Mcgreevy D.,Eastbourne District General Hospital
Nursing Inquiry | Year: 2014
Obesity is now commonly recognised to be a significant public health issue worldwide with its increasing prevalence frequently described as a global epidemic. In the United Kingdom, primary care nurses are responsible for weight management through the provision of healthy eating advice and support with lifestyle change. However, nurses themselves are not immune to the persistent and pervasive global levels of weight gain. Drawing on a Gadamerian informed phenomenological study of female primary care nurses in England, this paper considers the complex gendered understandings and experiences of being overweight, and of food and eating. The nurses' emotional and injurious experiences of being large is found to be capable of producing embodied caring practices, involving a fusion of horizons with patients over how it feels to inhabit a large body. Yet, even though subjected to similar derogatory stereotypes as patients, they simultaneously reinforce the dominant and damaging individualising psychopathology inherent to anti-obesity discourses. This suggests an urgent need to expose and challenge harmful discourses surrounding women's body size and weight in order to avoid nursing practices that unthinkingly reproduce culturally dominant and gendered understandings of weight, body size, food and eating. © 2012 John Wiley & Sons Ltd.
Howlett D.C.,Eastbourne District General Hospital |
Lawrence D.,Novartis |
Barter S.,Addenbrookes Hospital |
Nicholson T.,Royal Infirmary
Radiology | Year: 2013
Purpose: To determine the frequency of complications and death following image-guided and/or image-assisted liver biopsy and to identify significant variables associated with an increased risk of complications or death. Materials and Methods: Institutional review board approval for this type of study is not required in the United Kingdom. United Kingdom radiology departments with a department leader for audit registered with the Royal College of Radiologists were invited to participate. The first 50 consecutive patients who underwent liver biopsy in 2008 were included. Audit standards were developed for minor pain (<30%), severe pain (<3%), vasovagal hypotension (<3%), significant hemorrhage (<0.5%), hemobilia (<0.1%), puncture of another organ (<0.1%), and death (,0.1%). Organizational, clinical, and coagulation variables were investigated statistically for their association with complications and/or death. Results: Data were obtained from 87 of 210 departments (41%). Audit standards were met for pain, hypotension, hemorrhage, hemobilia, and puncture of another organ. There were four hemorrhage-related deaths, and this target was narrowly missed (rate achieved in practice, 0.11% [four of 3486 patients]). Fifteen additional patients experienced at least one major complication. The international normalized ratio (INR) was absent in 3% of cases (97 of 2951 patients), the platelet count was absent in 1% (32 of 2986 patients), the INR was more than 1 week old in 8% (229 of 2888 patients), and the platelet count was more than 1 week old in 10% (291 of 2955 patients). Conclusion: Results of this audit confirm that image-guided and image-assisted biopsy is performed safely in United Kingdom radiology departments, with complication rates within expected parameters. Preprocedural clotting assessment was inadequate in some cases and would merit repeat audit. © RSNA, 2012.
Khan M.S.,Urology Center |
Elhage O.,Urology Center |
Challacombe B.,Urology Center |
Murphy D.,Urology Center |
And 4 more authors.
European Urology | Year: 2013
Background: Long-term oncologic and functional outcomes after robot-assisted radical cystectomy (RARC) for bladder cancer (BCa) are lacking. Objective: To report oncologic and functional outcomes in a cohort of patients who have completed a minimum of 5 yr and a maximum of 8 yr of follow-up after RARC and extracorporeal urinary diversion. Design, setting, and participants: In this paper, we report on the experience from one of the first European urology centres to introduce RARC. Only patients between 2004 and 2006 were included to ensure follow-up of ≥5 yr. We report on an analysis of oncologic outcomes in 14 patients (11 males and 3 females) with muscle-invasive/high-grade non-muscle-invasive or bacillus Calmette-Guérin-refractory carcinoma in situ who opted to have RARC. Intervention: RARC with pelvic lymphadenectomy was performed using the three-arm standard da Vinci Surgical System (Intuitive Surgical, CA, USA). Urinary diversion, either ileal conduit (n = 12) or orthotopic neobladder (n = 2), was constructed extracorporeally. Outcome measurements: Parameters were recorded in a prospectively maintained database including assessment of renal function, overall survival, disease-specific survival, development of metastases, and functional outcomes. Statistical analysis: Results were analysed using descriptive statistical analysis. Survival data were analysed and presented using the Kaplan-Meier survival curve. Results and limitations: Five of the 14 patients have died. Three patients died of metastatic disease, and two died of unrelated causes. Two other patients are alive with metastases, and another has developed primary lung cancer. Six patients are alive and disease-free. These results show overall survival of 64%, disease-specific survival of 75%, and disease-free survival of 50%. None of the patients had deterioration of renal function necessitating renal replacement therapy. Three of four previously potent patients having nerve-sparing RARC recovered erectile function. The study is limited by the relatively small number of highly selected patients undergoing RARC, which was a novel technique 8 yr ago. The standard da Vinci Surgical System made extended lymphadenectomy difficult. Conclusions: Within limitations, in our experience RARC achieved excellent control of local disease, but the outcomes in patients with metastatic disease seem to be equivalent to the outcomes of open radical cystectomy. © 2013 European Association of Urology.
Harrison S.C.W.,Pinderfields General Hospital |
Lawrence W.T.,Eastbourne District General Hospital |
Morley R.,Kingston Hospital |
Pearce I.,Royal Infirmary |
Taylor J.,Pinderfields General Hospital
BJU International | Year: 2011
OBJECTIVE: To report the British Association of Urological Surgeons' guidelines on the indications for, safe insertion of, and subsequent care for suprapubic catheters. METHODS A comprehensive literature search was conducted to identify the evidence base. This was reviewed by a guideline development group (GDG), who then drew up the recommendations. Where there was no supporting evidence expert opinion of the GDG and a wider body of consultees was used. RESULTS Suprapubic catheterisation is widely used, and generally considered a safe procedure. There is however a small risk of serious complications. Whilst the evidence base is small, the GDG has produced a consensus statement on SPC use with the aim of minimising risks and establishing best practice (Table 1). It should be of relevance to all those involved in the insertion and care of suprapubic catheters. Given the paucity of evidence, areas for future research and development are also highlighted. This review has been commissioned and approved by BAUS and the Section of Female, Neurological and Urodynamic Urology. Summary of recommendations for suprapubic catheters (SPCs) practice General considerations • Clinicians who are involved in the management of patients with long-term catheters should consider in each case whether an SPC would offer advantages to the patient over the use of a urethral catheter • Patients in whom an SPC is felt to be appropriate should have access to an efficient and expert service for SPC insertion • Patients who are undergoing SPC placement either as an isolated or as a combined procedure should undergo an appropriate consent procedure with best practice including the provision of both verbal and written information The suprapubic catheterization procedure • If appropriate expertise for SPC insertion is not available at a particular time, suprapubic aspiration of urine using a needle of up to 21 gauge can be used as a means of temporarily relieving the patient's symptoms (LE3) • A general or regional anaesthetic should be used if the bladder cannot be comfortably filled with at least 300 mL of fluid and in spinal cord injury patients with an injury level of T6 or above (LE3) • The use of antibiotic prophylaxis is recommended for patients where the urine is likely to be colonized with bacteria despite there being a lack of published data addressing this issue (LE3) • The different catheter insertion techniques and kits have not been compared in adequate clinical trials; the choice of technique is therefore a matter of individual preference. All of the closed (abdominal puncture) techniques run the risk of injury to intra-abdominal organs and the operator must have received training that allows the level of risk to be appreciated (LE3) • Ultrasonographic examination of the abdomen may be used as an adjunct to SPC insertion. However, the practitioner involved must have appropriate training and experience. Ultrasonography should only be used to look for interposing bowel loops along the planned catheter track by individuals who have received specific training and are experienced in this task. (LE3) • In the patient with a readily palpable bladder and no history of lower abdominal surgery, it is considered reasonable to insert a SPC using a closed technique providing that urine can be easily aspirated from the bladder using a needle passed along the planned catheter track (LE3) • In the patient in whom there is no history of lower abdominal surgery but where the distended (over 300 mL) bladder cannot be palpated because of obesity, it is considered that blind insertion should not be undertaken. In such circumstances, ultrasonography may be used to identify the distended bladder or cystoscopy may be used to ensure that an aspirating needle on the planned catheter track is entering the bladder at an appropriate point on the anterior bladder wall (LE3) • In the patient with either a history of lower abdominal surgery or a bladder that cannot be adequately distended, the SPC should either be inserted using an open technique or with the adjunct of imaging that can reliably exclude the presence of bowel loops on the intended catheter track. An open procedure must be performed in a manner that will reliably identify the bladder and allow mobilization of any interposing intestine away from the catheter track. Imaging to support a closed procedure would include the use of ultrasonography in skilled hands (see above) or CT scanning (LE3) Postoperative complications • Patients, carers and clinical staff must be made aware that urgent medical attention is needed if there are symptoms present that might suggest the presence of a catheter insertion-related visceral injury. Symptoms would include the persistence or worsening of lower abdominal pain or pain that is spreading away from the catheter insertion site (LE3) • Written instructions covering contact details and indications for seeking medical assistance should be given to patients and carers immediately after catheter insertion (LE3) Long-term SPC management • The use of a catheter valve as an alternative to continuous free drainage should always be considered where the bladder is known to provide safe urinary storage • The patient should have prompt and easy access to catheter change services and be offered the option of either them or their immediate carers being taught to change the catheter • Immediate access to a urology unit should be provided in the event of a failed catheter change • Antibiotic administration is indicated where there is evidence of cellulitis in the catheter site area or where there is evidence of symptomatic urinary tract infection (LE3) • Systemic antibiotics should not be used to treat uncomplicated pericatheter discharge or asymptomatic bacteruria (LE3) • Regular catheter bypassing or blockage should prompt referral to the local urology department for further investigation and management • Cystoscopy should be undertaken if repeated catheter blockages are occurring CONCLUSIONS It is hoped that these guidelines will assist in minimising morbidity associated with SPC usage. © 2010 BJU International.
Watson T.,University of Birmingham |
Arya A.,Eastbourne District General Hospital |
Sulke N.,Eastbourne District General Hospital |
Lip G.Y.H.,University of Birmingham
Chest | Year: 2010
Background: Atrial fibrillation (AF) is associated with a high risk of stroke. The contribution of arrhythmia to events is clear in sustained forms of AF, but in paroxysmal AF, presently available data have yet to identify what proportion of time spent in AF (ie, arrhythmia burden [AFB]) is of clinical relevance. We aimed to assess this relationship using surrogate blood markers for the hypercoagulable state associated with AF. Methods: One hundred twenty-one consecutive outpatients (mean age 74.7 ± 7.8 years; 73 [60.3% ] men) with pacemakers capable of arrhythmia detection were recruited. AFB was assessed over a 1-month period and classified as AFB = 0%, 0.1% to 10%, 10.1% to 50%, or >50%. Results: Baseline characteristics and comorbidities were comparable between groups. There were no significant differences in levels of soluble E-selectin (sE-selectin), von Willebrand factor (vWf), high-sensitivity C-reactive protein, interleukin-6, soluble P-selectin (sP-selectin), or tissue factor (TF) across the four patient groups. Levels of plasma brain natriuretic peptide (BNP) were approximately twofold greater in the group with the highest AFB (P < .001). Following a stepwise multiple linear regression analysis, age was a significant predictor of vWf (P = .010), sP-selectin (P =.042), and BNP (P =.012). Left ventricular fractional shortening was predictive of BNP (P = .001) and sE-selectin (P = .012). Anticoagulation was a predictor of vWf levels (P = .005), and hypertension was predictive of TF (P < .001). Conclusion: Given no appreciable difference in levels of prothrombotic markers in relation to AFB in this study, it is plausible that these abnormalities do, in fact, relate to underlying risk fac-tors, and that such patients should be anticoagulated if risk factors dictate. Thus, AFB per se should probably not influence the decision to anticoagulate, but rather the presence of AF com-bined with clinical risk scoring should remain the predominant tool for stroke risk assessment. © 2010 American College of Chest Physicians.
Westerland O.,Eastbourne District General Hospital |
Howlett D.,Eastbourne District General Hospital
European Radiology | Year: 2012
Ultrasound is the first-line imaging investigation in the evaluation of parotid gland lesions; however, ultrasound alone cannot differentiate between benign and malignant lesions. An imaging technique with this capability would be of great value, as fine needle aspiration cytology (FNAC) is not always accurate and partial/total parotidectomy is associated with facial nerve palsy and Frey's syndrome. Sonoelastography is a novel imaging technique that has been employed in the research setting in the evaluation of tissues including breast, thyroid, prostate and the salivary glands. More recently it has been used as a diagnostic adjunct in the sonographic evaluation of major salivary gland lesions. This review article outlines the current role of sonoelastography in the diagnostic imaging of parotid lesions, with particular reference to the findings of two research papers published in European Radiology. These papers employ slightly different techniques: the first utilises shear wave elastography whilst the second uses real-time sonoelastography. Sonoelastography may have potential as a diagnostic imaging adjunct to conventional ultrasound. However, it seems likely that FNAC/core biopsy will continue to be necessary. Further studies to evaluate the reproducibility of sonoelastographic results across a range of operators and systems are also needed. Key Points • Ultrasound is the initial and often definitive investigation for parotid lesions • Ultrasound-based strain elastography has been attempted but offered little additional information • New shear wave elastographic techniques did not confer much advantage either • However, analysis of elastographic patterns seems to provide advantages over ultrasound alone. © European Society of Radiology 2012.
Kumar A.,Eastbourne District General Hospital
BMJ case reports | Year: 2013
Digital swelling is a common presentation in clinical practice. Patients presenting with swollen fingers to the emergency department will often have rings on their finger, which can be removed using a variety of simple non-operative techniques or by cutting the ring off and thus avoiding any long-term consequences. Very rarely, when there is a delay in presentation of these patients, serious consequences may proceed, including finger ischaemia, infection, tendon attrition or ultimately the need for surgical amputation. We present an unusual case of patient with psychiatric illness who presented late with a ring that had embedded upon the volar aspect of the index finger. The difficulties faced by the emergency care practitioners in such circumstances, the consequences of rings acting as a tourniquet and strategies for removal of rings on swollen fingers are highlighted.
Nanavaty M.A.,Eastbourne District General Hospital |
Wearne M.J.,Eastbourne District General Hospital
Clinical and Experimental Ophthalmology | Year: 2010
Purpose: To evaluate the commonest routinely used perioperative antibiotic, the preferred route of administration and the choice of antibiotic in 'penicillin allergy' by consultant ophthalmic surgeons in England. Methods: A postal survey was conducted, between December 2008 and April 2009, among consultant ophthalmic surgeons working in smaller National Health Service Ophthalmic departments in England. Smaller units were defined by having a maximum of eight consultant surgeons and tend to be based in district general hospitals. The questionnaires were sent to all consultant ophthalmic surgeons irrespective of special interests. The three questions asked were: (i) Which antibiotic(s) do you use routinely for phaco-emulsification and intraocular lens implantation? (ii) What is your usual route of administration? and (iii) Which antibiotic(s) do you use when the patient states that they have 'penicillin allergy'? Results: The questionnaire was sent to 401 consultant ophthalmic surgeons and 262 consultants (65.34%) replied. Further analysis showed, 44.7% used only intracameral cefuroxime, 31.7% used only subconjunctival cefuroxime, 2.3% used only subconjunctival gentamicin, 6.9% used subconjunctival gentamicin or cefuroxime, 0.4% used subconjunctival cefotaxime, 0.4% used subconjunctival ceftazidime and 0.8% used no antibiotic prophylaxis. One hundred and three (37%) used cefuroxime in patients allergic to penicillin and 47% switched to gentamicin in this situation. Conclusion: Routine phaco-emulsification and intraocular lens implantation is the commonest elective surgical procedure undertaken in the National Health Service and yet there is a wide variation in the use of prophylactic antibiotics in patients with or without 'penicillin allergy' despite The European Society of Cataract and Refractive Surgeons recommendations in 2007. Less than half of the surgeons working in smaller ophthalmic units routinely used intracameral cefuroxime and in 'penicillin allergy' only one-third used cefuroxime. This survey highlights the reluctance of using cefuroxime in patients allergic to penicillin despite evidence to the contrary. © 2010 The Authors. Journal compilation © 2010 Royal Australian and New Zealand College of Ophthalmologists.
Howlett D.C.,Eastbourne District General Hospital |
Skelton E.,Eastbourne District General Hospital |
Moody A.B.,Eastbourne District General Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2015
Abstract The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic. © 2015 The British Association of Oral and Maxillofacial Surgeons.
Burke C.J.,Eastbourne District General Hospital |
Thomas R.H.,Eastbourne District General Hospital |
Howlett D.,Eastbourne District General Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2011
Advances in imaging have led to improved sensitivity in the diagnosis of diseases that involve the major salivary glands. Ultrasound (US), plain radiography and sialography, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scintigraphy/positron emission tomography (PET) all play a part, and imaging often assists in the planning of further management, operative or otherwise. We review the methods used for imaging the major salivary glands, and apply the indications for these methods to the principal pathological processes. © 2010 The British Association of Oral and Maxillofacial Surgeons.