Aneurin Bevan Health Board

Newport, United Kingdom

Aneurin Bevan Health Board

Newport, United Kingdom
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Torrisi B.M.,University of Cardiff | Zarnitsyn V.,Georgia Institute of Technology | Prausnitz M.R.,Georgia Institute of Technology | Anstey A.,Aneurin Bevan Health Board | And 3 more authors.
Journal of Controlled Release | Year: 2013

Botulinum toxin A (BT) is used therapeutically for the treatment of primary focal hyperhidrosis, a chronic debilitating condition characterised by over-activity of the eccrine sweat glands. Systemic toxicity concerns require BT to be administered by local injection, which in the case of hyperhidrosis means multiple painful intradermal injections by a skilled clinician at 6-monthly intervals. This study investigates the potential of a liquid-loaded pocketed microneedle device to deliver botulinum toxin A into the human dermis with the aim of reducing patient pain, improving therapeutic targeting and simplifying the administration procedure. Initially, β-galactosidase was employed as a detectable model for BT to (i) visualise liquid loading of the microneedles, (ii) determine residence time of a liquid formulation on the device and (iii) quantify loaded doses. An array of five stainless steel pocketed microneedles was shown to possess sufficient capacity to deliver therapeutic doses of the potent BT protein. Microneedle-mediated intradermal delivery of β-galactosidase and formaldehyde-inactivated botulinum toxoid revealed effective deposition and subsequent diffusion within the dermis. This study is the first to characterise pocketed microneedle delivery of a liquid formulation into human skin and illustrates the potential of such systems for the cutaneous administration of potent proteins such as BT. A clinically appropriate microneedle delivery system for BT could have a significant impact in both the medical and cosmetic industries. © 2012 Elsevier B.V.

Rai P.R.,Aneurin Bevan Health Board | Kerr M.,Welsh Center for Learning Disability
Psychiatrist | Year: 2010

Aims and method: To study the use of antidepressants in adults with intellectual disability, focusing on medication type, indication, retention and clinical outcome. Case notes of all service users in a learning disability service were hand-searched to identify antidepressant usage, and those who had been treated with antidepressants and in whom at least 1 year of follow-up was possible were included in the study. Results: A total of 241 treatment episodes were identified. The rates of positive outcome in terms of clinical improvement at 6 weeks, 6 months and 12 months were 49.4%, 48.1% and 49% respectively, and only 29 (12%) episodes of side-effects had been noted. Clinical implications: Antidepressants are commonly prescribed in adults with intellectual disability. Approximately half did well in terms of clinical improvement.

Logan K.,Aneurin Bevan Health Board | Shaw C.,University of South Wales
International Journal of Urological Nursing | Year: 2011

Intermittent self-catheterization (ISC) is a recommended treatment for people with a neuropathic bladder due to spinal injury. The majority of the literature to date has focused on the safety and the complication rates of ISC and use of different catheters. The aim of this paper explores the lived experience of people with spinal cord injury carrying ISC and the impact of service provision on rehabilitation. A qualitative approach was used based on grounded theory. Fifteen users (11 men and 4 women) of ISC took part in semi-structured interviews during 2009. Ages ranged from 24 to 68 years. The sample was recruited from the regional spinal unit. Thematic analysis was used to analyse the emergent themes. The results of the core theme, the patients' journey, related to the patients' perspectives of health service provision. Incontinence was the biggest problem to impact on quality of life. Successful bladder management was considered crucial to independence. The services provided by professionals in relation to ISC impacted on the rehabilitation process and patients' journey through the care system and independence. Service provision during acute rehabilitation was excellent; however, follow-up support was poor and failed to meet expectations. The findings of this study have potential to help professionals to identify factors in relation to the service provision important to spinal cord injured patients when learning and living with ISC. The information could be used to help those who may be resistant to ISC or have difficulty complying with the treatment and to aid with the teaching, advice giving and ongoing care. © 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN & Blackwell Publishing Ltd.

van Rensburg K.J.,County Hospital | van Rensburg K.J.,Aneurin Bevan Health Board | Atkins E.,Society of Orthopaedic Medicine
International Musculoskeletal Medicine | Year: 2012

Aim: This pilot study was designed to assess the effect of thoracic manipulation on shoulder range and function in patients with subacromial impingement syndrome (SIS). Methods: Patients attending a National Health Service physiotherapy department with SIS were considered for inclusion. Participants were randomized into one of two groups. Both groups received weekly physiotherapy for a maximum of 6 weeks. In addition, the experimental group received thoracic spinal manipulation. Outcome measures were shoulder range and function measured by a goniometer and the Disability of the Arm, Shoulder and Hand Score, respectively. Results: Nine participants were recruited; eight completed the study. Both groups improved, but numbers were inadequate for statistically significant conclusions. Conclusions: This pilot study confirms the practicality of the study design used: a longer recruitment period and multicentre involvement is recommended together with a cost-benefit analysis. © W.S. Maney & Son Ltd. and the British Institute of Musculoskeletal Medicine 2012.

Mowbray N.,Aneurin Bevan Health Board | Ansell J.,Welsh Institute of Minimal Access Therapy WIMAT | Warren N.,Welsh Institute of Minimal Access Therapy WIMAT | Wall P.,Isca Healthcare Research | Torkington J.,University of Wales
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: Smoke is generated by energy-based surgical instruments. The airborne byproducts may have potential health implications. This study aimed to evaluate the properties of surgical smoke and the evidence for the harmful effects to the theater staff. Methods: Cochrane Database, MEDLINE, PubMed, Embase classic and Embase, and the metaRegister of Controlled Trials were searched for studies reporting the constituents found in the smoke plume created during surgical procedures, the methods used to analyze the smoke, the implications of exposure, and the type of surgical instrument that generated the smoke. Studies were excluded if they were animal based, preclinical experimental work, or opinion-based reports. The common end points were particle size and characteristics, infection risk, malignant spread, and mutagenesis. Results: The inclusion criteria were fulfilled by 20 studies. In terms of particle size, 5 (25 %) of the 20 studies showed that diathermy and laser can produce ultrafine particles (UFP) that are respirable in size. With regard to particle characterization, 7 (35 %) of the 20 studies demonstrated that a variety of volatile hydrocarbons are present in diathermy-, ultrasonic-, and laser-derived surgical smoke. These are potentially carcinogenic, but no evidence exists to support a cause-effect relationship for those exposed. In terms of infection risk, 6 (30 %) of the 20 studies assessed surgical smoke for the presence of viruses, with only 1 study (5 %) positively identifying viral DNA in laser-derived smoke. One study (5 %) demonstrated bacterial cell culture (Staphylococcus aureus) from a laser plume after surgery. Regarding mutagenesis and malignant spread, one study (5 %) reported the mutagenic effect of smoke, and one study (5 %) showed the presence of malignant cells in the smoke of a patient undergoing procedures for carcinomatosis. Conclusions: The potentially carcinogenic components of surgical smoke are sufficiently small to be respirable. Infective and malignant cells are found in the smoke plume, but the full risk of this to the theater staff is unproven. Future work could focus on the long-term consequences of smoke exposure. © 2013 Springer Science+Business Media New York.

Jones R.K.,University of Cardiff | Hampton D.,Royal Gwent Hospital | O'Sullivan D.J.,Aneurin Bevan Health Board | Phillips A.O.,University of Cardiff
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2013

Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Of those followed in nephrology, 70% showed no evidence of progressive renal dysfunction. The nephrology cohort were significantly younger that those seen by primary care physicians or diabetologists. Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD. © Royal College of Physicians, 2013. All rights reserved.

Evans E.,Aneurin Bevan Health Board | Aiking H.,VU University Amsterdam | Edwards A.,University of Cardiff
Quality in Primary Care | Year: 2011

Background General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. Aim To use peer review with consultant engagement to influence GPs to improve the quality and effectiveness of their referrals. Design Service development project. Setting Ten out of 13 GP practices in Torfaen, Gwent; consultants from seven specialties in Gwent Healthcare NHS Trust; project designed and managed within Torfaen Local Health Board between 2008 and 2009. Methods GPs discussed the appropriateness of referrals in selected specialties, including referral information and compatibility with local guidelines, usually on a weekly basis and were provided with regular feedback of 'benchmarked' referral rates. Six-weekly 'cluster groups', involving GPs, hospital specialists and community health practitioners discussed referral pathways and appropriate management in community based services. Results Overall there was a reduction in variation in individual GP referral rates (from 2.6-7.7 to 3.0-6.5 per 1000 patients per quarter) and a related reduction in overall referral rate (from 5.5 to 4.3 per 1000 patients per quarter). Both reductions appeared sustainable whilst the intervention continued, and referral rates rose in keeping with local trends once the intervention finished. Conclusion This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies. © 2011 Radcliffe Publishing.

Jones G.,Freeman Hospital | Parry-Jones N.,Aneurin Bevan Health Board | Wilkins B.,Guys and St Thomas NHS Foundation Trust | Else M.,The Institute of Cancer Research | Catovsky D.,The Institute of Cancer Research
British Journal of Haematology | Year: 2012

The British Committee for Standards in Haematology first produced guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant in 2000. This revision updates those guidelines and covers the areas of diagnosis, treatment and assessment of response to therapy. © 2011 Blackwell Publishing Ltd.

Jacks A.,Aneurin Bevan Health Board | Barling T.,Aneurin Bevan Health Board
International Musculoskeletal Medicine | Year: 2012

Objective: To evaluate the efficacy of prolotherapy in the lumbosacral spine of patients with symptomatic apparent ligamentous laxity, in a National Health Service (NHS) setting. Method: A two-centre, before-and-after study of 197 consecutive patients followed up for a year using Visual Analogue Scales and Oswestry Disability Index. Results: Allowing for minor differences in approach and population demographics 91% of respondents were better or the same after 12 months. Conclusions: This study looked at the use of prolotherapy in patients who had failed to respond to conservative approaches including spinal manipulation and physiotherapy in NHS back pain clinic settings. These patients had longstanding and often severe pain and disability. Previous trials of prolotherapy have produced conflicting results but all had methodological problems. The results of this study promote the case for a new NHS-based randomized controlled trial of prolotherapy in the syndrome described as ligamentous laxity. © The Society of Orthopaedic Medicine and the British Institute of Musculoskeletal Medicine 2012.

Thomas S.,Aneurin Bevan Health Board
Nursing children and young people | Year: 2012

To evaluate the experience of nursing respite care in families caring for children with complex health needs. Seven mothers took part in semi-structured, in-depth interviews, which were taped, transcribed and coded. Results were categorised thematically. Families described a positive impact on all aspects of life, the high value of respite care and the preference for more information, flexibility, choice and co-ordination of the different services. Respite care is highly beneficial to family life, but there need to be clearer communication lines and a stable, flexible and adequately resourced workforce. Families value a single point of contact and would prefer more respite care to be available.

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