Hampshire Hospitals NHS Foundation Trust

Winchester, United Kingdom

Hampshire Hospitals NHS Foundation Trust

Winchester, United Kingdom

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Ahmed H.U.,University College London | Hindley R.G.,Hampshire Hospitals NHS Foundation Trust | Dickinson L.,University College London | Freeman A.,University College London | And 7 more authors.
The Lancet Oncology | Year: 2012

Background: Radical whole-gland therapy can lead to significant genitourinary and rectal side-effects for men with localised prostate cancer. We report on whether selective focal ablation of unifocal and multifocal cancer lesions can reduce this treatment burden. Methods: Men aged 45-80 years were eligible for this prospective development study if they had low-risk to high-risk localised prostate cancer (prostate specific antigen [PSA] ≤15 ng/mL, Gleason score ≤4 + 3, stage ≤T2), with no previous androgen deprivation or treatment for prostate cancer, and who could safely undergo multiparametric MRI and have a general anaesthetic. Patients received focal therapy using high-intensity focused ultrasound, delivered to all known cancer lesions, with a margin of normal tissue, identified on multiparametric MRI, template prostate-mapping biopsies, or both. Primary endpoints were adverse events (serious and otherwise) and urinary symptoms and erectile function assessed using patient questionnaires. Analyses were done on a per-protocol basis. This study is registered with . ClinicalTrials.gov, number . NCT00561314. Findings: 42 men were recruited between June 27, 2007, and June 30, 2010; one man died from an unrelated cause (pneumonia) 3 months after treatment and was excluded from analyses. After treatment, one man was admitted to hospital for acute urinary retention, and another had stricture interventions requiring hospital admission. Nine men (22%, 95% CI 11-38) had self-resolving, mild to moderate, intermittent dysuria (median duration 5·0 days [IQR 2·5-18·5]). Urinary debris occurred in 14 men (34%, 95% CI 20-51), with a median duration of 14·5 days (IQR 6·0-16·5). Urinary tract infection was noted in seven men (17%, 95% CI 7-32). Median overall International Index of Erectile Function-15 (IIEF-15) scores were similar at baseline and at 12 months (p=0·060), as were median IIEF-15 scores for intercourse satisfaction (p=0·454), sexual desire (p=0·644), and overall satisfaction (p=0·257). Significant deteriorations between baseline and 12 months were noted for IIEF-15 erectile (p=0·042) and orgasmic function (p=0·003). Of 35 men with good baseline function, 31 (89%, 95% CI 73-97) had erections sufficient for penetration 12 months after focal therapy. Median UCLA Expanded Prostate Cancer Index Composite (EPIC) urinary incontinence scores were similar at baseline as and 12 months (p=0·045). There was an improvement in lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), between baseline and 12 months (p=0·026), but the IPSS-quality of life score showed no difference between baseline and 12 months (p=0·655). All 38 men with no baseline urinary incontinence were leak-free and pad-free by 9 months. All 40 men pad-free at baseline were pad-free by 3 months and maintained pad-free continence at 12 months. No significant difference was reported in median Trial Outcomes Index scores between baseline and 12 months (p=0·113) but significant improvement was shown in median Functional Assessment of Cancer Therapy (FACT)-Prostate (p=0·045) and median FACT-General scores (p=0·041). No histological evidence of cancer was identified in 30 of 39 men biopsied at 6 months (77%, 95% CI 61-89); 36 (92%, 79-98) were free of clinically significant cancer. After retreatment in four men, 39 of 41 (95%, 95% CI 83-99) had no evidence of disease on multiparametric MRI at 12 months. Interpretation: Focal therapy of individual prostate cancer lesions, whether multifocal or unifocal, leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinically significant prostate cancer. Funding: Medical Research Council (UK), Pelican Cancer Foundation, and St Peters Trust. © 2012 Elsevier Ltd.


Brooks A.P.,Hampshire Hospitals NHS Foundation Trust | Li Voon Chong J.S.W.,Hampshire Hospitals NHS Foundation Trust
Practical Diabetes | Year: 2014

Clinical and demographic data from the records of 694 white Caucasian patients with type 1 diabetes attending a secondary care diabetes clinic between 1983 and 2010 have been audited to give information on age at diagnosis of type 1 diabetes and frequency of a family history of diabetes in their first degree relatives over five chronological decades between 1961 and 2010. All patients in the cohort lived in 12 postcode areas (six urban and six rural) in west Hampshire, and, although ascertainment is thought to be at least 90%, the exact at-risk populations are not accurately known, so no incidence nor prevalence figures can be given. Mean age at diagnosis rose from 18.5 years in the decade 1961-70 to 26.7 years in 1991-2000, falling again to 21.9 in 2001-10. The ranges of ages at diagnosis were 0.7-53.5 years in the decade 1961-70, and 0.7-73.1 in the decade 1991-2000. Sixty-three of the 694 patients (9.1%) were diagnosed over the age of 45 years. This is important in the initial management of people presenting with new-onset diabetes at any age and for screening programmes to consider. Eighty-eight patients had a first degree relative with diagnosed diabetes, giving an overall risk of 1 in 8 (12.7%). Possible genetic mechanisms operating in this group, and their investigation, are put forward on a hypothetical basis. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.


Saeed K.,Hampshire Hospitals NHS Foundation Trust | Ahmad N.,Public Health England | Dryden M.,Hampshire Hospitals NHS Foundation Trust
Expert Review of Molecular Diagnostics | Year: 2014

Serum procalcitonin (PCT) is an established diagnostic marker for severe or systemic bacterial infections such as pneumonia, sepsis and septic shock. Data regarding the role of PCT in localized infections without systemic inflammatory response syndrome are scarce. The aim of this review is to assess the value of PCT measurements in localized infections such as skin and skin structure infections, diabetic foot infections, septic arthritis (SA) and osteomyelitis. It appears that serum PCT is unlikely to change the clinical practice in skin and skin structure infection. However, serum PCT could have a role in diagnosis and monitoring of diabetic foot infections in hospitalized settings. There are conflicting reports regarding the ability of serum PCT to distinguish SA from non-SA; synovial PCT may be more appropriate in these settings, including in implant-related infections. Better designed studies are needed to evaluate the usefulness of PCT with or without other biomarkers in localized infections. © 2014 Informa UK, Ltd.


Dryden M.,Hampshire Hospitals NHS Foundation Trust
Journal of Antimicrobial Chemotherapy | Year: 2014

There is increasing demand for prosthetic joint surgery and patients are becoming more challenging due to an ageing population often with comorbidities and immunosuppression. While prosthetic joint infection (PJI) rates are generally low, infection can be catastrophic for the patient and hence prevention of infection is critical. Infection, when it does occur, is further complicated by the global rise in antimicrobial resistance. This article introduces a series of papers on the epidemiology of PJI, its diagnosis, use of novel inflammatory markers and molecular techniques, clinical presentation, importance of biofilms, treatment guidelines and, finally, various strategies and novel antibiotic treatment regimens. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Saeed K.,Hampshire Hospitals NHS Foundation Trust | Saeed K.,University of Southampton
Journal of Antimicrobial Chemotherapy | Year: 2014

Prosthetic joint infection (PJI) poses a significant burden on patients, clinicians and the healthcare economy. Although various tests have been established for the diagnosis of PJI, the diagnosis remains challenging. In this review, established and potential future diagnostic tests are presented, some of which could provide stepping stones towards improved diagnosis, identification of aetiological agents and efficacious therapeutic options for the management of PJI. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Ahmed H.U.,University College London | Dickinson L.,University College London | Charman S.,London School of Hygiene and Tropical Medicine | Charman S.,Clinical Effectiveness Unit | And 11 more authors.
European Urology | Year: 2015

Background Although localised prostate cancer is multifocal in most instances, the index lesion might be responsible for disease progression. Objective To determine the early genitourinary functional and cancer control outcomes of index lesion ablation. Design, setting, and participants This was a single-centre prospective development study in which 56 men were treated (July 2009-January 2011). The mean age was 63.9 yr (standard deviation 5.8) and median prostate-specific antigen (PSA) was 7.4 ng/ml (interquartile range [IQR] 5.6-9.5). There were seven (12.5%) low-risk, 47 (83.9%) intermediate-risk, and two (3.6%) high-risk cancers. Intervention Multiparametric magnetic resonance imaging (mpMRI) and prostate biopsies to localise disease, followed by index lesion ablation using high-intensity focused ultrasound. Outcome measurements and statistical analysis Primary outcomes were genitourinary side effects measured using validated questionnaires. Secondary outcomes included absence of clinically significant disease at 12 mo. Results and limitations The composite of leak-free, pad-free continence, and erections sufficient for penetration decreased from a baseline frequency of 40/56 (71.4%) to 33/56 (58.9%) at 12 mo. Pad-free and leak-free, pad-free continence was preserved in 48/52 (92.3%) and 46/50 (92.0%) patients, respectively. Erections sufficient for intercourse were preserved in 30/39 (76.9%) patients. The median PSA nadir decreased to 2.4 ng/ml (IQR 1.6-4.1). At 12 mo, 42/52 (80.8%) patients had histological absence of clinically significant cancer and 85.7% (48/56) had no measurable prostate cancer (biopsy and/or mpMRI). Two (3.6%) patients had clinically significant disease in untreated areas not detected at baseline. The main study limitation is the short follow-up duration. Conclusions Index lesion ablation had low rates of genitourinary side effects and acceptable short-term absence of clinically significant cancer. Comparative effectiveness trials are required to assess cancer control outcomes against radical therapy. Patient summary In this study we looked at whether it is possible to treat the largest and highest-grade tumour in men who have more than one known prostate tumour. We show that the side effects of targeted ablation were low, with acceptable rates of early cancer control. Larger studies with longer follow-up are needed. © 2015 European Association of Urology.


Dryden M.S.,Hampshire Hospitals NHS Foundation Trust
Current Opinion in Infectious Diseases | Year: 2014

PURPOSE OF REVIEW: Acute bacterial skin and skin structure infection (ABSSSI) is a common and significant indication for antibiotic treatment. The microbial aetiology is becoming more resistant to available antibiotics and the treatment of patients is additionally challenged by extremes of age, obesity, diabetes and other co-morbidities. This review examines recent antimicrobial developments. RECENT FINDINGS: In many parts of the world, multidrug-resistant (MDR) staphylococci are the predominant cause of ABSSSI in both the community and in hospital. Increasing resistance in Gram-negative organisms presents problems in the management of surgical-site infections. Most new antibiotics have been developed to treat MDR Gram-positive bacteria and there are few agents to treat infections caused by MDR Gram-negative pathogens. SUMMARY: A number of novel agents are available clinically, with other agents of related chemical structure under development. There are no entirely new classes of antibiotics. Maintaining the efficacy of antimicrobial treatment require effective antibiotic stewardship, good infection prevention and the development of further new antibiotics. Copyright © 2014 Wolters Kluwer Health / Lippincott Williams & Wilkins.


Sykes L.,Hampshire Hospitals NHS Foundation Trust
The Cochrane database of systematic reviews | Year: 2014

This is an updated version of the original Cochrane review published in 2010, Issue 1. Seizures after stroke are an important clinical problem, and they may be associated with poor outcome. The effects of antiepileptic drugs for the primary and secondary prevention of seizures after stroke remain unclear. We aimed to assess the effects of antiepileptic drugs for the primary and secondary prevention of seizures after stroke. We searched the Specialised Registers of the Cochrane Epilepsy Group (12 August 2013) and the Cochrane Stroke Group (12 August 2013), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2013, Issue 7), and MEDLINE (OVID, 1946 to 12 August 2013). We also checked the reference lists of articles retrieved from these searches. Randomised and quasi-randomised controlled trials in which participants were assigned to treatment or control group (placebo or no drug). Two review authors independently screened all the titles, abstracts, and keywords of publications identified by the searches to assess their eligibility, and both review authors assessed their suitability for inclusion according to prespecified selection criteria. We included only one study for data collection and analysis. We found only one trial that fulfilled the study inclusion criteria of comparison of the effects of an antiepileptic drug with placebo (or no drug) for the primary or secondary prevention of seizures after stroke. This was a prospective randomised, double-blind, placebo-controlled trial comparing valproic acid with placebo for primary prevention of seizures in 72 adults (over 18 years of age) with spontaneous non-aneurysmal, non-traumatic intracerebral haemorrhage; no statistically significant difference in outcome (seizure occurrence at one year) was demonstrated between groups. Currently, there is insufficient evidence to support the routine use of antiepileptic drugs for the primary or secondary prevention of seizures after stroke. Further well-conducted research is needed for this important clinical problem.


Dale A.P.,Hampshire Hospitals NHS Foundation Trust | Saeed K.,Hampshire Hospitals NHS Foundation Trust
Current Opinion in Infectious Diseases | Year: 2015

Purpose of review The use of negative pressure wound therapy with instillation (NPWTi) in complex or difficult-to-treat acute and chronic wounds has expanded rapidly since the introduction of commercially available NPWTi systems. We summarize the evidence related to NPWTi and particularly focus on the application of this technology in diabetic foot ulcers, diabetic foot infections and postoperative diabetic wounds. Recent findings The benefits of negative pressure wound therapy (NPWT) are well documented in the treatment of complex acute and chronic wounds, including noninfected postoperative diabetic wounds and diabetic foot ulcers. Combining intermittent wound irrigation with NPWT may offer additional benefits compared to NPWT alone, including further reduction of wound bed bioburden, increased granulation tissue formation and provision of wound irrigation in a sealed environment, thus preventing potential cross-contamination events. Recently, available evidence suggests that adjunctive NPWTi may be superior to standard NPWT in the management of diabetic infections following surgical debridement and may promote granulation tissue formation in slow-to-heal wounds. Summary Available evidence relating to the utilization of NPWTi in diabetic foot infections is promising but limited in quality, being derived mostly from case series or small retrospective or prospective studies. In order to confirm or refute the potential benefits of NPWTi in this patient cohort, well designed randomized controlled studies are required that compare NPWTi to NPWT or standard wound care methodologies. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Knowles B.,Hampshire Hospitals NHS Foundation Trust | Welsh F.K.S.,Hampshire Hospitals NHS Foundation Trust | Chandrakumaran K.,Hampshire Hospitals NHS Foundation Trust | John T.G.,Hampshire Hospitals NHS Foundation Trust | Rees M.,Hampshire Hospitals NHS Foundation Trust
HPB | Year: 2012

Background: Neoadjuvant chemotherapy for colorectal liver metastases (CRLM) reduces the accuracy of liver imaging which may understage patients pre-operatively. Retrospective review of a prospective database to determine whether liver-specific magnetic resonance imaging (MRI) prior to pre-operative chemotherapy affects intra-hepatic recurrence and long-term outcome after hepatectomy. Patients and methods: Between 2003 and 2009, 242 patients with CRLM underwent a hepatectomy after ≥3 cycles of oxaliplatin or irinotecan-based chemotherapy. All had a liver-specific MRI immediately pre-operatively. The outcome of patients who had a liver-specific MRI prior to chemotherapy (PCI group, n= 92) was compared with those who did not (non-PCI group, n= 150). Results: A liver-specific MRI pre-chemotherapy changed the staging in 56% of patients. At a median (range) follow-up of 55 (6-94) months, there was a higher incidence of intra-hepatic recurrence at a new site in the non-PCI group (65% vs. 48% in the PCI group, P= 0.041) and an increased rate of recurrence in patients with the same number of lesions pre- and post-chemotherapy [hazard ratio (HR) 2.02, 1:10-3.37, P= 0.024]. The non-PCI group underwent more repeat hepatectomies than the PCI group (24.7% vs. 13%, P= 0.034), achieving similar long-term survival. Conclusions: A liver-specific MRI prior to chemotherapy reduces intra-hepatic recurrence and avoids a repeat hepatectomy. © 2012 International Hepato-Pancreato-Biliary Association.

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