Hudelist G.,Wilhelminen Hospital |
Hudelist G.,University of Surrey |
Ballard K.,University of Surrey |
English J.,Worthing and Southlands Hospital |
And 7 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2011
Objective The aim of this study was to compare the diagnostic performance of clinical vaginal examination with that of transvaginal sonography (TVS) in the presurgical diagnosis of deep infiltrating endometriosis. Methods One-hundred and fifty-five women with symptoms suggestive of endometriosis were included. One-hundred and twenty-nine patients met the inclusion criteria and were prospectively and independently assessed by vaginal examination and TVS prior to a diagnostic laparoscopy and, where appropriate, radical resection and histological confirmation of endometriosis was performed. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and positive and negative likelihood ratios (LR+ and LR-) were calculated for each test method. Results In total, 83 (64%) women had histological confirmation of endometriosis, 52 (40%) of whom had deep infiltrating endometriosis. The prevalence of endometriosis on the uterosacral ligaments, pouch of Douglas, vagina, bladder, rectovaginal space and rectosigmoid was 23.3%, 16.3%, 8.5%, 3.1%, 6.9% and 24%. PPV, NPV, LR+ and LR- for vaginal examination were 92%, 87%, 41.56 and 0.60 for ovarian endometriosis; 43%, 84%, 2.48 and 0.63 for uterosacral ligament disease; 64%, 95%, 9.14 and 0.26 for involvement of the pouch of Douglas; 80%, 97%, 42.91 and 0.28 for vaginal endometriosis; 78%, 98%, 46.67 and 0.23 for endometriosis of the rectovaginal space; 100%, 98%, 75.60 and 0.75 for bladder involvement; 86%, 84%, 18.97 and 0.63 for rectosigmoidal endometriosis. Values for TVS were similar with regard to vaginal and rectovaginal space endometriosis, but were clearly superior to vaginal examination in cases of ovarian (87%, 99%, 24.56 and 0.04), uterosacral ligament (91%, 90%, 31.35 and 0.37) and rectosigmoidal (97%, 97%, 88.51 and 0.1) endometriosis. Conclusions TVS is a more useful test than is vaginal examination in detecting endometriosis in the ovaries and rectosigmoid. © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Dodds A.L.,Imperial College London |
Narvani A.,Ashford and St Peters Hospital |
Williams A.,Chelsea and Westminster Hospital
Orthopaedics and Trauma | Year: 2013
Multi-ligament injuries of the knee are complex. A high index of suspicion for knee dislocation having occurred at the time of injury is necessary, as many dislocations spontaneously reduce and are therefore occult. Significant vascular and neurological injuries often occur at the time of injury and need to be diagnosed and managed. Consequently, there should be a low threshold for angiography. MR imaging is a useful aid but careful clinical examination is essential. Non-surgical management is, in general, not advocated but has a role for structures that have a high chance of healing such as the medial collateral ligament. Good results from surgery can be obtained, especially when surgery occurs within 2-3 weeks post-injury, but this is only possible in uncomplicated cases. An osteotomy may be necessary in chronic cases, especially if the posterolateral corner is affected. The patient should be warned of prolonged rehabilitation, which may take up to 2 years before the full result is achieved. With appropriate treatment a majority of patients can return to pre-injury levels of work and daily activity. Higher level function is much less certain. © 2013.
Barrow T.,Imperial College London |
Khan M.S.,University of London |
Khan M.S.,Ashford and St Peters Hospital |
Khan M.S.,Imperial College London |
And 5 more authors.
Stroke | Year: 2016
Background and Purpose - Estimating patient weight forms an important part of emergency ischemic stroke management guiding the dose of alteplase (tissue-type plasminogen activator). Weighing patients with stroke can be logistically challenging and time consuming, potentially delaying treatment times. We aimed to assess the reliability of approximating weight to determine recombinant tissue-type plasminogen activator dose and whether potential inaccurate dosing affected patient outcomes. Methods - Two hundred forty-two consecutive patients were studied at a large tertiary stroke center. Estimated and actual measured weight, alteplase dose, and pre-and post-modified Rankin Scale/National Institute of Health Stroke Scale outcome were recorded for each patient. Results - Clinicians significantly underestimated weights by 1.13 kg (range, -43 to +18 kg; SD, 7.14; P<0.05). The difference between estimated and actual weight proved to be greatest in the heaviest third of patients (-4.51 kg; SD, 8.35; P<0.001), resulting in 19.7% of patients receiving a deviation of at least 10% from the recommended recombinant tissue-type plasminogen activator dose. On average, the heaviest third of patients received an underdose of 0.04 mg/kg and were found to have a greater baseline National Institute of Health Stroke Scale on admission (P<0.001). National Institute of Health Stroke Scale improvement by day 7 or on discharge was significantly reduced in patients weighing >78 kg (National Institute of Health Stroke Scale score difference of 4.0 points, P<0.05) than in lighter individuals. Conclusions - Clinicians are poor at approximating the weights of patients with stroke in the acute setting, especially when patients lie at the extremes of weight. Beds capable of weighing patients should be mandated in emergency rooms for patients with acute stroke. © 2015 American Heart Association, Inc.
Silberbauer J.,Eastbourne General Hospital |
Arya A.,Eastbourne General Hospital |
Veasey R.A.,Eastbourne General Hospital |
Boodhoo L.,Eastbourne General Hospital |
And 7 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2010
Introduction: Accurate atrial arrhythmia discrimination is important for dual chamber pacemakers and defibrillators. The aim was to assess the accuracy of atrial arrhythmia recording using modern devices and relate this to atrial tip-to-ring (TTR) distance. Methods: One hundred eighty-two patients (72 ± 9 years, 55% male) with paroxysmal atrial fibrillation were enrolled and were included in the study if they had an atrial fibrillation (AF) burden of 1-50% during a monitoring phase. Seventy-nine patients fulfilled these criteria and were followed for at least 5 months. Electrodes were classified as having short (<10 mm), medium (10-12), or long (13-18) atrial TTR spacing. Results: Two thousand eight hundred eighty-three detailed onset reports were analyzed; 730 (25%) demonstrated aberrant sensing. Six percent were due to farfield R wave oversensing (FFRWO) and 19% due to undersensing, sometimes occurring in the same patient and study phase. FFRWO was significantly reduced with short TTR electrodes (P < 0.05). Undersensing due to sensitivity fallout was 18% (short), 24% (medium), and 17% (long) (P = ns). Undersensing due to pacemaker blanking was 11% (short), 11% (medium), and 12% (long) (P = ns). Active fixation electrodes did not show any difference from passive fixation. Conclusion: Atrial electrodes with a short TTR (<10 mm) significantly reduce FFRWO without increasing undersensing and should be used routinely in patients with paroxysmal atrial tachyarrhythmias. However, 20% of atrial tachyarrythmia episodes were incorrectly classified as terminated by these modern devices due to undersensing. Clinicians should be wary of using device-derived endpoints that rely on AF episode number or duration as these may be falsely increased or reduced, respectively. (PACE 2010; 85-93) © 2009 Wiley Periodicals, Inc.
Lesage E.,Royal Holloway, University of London |
Apps M.A.J.,Royal Holloway, University of London |
Hayter A.L.,Royal Holloway, University of London |
Beckmann C.F.,Imperial College London |
And 4 more authors.
Behavioural Neurology | Year: 2010
Recent research has characterized the anatomical connectivity of the cortico-cerebellar system - a large and important fibre system in the primate brain. Within this system, there are reciprocal projections between the prefrontal cortex and Crus II of the cerebellar cortex, which both play important roles in the acquisition and execution of cognitive skills. Here, we propose that this system also plays a particular role in sustaining skilled cognitive performance in patients with Relapsing-Remitting Multiple Sclerosis (RRMS), in whom advancing neuropathology causes increasingly inefficient information processing. We scanned RRMS patients and closely matched healthy subjects while they performed the Paced Auditory Serial Addition Test (PASAT), a demanding test of information processing speed, and a control task. This enabled us to localize differences between conditions that change as a function of group (group-by-condition interactions). Hemodynamic activity in some patient populations with CNS pathology are not well understood and may be atypical, so we avoided analysis strategies that rely exclusively on models of hemodynamic activity derived from the healthy brain, using instead an approach that combined a 'model-free' analysis technique (Tensor Independent Component Analysis, TICA) that was relatively free of such assumptions, with a post-hoc 'model-based' approach (General Linear Model, GLM). Our results showed group-by-condition interactions in cerebellar cortical Crus II. We suggest that this area may have in role maintaining performance in working memory tasks by compensating for inefficient data transfer associated with white matter lesions in MS. © 2010 - IOS Press and the authors. All rights reserved.
Lisk R.,Ashford And St Peters Hospital |
Yeong K.,Ashford And St Peters Hospital |
Nasim A.,Ashford And St Peters Hospital |
Baxter M.,Ashford And St Peters Hospital |
And 3 more authors.
Archives of Gerontology and Geriatrics | Year: 2012
Nursing home residents are often very dependent, very frail and have complex care needs. Effective partnerships between primary and secondary care will be of benefit to these residents. We looked at 1954 admission episodes to our Trust from April 2006 to March 2009 inclusive. 3 nursing homes had the highest number of multiple admissions (≥4). Four strategies to reduce hospital admissions were used at these nursing homes for 3 months. An alert was also sent to the geriatrician if one of the residents was admitted so that their discharge from hospital could be expedited. The project was then extended for another 4 months with 6 nursing homes. The results showed that geriatrician input into nursing homes had a significant impact on admissions from nursing homes (χ2(2)=6.261, p<0.05). The second part of the project also showed significant impact on admissions (χ2(2)=12.552, p<0.05). Furthermore, in both parts of the project the length of stay in hospital for the residents was reduced. Geriatricians working together with co-ordinated multidisciplinary teams are well placed to manage the care needs of frail, elderly care home residents. © 2011 Elsevier Ireland Ltd.
PubMed | Ashford and St Peters Hospital
Type: Journal Article | Journal: The practising midwife | Year: 2014
The 1999 Asylum and Immigration Act has had a great impact on the lives of pregnant asylum seekers and their ability to access good maternity care by dispersing them at will throughout the country to prevent destitution. Midwives in this country are striving to provide the best care they can to vulnerable groups, though their ability to do so is impacted by damaging social policy. Pregnant asylum seekers face upheaval, distress and risks to them and their unborn baby by being moved around the country to unsuitable housing, often hundreds of miles from the only people they know, fragmenting their maternity care. This has led to an unacceptable level of maternal mortality in this group of vulnerable women.