Eastbourne District General Hospital
Eastbourne District General Hospital
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.
Grant P.,Eastbourne District General Hospital
Phytotherapy Research | Year: 2010
Hirsutism in polycystic ovarian syndrome (PCOS), consequent to elevated androgen levels leads to significant cosmetic and psychological problems. Recent research in Turkey has shown that spearmint tea has antiandrogenic properties in females with hirsutism. No research has yet been undertaken to assess whether a reduction in androgen levels brought about by spearmint tea, translates to a clinical improvement in the degree of hirsutism. This study was a two centre, 30 day randomized controlled trial. Forty two volunteers were randomized to take spearmint tea twice a day for a 1 month period and compared with a placebo herbal tea. At 0, 15 and 30 days of the study serum androgen hormone levels and gonadotrophins were checked, the degree of hirsutism was clinically rated using the Ferriman-Galwey score and a questionnaire (the modified DQLI = Dermatology Quality of Life Index) was used to assess improvements in the level of self-reported hirsutism. Forty one of 42 patients completed the study. Free and total testosterone levels were significantly reduced over the 30 day period in the spearmint tea group (p < 0.05). LH and FSH also increased (p < 0.05). Patient's subjective assessments of their degree of hirsutism scored by the modified DQLI were significantly reduced in the spearmint tea group (p < 0.05). There was, however, no significant reduction in the objective Ferriman-Galwey ratings of hirsutism between the two trial groups over the trial duration (p = 0.12). There was a clear and significant alteration in the relevant hormone levels. This is associated clinically with a reduction in the self-reported degree of hirsutism but unfortunately not with the objectively rated score. It was demonstrated and confirmed that spearmint has antiandrogen properties, the simple fact that this does not clearly translate into clinical practice is due to the relationship between androgen hormones and follicular hair growth and cell turnover time. Simply put, the study duration was not long enough. The original studies from Turkey were in fact only 5 days long. The time taken for hirsutism to resolve is significant and a much longer future study is proposed as the preliminary findings are encouraging that spearmint has the potential for use as a helpful and natural treatment for hirsutism in PCOS. Copyright © 2009 John Wiley & Sons, Ltd.
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.
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.