Countess of Chester Hospital

Chester, United Kingdom

Countess of Chester Hospital

Chester, United Kingdom
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Utomi V.,Liverpool John Moores University | Oxborough D.,Liverpool John Moores University | Whyte G.P.,Liverpool John Moores University | Somauroo J.,Liverpool John Moores University | And 5 more authors.
Heart | Year: 2013

Context: The athlete's heart (AH) remains a popular topic of study. Controversy related to training-specific cardiac adaptation in male athletes, and continuing developments in imaging technology and scaling prompted this systematic review and meta-analysis. Objective: To provide new insight in relation to: 1) cardiac adaptation to divergent training patterns in male athletes, 2) a developing research database using cardiac magnetic resonance (CMR) in athletes; 3) functional data derived from tissue-Doppler analysis as well as right ventricular (RV) and left atrial (LA) measurements in athletes; and 4) an awareness of the impact of body size on cardiac dimensions. Study design: Systematic review and meta-analysis of prospective trials. Data extraction performed by two researchers. Data sources: Pub Med, Medline, Scopus and ISI Web of knowledge scholarly data base. Study selection: Prospective studies were included if they were echocardiographic or CMR trials of elite young male athletes, with clear indication of type of sports and passed a quality criteria checklist. Results: All left ventricular (LV) structural parameters were higher in athletes than in controls. Only LV end-diastolic diameter and volume were higher in endurance athletes than in resistance athletes: 54.8 mm (95% CI 54.1 to 55.6) vs 52.4 mm (95% CI 51.2 to 53.6); p<0.001 and 171 ml (95% CI 157 to 185) vs 131 ml (95% CI 120 to 142); p<0.001, respectively. RV end-diastolic volume, mass and LA diameter were higher in endurance athletes than controls. LV end-diastolic volume was larger when CMR was used rather than echocardiography: 178 ml (95% CI Q7 162 to 194) vs 135 ml (95% CI 128 to 142); p<0.001. Meta-analysis regression models demonstrated positive and significant associations between body surface area (BSA) and LV mass, RV mass and LA diameter. Conclusions: Morphological features of the male AH were noted in both athlete groups. A training-specific pattern of concentric hypertrophy was not discerned in resistance athletes. Both imaging mode and BSA can have a significant impact on the interpretation of AH data.


Bathla S.,Countess of Chester Hospital
Journal of Patient Safety | Year: 2017

OBJECTIVES: Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. METHODS: A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom. This included all surgical trainees in Mersey (47 registrars, 56 core trainees), 15 consultants, and 2 surgical care practitioners. This sought to ascertain their routine practice and how they would choose to mark for 12 index procedures in general surgery, if mandated to do so. RESULTS: A total of 72 responses (60%) were obtained to the SurveyMonkey questionnaire. Only 26 (36.1%) said that they routinely marked all of their patients preoperatively. The operating surgeon marked the patient in 69% of responses, with the remainder delegating this task. Markings were visible after draping in only 55.6% of marked cases. CONCLUSIONS: Based on our findings, surgeons may not be adhering to “Good Surgical Practice”; practice is widely variable and surgeons are largely opposed and resistant to marking patients unless laterality is involved. We suggest that all surgeons need to be actively engaged in the design of local marking protocols to gain support, change practice, and reduce errors. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved


Babamiri K.,Leigh NHS Foundation Trust | Nassab R.,Countess of Chester Hospital
Aesthetic Surgery Journal | Year: 2010

A wide range of cosmeceutical products are available on the market currently, but evidence to support their use is often lacking in the literature. Specifically, there is a substantial amount of evidence supporting the efficacy of tretinoin in photoaging, but the evidence supporting retinoid-based cosmeceuticals remains sparse. The authors review the current data in the literature related to vitamin A-derived cosmeceutical products and conclude that cosmeceuticals containing retinaldehyde have been shown in large randomized, controlled trials to have the most beneficial effect on aging skin. © 2010 The American Society for Aesthetic Plastic Surgery, Inc.


Gillams A.,The London Clinic | Khan Z.,Countess of Chester Hospital | Osborn P.,Queen Alexandra Hospital | Lees W.,University College London
CardioVascular and Interventional Radiology | Year: 2013

Purpose: To analyze the factors associated with favorable survival in patients with inoperable colorectal lung metastases treated with percutaneous image-guided radiofrequency ablation. Methods: Between 2002 and 2011, a total of 398 metastases were ablated in 122 patients (87 male, median age 68 years, range 29-90 years) at 256 procedures. Percutaneous CT-guided cool-tip radiofrequency ablation was performed under sedation/general anesthesia. Maximum tumor size, number of tumors ablated, number of procedures, concurrent/prior liver ablation, previous liver or lung resection, systemic chemotherapy, disease-free interval from primary resection to lung metastasis, and survival from first ablation were recorded prospectively. Kaplan-Meier analysis was performed, and factors were compared by log rank test. Results: The initial number of metastases ablated was 2.3 (range 1-8); the total number was 3.3 (range 1-15). The maximum tumor diameter was 1.7 (range 0.5-4) cm, and the number of procedures was 2 (range 1-10). The major complication rate was 3.9 %. Overall median and 3-year survival rate were 41 months and 57 %. Survival was better in patients with smaller tumors - a median of 51 months, with 3-year survival of 64 % for tumors 2 cm or smaller versus 31 months and 44 % for tumors 2.1-4 cm (p = 0.08). The number of metastases ablated and whether the tumors were unilateral or bilateral did not affect survival. The presence of treated liver metastases, systemic chemotherapy, or prior lung resection did not affect survival. Conclusion: Three-year survival of 57 % in patients with inoperable colorectal lung metastases is better than would be expected with chemotherapy alone. Patients with inoperable but small-volume colorectal lung metastases should be referred for ablation. © 2012 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).


Nassab R.,Countess of Chester Hospital | Nassab R.,Lancashire Teaching Hospitals NHS Foundation Trust
Aesthetic Surgery Journal | Year: 2015

The demand for body contouring is rapidly increasing, and interest in noninvasi ve approaches has also grown. The author reviewed the evidenc e base behind the currently available de vices and m ethods for nonsurgic al body contouring. There is little high-level evidence in the present literature to suppor t the effecti veness of any of these devices. © 2015 The Americ an Soc iety for Aesthetic Plastic Surgery, Inc.


Chatterjee K.,Countess of Chester Hospital | Fall S.,Queen Elizabeth Hospital | Barer D.,Queen Elizabeth Hospital
BMC Neurology | Year: 2010

Background: Though vascular factors may be important in the aetiology of late-life depression, it is not clear whether they have a major effect on the risk of depression after a stroke. We investigated the relationship between physiological, biochemical, neuro-imaging and socio-economic factors and late-phase post-stroke depression in a cross-sectional case-control study.Methods: People living at home at least 9 months after a stroke were interviewed using a structured proforma. Depression was diagnosed according to DSM-IV criteria, together with a Montgomery Asberg (MADRS) score ≥17. Stroke survivors of similar age and functional status but without symptoms of, or recent treatment for, depression and with MADRS score <7, were recruited as controls.Results: Stroke survivors with depression were more likely than controls to have been smokers, to have had hypertension or peripheral arterial disease, and to have had more than one stroke or multiple discrete brainscan lesions. In univariate analysis they had significantly higher blood pressure, lower Mini-Mental State (MMSE) scores, higher serum homocysteine and lower folate levels, as well as more extensive white matter and basal ganglia changes on brainscan. In logistic regression, previous hypertension (OR 3.4), peripheral vascular disease (OR 4.7), number of strokes (OR 2), MMSE score (OR 0.76) and basal ganglia changes (OR 2.2), were independently associated with depression.Conclusion: These results suggest that patients with hypertension, hyperhomocysteinaemia and other factors associated with cerebral small vessel disease, may be more susceptible to post-stroke depression. Future intervention trials should focus on such high risk groups. © 2010 Chatterjee et al; licensee BioMed Central Ltd.


Vishwanathan K.,Countess of Chester Hospital | Alizadehkhaiyat O.,University of Liverpool | Kemp G.J.,University of Liverpool | Frostick S.P.,University of Liverpool
Journal of Shoulder and Elbow Surgery | Year: 2013

Background: Responsiveness and floor and ceiling effect are important parameters for evaluating the sensitivity of an outcome instrument in detecting the changes in the clinical condition of patients after an intervention as well as evaluating the content validity of the instrument. The aim of this prospective observational study was to assess these parameters for the Liverpool Elbow Score (LES) in total elbow replacement (TER). Methods: The study included 121 cemented TER cases with linked elbow prosthesis (Discovery Elbow, Biomet Orthopaedics, Swindon, UK) for various conditions, including inflammatory arthritis, noninflammatory arthritis, trauma, and loosening. The proportion of patients with the lowest score (0 points; floor effect) and maximum score (10 points; ceiling effect) was checked preoperatively and 1 year postoperatively. Distribution-based methods (effect size [ES], standardized response mean [SRM], Guyatt responsiveness ratio [GRR]) and anchor-based methods (receiver operating characteristic [ROC] curve and Spearman correlation coefficient) were used to assess responsiveness. Patient satisfaction after TER was used as an external anchor. Results: Patients were a mean age of 63 years (range, 20-86 years). Large ES (1.64), SRM (1.25), and GRR (1.69) were found during the follow-up period. Area under the ROC curve was 0.71 (95% confidence interval, 0.56-0.87; P = .03). There was significant positive correlation (Spearman correlation coefficient, 0.35; P = .004) between changes in LES and satisfaction level. LES showed no floor and ceiling effect preoperatively and at 1 year postoperatively. Conclusion: LES is a responsive measure and has no floor and ceiling effect. This encourages its use as an outcome instrument for TER. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.


Hawkesford M.P.,Countess of Chester Hospital
Scottish medical journal | Year: 2011

A 37-year-old Polish immigrant presented with unilateral hip pain and difficulty weight-bearing. Plain radiography and magnetic resonance imaging (MRI) revealed a lytic lesion in the acetabulum, with abnormal serum electrophoresis and bone marrow biopsy. The patient was diagnosed with two rare conditions presenting synchronously - Gaucher disease and plasmacytoma. He was treated with enzyme therapy and radiotherapy, but subsequently developed a recurrence of plasmacytoma in the right femur, confirmed with bone marrow biopsy. This was also treated with radiotherapy, followed by a retrograde femoral nail to reduce the risk of pathological fracture. The patient went on to develop multiple lytic lesions in the ribs and vertebra, seen on MRI. Further bone marrow biopsy confirmed dissemination of the plasmacytoma into multiple myeloma, for which he was treated with systemic chemotherapy. In patients presenting with refractory bone or joint pain, haematological and histological investigations should be considered to exclude less common diagnoses.


Ainsworth P.D.,Countess of Chester Hospital | Johnson M.A.,Countess of Chester Hospital
Colorectal Disease | Year: 2010

Aim Our aim was to determine if the lymph node ratio would predict overall survival and disease-free survival in Dukes C colorectal cancer in a district general hospital setting in the UK.Method Fifty-six patients were analysed from a prospectively maintained colorectal cancer database. The lymph node ratio was defined as the number of positive lymph nodes divided by the total number of nodes harvested. Comparison was made between the lymph node ratio,TNM nodal status and number of positive lymph nodes by the Kaplan-Meier method. An analysis of covariates was performed by a Cox proportional hazard regression analysis.Results A lymph node ratio of > 0.25 is prognostically significant for overall survival (P = 0.03) and disease-free survival (P = 0.0003). The lymph node ratio was the strongest covariate in the multivariate regression analysis for recurrence (P = 0.003).Conclusion The lymph node ratio may help clinicians determine which patients have a more aggressive tumour biology and direct appropriate more aggressive chemotherapy regimes towards these patients. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.


Scott S.,Countess of Chester Hospital
British Journal of Health Care Management | Year: 2015

Asthma is a common condition affecting 5.4 million people in the UK and is seen across primary, secondary and tertiary care settings. Despite treatment and guidelines being available for a long time, the Royal College of Physicians' 2014 report, Why Asthma Kills: The National Review of Asthma Deaths (NRAD) suggested that we could do better. This was a wake-up call and there has been renewed interest in a condition that directly costs the NHS £1 billion pounds per year and £6 billion indirectly. Approaches that improve the care of asthmatics, even in a small way, can potentially have a large impact on the healthcare economy by reducing this cost. Relatively expensive new treatments for severe asthma have potential cost implications, which has led NHS England to propose specialist commissioning for this group of patients. This has stimulated innovation in how to provide access to services more locally through a network approach in the North West. The British Thoracic Society (BTS) exists to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. The BTS supports and welcomes the renewed interest improving the care of asthmatics. © 2015 MA Healthcare Ltd.

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