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Swindon, United Kingdom

Boyages J.,University of Sydney | Jayasinghe U.W.,University of Sydney | Coombs N.,Great Western Hospital
European Journal of Cancer

Purpose: The objective of this study is to determine whether the aggregate tumour size of every focus in multifocal breast cancer more accurately predicts 10-year survival than current staging systems which use the largest or dominant tumour size. Patients and methods: This study examined the original histological reports of 848 consecutive patients with invasive breast cancer treated in New South Wales (NSW), Australia between 1 April 1995 and 30 September 1995. Multifocal tumours were assessed using two estimates of pathologic tumour size: largest tumour focus diameter and the aggregate diameter of every tumour focus. The 10-year survival of patients with multifocal tumours measured in both ways was compared to that with unifocal tumours. Results: At a median follow-up of 10.4 years, 27 of 94 patients (28.7%) with multifocal breast cancer have died of breast cancer compared to 141 of 754 (18.7%) with unifocal breast cancer (P = .022). Ten-year survival was not affected by size for tumours measuring 20 mm or less, whether or not dominant tumour size (87.9%) or aggregate tumour size (87.0%) was used for multifocal tumours, compared to unifocal tumours (88.1%). For tumours larger than 20 mm, 10-year survival was 72.1% for unifocal tumours compared to 54.7% (P = .008) for multifocal tumours using dominant tumour size, but this was 69.5% and not significant when multifocal tumours were classified using aggregate tumour size (P = .49). Multivariate analysis also confirmed the above-mentioned results after adjustment for important prognostic factors. Conclusion: Aggregate size of every focus should be considered along with other prognostic factors for metastasis when treatment is planned. The current convention of using the largest (dominant) lesion as a measure of stage and associated breast cancer survival needs further validation. © 2010 Elsevier Ltd. All rights reserved. Source

Palazzo S.,University of Oxford | Hocken D.B.,Great Western Hospital
Journal of Hospital Infection

Infection in hospitals is a serious problem. Attempting to address the spread of infection, many UK National Health Service trusts have adopted a 'bare-below-the-elbows' and tie-less dress-code policy. This followed publication of Department of Health guidelines on staff uniforms in September 2007. Although the potential for colonisation of clothing with pathogens has been investigated, patients' opinions on dress-code and policy change have not. This survey of 75 patients in Great Western Hospital, Swindon, UK, used questionnaires to address this. The survey showed that, although patients did feel that doctors' dress was important, neckties and white coats were not expected. Moreover, surgical scrubs were considered acceptable forms of attire. Problems of identifying doctors and determining their grade were repeatedly raised. Patients were generally unaware of the new dress-code, and few knew anything of its relationship to infection control. This work demonstrates that more 'traditional' dress is not expected. Given the problems of identification and perception of surgical scrubs as suitable, their introduction as a 'uniform for doctors' should be considered. Furthermore, work needs to be done to advertise policy change and increase patient awareness of infection control. © 2009 The Hospital Infection Society. Source

Vaughan-Shaw P.G.,Southampton General Hospital | Cannon C.,Great Western Hospital

Objective: Medical inpatients have been shown to be at risk of venous thromboembolism (VTE) including fatal pulmonary emboli. Several studies have shown that pharmacological thromboprophylaxis significantly reduces the rates of VTE, yet studies published to date have shown a considerable underuse of thromboprophylaxis in medical patients. This study assesses the current use of thromboprophylaxis in medical patients at our institution and aims to identify simple strategies to improve practice. Design: A prospective study of thromboprophylaxis prescription was undertaken on three occasions over a 12-month period. Patients were stratified according to the number of risk factors and standards of thromboprophylaxis assessed according to risk. After the first round of data collection, results were presented, a local guideline was developed and a risk assessment was added to the clerking pro forma. Results: There were 122 patients in the first round, 101 in the second and 163 in the third. Eligible moderate and high-risk patients receiving a low molecular weight heparin (LMWH) increased from 31% to 63% (P < 0.005) over the study period. Prescription of thromboembolic deterrent (TED) stockings in those contraindicated to LMWH increased from 23% to 35% although this was not statistically significant (P = 0.08), and the percentage of high-risk patients correctly receiving LMWH, TED stockings or both increased from 22% to 62% (P < 0.0005). Documentation of contraindications to thromboprophylaxis increased from 0% to 59% (P < 0.0005). Conclusion: This paper demonstrates an initial rate of thromboprophylaxis use considerably less than the ENDORSE trial. However the strategies employed following initial audit resulted in a significant increase in the prescription of both mechanical and pharmacological thromboprophylaxis. This example demonstrates the role of audit education and a risk assessment in stimulating change. Such strategies could be used to ensure compliance to recently published National Institute of Clinical Excellence VTE guidelines. Furthermore this example could be generalized to improve other aspects of care. Source

Sheard R.M.,Royal Hallamshire Hospital | Smith G.T.,Great Western Hospital | Cooke D.L.,Great Lakes Eye Care
Journal of Cataract and Refractive Surgery

Purpose: To investigate the causes of nonphysiologic behavior of the SRK/T formula, assess their clinical significance, and develop and evaluate solutions. Setting: Two NHS ophthalmology departments, United Kingdom, and a private practice, United States. Design: Evaluation of technology. Methods: The individual steps of the SRK/T formula were examined for nonphysiologic behavior, and the clinical significance of behaviors was assessed with reference to a database of biometry and refractive outcomes in 11189 eyes. The full data set was divided into 2 subsets, the first to develop solutions to nonphysiologic behavior of the SRK/T formula and the second to evaluate their performance. Results: The SRK/T formula showed nonphysiologic behavior in the calculation of corrected axial length and corneal height. Although the former is of little clinical significance, the latter showed a systematic error that contributes to inaccurate intraocular lens (IOL) power prediction. The T2 formula was developed using a regression formula for corneal height derived from the development subset. Comparison of the performance of the T2 and SRK/T formulas using the evaluation subset showed significant improvement in the mean absolute error with the T2 formula (0.3064 diopter [D] versus 0.3229 D; P<.0001). On average, the prediction error with the T2 formula was 9.7% less than with the SRK/T formula, with significantly higher proportions of eyes within ±0.50 D of target (P<.0001). Conclusions: The SRK/T formula has nonphysiologic behavior that contributes to IOL power prediction errors. A modification to the formula algorithm, the T2 formula, can be directly substituted for SRK/T, resulting in significantly improved prediction accuracy. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2010 ASCRS and ESCRS. Source

Upchurch E.,Great Western Hospital
British Journal of Hospital Medicine

Acute pancreatitis is seen commonly on the surgical take. It can be complicated by the development of pseudocysts and necrosis. This review discusses each of these in turn and outlines the different management strategies now on offer. © 2014 MA Healthcare Ltd. Source

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