O'Loughlin P.M.,Darlington Memorial Hospital |
Gilliam A.D.,Darlington Memorial Hospital |
Shaban F.,Royal Infirmary |
Varma J.S.,Durham University
Surgeon | Year: 2013
Background: Gastric electrical stimulation (GES) may be of benefit in cases of gastroparesis that fail to respond to standard medical therapy. Response to this treatment is varied and prediction of clinical improvement is difficult. Methods: This was a retrospective review and symptom questionnaire survey for all patients who underwent GES insertion in a single institution from November 2008 until May 2010 using the gastroparesis cardinal symptom index (GCSI). Results: 14 out of 17 patients who had GES insertion responded to telephone or postal questionnaire. Mean pre-operative gastric emptying time was 151 min (median 146 min, range 18-318). Median follow up was 14 months (range 7-25 months). The mean reduction in GCSI score after GES insertion was 51% (13.4 vs 6.4, Z = 0.0013). Percentage reduction in GCSI correlated with pre-operative solid gastric emptying time (p = 0.0086). Two patients who responded to questionnaire required device removal, one due to a gastric perforation and the other for discomfort related to the implant and a poor clinical response. Conclusions: GES significantly improves symptoms of gastroparesis on the GCSI score. Not all patients respond equally to GES, and response may be predicted by pre-operative solid gastric emptying times. © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
Hancock H.C.,Durham University |
Close H.,Durham University |
Fuat A.,Durham University |
Fuat A.,Darlington Memorial Hospital |
And 4 more authors.
BMJ Open | Year: 2014
Objectives: To explore changes in healthcare professionals' views about the diagnosis and management of heart failure since a study in 2003. Design: Focus groups and a national online cross-sectional survey. Setting and participants: Focus groups (n=8 with a total of 56 participants) were conducted in the North East of England using a phenomenological framework and purposive sampling, informing a UK online survey (n=514). Results: 4 categories were identified as contributing to variations in the diagnosis and management of heart failure. Three previously known categories included: uncertainty about clinical practice, the value of clinical guidelines and tensions between individual and organisational practice. A new category concerned uncertainty about end-of-life care. Survey responses found that confidence varied among professional groups in diagnosing left ventricular systolic dysfunction (LVSD): 95% of cardiologists, 93% of general physicians, 66% of general practitioners (GPs) and 32% of heart failure nurses. For heart failure with preserved ejection fraction (HFpEF), confidence levels were much lower: 58% of cardiologists, 43% of general physicians, 7% of GPs and 6% of heart failure nurses. Only 5-35% of respondents used natriuretic peptides for LVSD or HFpEF. Confidence in interpreting test findings was fundamental to the use of all diagnostic tests. Clinical guidelines were reported to be helpful when diagnosing LVSD by 33% of nurses and 50-56% of other groups, but fell to 5-28% for HFpEF. Some GPs did not routinely initiate diuretics (23%), ACE-inhibitors (22%) or β-blockers (38%) for LVSD for reasons including historical teaching, perceived side effects and burden of monitoring. For end-of-life care, there was no consensus about responsibility for heart failure management. Conclusions: Reported differences in the way heart failure is diagnosed and managed have changed little in the past decade. Variable access to diagnostic tests, modes of care delivery and non-uniform management approaches persist. The current National Health Service (NHS) context may not be conducive to addressing these issues.
Chuter G.S.J.,Darlington Memorial Hospital |
Chua Y.P.,University of Malaya |
Connell D.A.,Monash University |
Blackney M.C.,Park Clinic
Skeletal Radiology | Year: 2013
Objective: To identify the benefits of ultrasound-guided radiofrequency ablation of Morton's neuroma as an alternative to surgical excision. Materials and methods: We studied a consecutive cohort of surgical candidates for Morton's neurectomy who we referred, instead, for radiofrequency ablation (RFA). Under local anaesthetic, RFA was performed under ultrasound guidance, by a single radiologist. This out-patient procedure was repeated after 4 weeks if necessary. We followed patients for a minimum of 6 months to assess their change in visual analogue pain scores (VAS), symptom improvement, complications and progression to surgical excision. Results: Thirty feet in 25 patients were studied. There were 4 men and 21 women with an average age of 55 years (range 33-73 years). All had tried previous methods of conservative management. Forty percent presented with 2nd space neuromas and 60% with 3rd space ones. The average number of treatment sessions was 1.6 (range 1-3, mode 1). Prior to treatment, all patients had pain on activity (VAS average: 6.0, range 3-9). Post-treatment there was a statistically significant reduction in pain scores (post-RFA VAS average: 1.7, range 0-8, p<0.001). The average overall symptom improvement was 76%. There was one minor complication of temporary nerve irritation. Three neuromas (10%) have progressed to surgical excision; 1 patient has ongoing, unchanged pain with no obvious cause. At 6 months, 26 out of 30 feet had a satisfactory outcome. Conclusion: Ultrasound-guided RFA has successfully alleviated patients' symptoms of Morton's neuroma in >85% of cases. Only 10% have proceeded to surgical excision in the short term. © 2012 ISS.
Edwards K.H.,Lensar Inc. |
Gibson G.A.,Darlington Memorial Hospital
Clinical and Experimental Optometry | Year: 2010
There is increasing interest in the effects of reactive oxygen species ('free radicals') in ageing, both in the body overall and specifically in the eye. Cataract and age-related macular degeneration (AMD) are two major causes of blindness, with cataract accounting for 48 per cent of world blindness and AMD accounting for 8.7 per cent. Both cataract and AMD affect an older population (over 50-years of age) and while cataract is largely treatable provided resources are available, AMD is a common cause of untreatable, progressive visual loss. There is evidence that AMD is linked to exposure to short wavelength electromagnetic radiation, which includes ultraviolet, blue and violet wavelengths. The ageing crystalline lens provides some protection to the posterior pole because, as it yellows with age, its spectral absorption increasingly blocks the shorter wavelengths of light. Ultraviolet blocking intraocular lenses (IOLs) have been the standard of care for many years but a more recent trend is to include blue-blocking filters based on theoretical benefits. As these filters absorb part of the visible spectrum, they may affect visual function. This review looks at the risks and the benefits of filtering out short wavelength light in pseudophakic patients. © 2010 The Authors. Clinical and Experimental Optometry © 2010 Optometrists Association Australia.
Ahmed S.,Darlington Memorial Hospital |
Howel D.,Northumbria University |
Debrah S.,Darlington Memorial Hospital |
Debrah S.,University Of Cape Coast
Journal of Geriatric Oncology | Year: 2014
Objectives: We investigated factors associated with post-operative mortality rates in those aged ≥ 60, and in particular, the relative survival of age bands within this group. Methods: Secondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998-2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery. Results: 6083 patients aged ≥ 60 underwent colorectal cancer surgery. Approximately 8% had died within 30. days of surgery and 17% had died within 6. months. Thirty-day mortality was greater in the elderly (80. years. +) compared to the young-old (60-69. years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females. Conclusions: This large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6. months was seen in elderly female patients. © 2014 Elsevier Inc.
Borthwick H.-A.,Darlington Memorial Hospital |
Brunt L.K.,Royal Hallamshire Hospital |
Mitchem K.L.,Prince Charles Hospital |
Chaloner C.,Central Manchester NHS Foundation Trust
Annals of Clinical Biochemistry | Year: 2012
Background: There is a need for practical, efficient and effective prognostic markers for patients admitted to the intensive care unit (ICU) with sepsis, to identify patients at highest risk and guide and monitor treatment. Although many biomarkers and scoring systems have been advocated, none have yet achieved this elusive combination. Most ICUs already use blood lactate concentrations to monitor patients but the evidence base for this application is unclear. Methods: A systematic review of the last five years of evidence of effectiveness of lactate measurement in prediction of outcome in ICUs was performed. Results: It was found that there is a lack of high-quality evidence, and no specific studies of prognostic accuracy. D-orL-Lactate concentrations measured in plasma, serum, whole blood or colonic washings were raised at admission in almost all patient groups, and were higher in patient groups who had the worst outcomes (in-hospital mortality, sequential organ failure). However, there was significant overlap in individual concentrations measured in those who died within 28 days of admission, or who developed multiple organ failure, and those who did not. For serum L-lactate concentrations, no specific cut-off value capable of predicting in-hospital mortality or sequential organ failure could be recommended. Conclusions: The evidence reviewed suggested that whole blood, plasma or serum lactate measurement could not provide specific prognostic information for individual patients. There may be a role for monitoring for normalization of serum D-orL-lactate concentrations during goal-directed therapy in the ICU but further good-quality studies are needed. Measurement of the D-lactate stereoisomer shows promise, such that further studies are warranted.
Iqbal I.Z.,Northern Deanery |
Watson C.,Darlington Memorial Hospital
Journal of Laryngology and Otology | Year: 2016
Objectives: This study aimed to evaluate the relationship between cholesteatoma formation and the degree of mastoid pneumatisation, and to assess the relationship between the location of cholesteatoma and the degree of mastoid pneumatisation. Methods: Data on all patients undergoing mastoid exploration for cholesteatoma between 1993 and 2011 were collected prospectively. Basic demographics, the degree of mastoid pneumatisation and cholesteatoma site were recorded. Results: A total of 393 patients (222 males and 171 females) underwent surgery for cholesteatoma. Patients' mean age was 37 years (range, 6-79 years). Pneumatisation of the mastoid was sclerotic in 23 per cent (n = 90), diploic in 16.7 per cent (n = 66) and cellular in 60.3 per cent of cases (n = 237) (p < 0.001). Atticoantral disease was present in 88.9 per cent of sclerotic, 95.4 per cent of diploic and 91.1 per cent of cellular mastoids. Middle-ear cholesteatoma was present in 54.4 per cent of sclerotic, 56 per cent of diploic and 51.9 per cent of cellular mastoids. Conclusion: The findings demonstrate the presence of cholesteatoma in well-pneumatised mastoids. It is hypothesised that a well-pneumatised mastoid may lead to cholesteatoma formation. © Copyright 2015 JLO (1984) Limited.
Truran P.,Queen Elizabeth Hospital |
Critchley R.J.,Darlington Memorial Hospital |
Gilliam A.,Darlington Memorial Hospital
Surgeon | Year: 2011
Background: Using the World Health Organisation (WHO) surgical checklist has been shown to improve the safety of patients undergoing surgery. Its effect on the compliance to venous thromboembolism(VTE) guidelines has not been established before. Our objective was to assess if using the WHO checklist improved compliance to VTE prophylaxis guidelines. Methods: Compliance to NICE VTE guidelines were prospectively assessed in all general surgery patients over two separate audit periods, before and after 6 months of the routine use of the WHO checklist. Correct completion of the checklist was verified. Results: 370 patients (173 [47%] male, 197 [53%] female, mean age 61.6 yrs). Non compliance to NICE VTE guidelines was reduced form 16/233 (6.9%) to 3/137 (2.1%) after introduction of the checklist (. p = 0.046 Fisher exact test). Non compliance was reduced in both emergency and elective procedures. Conclusions: Establishment of the WHO checklist for routine use in all general surgery patients may significantly improve VTE guideline compliance of all general surgery patients. © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
Philipson M.R.,Darlington Memorial Hospital
Orthopaedics and Trauma | Year: 2012
Sternoclavicular joint dislocation is an uncommon injury and few clinicians have a great deal of experience treating it. Clinically, it can be surprisingly easy to miss and the presentation is often delayed. Depending on the type of dislocation, the sequelae can be life-threatening or relatively benign.This article discusses the relevant anatomy, clinical presentation, investigation and management of sternoclavicular dislocation and injuries of the medial clavicular physis. © 2012.
Raghupathi A.K.,Darlington Memorial Hospital |
Kumar P.,Darlington Memorial Hospital
Journal of Orthopaedics | Year: 2014
Aims: Nonscaphoid fractures comprise approximately 40% of all carpal fractures. But the exact incidence of these rare injuries is still not clear. Missed or late diagnosis can lead to serious ligamentous disruption and permanent wrist dysfunction. Methods: A retrospective analysis of wrist X-rays and CT scans were carried out for a period of 3 years. Incidence and associated injuries from this study was compared with literature. A total of 33 patients were included in our study. Both wrist X-rays and CT scans were reviewed individually by two authors. DASH scores were recorded for each patient. Results: There were 26 male and 7 female patients. Out of 33 patients 13 (35%) were Triquetral fractures, 10 (27%) were Hamate fractures, 5 (14%) were Capitate fractures, 4 (11%) were Lunate fractures, 3 (8%) were Trapezium fractures and 2 (5%) were Pisiform fractures. There were no Trapezoid fractures in our study. Conclusion: Incidence of nonscaphoid carpal fractures in our study is considerably higher when compared to literature. We propose that high index of suspicion should always be borne in mind when dealing with carpal fractures and detailed examination of wrist should be conducted even when X-rays does not show any obvious bony injuries. CT scans and other specialized images should be judiciously used in areas of suspicion for early diagnosis, to initiate immediate treatment, for early mobilisation and good functional recovery. © 2014 .