Citation: Techniques in Hand & Upper Extremity Surgery. 2015, 19(4), 163-7
Author: Kapur B, Paniker J, Casaletto J
Abstract: BACKGROUND: Intra-articular fractures of the proximal interphalangeal (PIP) joint are commonly treated with dynamic external fixation. Most commonly used is the Suzuki modification of the pins and rubber traction system (PRTS). There are a few other modifications of the PRTS external fixators. We present an alternative pin external fixator that is simple and effective.
METHODS: Under a suitable anesthesia and image intensification a true lateral view of the head of the proximal phalanx is obtained. A K-wire construct holds the affected digit out to length with the fracture reduced and Jurgan pin-balls hold the construct into position. Under image intensification the whole device is checked to ensure the joint and fracture is reduced and the joint is not over distracted. The PIP joint is also checked to ensure good range of motion. The device was checked in clinic at 1 week with radiographs. The wires are removed at 4 weeks followed by intensive hand physiotherapy.
RESULTS: Over 20 patients with intra-articular fractures of the proximal and middle phalangeal were treated with this technique. In all cases the fracture healed with good joint congruency. All patients achieved good range of motion of the PIP joint but with some restriction of full flexion (mean, 20 degrees). There was no loss of position or pin-site infections. There was good compliance with the treatment.
DISCUSSION: The main advantages of the technique we describe are: (1) the compact design, making it less cumbersome for the patient compared with other PRTS external fixators; (2) it is straightforward to assemble and the device is easy to adjust in clinic if there is any loss of reduction; (3) the pin-balls prevent sharp ends of the wire protruding causing morbidity to the patient; (4) there is less chance of loss of traction compared with traction devices using rubber bands. It is a dynamic device, which allows mobilization of the joints reducing stiffness.
Link to PubMed record
Friday, 23 October 2015
Monday, 12 October 2015
WUTH publication: UK AMD EMR USERS GROUP REPORT V: benefits of initiating ranibizumab therapy for neovascular AMD in eyes with vision better than 6/12
Citation: The British Journal of Ophthalmology. 2015, 99(8), 1045-50
Author: Lee AY, Lee CS, Butt T, Xing W, Johnston RL, Chakravarthy U, Egan C, Akerele T, McKibbin M, Downey L, Natha S, Bailey C, Khan R, Antcliff R, Varma A, Kumar V, Tsaloumas M, Mandal K, Liew G, Keane PA, Sim D, Bunce C, Tufail A, UK AMD EMR Users Group
Abstract: BACKGROUND/AIMS: To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy.
METHODS: Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections.
RESULTS: The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12.
CONCLUSIONS: All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding.
Link to PubMed record.
Author: Lee AY, Lee CS, Butt T, Xing W, Johnston RL, Chakravarthy U, Egan C, Akerele T, McKibbin M, Downey L, Natha S, Bailey C, Khan R, Antcliff R, Varma A, Kumar V, Tsaloumas M, Mandal K, Liew G, Keane PA, Sim D, Bunce C, Tufail A, UK AMD EMR Users Group
Abstract: BACKGROUND/AIMS: To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy.
METHODS: Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections.
RESULTS: The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up. Mean VA of first treated eyes with baseline VA>6/12 at year 1, 2, 3 were 6/10, 6/12, 6/15, respectively and those with baseline VA 6/12 to >6/24 were 6/15, 6/17, 6/20, respectively (p values <0.001 for comparing differences between 6/12 and 6/12-6/24 groups). For the second eyes with baseline VA>6/12, mean VA at year 1, 2, 3 were 6/9, 6/9, 6/10 and those with baseline VA 6/12 to >6/24 were 6/15, 6/15, 6/27, respectively (p values <0.001-0.005). There was no significant difference in the average number of clinic visits or injections between those with VA better and worse than 6/12.
CONCLUSIONS: All eyes with baseline VA>6/12 maintained better mean VA than the eyes with baseline VA 6/12 to >6/24 at all time points for at least 2 years. The significantly better visual outcome in patients who were treated with good baseline VA has implications on future policy regarding the treatment criteria for nAMD patients' funding.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
KEYWORDS: Drugs; Macula; Retina; Treatment Medical
KEYWORDS: Drugs; Macula; Retina; Treatment Medical
Link to PubMed record.
Friday, 9 October 2015
On-site access to Dynamed
The Library & Knowledge Service is pleased to announce that if you are on site at Wirral University Teaching Hospital then you can access Dynamed via this link without having to log in.
WUTH publication: Inpatients' expectations and experiences of hospital pharmacy services: qualitative study
Citation: Health Expectations. 2015, 18(5), 1009-17
Author: Morecroft, Charles W; Thornton, David; Caldwell, Neil A
Abstract: INTRODUCTION: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services.
OBJECTIVE: To explore inpatients' expectations and experiences of hospital-based pharmacy services.
STUDY SETTING AND DESIGN: Face-to-face semi-structured interviews with inpatients admitted to acute medical wards of three NHS general hospitals.
PRINCIPAL FINDINGS: Seventy-four inpatients were interviewed: 37 were male with average age 73 years (age range of 19 -86 years). The predominate number of participants (62/74, 84%) being in the 65-80 years of age group. Thematic analysis of the data was driven by three themes; patients' expectations of the pharmacist's involvement in their treatment and care, the patients' experiences of any interaction that may have taken place and the patients' evaluation of their interaction with the pharmacist.
CONCLUSIONS: There was a dichotomy of expectations and opinions from patients about the role of hospital pharmacists and the services being provided. As pharmacists' roles are developing towards a patient-orientated model in which pharmacists have direct contact with patients and their care, it is important to ensure that patients are aware of these developments to help them maximize the benefit they derive from their country's health-care system.
Link to PubMed record
Author: Morecroft, Charles W; Thornton, David; Caldwell, Neil A
Abstract: INTRODUCTION: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services.
OBJECTIVE: To explore inpatients' expectations and experiences of hospital-based pharmacy services.
STUDY SETTING AND DESIGN: Face-to-face semi-structured interviews with inpatients admitted to acute medical wards of three NHS general hospitals.
PRINCIPAL FINDINGS: Seventy-four inpatients were interviewed: 37 were male with average age 73 years (age range of 19 -86 years). The predominate number of participants (62/74, 84%) being in the 65-80 years of age group. Thematic analysis of the data was driven by three themes; patients' expectations of the pharmacist's involvement in their treatment and care, the patients' experiences of any interaction that may have taken place and the patients' evaluation of their interaction with the pharmacist.
CONCLUSIONS: There was a dichotomy of expectations and opinions from patients about the role of hospital pharmacists and the services being provided. As pharmacists' roles are developing towards a patient-orientated model in which pharmacists have direct contact with patients and their care, it is important to ensure that patients are aware of these developments to help them maximize the benefit they derive from their country's health-care system.
© 2013 John Wiley & Sons Ltd.
KEYWORDS: expectations; experiences; inpatient; pharmacy services
KEYWORDS: expectations; experiences; inpatient; pharmacy services
Link to PubMed record
Thursday, 8 October 2015
Try Dynamed Plus for free until 30th November!
The LKS has a free trial to Dynamed Plus until the end of
November 2015. This clinical decision
support tool provides the usual quick-reference evidence summaries, but
includes additional features such as calculators and images.
If you’re on the WUTH network you can access Dynamed Plus here. If you’re off-site you can use your Athens
account to login here.
During the trial period you can also download the Dynamed
Plus app which enables you to access all this content via your mobile
device. You can also receive updates to
notify you of new evidence in your specialty.
Please send your feedback on this resource to Victoria
Treadway, Library and Knowledge Service Lead at Victoria.treadway@nhs.net or 8608.
For technical help and FAQs, see the Dynamed
help page.
Friday, 2 October 2015
WUTH publication: An interesting case of an antihypertensive causing post-prostatectomy incontinence
Citation: BMJ Case Rep. 2015;2015
Author: Sarkar D, Kumar M
Abstract: A 70-year-old man underwent a laparoscopic radical prostatectomy with preservation of bladder neck for T3aN0R0 prostate cancer in December 2009, (Gleason 4+3, negative surgical margin). His postoperative prostate-specific antigen rose from 0.01 to 0.05 ng/mL over 19 months. He had salvage radiotherapy in May 2012. Following radiotherapy, his urinary control worsened and he needed to wear up to four pads per day. He was being considered for an artificial urinary sphincter placement. He was also taking doxazosin for hypertension, which was discontinued. After stopping the doxazosin, his urinary control improved and he did not require any further intervention. Doctors should be aware of the effect of α-blockers on the internal sphincter and the risk of incontinence in patients post-prostate cancer treatment.
Link to PubMed record
Author: Sarkar D, Kumar M
Abstract: A 70-year-old man underwent a laparoscopic radical prostatectomy with preservation of bladder neck for T3aN0R0 prostate cancer in December 2009, (Gleason 4+3, negative surgical margin). His postoperative prostate-specific antigen rose from 0.01 to 0.05 ng/mL over 19 months. He had salvage radiotherapy in May 2012. Following radiotherapy, his urinary control worsened and he needed to wear up to four pads per day. He was being considered for an artificial urinary sphincter placement. He was also taking doxazosin for hypertension, which was discontinued. After stopping the doxazosin, his urinary control improved and he did not require any further intervention. Doctors should be aware of the effect of α-blockers on the internal sphincter and the risk of incontinence in patients post-prostate cancer treatment.
Link to PubMed record
Monday, 28 September 2015
WUTH publication: Documentation of Focal Neurology on Patients with Suspected Cauda Equina Syndrome and the Development of an Assessment Proforma
Citation: The Open Orthopaedics Journal 2015, 31, (9), 390-4
Author: Mehta N, Garbera D, Kaye J, Ramakrishnan M
Abstract: OBJECTIVE: Cauda equina syndrome is a relatively rare condition with a disproportionately high medico legal profile. Definitive management involves prompt surgical decompression with outcome dependent on timing of surgery. Documentation of a comprehensive clinical and neurological assessment including examination of anal tone and perianal sensation is essential in reducing litigation and identifying patients requiring urgent surgical decompression. The aim of this study was to evaluate the documentation of focal neurology in patients with suspected cauda equina syndrome and devise an assessment proforma to use in the accident and emergency departments.
METHODS: A retrospective case note review was performed in all patients presenting to A&E with suspected cauda equina syndrome from January 2013 to March 2014. A full neurological examination was defined as having all modalities documented such as: MRC grade power, reflexes, sensory exam, vibration proprioception, anal tone & perianal sensation.
RESULTS: Sixty-nine patients with suspected cauda equina syndrome were identified with a median age of 44 (35-55) and a male to female ratio of 1:1.6. 4 patients (6%) had confirmed cauda equina syndrome and were transferred to a tertiary neurosurgical centre for further management. Only 2 patients (3%) had a complete neurological examination documented. 11 (16%) patients did not have any documentation of perianal sensation and 8 patients (12%) did not have documentation of anal tone.
CONCLUSION: Documentation of neurological was poor across our department. The introduction of an assessment proforma is proposed to increase documentation and optimise emergency department evaluation in these patients.
KEYWORDS: Assessment proforma; cauda equina syndrome; documentation; focal neurology; medico-legal
Link to PubMed record
Author: Mehta N, Garbera D, Kaye J, Ramakrishnan M
Abstract: OBJECTIVE: Cauda equina syndrome is a relatively rare condition with a disproportionately high medico legal profile. Definitive management involves prompt surgical decompression with outcome dependent on timing of surgery. Documentation of a comprehensive clinical and neurological assessment including examination of anal tone and perianal sensation is essential in reducing litigation and identifying patients requiring urgent surgical decompression. The aim of this study was to evaluate the documentation of focal neurology in patients with suspected cauda equina syndrome and devise an assessment proforma to use in the accident and emergency departments.
METHODS: A retrospective case note review was performed in all patients presenting to A&E with suspected cauda equina syndrome from January 2013 to March 2014. A full neurological examination was defined as having all modalities documented such as: MRC grade power, reflexes, sensory exam, vibration proprioception, anal tone & perianal sensation.
RESULTS: Sixty-nine patients with suspected cauda equina syndrome were identified with a median age of 44 (35-55) and a male to female ratio of 1:1.6. 4 patients (6%) had confirmed cauda equina syndrome and were transferred to a tertiary neurosurgical centre for further management. Only 2 patients (3%) had a complete neurological examination documented. 11 (16%) patients did not have any documentation of perianal sensation and 8 patients (12%) did not have documentation of anal tone.
CONCLUSION: Documentation of neurological was poor across our department. The introduction of an assessment proforma is proposed to increase documentation and optimise emergency department evaluation in these patients.
KEYWORDS: Assessment proforma; cauda equina syndrome; documentation; focal neurology; medico-legal
Link to PubMed record
WUTH publication: The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty
Citation: Indian Journal of Otolaryngology and head and neck surgery 2014 Dec;66(4):449-54
Author: Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V
Abstract: Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12-102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention.
KEYWORDS: Cartilage tympanoplasty; Middle ear surgery; Tympanic membrane retraction
Link to PubMed record
Author: Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V
Abstract: Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12-102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention.
KEYWORDS: Cartilage tympanoplasty; Middle ear surgery; Tympanic membrane retraction
Link to PubMed record
Thursday, 27 August 2015
WUTH publication:
Citation: Haematologica. 2015, 100, 574-575
Author: Dixon L.
Abstract: Background: Sharing potentially devastating news with a patient is often considered the
most difficult task of a healthcare professional. The quality of the delivery of the bad
news can have a direct impact on patients' emotions and adjustment to the condition;
therefore doctors have a great responsibility. Aims: The main aim of this study was to
learn the theory behind breaking bad news and discover patients' perceptions of receiving
bad news in the haematology setting; including what they thought was done well and
areas that could be improved. The study was designed following the SPIKES protocol
because it comprises the basic principles and provides a structure. There is an ever
increasing amount of literature available surrounding this topic. Yet, there is a noticeable
lack of research concentrating on the experience from the patient's view. Methods: A
questionnaire was written based on the steps of the SPIKES model. The questions were
divided into sections. The first section, titled 'patient demographics', aimed to elicit
personal information without comprising anonymity. The next six sections represented the
six steps of the SPIKES model. There were a mixture of qualitative responses and
multiple choice answers; however the participants were always able to give qualitative
responses if they felt there were no multiple choice answers that represented their views.
The participants were asked the questions by interviewers, who documented their
answers. The interviewers were also available to explain the questions to the participants.
The questionnaire was attempted by 20 participants who were in/out patients at Arrowe
Park Hospital. The inclusion criteria for participation comprised a diagnosis of a
haematological malignant disease and treatment for the disease at this hospital.
Additionally, it was essential the patients gave voluntary and informed verbal consent.
Results: Due to help from the interviewers, all of the 20 questionnaires attempted were
completed and used in this study. The participants rated their experience: 55% said
'excellent'; 25% reported 'good'; 5% said 'satisfactory' and 15% stated 'poor'. 'Poor' was
rated more commonly by women and participants aged 45-64. Those who received their
diagnosis within the past few years tended to have a better consultation. The main
differences between the 'excellent' and 'poor' consultations include the doctor's sensitivity
and the patients having their understanding checked. Problem areas include only 35% of
patients were asked their existing knowledge and 85% of consultations failed to discuss
the impact of the diagnosis on daily life. Summary and Conclusions: Overall, most
patients were happy with their consultation. The areas patients particularly praised were
the set-up of the consultation and how sensitively the news was delivered. The knowledge
section was done well generally, however it showed the greatest difference between 'poor'
and 'excellent' consultations; therefore should be improved to standardise the experience.
Other areas patients felt needed improvement include the doctor determining the patient's
existing knowledge and what they would like to know. With a poorer prognosis, doctors
should work on reassurance and conveying hope. Most consultations could be improved
by the doctor exploring the effect of the diagnosis on other areas of the patient's life. This
study was limited by a small sample size and potential recall bias.
Author: Dixon L.
Abstract: Background: Sharing potentially devastating news with a patient is often considered the
most difficult task of a healthcare professional. The quality of the delivery of the bad
news can have a direct impact on patients' emotions and adjustment to the condition;
therefore doctors have a great responsibility. Aims: The main aim of this study was to
learn the theory behind breaking bad news and discover patients' perceptions of receiving
bad news in the haematology setting; including what they thought was done well and
areas that could be improved. The study was designed following the SPIKES protocol
because it comprises the basic principles and provides a structure. There is an ever
increasing amount of literature available surrounding this topic. Yet, there is a noticeable
lack of research concentrating on the experience from the patient's view. Methods: A
questionnaire was written based on the steps of the SPIKES model. The questions were
divided into sections. The first section, titled 'patient demographics', aimed to elicit
personal information without comprising anonymity. The next six sections represented the
six steps of the SPIKES model. There were a mixture of qualitative responses and
multiple choice answers; however the participants were always able to give qualitative
responses if they felt there were no multiple choice answers that represented their views.
The participants were asked the questions by interviewers, who documented their
answers. The interviewers were also available to explain the questions to the participants.
The questionnaire was attempted by 20 participants who were in/out patients at Arrowe
Park Hospital. The inclusion criteria for participation comprised a diagnosis of a
haematological malignant disease and treatment for the disease at this hospital.
Additionally, it was essential the patients gave voluntary and informed verbal consent.
Results: Due to help from the interviewers, all of the 20 questionnaires attempted were
completed and used in this study. The participants rated their experience: 55% said
'excellent'; 25% reported 'good'; 5% said 'satisfactory' and 15% stated 'poor'. 'Poor' was
rated more commonly by women and participants aged 45-64. Those who received their
diagnosis within the past few years tended to have a better consultation. The main
differences between the 'excellent' and 'poor' consultations include the doctor's sensitivity
and the patients having their understanding checked. Problem areas include only 35% of
patients were asked their existing knowledge and 85% of consultations failed to discuss
the impact of the diagnosis on daily life. Summary and Conclusions: Overall, most
patients were happy with their consultation. The areas patients particularly praised were
the set-up of the consultation and how sensitively the news was delivered. The knowledge
section was done well generally, however it showed the greatest difference between 'poor'
and 'excellent' consultations; therefore should be improved to standardise the experience.
Other areas patients felt needed improvement include the doctor determining the patient's
existing knowledge and what they would like to know. With a poorer prognosis, doctors
should work on reassurance and conveying hope. Most consultations could be improved
by the doctor exploring the effect of the diagnosis on other areas of the patient's life. This
study was limited by a small sample size and potential recall bias.
WUTH publication: Longitudinal studies are required
Citation: Journal of the Royal Society of Medicine. 2015, 108(6), 210
Author: Ahmad N, Thomas GN, Gill P, Chan C, Torella F
Link to PubMed record
Author: Ahmad N, Thomas GN, Gill P, Chan C, Torella F
Link to PubMed record
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