Ipswich Hospital NHS Trust

Ipswich, United Kingdom

Ipswich Hospital NHS Trust

Ipswich, United Kingdom

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Yung M.,Ipswich Hospital NHS Trust | Bennett A.,Royal Infirmary
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2013

Purpose of Review: To evaluate the choice of techniques, safety and long-term outcome of mastoid obliteration and assess the place of imaging in the postoperative monitoring of residual cholesteatoma. Recent Findings: All recent reports on mastoid obliteration for the management of cholesteatoama were favourable. Long-term follow-up reports did not show problems arising from hidden cholesteatoma, even for the paediatric population. Non-EPI DW MR imaging has shown great promise in detecting residual cholesteatoma in obliterated cavities. Summary: Canal wall down technique with primary mastoid obliteration for cholesteatoma has low recurrent and residual cholesteatoma rates. Most ears remained dry and waterproof on long-term follow-up. © 2013 Lippincott Williams and Wilkins.


Kerr M.,Insight Health Economics | Rayman G.,Ipswich Hospital NHS Trust | Jeffcoate W.J.,University of Nottingham
Diabetic Medicine | Year: 2014

Aim: To estimate the annual cost of diabetic foot care in a universal healthcare system. Methods: National datasets and economic modelling were used to estimate the cost of diabetic foot disease to the National Health Service in England in 2010-2011. The cost of hospital admissions specific to foot disease or amputation was estimated from Hospital Episode Statistics and national tariffs. Multivariate regression analysis was used to estimate the impact of foot disease on length of stay in admissions that were not specific to foot disease or amputation. Costs in other areas were estimated from published studies and data from individual hospitals. Results: The cost of diabetic foot care in 2010-2011 is estimated at £580m, almost 0.6% of National Health Service expenditure in England. We estimate that more than half this sum (£307m) was spent on care for ulceration in primary and community settings. Of hospital admissions with recorded diabetes, 8.8% included ulcer care or amputation. Regression analysis suggests that foot disease was associated with a 2.51-fold (95% CI 2.43-2.59) increase in length of stay. The cost of inpatient ulcer care is estimated at £219 m, and that of amputation care at £55 m. Conclusions: The cost of diabetic foot disease is substantial. Ignorance of the cost of current care may hinder commissioning of effective services for prevention and management in both community and secondary care. © 2014 Diabetes UK.


Vas P.R.J.,Ipswich Hospital NHS Trust | Rayman G.,Ipswich Hospital NHS Trust
Muscle and Nerve | Year: 2013

Introduction: In this study we validated a modified laser Doppler imager method (mLDIf) for assessing C-fiber function and compared it to the original (oLDIf). Both measure flare size in foot skin after heating, but the mLDIf uses 47°C (vs. 44°C), making it quicker and better suited for clinical use. Methods: To confirm that mLDIf assesses C-fiber function, 5 healthy controls (HC) were studied before and after local anesthesia (LA). Reproducibility and comparison with oLDIf was assessed in HC (n = 16). Finally, diabetes subjects with (DN+, n = 10) and without (DN-, n = 16) neuropathy were studied. Results: LA almost abolished the flare (9.3 ± 3.0 cm2 vs. 1.7 ± 0.3 cm2, P < 0.0001). mLDIf produced larger flares (9.9 ± 3.4 vs. 5.7 ± 2.3 cm2, P < 0.0001), but correlated with oLDIf (r = 0.81, P < 0.001). mLDIf was reduced in DN- (6.8 ± 2.8 vs. HC, P = 0.003), markedly so in DN+ (2.0 ± 1.1 vs. HC and DN-, P < 0.0001). Conclusion: The mLDIf is a quick, practical method for assessing C-fiber function in the clinical setting. © 2012 Wiley Periodicals, Inc., a Wiley company.


Vas P.R.J.,Ipswich Hospital NHS Trust | Green A.Q.,Ipswich Hospital NHS Trust | Rayman G.,Ipswich Hospital NHS Trust
Diabetologia | Year: 2012

Aims/hypothesis: The aim of this study was to determine the influence of microvascular disease on C-fibre function in patients with type 1 diabetes of moderate duration. Methods: The axon-reflex flare area induced on the dorsum of the foot by local skin heating to 47°C was measured with a laser Doppler imager (LDI) in sex-, age- and height-matched groups with type 1 diabetes, with and without microvascular disease (MV+ and MV-, respectively) and in healthy controls (HC). Each group consisted of 24 individuals and all were free from clinical neuropathy (neuropathy disability score <3 and Toronto clinical neuropathy score <5). Results: LDI flare (LDIflare) was reduced in MV+ compared with HC (5.1±1.8 vs 10.0±3.1 cm 2, p<0.0001) and MV- groups (9.9±2.9 cm 2, p<0.0001). MV- and HC groups did not differ. There was no difference in diabetes duration between MV- and MV+ groups (17.5±5.7 and 20.1±5.2 years, p=0.21) nor current HbA 1c (MV- 8.0±1.2% [64±10 mmol/mol]; MV+ 8.0±0.9% [64±9 mmol/mol], p=0.53); neither variable correlated with flare size. In contrast, duration-averaged HbA 1c was higher in the MV+ group (8.6±0.9% [70±9 mmol/mol] vs 7.6±0.6% [60±7 mmol/mol], p<0.001) and correlated with LDIflare size (r=-0.50, p<0.001). Triacylglycerols were higher in MV+ compared with MV- (1.23±0.121 vs 0.93±0.7 mmol/l, p=0.04), but other metabolic variables did not differ between the groups. Conclusions/interpretation: We have shown that glycaemic burden and the presence of microvascular complications are associated with small fibre dysfunction in type 1 diabetes. © 2011 Springer-Verlag.


Smith S.L.,Ipswich Hospital NHS Trust | Jennings P.E.,Ipswich Hospital NHS Trust
British Journal of Radiology | Year: 2015

Lung ablation can be used to treat both primary and secondary thoracic malignancies. Evidence to support its use, particularly for metastases from colonic primary tumours, is now strong, with survival data in selected cases approaching that seen after surgery. Because of this, the use of ablative techniques (particularly thermal ablation) is growing and the Royal College of Radiologists predict that the number of patients who could benefit from such treatment may reach in excess of 5000 per year in the UK. Treatment is often limited to larger regional centres, and general radiologists often have limited awareness of the current indications and the techniques involved. Furthermore, radiologists without any prior experience are frequently expected to interpret post-treatment imaging, often performed in the context of acute complications, which have occurred after discharge. This review aims to provide an overview of the current indications for pulmonary ablation, together with the techniques involved and the range of post-procedural appearances. © 2015 The Authors. Published by the British Institute of Radiology.


Kwok C.S.,Ipswich Hospital NHS Trust | Harrison T.,Ipswich Hospital NHS Trust | Servant C.,Ipswich Hospital NHS Trust
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The aim of this meta-analysis was to compare the risk of stiffness between early and delayed anterior cruciate ligament (ACL) surgery in studies that use a modern accelerated rehabilitation protocol. Methods: Medline, Embase, and the Cochrane library were searched for studies that compared outcomes for early and delayed ACL reconstruction with a modern accelerated rehabilitation protocol. Risk ratios for stiffness were pooled using random effects meta-analysis. Results: A total of 8 studies were included in this review. The 3 randomized trials found no difference in the risk of postoperative stiffness at cutoff points of <2, <3, and <10 weeks between early surgery and delayed surgery. An analysis of the 7 studies whose outcomes could be pooled revealed no significant increase in risk of adverse outcomes with early surgery using a variety of cutoff points (1, 2, 10, 12, and 20 weeks). Sensitivity analysis of individual outcomes failed to show any significant difference between early and delayed surgery with respect to arthrofibrosis, stiffness, range of motion deficits, extension deficits, and flexion deficits. Conclusions: If a modern surgical technique and an accelerated rehabilitation protocol are used, there is no increased risk of knee stiffness if an ACL reconstruction is performed as early as 1 week after injury. Level of Evidence: Level II, meta-analysis of Level I and II studies. © 2013 by the Arthroscopy Association of North America.


Venkitaraman R.,Ipswich Hospital NHS Trust
Breast Journal | Year: 2010

Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer. The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia. The indications for wide local excision for patients diagnosed to have lobular neoplasia on biopsy are eing defined. The evidence for preventive strategies like hormonal treatment with Tamoxifen or aromatase inhibitors for high risk patients is increasing, with the results from prospective interventional trials. The role of screening magnetic resonance imaging for surveillance of high risk patients with lobular neoplasia is under evaluation. © 2010 Wiley Periodicals, Inc.


Background: The LDIflare technique (LDIflare) is a simple non-invasive test of small fibre function in dorsal foot skin involving skin heating and measuring the size of the resulting axon reflex-mediated vasodilator (flare) response using a laser Doppler imager (LDI). This study establishes age-related normative reference ranges for the test and determines the rate of decline in small fibre function per decade. Additionally, the potential value of using age related centiles rather than Receiver Operator Curves (ROC) was explored by comparison of the sensitivity and specificity of each analytic technique in identifying clinical neuropathy. Methods: LDIflare areas were assessed in 94 healthy controls and 66 individuals with diabetes with (DN+, n = 31) and without clinical neuropathy (DN-, n = 35); neuropathy defined as a Neuropathy Disability Score ≥3. The age specific 5th centile values were used as the 'cut-offs' for the diagnosis of neuropathy from which sensitivity and specificity were calculated. Results: There was a significant age dependant decrease in LDIflare size (r = -0.42, p<0.0001) with no significant gender differences. The LDIflare size reduced 0.56 cm2 per decade which gives a percentage reduction of approximately 5.5% per decade. Using the normative 5th centiles as the cut-offs, the technique had a sensitivity of 77%, specificity of 90%, positive predictive value of 82% and negative predictive value of 87%.The ROC analysis gave a threshold of <3.66 cm2 for the cut-off, resulting in a sensitivity of 75%, specificity of 85%, positive predictive value of 74% and negative predictive value of 86%. Conclusions: There is an age dependent decrease in small fibre function in the foot of 5.5% per decade. Both analytic techniques demonstrate good sensitivity and specificity for detecting clinical neuropathy but the technique based on age centiles offers better diagnostic accuracy and is therefore proposed as the method of choice. © 2013 Vas, Rayman.


Venkitaraman R.,Ipswich Hospital NHS Trust
Expert Review of Anticancer Therapy | Year: 2010

Review of the spectrum of breast cancer tumor subtypes, which include basal-like, triple-negative and BRCA1-positive tumors, suggest that they have overlapping clinical, pathologic and molecular features, which are different from endocrine responsive breast cancers. Although response to chemotherapy is high in the neoadjuvant setting, the overall prognosis of this subset of tumors remains poor. Gene-profiling studies of this heterogeneous subset have lead to a better understanding of the molecular pathology of these aggressive tumors and the identification of possible therapeutic targets. Ongoing clinical studies of newer targeted agents, along with optimal chemotherapy, portend an improved clinical outcome for patients with aggressive basal-like/triple-negative breast cancer in the future. © 2010 Expert Reviews Ltd.


Yung M.,Ipswich Hospital NHS Trust
Otology and Neurotology | Year: 2010

OBJECTIVE:: The study compares the medium-term outcome of ossiculoplasty using titanium and nontitanium prostheses. STUDY DESIGN:: Randomized controlled, prospective clinical trial. SETTING:: District general hospital. PATIENTS:: Patients with chronic otitis media with partial and total ossicular reconstructions were included. Trauma and congenital malformation cases were excluded. INTERVENTION(S):: Partial and total ossicular reconstructions using either titanium (Ti) or hydroxyapatite (HA) prostheses. Cartilage plate was used to cover the Ti head plate but not the HA head plate. MAIN OUTCOME MEASURE(S):: The principal outcome was hearing gain and postoperative air-bone gaps. The secondary outcome was extrusion of the prosthesis. RESULTS:: The mean hearing gain in the HA partial ossicular replacement prosthesis (PORP) and the Ti PORP cohorts were 14.30 and 15.10 dB, respectively. The mean hearing gain in the HA total ossicular replacement prosthesis (TORP) and Ti TORP cohorts were 13.52 and 13.48 dB, respectively. There was no significant difference between HA and Ti for both PORPs and TORPs. There also was no significant difference in the extrusion rate between both prostheses. CONCLUSION:: The lack of statistical difference in the clinical outcome of the 2 prostheses may be due to the limitation of randomized controlled trial with the small sample size and limited statistical power in the comparison of surgical techniques. Copyright © 2010 Otology & Neurotology, Inc.

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