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Jones B.,University of Oxford | Grant W.,Gloucestershire Hospitals NHS Foundation Trust
Clinical Oncology | Year: 2014

The purpose of this overview is to describe radiotherapy retreatment of primary central nervous system tumours from a practical clinical management perspective, including patient selection, choice of radiation technique, dose and fractionation. Useful relief of clinical symptoms and occasionally prolonged survival can follow retreatment. Further analysis of a previously published data set shows that the duration of remission after initial radiotherapy does not correlate with the duration of the remission after retreatment. Also there is no clear relationship between delivered tissue and tumour biological effective dose (BED) and duration of second remission. 'Recovery' of radiation tolerance with time is important and the radiobiological experiments that show this phenomenon have important limitations. To improve the decision as to how much recovery safely occurs with increasing time after radiotherapy, a new mathematical formulation is proposed. This is essentially conservative in its intent, compatible with experimental data sets, and provides a method for tentative calculation of retreatment dose and fractionation. Worked examples are provided of such calculations.As an increasing number of relatively young patients are now retreated, it is important to extend the experimental and human evidence base. A nationally co-ordinated analysis of patients already retreated would be valuable, in order to make future retreatment as safe and effective as possible, with validation of the permissible retreatment schedules for the particular radiation technique used. A national register and task force is proposed to facilitate this. © 2014 The Royal College of Radiologists.

Mohan N.,Gloucestershire Hospitals NHS Foundation Trust | Caldwell G.,Worthing Hospital
Clinical Teacher | Year: 2013

Background: Ward rounds are complex clinical activities, and are an integral part of hospital life. Failures in care can have a direct consequence on patient safety. Recently, simulation ward rounds have allowed medical students and junior doctors to practise their skills in a safe environment, yet there is no commonly accepted and taught framework on how to conduct a ward round. Context: After the success of the WHO Surgical Safety checklist in reducing patient morbidity and mortality, Dr Gordon Caldwell designed a Considerative Checklist for his ward rounds to ensure a comprehensive patient review. Although it does not ensure that the clinical decision-making is adequate, it does ensure that various hospital protocols have been adhered to, for example assessing patient venous thromboembolism (VTE) risk and prescribing prophylaxis. I spent 8weeks as a part of Dr Caldwell's medical team, and during this time I was assigned the role of 'checker'. This role allowed me to actively participate in the ward rounds, and gave me a framework for the ward round that was easy to learn and follow. Implications: Clinical checklists have become integral to improving patient outcomes, and Dr Caldwell's checklist could be used to improve patient safety while they are in-patients. The Considerative Checklist could be a vital tool in teaching this skill to students and junior doctors, but further qualitative and quantitative research is required to investigate whether using the checklist improves student performance, learning and engagement on the wards, and whether this improves patient outcomes. © 2013 John Wiley & Sons Ltd.

Whitehurst J.L.,Gloucestershire Hospitals NHS Foundation Trust | Reid C.M.,University of Bristol
Palliative Medicine | Year: 2014

Background: Vitamin D deficiency is common in the general population and has been implicated as a cause of chronic pain. The palliative care population has a number of risk factors for vitamin D deficiency. We present two cases of unexplained pain in patients attending the palliative medicine outpatient clinic that improved after vitamin D replacement. Cases: Case 1 is a 46-year-old man with thalassaemia intermedia and back and leg pain without a clear cause. Case 2 is a 28-year-old woman undergoing treatment for cervical cancer whose initial disease and treatment-related abdominal pain resolved but subsequently reported ongoing non-specific aches and pains. Case management: Both patients were found to have vitamin D levels <50 nmol/L and were treated with vitamin D replacement therapy. Case outcome: Following vitamin D replacement therapy, pain resolved in both patients allowing a reduction in analgesic therapy. Conclusions: The prevalence of vitamin D deficiency in the palliative care population merits further investigation, since these patients are at high risk of deficiency. Having an index of suspicion, particularly in those patients with known risk factors and pain that is not fully explained, may result in better pain control and functional outcomes. © 2013 The Author(s).

Earnshaw J.J.,Gloucestershire Hospitals NHS Foundation Trust
Surgery (United Kingdom) | Year: 2012

Research is an essential part of surgical training, so a surgical trainee must publish to prosper. The most important piece of advice is to seek expert help before commencing the process of research and subsequent publication. Having a piece of research worthy of communication to peers is an essential prerequisite, but there are many different types of publication, and many different avenues for publication. Starting with a simple case report is often a good beginning; publication in high-profile, high-impact-factor journals requires high-quality research such as randomized trials or systematic reviews. The more high profile the research, the more likely there are to be formal rules about its conduct and its publication (CONSORT, PRISMA etc). Writing in scientific English requires economy of style and linguistic restraint; many readers will not have English as a first language. By convention, scientific articles are written in IMRAD style - introduction, methods, results and discussion. This author has evolved a method to make writing a scientific manuscript as painless as possible. It may be tempting to relax once the writing is complete, but managing the paper through submission can also be challenging. Most journals will not accept a paper immediately, but will require corrections suggested by independent referees after formal peer review. All dealings with journal editors should be professional and courteous. © 2012 Elsevier Ltd. All rights reserved.

Gloucestershire Hospitals Nhs Foundation Trust and University of Bristol | Date: 2012-07-27

An optical device with a first sub-assembly and a second sub-assembly. The first sub-assembly has: an input lens for collimating illuminating light, the input lens having an optical axis, an output lens for focusing collimated light received from a sample, the output lens having an optical axis which is offset and substantially parallel with the optical axis of the input lens, and a first support piece which houses and supports the input lens and the output lens. The second sub-assembly has: an input filter for filtering the collimated illuminating light, an output filter for filtering the collimated light received from the sample, and a second support piece which houses and supports the input filter and the output filter. The first and second support pieces are joined together by a liquid-tight joint.

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