Citation: Ecancermedicalscience. 2016 Dec 1
Author: Ormsby NM, Leong WY, Wong W, Hughes HE, Swaminathan V
Abstract: The most common site for cancer to spread is bone. At post-mortem, bony metastases have been found in 70% of patients dying from breast and prostate cancer. Due to the prevalence of cancer, bone metastasis and the associated management represents a huge burden on NHS resources. In patients with metastasis, around 56% of these involve the lower limb long bones. Due to the huge forces placed upon long bones during weight bearing, there is a high risk of fracture through areas of metastasis. It is reported that 23% of pathological fractures occur in the femoral subtrochanteric region. This area is subjected to forces up to four times the body weight, resulting in poor union rate for these fractures, and significant morbidity associated with difficulty in mobilising, and in patient nursing. As cancer treatments improve, the life expectancy in this subgroup of patients is likely to increase. Therefore medium-to-long-term management of these fractures, beyond the palliative, will become essential. We aim to evaluate the current management for metastatic malignant femoral disease, with particular focus on the prophylactic augmentation of diseased femorii using intramedullary nails.
KEYWORDS:
arthroplasty; internal fixation; intramedullary nailing; metastatic cancer; pathological fracture; prophylactic nailing
Link to PubMed record
Monday, 23 January 2017
Friday, 13 January 2017
Allied Health Professions (AHP) Research Bursary
The Cheshire & Merseyside AHP Research Network is offering bursaries of up to £1000 to facilitate small scale research studies conducted and led by AHPs.
Please note these applications are only open to AHPs (registered with HCPC) who work in the Cheshire & Merseyside region.
The applicant is expected to complete a small research project and provide a written report of results.
Examples of suitable studies may include pilot work (small scale preliminary studies) and proof of concept (feasibility studies collecting and analysing data to obtain evidence to support or refute ideas or plans). Preference will be given to projects that incorporate patient and public involvement.
Funding may be used in a number of ways, for example:
To back fill staff time – release researcher from clinical duties to undertake the research,
For training – for help with statistics, surveys, interviews, etc,
For transcription costs,
For payment of patient and public expenses.
Only direct costs can be covered by the Bursary.
The applicant is expected to forge a link with their NHS Trust Research office and establish a mentor within the Trust, who will be able to provide support.
Applicants should submit their application form via email by Monday 27th February 2017, 5pm to rowef@liverpool.ac.uk.
Please note these applications are only open to AHPs (registered with HCPC) who work in the Cheshire & Merseyside region.
The applicant is expected to complete a small research project and provide a written report of results.
Examples of suitable studies may include pilot work (small scale preliminary studies) and proof of concept (feasibility studies collecting and analysing data to obtain evidence to support or refute ideas or plans). Preference will be given to projects that incorporate patient and public involvement.
Funding may be used in a number of ways, for example:
To back fill staff time – release researcher from clinical duties to undertake the research,
For training – for help with statistics, surveys, interviews, etc,
For transcription costs,
For payment of patient and public expenses.
Only direct costs can be covered by the Bursary.
The applicant is expected to forge a link with their NHS Trust Research office and establish a mentor within the Trust, who will be able to provide support.
Applicants should submit their application form via email by Monday 27th February 2017, 5pm to rowef@liverpool.ac.uk.
Thursday, 29 December 2016
WUTH publication: On-scene treatment of spinal injuries in motor sports
Citation: European Journal of Trauma and Emergency Surgery. 2017, 43(2), 191-200
Author: Kreinest M, Scholz M, Trafford P
Abstract: Because spinal cord injuries can have fatal consequences for injured race car drivers, prehospital treatment of spinal injuries is a major concern in motor sports. A structured procedure for assessing trauma patients and their treatment should follow established ABCDE principles. Only then, a stable patient could be further examined and appropriate measures can be undertaken. For patients in an acute life-threatening condition, rapid transport must be initiated and should not be delayed by measures that are not indicated. If a competitor must first be extricated from the racing vehicle, the correct method of extrication must be chosen. To avoid secondary injury to the spine after a racing accident, in-line extrication from the vehicle and immobilization of the patient are standard procedures in motor sports and have been used for decades. Since immobilization can be associated with disadvantages and complications, the need for immobilization of trauma patients outside of motor sports medicine has become the subject of an increasing number of reports in the scientific literature. Even in motor sports, where specific safety systems that offer spinal protection are present, the indications for spinal immobilization need to be carefully considered rather than being blindly adopted as a matter of course. The aim of this article is to use recent literature to present an overview about the treatment of spinal injuries in motor sports. Further, we present a new protocol for indications for immobilizing the spine in motor sports that is based on the ABCDE principles and takes into account the condition of the patient.
KEYWORDS: Emergency; Extrication; Immobilization protocol; Out-of-hospital; Prehospital
Link to PubMed record
Author: Kreinest M, Scholz M, Trafford P
Abstract: Because spinal cord injuries can have fatal consequences for injured race car drivers, prehospital treatment of spinal injuries is a major concern in motor sports. A structured procedure for assessing trauma patients and their treatment should follow established ABCDE principles. Only then, a stable patient could be further examined and appropriate measures can be undertaken. For patients in an acute life-threatening condition, rapid transport must be initiated and should not be delayed by measures that are not indicated. If a competitor must first be extricated from the racing vehicle, the correct method of extrication must be chosen. To avoid secondary injury to the spine after a racing accident, in-line extrication from the vehicle and immobilization of the patient are standard procedures in motor sports and have been used for decades. Since immobilization can be associated with disadvantages and complications, the need for immobilization of trauma patients outside of motor sports medicine has become the subject of an increasing number of reports in the scientific literature. Even in motor sports, where specific safety systems that offer spinal protection are present, the indications for spinal immobilization need to be carefully considered rather than being blindly adopted as a matter of course. The aim of this article is to use recent literature to present an overview about the treatment of spinal injuries in motor sports. Further, we present a new protocol for indications for immobilizing the spine in motor sports that is based on the ABCDE principles and takes into account the condition of the patient.
KEYWORDS: Emergency; Extrication; Immobilization protocol; Out-of-hospital; Prehospital
Link to PubMed record
Friday, 16 December 2016
WUTH publication: The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group, Report 1: baseline characteristics and visual acuity outcomes in eyes treated with intravitreal injections of ranibizumab for diabetic macular oedema
Citation: The British Journal of Ophthalmology, 2017, 101(1), 75-80
Author: Egan C, Zhu H, Lee A, Sim D, Mitry D, Bailey C, Johnston R, Chakravarthy U, Denniston A, Tufail A, Khan R, Mahmood S, Menon G, Akerele T, Downey L, McKibbin M, Varma A, Lobo A, Wilkinson E, Fitt A, Brand C, Tsaloumas M, Mandal K, Kumar V, Natha S, Crabb D, UK AMD and DR EMR Users Group
Abstract: AIMS: To describe baseline characteristics and visual outcome for eyes treated with ranibizumab for diabetic macular oedema (DMO) from a multicentre database.METHODS: Structured clinical data were anonymised and extracted from an electronic medical record from 19 participating UK centres: age at first injection, ETDRS visual acuity (VA), number of injections, ETDRS diabetic retinopathy (DR) and maculopathy grade at baseline and visits. The main outcomes were change in mean VA from baseline, number of injections and clinic visits and characteristics affecting VA change and DR grade. RESULTS: Data from 12 989 clinic visits was collated from baseline and follow-up for 3103 eyes. Mean age at first treatment was 66 years. Mean VA (letters) for eyes followed at least 2 years was 51.1 (SD=19.3) at baseline, 54.2 (SD: 18.6) and 52.5 (SD: 19.4) at 1 and 2 years, respectively. Mean visual gain was five letters. The proportion of eyes with VA of 72 letters or better was 25% (baseline) and 33% (1 year) for treatment naïve eyes. Eyes followed for at least 6 months received a mean of 3.3 injections over a mean of 6.9 outpatient visits in 1 year.CONCLUSIONS: In a large cohort of eyes with DMO treated with ranibizumab injections in the UK, 33% of patients achieved better than or equal to 6/12 in the treated eye at 12 months compared with 25% at baseline. The mean visual gain was five letters. Eyes with excellent VA at baseline maintain good vision at 18 months.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/KEYWORDS: Macula; Public health; Retina; Treatment Medical; Treatment Surgery
Link to PubMed record
Author: Egan C, Zhu H, Lee A, Sim D, Mitry D, Bailey C, Johnston R, Chakravarthy U, Denniston A, Tufail A, Khan R, Mahmood S, Menon G, Akerele T, Downey L, McKibbin M, Varma A, Lobo A, Wilkinson E, Fitt A, Brand C, Tsaloumas M, Mandal K, Kumar V, Natha S, Crabb D, UK AMD and DR EMR Users Group
Abstract: AIMS: To describe baseline characteristics and visual outcome for eyes treated with ranibizumab for diabetic macular oedema (DMO) from a multicentre database.METHODS: Structured clinical data were anonymised and extracted from an electronic medical record from 19 participating UK centres: age at first injection, ETDRS visual acuity (VA), number of injections, ETDRS diabetic retinopathy (DR) and maculopathy grade at baseline and visits. The main outcomes were change in mean VA from baseline, number of injections and clinic visits and characteristics affecting VA change and DR grade. RESULTS: Data from 12 989 clinic visits was collated from baseline and follow-up for 3103 eyes. Mean age at first treatment was 66 years. Mean VA (letters) for eyes followed at least 2 years was 51.1 (SD=19.3) at baseline, 54.2 (SD: 18.6) and 52.5 (SD: 19.4) at 1 and 2 years, respectively. Mean visual gain was five letters. The proportion of eyes with VA of 72 letters or better was 25% (baseline) and 33% (1 year) for treatment naïve eyes. Eyes followed for at least 6 months received a mean of 3.3 injections over a mean of 6.9 outpatient visits in 1 year.CONCLUSIONS: In a large cohort of eyes with DMO treated with ranibizumab injections in the UK, 33% of patients achieved better than or equal to 6/12 in the treated eye at 12 months compared with 25% at baseline. The mean visual gain was five letters. Eyes with excellent VA at baseline maintain good vision at 18 months.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/KEYWORDS: Macula; Public health; Retina; Treatment Medical; Treatment Surgery
Link to PubMed record
Wednesday, 19 October 2016
Healthcare Databases Advanced Search (HDAS) has changed
So how you search MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, British Nursing Index, HMIC and Health Business Elite will be different.
Monday, 17 October 2016
WUTH publication: Diagnostic Imaging of Diabetic Foot Disorders
Citation: Foot and Ankle International. 2017, 38(1), 86-95
Author: Peterson N, Widnall J, Evans P, Jackson G, Platt S
Abstract: LEVEL OF EVIDENCE: Level V, expert opinion.
Link to PubMed record
Author: Peterson N, Widnall J, Evans P, Jackson G, Platt S
Abstract: LEVEL OF EVIDENCE: Level V, expert opinion.
Link to PubMed record
Monday, 3 October 2016
WUTH publication: Laparoscopic Management of a Ruptured Interstitial Pregnancy Associated With Massive Haemoperitoneum and History of Ipsilateral Salpingectomy
Citation: Journal of minimally invasive gynecology. 2015, 22(6S), S147
Abstract: Minas V, Ashraf K
Link to PubMed record
Abstract: Minas V, Ashraf K
Link to PubMed record
WUTH publication: The Introduction of "Mini-Touch" Microwave Endometrial Ablation in an Outpatient Setting in a UK District General Hospital
Citation: Journal of minimally invasive gynecology. 2015, 22(6S), S225-S226
Author: Alam MA, Steele G, Jones KE
Link to PubMed record
Author: Alam MA, Steele G, Jones KE
Link to PubMed record
Monday, 26 September 2016
WUTH publication: Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate: A Prospective, Cross-sectional Study
Citation: American Journal of Kidney Diseases. 2017, 69(3), 358-366
Author: Sridharan S, Vilar E, Davenport A, Ashman N, Almond M, Banerjee A, Roberts J, Farrington K
Abstract: BACKGROUND: Women and small men treated by hemodialysis (HD) have reduced survival. This may be due to use of total-body water (V) as the normalizing factor for dialysis dosing. In this study, we explored the equivalent dialysis dose that would be delivered using alternative scaling parameters matching the current recommended minimum Kt/V target of 1.2.
STUDY DESIGN: Prospective cross-sectional study.SETTING & PARTICIPANTS: 1,500 HD patients on a thrice-weekly schedule, recruited across 5 different centers.PREDICTORS: Age, sex, weight, race/ethnicity, comorbid condition level, and employment status. OUTCOMES: Kt was estimated by multiplying V by 1.2. Kt/body surface area (BSA), Kt/resting energy expenditure (REE), Kt/total energy expenditure (TEE) and Kt/normalized protein catabolic rate (nPCR) equivalent to a target Kt/V of 1.2 were then estimated by dividing Kt by the respective parameters. MEASUREMENTS: Anthropometry, HD adequacy details, and BSA were obtained by standard procedures. REE was estimated using a novel validated equation. TEE was calculated from physical activity data obtained using the Recent Physical Activity Questionnaire. nPCR was estimated using a standard formula.RESULTS: Mean BSA was 1.87m2; mean REE, 1,545kcal/d; mean TEE, 1,841kcal/d; and mean nPCR, 1.03g/kg/d. For Kt/V of 1.2, there was a wide range of equivalent doses expressed as Kt/BSA, Kt/REE, Kt/TEE, and Kt/nPCR. The mean equivalent dose was lower in women for all 4 parameters (P<0.001). Small men would also receive lower doses compared with larger men. Younger patients, those with low comorbidity, those employed, and those of South Asian race/ethnicity would receive significantly lower dialysis doses with current practice.LIMITATIONS: Cross-sectional study; physical activity data collected by an activity questionnaire. CONCLUSIONS: Current dosing practices may risk underdialysis in women, men of smaller body size, and specific subgroups of patients. Using BSA-, REE-, or TEE-based dialysis prescription would result in higher dose delivery in these patients.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. KEYWORDS: Hemodialysis target dose; Kt/V; body size; dialysis adequacy; dialysis dosing; end-stage renal disease (ESRD); energy expenditure; metabolism; physical activity; sex differences
Link to PubMed record
Author: Sridharan S, Vilar E, Davenport A, Ashman N, Almond M, Banerjee A, Roberts J, Farrington K
Abstract: BACKGROUND: Women and small men treated by hemodialysis (HD) have reduced survival. This may be due to use of total-body water (V) as the normalizing factor for dialysis dosing. In this study, we explored the equivalent dialysis dose that would be delivered using alternative scaling parameters matching the current recommended minimum Kt/V target of 1.2.
STUDY DESIGN: Prospective cross-sectional study.SETTING & PARTICIPANTS: 1,500 HD patients on a thrice-weekly schedule, recruited across 5 different centers.PREDICTORS: Age, sex, weight, race/ethnicity, comorbid condition level, and employment status. OUTCOMES: Kt was estimated by multiplying V by 1.2. Kt/body surface area (BSA), Kt/resting energy expenditure (REE), Kt/total energy expenditure (TEE) and Kt/normalized protein catabolic rate (nPCR) equivalent to a target Kt/V of 1.2 were then estimated by dividing Kt by the respective parameters. MEASUREMENTS: Anthropometry, HD adequacy details, and BSA were obtained by standard procedures. REE was estimated using a novel validated equation. TEE was calculated from physical activity data obtained using the Recent Physical Activity Questionnaire. nPCR was estimated using a standard formula.RESULTS: Mean BSA was 1.87m2; mean REE, 1,545kcal/d; mean TEE, 1,841kcal/d; and mean nPCR, 1.03g/kg/d. For Kt/V of 1.2, there was a wide range of equivalent doses expressed as Kt/BSA, Kt/REE, Kt/TEE, and Kt/nPCR. The mean equivalent dose was lower in women for all 4 parameters (P<0.001). Small men would also receive lower doses compared with larger men. Younger patients, those with low comorbidity, those employed, and those of South Asian race/ethnicity would receive significantly lower dialysis doses with current practice.LIMITATIONS: Cross-sectional study; physical activity data collected by an activity questionnaire. CONCLUSIONS: Current dosing practices may risk underdialysis in women, men of smaller body size, and specific subgroups of patients. Using BSA-, REE-, or TEE-based dialysis prescription would result in higher dose delivery in these patients.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. KEYWORDS: Hemodialysis target dose; Kt/V; body size; dialysis adequacy; dialysis dosing; end-stage renal disease (ESRD); energy expenditure; metabolism; physical activity; sex differences
Link to PubMed record
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