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.
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.
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.
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).
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.