: Watch and wait was more effective (60-year-old male cohort with no comorbidities = 0.63 quality-adjusted life-years (95% CI, 2.48-3.65 quality-adjusted life-years); 80-year-old male cohort with no comorbidities = 0.56 quality-adjusted life-years (95% CI, 0.52-1.59 quality-adjusted life-years); 80-year-old male cohort with significant comorbidities = 0.72 quality-adjusted life-years (95% CI, 0.34-1.76 quality-adjusted life-years)) and less costly (60-year-old male cohort with no comorbidities = $11,332.35 (95% CI, $668.50-$23,970.20); 80-year-old male cohort with no comorbidities = $8783.93 (95% CI, $2504.26-$21,900.66); 80-year-old male cohort with significant comorbidities = $10,206.01 (95% CI, $2762.014-$24,135.31)) independent of patient cohort age and comorbidity. Consequently, watch and wait was more cost-effective with a high degree of certainty (range, 69.6%-89.2%) at a threshold of $50,000/quality-adjusted life-year.
LIMITATIONS: Long-term outcomes were derived from modeled cohorts. Analysis was performed for a United Kingdom third-party payer perspective, limiting generalizability to other healthcare contexts.
CONCLUSIONS: Watch and wait is likely to be cost-effective compared with radical surgery. These findings strongly support the discussion of organ-preserving strategies with suitable patients.
Link to PubMed record
Tuesday, 11 April 2017
Easter Opening Times
The Library & Knowledge Service will close
at 5pm on Thursday 13th April
and re-open
at 9am on Tuesday 18th April 2017
Unfortunately 24-Hour access is not currently available.
Apologies for any inconvenience this may cause.
During this period, please send any queries to mcardle.library@nhs.net
and we will get back to you after the Easter break.
Monday, 10 April 2017
WUTH publication: Opioid-induced myoclonus and hyperalgesia following a short course of low-dose oral morphine
Citation: British Journal of Pain. 2017, 11(1), 32-35
Author: Woodward OB, Naraen S, Naraen A
Abstract: A 76-year-old man was admitted to hospital with a right-sided fractured neck of femur requiring repair via a cemented hemiarthroplasty. Intraoperatively he received 10 mg of intravenous morphine. Post-operatively he received a short course of low-dose oral opioids and subsequently developed myoclonic jerks and hyperalgesia. The opioids were discontinued and both adverse effects resolved. This case report discusses the concurrent development of myoclonus and hyperalgesia following a low dose of opioids and explores possible management options.
KEYWORDS: Pain perception; adverse effect; hyperalgesia; myoclonus; opioid
Link to PubMed record
Author: Woodward OB, Naraen S, Naraen A
Abstract: A 76-year-old man was admitted to hospital with a right-sided fractured neck of femur requiring repair via a cemented hemiarthroplasty. Intraoperatively he received 10 mg of intravenous morphine. Post-operatively he received a short course of low-dose oral opioids and subsequently developed myoclonic jerks and hyperalgesia. The opioids were discontinued and both adverse effects resolved. This case report discusses the concurrent development of myoclonus and hyperalgesia following a low dose of opioids and explores possible management options.
KEYWORDS: Pain perception; adverse effect; hyperalgesia; myoclonus; opioid
Link to PubMed record
Monday, 20 March 2017
WUTH publication: Severe co-trimoxazole-induced hypoglycaemia in a patient with microscopic polyangiitis
Citation: BMJ Case Reports. 2017 Mar 16
Author: Conley TE, Mohiuddin A, Naz N
Abstract: A 69-year-old man presented to the emergency department with lower respiratory tract infection and febrile neutropaenia. He was recently discharged following a 50-day hospital stay with newly diagnosed microscopic polyangiitis, complicated by pulmonary haemorrhage and severe renal dysfunction requiring renal replacement therapy, plasma exchange and immunosuppression (cyclophosphamide and methylprednisolone). High risk of pneumocystis pneumonia (PCP) led to an escalation in treatment from prophylactic to therapeutic oral co-trimoxazole, alongside broad-spectrum antibiotics. The patient suffered from severe and protracted hypoglycaemia, complicated by a tonic-clonic seizure 7 days after escalation to therapeutic co-trimoxazole. Endogenous hyperinsulinaemia was confirmed and was attributed to co-trimoxazole use. Hypoglycaemia resolved 48 hours after discontinuation of co-trimoxazole. PCP testing on bronchoalveolar lavage was negative. Owing to the prescription of heavy immunosuppression in patients with vasculitis and the subsequent risk of PCP warranting co-trimoxazole prophylaxis, we believe that the risk of hypoglycaemia should be highlighted.
Link to PubMed record
Author: Conley TE, Mohiuddin A, Naz N
Abstract: A 69-year-old man presented to the emergency department with lower respiratory tract infection and febrile neutropaenia. He was recently discharged following a 50-day hospital stay with newly diagnosed microscopic polyangiitis, complicated by pulmonary haemorrhage and severe renal dysfunction requiring renal replacement therapy, plasma exchange and immunosuppression (cyclophosphamide and methylprednisolone). High risk of pneumocystis pneumonia (PCP) led to an escalation in treatment from prophylactic to therapeutic oral co-trimoxazole, alongside broad-spectrum antibiotics. The patient suffered from severe and protracted hypoglycaemia, complicated by a tonic-clonic seizure 7 days after escalation to therapeutic co-trimoxazole. Endogenous hyperinsulinaemia was confirmed and was attributed to co-trimoxazole use. Hypoglycaemia resolved 48 hours after discontinuation of co-trimoxazole. PCP testing on bronchoalveolar lavage was negative. Owing to the prescription of heavy immunosuppression in patients with vasculitis and the subsequent risk of PCP warranting co-trimoxazole prophylaxis, we believe that the risk of hypoglycaemia should be highlighted.
Link to PubMed record
Tuesday, 7 March 2017
Today’s QI Network meeting at 11:30 in Maternity Conference Room has been cancelled.
Unfortunately due to the problems at Lime Street Station the presenter is unable to attend and the activation of the full capacity policy it has been decided to cancel this meeting.
Wednesday, 1 March 2017
WUTH Library and Knowledge Service (LKS) featured in national library campaign!
Earlier this year the ‘A Million Decisions campaign’ which demonstrated the impact NHS Library Services have on clinical and non-clinical decisions made each year in the
NHS was launched by the Chartered Institute for Library and Information
Professionals (CILIP).
The work that WUTH Library and Knowledge Service has
undertaken with both the WUTH Critical Care unit and with the Microbiology
department has been showcased as examples of how the partnership between the LKS and clinical colleagues has impacted on
patient care, decision making and service improvement.
Has the WUTH LKS had an impact on your service or practice?
If so please:
· Submit a case study to the Knowledge for
Healthcare website at http://kfh.libraryservices.nhs.uk/share-your-impact-case-studies
· Tweet or post on Facebook using the
#amilliondecisions hashtag
For more details visit the CILIP website at http:// www.cilip.org.uk/amilliondecisions
or ask a member of the Library team.
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