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Chelmsford, United Kingdom

We present the outcomes of the delayed management of eight displaced intra-articular fractures of the metacarpal and phalangeal heads treated with capsuloligamentotaxis using the Penning mini-external fixator. Closed anatomical reduction with a 2 mm over-distraction was achieved at the time of operation at an average of 20 days after the initial injury. Excellent outcomes in terms of function and pain were obtained at 6 month's follow-up in all cases. This technique is simple, minimally invasive, and effective, with minimal complications. © 2013 The Author(s). Source

Touma O.,Broomfield Hospital | Davies M.,Addenbrookes Hospital

Introduction: Cardiac arrest is a common presentation to the emergency care system. The decision to terminate CPR is often challenging to heath care providers. An accurate, early predictor of the outcome of resuscitation is needed. The purpose of this systematic review is to evaluate the prognostic value of ETCO2 during cardiac arrest and to explore whether ETCO2 values could be utilised as a tool to predict the outcome of resuscitation. Method: Literature search was performed using Medline and EMBASE databases to identify studies that evaluated the relationship between ETCO2 during cardiac arrest and outcome. Studies were thoroughly evaluated and appraised. Summary of evidence and conclusions were drawn from this systematic literature review. Results: 23 observational studies were included. The majority of studies showed that ETCO2 values during CPR were significantly higher in patients who later developed ROSC compared to patients who did not. Several studies suggested that initial ETCO2 value of more than 1.33kPa is 100% sensitive for predicting survival making ETCO2 value below 1.33kPa a strong predictor of mortality. These studies however had several limitations and the 100% sensitivity for predicting survival was not consistent among all studies. Conclusion: ETCO2 values during CPR do correlate with the likelihood of ROSC and survival and therefore have prognostic value. Although certain ETCO2 cut-off values appears to be a strong predictor of mortality, the utility of ETCO2 cut-off values during CPR to accurately predict the outcome of resuscitation is not fully established. Therefore, ETCO2 values cannot be used as a mortality predictor in isolation. © 2013 Elsevier Ireland Ltd. Source

Turner R.,Broomfield Hospital | Nicholson S.,Academic Unit of Community based Medical Education
Medical Education

Medical Education 2011: 45: 1041-1047 Context UK medical school traditional selection processes are faltering in their ability to distinguish among highly qualified candidates. New methods of selection, including the UK Clinical Aptitude Test (UKCAT), herald a new era in which candidates are selected on aptitude and also aim to widen participation. However, the predictive validity of UKCAT and its role in the selection process are yet to be defined. This paper examines current selection practices and questions the role that such an aptitude test may take. Objective This study is intended to determine whether UKCAT can select suitable candidates for interview. Methods The study was designed to determine whether selectors rejected fewer candidates with high rather than low UKCAT scores using routine selection techniques. Selector rejection rates for 812 candidates with high UKCAT scores and 200 candidates with low UKCAT scores were compared. Additionally, any relationships among UKCAT and subsequent interview performance scores were explored by examining the correlation coefficients between overall and component UKCAT and interview scores for 637 candidates with high UKCAT scores. Results The rejection rate before interview of candidates with low UKCAT scores was 2.7 times that of candidates with high UKCAT scores. However, no relationship between overall UKCAT score and overall interview score existed within a pre-selected cohort of applicants with high UKCAT scores (Kendall's correlation coefficient, tau b=-0.004; p=0.88). Conclusions UKCAT can facilitate the independent selection of appropriate candidates for interview when used as described. However, UKCAT is not predictive of success at interview. The long-term predictive validity of UKCAT is currently under investigation. Therefore, we conclude that UKCAT is best viewed as a useful adjunct to current selection processes. © Blackwell Publishing Ltd 2011. Source

Ghosh G.,Broomfield Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987)

Oral bowel-cleansing agents are commonly used to prepare the bowel for colorectal surgery, and before endoscopic and radiological examination of the large intestine to ensure the bowel is free of solid contents. Good bowel preparation enhances detection of lesions, reducing the need for repeat procedures and delayed diagnosis. Knowledge of the potential risks associated with oral bowel-cleansing preparations is necessary to improve patient safety and outcomes. Source

Hammond T.,Broomfield Hospital
International Journal of Colorectal Disease

Purpose of review: Acute uncomplicated diverticulitis is traditionally managed by inpatient admission for bowel rest, intravenous fluids and intravenous antibiotics. In recent years, an increasing number of publications have sought to determine whether care might instead be conducted in the community, with earlier enteral feeding and oral antibiotics. This systematic review evaluates the safety and efficacy of such an ambulatory approach. Methods: Medline, Embase and Cochrane Library databases were searched. All peer-reviewed studies that investigated the role of ambulatory treatment protocols for acute uncomplicated diverticulitis, either directly or indirectly, were eligible for inclusion. Results: Nine studies were identified as being suitable for inclusion, including one randomised controlled trial, seven prospective cohort studies and one retrospective cohort study. All, except one, employed imaging as part of their diagnostic criteria. There was inconsistency between studies with regards to whether patients with significant co-morbidities were eligible for ambulatory care and whether bowel rest therapy was employed. Neither of these variables influenced outcome. Across all studies, 403 out of a total of 415 (97 %) participants were successfully treated for an episode of acute uncomplicated diverticulitis using an outpatient-type approach. Cost savings ranged from 35.0 to 83.0 %. Conclusion: Current evidence suggests that a more progressive, ambulatory-based approach to the majority of cases of acute uncomplicated diverticulitis is justified. Based on this evidence, the authors present a possible outpatient-based treatment algorithm. An appropriately powered randomised controlled trial is now required to determine its safety and efficacy compared to traditional inpatient management. © 2014 Springer-Verlag. Source

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