Ipswich General Hospital

Ipswich, United Kingdom

Ipswich General Hospital

Ipswich, United Kingdom
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Quested R.,University of Queensland | Wiltshire D.,Ipswich General Hospital | Sommerville S.,University of Queensland | Lutz M.,University of Queensland
Injury | Year: 2017

Background: Patients with lower limb injuries are commonly advised to non weight bear (NWB) on their injured limb as part of treatment. Occasionally, patients complain that offloading one limb, associated with the use of crutches or other mobility aids, may lead to pain on one of the other supporting limbs. This has led to compensation claims (1) but has never been the subject of formal research. Methods: A prospective cohort trial was undertaken to address this question. Patients were recruited from two Metropolitan Hospital Orthopaedic Fracture Clinics and Orthopaedic Wards. A survey was administered at two time points; the first at the point of definitive orthopaedic treatment and commencement of the NWB phase. The second after the NWB phase was completed. The surveys included a pain Visual Analogue Scale (VAS), Short Form (SF)12, a pain body chart and a health questionnaire. Results: A total of 55 patients were enrolled in the study. Seven patients developed new joint pain after a period NWB. These patients scored significantly lower on the follow up SF12 when compared to those who did not develop new pain (p = 0.045). Follow up phone calls at least 6 months following completion of the second survey revealed that all initial and new pain areas in these participants had resolved. The main limitation of this study was the limited numbers. Conclusion: This study supports the idea that crutches, prescribed in the short term to allow a limb to be NWB, achieve this aim with minimal impact. Their use may be associated with new other joint pain however it can be anticipated this will resolve after cessation of crutch use. © 2017 Elsevier Ltd.

Peters P.,Australian Military Medicine Association | Peters P.,Ipswich General Hospital | Peters P.,Griffith University
Military Medicine | Year: 2011

The tympanic membrane (TM) has long been viewed as an indicator of primary blast injury. A primary blast injury occurs due overpressure occurring as a result of the detonation of high explosives. Cadaver studies indicated pressure required for perforation of the tympanic membrane to be 137 kPa for adults. The accepted range in which other organs (lung, colon, and intestines) are damaged by the pressure wave emanating from an explosion is in the 400-kPa range. The use of the perforation of the tympanic membrane as an indicator of a primary blast injury missed a range of up to 50% of those suffering a primary blast injury to the lung. The status of the tympanic membrane following exposure to a blast does not preclude the need for further investigations for a primary blast injury and the clinician needs to evaluate the patient dependent on their particular exposure to an explosion. Copyright © Association of Military Surgeons of the US. All rights reserved.

Milne T.E.,Ipswich General Hospital | Rogers J.R.,Launceston General Hospital | Kinnear E.M.,The Prince Charles Hospital | Martin H.V.,The Prince Charles Hospital | And 4 more authors.
Journal of Foot and Ankle Research | Year: 2013

Background: Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors' knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes.Methods: Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway.Results: The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN.Conclusions: This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations. © 2013 Milne et al.; licensee BioMed Central Ltd.

Burbos N.,Norwich University | Musonda P.,University of East Anglia | Rufford B.,Ipswich General Hospital
Archives of Gynecology and Obstetrics | Year: 2011

Purpose: The objective of this study was to investigate the outcome of the urgent referrals with suspected gynaecological malignancy. Methods: Retrospective analysis of the data of the urgent referrals for suspected gynaecological cancers over a 12-month period at a gynaecological oncology cancer centre in the UK. Results: A total of 233 patients (70.61%) were referred with suspected endometrial pathology, 59 patients (17.88%) with suspected ovarian, 25 patients (7.58%) with suspected cervical and 13 patients (3.94%) with suspected vulval malignancy. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulval malignancy was 11.6, 23.7, 12.0 and 15.4%, respectively. Amongst the indications for referral for suspected endometrial cancer, presence of postmenopausal vaginal bleeding had the higher odds for cancer (odds = 0.13; 95% CI 0.08-0.21). The odds for cancer for women referred with a pelvic mass was 0.17 (95% CI, 0.07-0.42) and for women referred with abdominal bloating was 0.66 (95% CI, 0.18-2.36). All the cases of malignancy were diagnosed in women referred with suspicious appearance of the cervix on clinical examination. The odds for cancer was 0.50 if the indication for referral was vulval itching. The majority of cases of gynaecological cancers during the study period were diagnosed following routine referrals. Conclusion: The overall predictive value of two-week wait referrals for suspected gynaecological malignancies is low. Refinement of the current referral guidelines is required with particular emphasis in the premenopausal women where the diagnostic performance of the urgent referrals is significantly poorer. © Springer-Verlag 2011.

Kelly S.L.,Ipswich General Hospital | Jackson J.E.,Radiation Oncology Materials Center South Brisbane | Hickey B.E.,Radiation Oncology Materials Center South Brisbane | Szallasi F.G.,Ipswich General Hospital | Bond C.A.,Ipswich General Hospital
American Journal of Otolaryngology - Head and Neck Medicine and Surgery | Year: 2013

Purpose: Multidisciplinary team (MDT) care is widely accepted as best practice for patients with head and neck cancer, although there is little evidence that MDT care improves head and neck cancer related outcomes. This study aims to determine the impact of MDT care on measurable clinical quality indicators (CQIs) associated with improved patient outcomes. Materials and methods: Patients treated for head and neck cancer at Ipswich Hospital from 2001 to 2008 were identified. Comparisons were made in adherence to CQIs between patients treated before (pre MDT) and after (post MDT) the introduction of the MDT. Associations were tested using the Chi-square and Whitney U-test. Results: Treatment post MDT was associated with greater adherence to CQIs than pre MDT. Post MDT had higher rates of: dental assessment (59% versus 22%, p <.0001), nutritional assessment (57% versus 39%, p =.015), PET staging (41% versus 2%, p <.0001), chemo-radiotherapy (CRT) for locally advanced disease (66% versus 16%, p <.0001) and use of adjuvant CRT for high risk disease (49% versus 16%, p <.0001). The interval between surgery and radiotherapy was shorter in the post MDT group (p =.009) as was the mean length of hospitalization (p =.002). Conclusions: This study highlights the measurable advantages of MDT care over the standard, less formalized, referral process. © 2013 Elsevier Inc.

Henderson A.,Princess Alexandra Hospital | Burmeister L.,Princess Alexandra Hospital | Schoonbeek S.,Princess Alexandra Hospital | Ossenberg C.,Princess Alexandra Hospital | Gneilding J.,Ipswich General Hospital
Journal of Nursing Management | Year: 2014

Aim: This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator. Background: The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff. Design: A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia. Method: Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after 'practice learning' interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture). Results: Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention. Implications for nursing management: Middle management should work closely with facilitators to assist embedding practice interventions. © 2014 John Wiley & Sons Ltd.

Trinidade A.,Ipswich General Hospital | Skingsley A.,Imperial College London | Yung M.W.,Ipswich General Hospital
Otology and Neurotology | Year: 2015

Objective: To present the results of a 5-year longitudinal study in a pediatric population undergoing surgery for extensive cholesteatoma using a canal wall down (CWD) approach with obliteration.Study Design: Prospective longitudinal study.Patients: Children (G16 years) undergoing surgery for cholesteatoma (58 ears) between 1999 and 2013. Interventions: Therapeutic. Setting: District general hospital.Main Outcome Measures: (1) Residual, recurrence, and recidivist cholesteatoma rates at 5 years post-surgery; (2) postoperative hearing; (3) postoperative waterproofing of the ear; (4) number of subsequent ear surgery required.Results: Fifty-five children (58 ears) contributed to the study. At 5 years, 16 of 58 (27.6%) had been lost to follow-up. Using Kaplan-Meier survival analysis, the residual rate after 5 years was 9.9% (95% CI: 3.8Y24.4%), representing four residual cholesteatomas, and there were no recurrences detected. Using a cross-sectional analysis at 12 months of follow-up, the otorrhea risk was 0% and the risk of definitive waterproofing was 94.8%. There was a re-operation risk of 17.2% within 5 years which included second-stage ossiculoplasty. Regarding hearing, of the data available (n = 16), 10 children (62.5%) maintained their hearing (change between j10 and =10 dB), 2 (12.5%) had hearing gain (910 dB), and 4 children (25%) had hearing reduction at 12 months postoperation. Four of 16 children (25%) had a postoperative hearing level of 30 dB or lower.Conclusion: The use of a CWD approach with obliteration of the mastoid cavity to surgically treat extensive cholesteatoma in children results in a low recurrence rate and high rate of a troublefree ear in the long term. © 2014, Otology & Neurotology, Inc.

Trinidade A.,Ipswich General Hospital | Yung M.W.,Ipswich General Hospital
Clinical Otolaryngology | Year: 2014

Objective: A specialist balance clinic to effectively deal with dizzy patients is recommended by ENT-UK. We audit the patient pathway before and following the introduction of a consultant-led dedicated balance clinic. Design: Process evaluation and audit. Setting: ENT outpatients department of a district general hospital. Main Outcome Measures: The journey of dizzy patients seen in the general ENT clinic was mapped from case notes and recorded retrospectively. A consultant-led, multidisciplinary balance clinic involving an otologist, a senior audiologist and a neurophysiotherapist was then set up, and the journey was prospectively recorded and compared with that before the change. Results: Of the 44 dizzy patients seen in the general clinic, 41% had further follow-up consultations; 64% were given definitive or provisional diagnoses; 75% were discharged without a management plan. Oculomotor examination was not systematically performed. The mean interval between Visits 1 and 2 was 8.4 weeks and the mean number of visits was 3. In the consultant-led dedicated balance clinic, following Visit 1, only 8% of patients required follow-up; 97% received definitive diagnoses, which guided management; all patients left with definitive management plans in place. In all patients, oculomotor assessment was systematically performed and all patients received consultant and, where necessary, allied healthcare professional input. Conclusions: By standardising the management experience for dizzy patients, appropriate and timely treatment can be achieved, allowing for a more seamless and efficient patient journey from referral to treatment. A multidisciplinary balance clinic led by a consultant otologist is the ideal way to achieve this. © 2014 John Wiley & Sons Ltd.

Coutinho A.K.,Ipswich General Hospital | Glancey G.R.,Ipswich General Hospital
Nephrology Dialysis Transplantation | Year: 2013

Obesity is an emerging risk factor for chronic kidney disease (CKD) in the developed world. Orlistat, an intestinal lipase inhibitor, used in the treatment of obesity is available as an over-the-counter medication across the European union and in many countries worldwide. It is associated with acute kidney injury (AKI). We present three adults, followed up from 1 to 6 years, who developed de novo or worsening renal impairment while on orlistat. Stopping the drug halted progression, but did not reverse the degree of renal impairment at presentation. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Trinidade A.,Ipswich General Hospital | Yung M.W.,Ipswich General Hospital
Clinical Otolaryngology | Year: 2014

Objective: To investigate Fallopian canal dehiscence (FCD) during cholesteatoma surgery. Study design: Prospective case-control study. Patients: Four hundred and one patients with cholesteatoma and 172 with otosclerosis. Interventions: Therapeutic. Setting: District general hospital. Main outcome measures: (i) Intra-operative incidence of FCD during (a) surgery for cholesteatoma versus a homogeneous control group (patients with otosclerosis); (b) revision surgery for cholesteatoma as compared to primary surgery. (ii) Intra-operative incidence of a fistula if FCD is present. Results: Data were prospectively collected and analysed using chi-square tests. FCD was found in 19% of cases versus 5.2% of controls. Intra-operative incidence of (i) FCD during cholesteatoma surgery versus otosclerosis surgery was statistically very highly significant (P < 0.0001, OR = 5.43); (ii) FCD during revision versus primary cholesteatoma surgery was not statistically significant (P = 0.83); and (iii) encountering a fistula in the presence of FCD during cholesteatoma surgery was statistically very highly significant (P < 0.0001, OR = 6.71). Conclusions: A surgeon is more likely to encounter FCD during cholesteatoma surgery than in stapes surgery. If during cholesteatoma surgery FCD is found, then a fistula is also more likely to be present, mainly of the semicircular canal. The incidence of FCD is not increased in revision surgery. These findings are very relevant for any otologist undertaking cholesteatoma surgery. © 2014 John Wiley & Sons Ltd.

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