Kings Mill Hospital

Sutton in Ashfield, United Kingdom

Kings Mill Hospital

Sutton in Ashfield, United Kingdom
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Subramonia S.,Kings Mill Hospital | Lees T.,Freeman Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2010

Objective: To compare the costs involved (from procedure to recovery) following radiofrequency ablation and conventional surgery for lower limb varicose veins in a selected population. Design: Prospective randomised controlled trial. Methods: Patients with symptomatic great saphenous varicose veins suitable for radiofrequency ablation were randomised to either RF ablation or surgery (sapheno-femoral ligation and stripping). The hospital, general practice and patient costs incurred until full recovery and the indirect cost to society, due to sickness leave after surgery, were calculated to indicate mean cost per patient under each category. Results: Ninety three patients were randomised. Eighty eight patients (47 - RF ablation, 41 - surgery) underwent the allocated intervention. Ablation took longer to perform than surgery (mean 76.8 vs 47.0 min, p < .001). Ablation was more expensive (mean hospital cost per patient £1275.90 vs £559.13) but enabled patients to return to work 1 week earlier than after surgery (mean 12.2 vs 19.8 days, p = 0.006). Based on the Annual Survey of Hours and Earnings (Office of National Statistics, UK) for full time employees, the cost per working hour gained after ablation was £6.94 (95% CI 6.26, 7.62). Conclusion: The increased cost of radiofrequency ablation is partly offset by a quicker return to work in the employed group (ISRCTN29015169 © 2009 European Society for Vascular Surgery.

Subramonia S.,Kings Mill Hospital | Lees T.,Freeman Hospital
British Journal of Surgery | Year: 2010

Background: This randomized clinical trial compared early outcomes after radiofrequency ablation (RFA) and conventional surgery for varicose veins. Methods: Consecutive patients with symptomatic varicose veins due to isolated great saphenous vein (GSV) incompetence and suitable for RFA were randomized to either RFA or conventional surgery (saphenofemoral disconnection and stripping). Clinical, radiological and patient-based outcomes were recorded at 1 and 5 weeks after intervention. Results: RFA resulted in successful obliteration of the GSV in all 47 patients. Complete above-knee stripping was unsuccessful in seven of 41 patients. RFA took longer than conventional surgery: median interquartile range 76 (67-84) versus 48 (39-54) min; P < 0-001. Patients returned to their normal activities significantly earlier after RFA (median 3 (2-5) versus 12-5 (4-21) days; P < 0-001). Postoperative pain was significantly less after RFA (median score on visual analogue scale 1-70 (0-50-4-30) versus 4-0 (2-35-6-05); P = 0-001). Patient satisfaction, quality of life improvement and analgesic requirements significantly favoured RFA. Conclusion: RFA took longer to perform but resulted in a significantly better early outcome than conventional surgery in suitable patients with great saphenous varicose veins. Registration number: ISRCTN29015169 ( Copyright © 2009 British Journal of Surgery Society Ltd.

Armstrong R.G.,United Lincolnshire Hospitals NHS Trust | West J.,University of Nottingham | Card T.R.,University of Nottingham | Card T.R.,Kings Mill Hospital
American Journal of Gastroenterology | Year: 2010

OBJECTIVES: Azathioprine is an accepted treatment of inflammatory bowel disease (IBD), but concerns exist regarding its carcinogenic potential. Studies in renal transplant and rheumatology patients have reported an increased cancer risk. In IBD, studies suggest a small increased risk of lymphoma and protection against colorectal cancer, but the overall risk of malignancy has not been established. METHODS: We conducted a nested case-control study using the General Practice Research Database. Records of IBD patients were examined for azathioprine prescriptions and cancers. Prescriptions per year of follow-up were grouped for analysis. Azathioprine use was compared between IBD cases (with a diagnosed cancer) and IBD controls (without). Results: Overall, 15,471 patients with IBD and over 1 year of appropriate data were identified. Among these, 392 developed cancer, of whom 10.5% received at least one prescription for azathioprine, compared with 1,914 (12.7%) of the controls. Analyzing the occurrence of any cancer against azathioprine prescription showed a nonsignificant protective effect (odds ratio (OR)0.92, 95% confidence interval (CI)=0.79-1.06). Correction for the effects of age and smoking removed this effect (OR=1.04, 95% CI=0.89-1.21). Diagnosis of lymphoma was associated with ever use of azathioprine with OR of 3.22, CI=1.01-10.18. Conclusions: We found evidence of an increased risk of lymphoma, which is consistent with previous studies. We found no overall increase in risk of cancer in individuals with IBD who had taken azathioprine. Our study does not show a need for azathioprine cessation in the medium term in IBD because of the risk of malignancy. © 2010 by the American College of Gastroenterology.

Sloan T.J.,Kings Mill Hospital | Walsh D.A.,University of Nottingham
Spine | Year: 2010

Study Design. Content analysis of patient interviews, clinic letters, and radiology reports for patients with chronic low back pain of greater than 12 months duration. Objective. To explore the language used by patients and healthcare professionals to describe low back pain and any potential effect on patient perceived prognosis. Summary of Backgrounf Data. Diagnostic explanations by healthcare professionals may influence patient coping and uptake of therapy by patients with chronic low back pain. Although the correlation between radiologic changes and chronic low back pain is weak, these investigations are often used by clinicians as an explanation of the underlying cause for the pain. Methods. Patients were asked about their understanding of the mechanisms underlying their pain, flares, and future outcome. Notes from these interviews were transcribed, along with correspondence from primary care physicians, orthopedic surgeons and pain physicians, and lumbar spine radiology reports for these patients. Content analysis was performed to identify and group key terms. Results. Two major categories representing the predominant themes emerging from the content analysis were "Degeneration" and "Mechanical." Degenerative terms such as "wear and tear" and "disc space loss" indicated a progressive loss of structural integrity. Examples of phrases used by patients included "deterioration [...] spine is crumbling" and "collapsing [...] discs wearing out." The use of degenerative terms by patients was associated with a poor perceived prognosis (P < 0.01). Degenerative and mechanical terms were more commonly used by patients when they were documented in correspondence from secondary care specialists (P = 0.03 and 0.01, respectively). Conclusion. A common language is shared between professionals and patients that may encourage unhelpful beliefs. The use of degenerative terms such as wear and tear by patients is associated with a poor perceived prognosis. The explanation of radiological findings to patients presents an opportunity to challenge unhelpful beliefs, thus facilitating uptake of active treatment strategies. © 2010, Lippincott Williams & Wilkins.

Muraleedharan V.,Barnsley Hospital | Muraleedharan V.,University of Sheffield | Jones T.H.,Barnsley Hospital | Jones T.H.,University of Sheffield | Jones T.H.,Kings Mill Hospital
Clinical Endocrinology | Year: 2014

Epidemiological studies have found that men with low or low normal endogenous testosterone are at an increased risk of mortality than those with higher levels. Cardiovascular disease accounts for the greater proportion of deaths in those with low testosterone. Cancer and respiratory deaths in some of the studies are also significantly more prevalent. Disease-specific studies have identified that there are higher mortality rates in men with cardiovascular, respiratory and renal diseases, type 2 diabetes and cancer with low testosterone. Obesity, metabolic syndrome, type 2 diabetes, cardiovascular disease and inflammatory disorders are all associated with an increased prevalence of testosterone deficiency. Two major questions that arise from these findings are (1) is testosterone deficiency directly involved in the pathogenesis of these conditions and/or a contributory factor impairing the body's natural defences or is it merely a biomarker of ill health and the severity of underlying disease process? (2) Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival? This review will discuss the current state of knowledge and discuss whether or not there are any answers to either of these questions. There is convincing evidence that low testosterone is a biomarker for disease severity and mortality. Testosterone deficiency is associated with adverse effects on certain cardiovascular risk factors that when combined could potentially promote atherosclerosis. The issue of whether or not testosterone replacement therapy improves outcomes is controversial. Two retrospective studies in men with diagnosed hypogonadism with or without type 2 diabetes have reported significantly improved survival. © 2014 John Wiley & Sons Ltd.

Sharma J.C.,Lincoln County Hospital | Sharma J.C.,University of Nottingham | Turton J.,Kings Mill Hospital
Parkinsonism and Related Disorders | Year: 2012

Objectives: To study the relationship between olfaction and body weight profile in Parkinson's disease. Methods: Prospective assessment of 99 PD patients for clinical parameters, olfaction using UPSIT and current and previous body weight. Patients were categorised as weight losers (WL) and non-weight losers (NWL) depending on change of weight from previous years. Olfaction was categorised into two groups at the cut-off of the median level of UPSIT scores. Data was analysed to study the relationship of olfaction on weight change. Results: Thirty-nine were weight losers (WL) and 60 non-weight losers (NWL). WL were significantly older (p = 0.02), females (p = 0.03) and had more severe impairment of olfaction, UPSIT 15 ± 4 vs 19 ± 5; p < 0.004. Patients with more severe olfaction (anosmic) impairment were older (p = 0.001) and had significantly lower weight, 75 vs 83 kg, p = 0.01. There was no difference in the proportion of smokers, medication usage, difficult swallowing or calorie consumption in any group. Weight losers and severe olfaction loss were associated with more severe H&Y stage. Patients below the median-UPSIT (anosmic) had lost weight during the previous years whereas those above the median (hyposmic) had gained weight. Regression analysis revealed UPSIT at the median level to be the most significant variable (p < 0.001) for weight loss. There was continuous loss of olfaction with increasing disease severity. Higher olfactory loss was associated with higher risk of dyskinesia. Conclusion: Early assessment of olfaction may identify patients of different phenotypes for weight change and risk of dyskinesia during the course of the disease. © 2012 Elsevier Ltd.

Grainge M.J.,University of Nottingham | West J.,University of Nottingham | Card T.R.,University of Nottingham | Card T.R.,Kings Mill Hospital
The Lancet | Year: 2010

Background: Patients with inflammatory bowel disease who develop deep vein thrombosis or pulmonary embolism often have active disease at the time of thromboembolism. We therefore aimed to quantify the risk of venous thromboembolism prospectively during different activity phases of inflammatory bowel disease. Methods: From the General Practice Research Database, we matched patients with prospectively recorded inflammatory bowel disease from November, 1987, until July, 2001 with up to five controls by age, sex, and general practice. A flare was defined as the period 120 days after a new corticosteroid prescription. We used Cox regression analysis with time-varying covariates to accommodate changes in the state of inflammatory bowel disease, and whether patients were at high risk of venous thromboembolism after hospitalisation. Findings: 13 756 patients with inflammatory bowel disease and 71 672 matched controls were included in the analysis, and of these 139 patients and 165 controls developed venous thromboembolism. Overall, patients with inflammatory bowel disease had a higher risk of venous thromboembolism than did controls (hazard ratio 3·4, 95% CI 2·7-4·3; p<0·0001; absolute risk 2·6 per 1000 per person-years). At the time of a flare, however, this increase in risk was much more prominent (8·4, 5·5-12·8; p<0·0001; 9·0 per 1000 person-years). This relative risk at the time of a flare was higher during non-hospitalised periods (15·8, 9·8-25·5; p<0·0001; 6·4 per 1000 person-years) than during hospitalised periods (3·2, 1·7-6·3; p=0·0006; 37·5 per 1000 person-years). Interpretation: Trials of primary prophylaxis of venous thromboembolism are warranted to find out whether this important complication can be prevented. Funding: National Association for Colitis and Crohn's Disease. © 2010 Elsevier Ltd. All rights reserved.

McMahon M.A.,University of Nottingham | Squirrell C.A.,Kings Mill Hospital
Radiographics | Year: 2010

Aortic dissection is the most common acute emergency condition of the aorta and often has a fatal outcome. Outcome is determined by the type and extent of dissection and the presence of associated complications (eg, cerebral sequelae, aortic branch involvement, pericardial involvement, and visceral involvement), with early diagnosis and treatment being essential for improved prognosis. Aortic dissections are classified on the basis of the site of the intimal tear according to the Stanford classification system. Type A aortic dissection involves the ascending thoracic aorta and may extend into the descending aorta, whereas in a type B dissection the intimal tear is located distal to the left subclavian artery. Type A dissection typically requires urgent surgical intervention, whereas type B dissection can often be treated medically. Modern multidetector computed tomography (CT) is a fast, widely available imaging modality with high sensitivity and specificity. Multidetector CT allows the early recognition and characterization of aortic dissection as well as determination of the presence of any associated complications, findings that are essential for optimizing treatment and improving clinical outcomes. © RSNA, 2010.

Fitzgerald J.E.F.,University of Nottingham | Tang S.-W.,University of Nottingham | Ravindra P.,Kings Mill Hospital | Maxwell-Armstrong C.A.,University of Nottingham
American Journal of Surgery | Year: 2013

Background: Despite promotional measures at a national level, female surgeons account for only 10% of the consultant workforce in the United Kingdom. With rising proportions of female medical graduates, it is important that surgery continues to recruit the most able candidates regardless of sex. This study investigates the differing perceptions of surgical careers among recent medical school graduates and identifies factors discouraging female doctors from pursuing a career in surgery. Methods: Newly qualified graduates from the University of Nottingham Medical School, Nottingham, UK, were invited to complete a nonmandatory questionnaire investigating career intentions and factors influencing this. Results: Two hundred and eight questionnaires were returned (a 66% response rate). Male respondents were significantly more likely to rate surgery as an attractive or very attractive career (P =.0116). Overall, only 33 (25%) female doctors expressed interest in a surgical career as opposed to 33 (42%) male doctors (P =.010). Frequently cited reasons included no interest in surgery itself (21%) and negative attitudes toward women in surgery among the surgical teams (18%). Irrespective of career interests, 59% of male and 68% of female respondents believed surgery was not a career welcoming women (P =.186). Reasons included difficulty maintaining family life, limited flexible training, and lack of role models. Conclusions: This study identifies significant sex differences in the perception of surgical careers. The majority believes surgery does not welcome female trainees. Future strategies to promote surgery must address attitudes and behaviors in both sexes while taking active steps to support female surgeons during their training and in the workplace. © 2013 Elsevier Inc.

Grainge M.J.,University of Nottingham | West J.,University of Nottingham | Card T.R.,University of Nottingham | Card T.R.,Kings Mill Hospital | Holmes G.K.T.,Royal Derby Hospital
American Journal of Gastroenterology | Year: 2011

Objectives: The objective of the study was to compare cause-specific mortality risks in the periods before and after the introduction of accurate and specific serological tests for diagnosing celiac disease. Methods: This was a prospective cohort study of people with celiac disease diagnosed in Southern Derbyshire, United Kingdom, from the late 1950s onward, and followed-up from 1978 until death or 31 December 2006. Standardized mortality ratios (SMRs) were calculated for all-cause mortality and various cause-specific groups concentrating on the period commencing 2 years after diagnosis of celiac disease. Results: A total of 1,092 celiac patients (of whom 90% were incident) contributed 10,152 person-years of follow-up beyond 2 years of diagnosis and 142 deaths. A statistically significant increase in all-cause mortality was observed (SMR 1.37; 95% confidence interval (CI) 1.16-1.62), along with an increase in deaths from cancer (SMR 1.61; 95% CI 1.19-2.13), digestive disease (SMR 2.19; 10 deaths, 4 due to liver disease), and respiratory disease (SMR 1.57; 21 deaths, 11 due to pneumonia). The overall increase in mortality risk was higher for males (SMR 1.86; 95% CI 1.45-2.34) than it was for females (SMR 1.10; 95% CI 0.86-1.38). When results were stratified by period of diagnosis (pre-1990, 1990-1999, and 2000 onward), we found no evidence of differing all-cause mortality between cases diagnosed within these periods. Conclusions: Mortality in people with celiac disease has not materially changed over the 25 years of this study with the introduction of serological tests to aid diagnosis. The excess overall mortality we observed was partly explained by deaths from cancer, digestive disease, and respiratory diseases, of which the majority were deaths from pneumonia, supporting existing guidelines that advise pneumococcal vaccination for celiac patients. © 2011 by the American College of Gastroenterology.

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