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Khan K.Z.,Manchester Medical School | Khan K.Z.,Mafraq Hospital | Gaunt K.,Lancashire Teaching Hospitals NHS Trust | Ramachandran S.,Lancashire Teaching Hospitals NHS Trust | Pushkar P.,Aintree University Hospitals Trust
Medical Teacher | Year: 2013

The organisation, administration and running of a successful OSCE programme need considerable knowledge, experience and planning. Different teams looking after various aspects of OSCE need to work collaboratively for an effective question bank development, examiner training and standardised patients' training. Quality assurance is an ongoing process taking place throughout the OSCE cycle. In order for the OSCE to generate reliable results it is essential to pay attention to each and every element of quality assurance, as poorly standardised patients, untrained examiners, poor quality questions and inappropriate scoring rubrics each will affect the reliability of the OSCE. The validity will also be influenced if the questions are not realistic and mapped against the learning outcomes of the teaching programme. This part of the Guide addresses all these important issues in order to help the reader setup and quality assure their new or existing OSCE programmes. © 2013 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.


Khan K.Z.,Manchester Medical School | Khan K.Z.,Mafraq Hospital | Ramachandran S.,Lancashire Teaching Hospitals NHS Trust | Gaunt K.,Lancashire Teaching Hospitals NHS Trust | Pushkar P.,Aintree University Hospitals Trust
Medical Teacher | Year: 2013

The Objective Structured Clinical Examination (OSCE) was first described by Harden in 1975 as an alternative to the existing methods of assessing clinical performance (Harden et al. 1975). The OSCE was designed to improve the validity and reliability of assessment of performance, which was previously assessed using the long case and short case examinations. Since then the use of the OSCE has become widespread within both undergraduate and postgraduate clinical education. We recognise that the introduction of the OSCE into an existing assessment programme is a challenging process requiring a considerable amount of theoretical and practical knowledge. The two parts of this Guide are designed to assist all those who intend implementing the OSCE into their assessment systems. Part I addresses the theoretical aspects of the OSCE, exploring its historical development, its place within the range of assessment tools and its core applications. Part II offers more practical information on the process of implementing an OSCE, including guidance on developing OSCE stations, choosing scoring rubrics, training examiners and standardised patients and managing quality assurance processes. Together we hope these two parts will act as a useful resource both for those choosing to implement the OSCE for the first time and also those wishing to quality assure their existing OSCE programme. © 2013 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.


Nagy E.,King's College London | Gajjar K.B.,Lancaster University | Patel I.I.,University of Cambridge | Taylor S.,Liverpool Womens Hospital NHS Foundation Trust | And 5 more authors.
British Journal of Cancer | Year: 2014

Background:Tamoxifen has anti-oestrogenic and anti-tumour activity in the breast, but is oestrogenic and carcinogenic in the endometrium. It can induce experimental tumours by both hormonal and DNA-damaging mechanisms, but its carcinogenic mode of action in human endometrium remains unclear.Methods:We investigated whether an epigenetic mechanism, involving promoter hypermethylation of the gene for the DNA repair enzyme MGMT (O6-methylguanine DNA methyltransferase), was associated with K-RAS, TP53 and PTEN mutations in endometrial tumours from women treated with tamoxifen (TAM, n=30) or unexposed to the drug (EC, n=38).Results:There were significant (P<0.05) differences in tumour grade between the TAM and EC groups, with more favourable morphology in the latter. K-RAS mutations, predominantly G>A, occurred in small numbers in both groups. TP53 mutations were of mainly A>G, C>T and indel modifications in both groups, but more frequent in TAM cases. PTEN mutations dominated in EC tumours and were of the type that has large impact on protein function, such as indel or nonsense mutations. These observations alongside the mutational spectrum in PTEN suggest that the malignancies arise from different backgrounds, hence pointing to an effect of tamoxifen. Both groups displayed MGMT promoter hypermethylation. This coincided with mutations more frequently in the TAM (78%) than in the EC (50%) group, even though there were significantly (P<0.05) fewer mutations and methylations in TAM cases.Conclusions:Although the difference in coincidence did not reach significance with the current sample size, the findings suggest that epigenetic processes may play a role in the way tamoxifen induces endometrial cancer. © 2014 Cancer Research UK.


Du Rand I.A.,Worcestershire Royal Hospital | Blaikley J.,University of Manchester | Booton R.,University of Manchester | Chaudhuri N.,University of Manchester | And 9 more authors.
Thorax | Year: 2013

Monitoring, precautions and complications All patients undergoing bronchoscopy should have heart rate, respiratory rate, blood pressure and oxygen saturation recorded repeatedly, including before, during and after the procedure. (Grade D) . All bronchoscopy units should undertake periodic audit of bronchoscopic performance, including efficacy, complications and patient satisfaction surveys. (Good practice point . All Trusts should have a 'safe sedation policy', and ensure all bronchoscopy unit staff, including trainees, receive appropriate training.


Ashraf A.,University of Manchester | Raut V.V.,Lancashire Teaching Hospitals NHS Trust | Canty S.J.,Lancashire Teaching Hospitals NHS Trust | McLauchlan G.J.,Lancashire Teaching Hospitals NHS Trust
Knee | Year: 2013

Background: We report a prospective blinded randomised trial of local infiltration versus femoral nerve block in patients undergoing primary total knee replacement (TKR), in accordance with the CONSORT statement 2010. Methods: Fifty patients in a teaching hospital were consented for the study. The study arms were intraoperative local anaesthesia (150. ml 0.2% ropivacaine/1. ml 1:1000 adrenaline/30. mg ketolorac) and femoral nerve block (30. ml 0.2% ropivacaine) with a primary outcome of pain score at 4. h post operatively. Secondary outcomes were pain at 2. h, pain scores before and after physiotherapy on day one, total opiate administered, time to physiotherapy goals and length of stay. Randomisation was by sealed envelope. The assessor was blinded and the patients partially blinded to the intervention. Results: Ten patients were excluded, eight before randomisation. The trial is complete. Forty patients were analysed for the primary outcome measure. The local infiltration group had significantly lower pain scores at 4. h post-operatively; mean [SD] score 2.1 [2.6] versus 6.8 [3.2], p<. 0.00001 and on post-operative day one prior to physiotherapy; mean score 2.4 [2.3] versus 4.4 [2.3], p<. 0.05. Total opiate use was also significantly lower in the local infiltration group; mean total 115 [50.3]. mg versus 176.5 [103.5]. mg, p<. 0.01. There was no difference in any other outcome. There were no harms as a result of either intervention. Conclusion: Intraoperative local infiltration gives superior pain relief compared to single shot femoral nerve block over the first 24. h following primary TKR and minimises post-operative opiate use. © 2013 Elsevier B.V.


Banerjee M.,Lancashire Teaching Hospitals NHS Trust | MacDougall M.,Lancashire Teaching Hospitals NHS Trust | Lakhdar A.F.,University of London
Journal of Diabetes | Year: 2012

Background: Education is one of the pivotal aspects of diabetes care. The impact of education has been found to be efficacious in the short term, but tends to lose efficacy in the long term. The hypothesis tested here was that one-to-one education would confer knowledge that would be reflected in metabolic improvement in this group of participants with diabetes. Methods: Thirty-nine patients with type 2 diabetes mellitus and poor diabetes control attended a one-to-one diabetic and dietetic education session with a diabetic specialist nurse and a diabetes specialist dieticican. Glycemic control was assessed by measuring serum glycosolated hemoglobin (HbA1c) measurements before the session and at 6 and 12months afterwards. Results: The HbA1c levels fell significantly in the whole group to 8.0±0.5% (P<0.05) at 6months and to 8.3±0.7% (P<0.05) at the final visit from a baseline of 9.2±0.5%. Compared to female patients, male patients had a similar drop in HbA1c at 6months of 1.1%, which persisted until the final visit, when the drop was -1.3% vs 0.3% (P<0.05). Conclusions: A single episode of one-to-one diabetic and dietetic education to subjects with poor diabetic control is effective in improving short- and long-term diabetic control for up to 1year. Male patients were found to have a better response than female patients. © 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.


Anwar S.,Calderdale and Huddersfield NHS Trust | Peter M.B.,Calderdale and Huddersfield NHS Trust | Dent J.,Calderdale and Huddersfield NHS Trust | Scott N.A.,Lancashire Teaching Hospitals NHS Trust
Colorectal Disease | Year: 2012

Aim Patients with stage IV colorectal cancer with unresectable metastases can either receive chemotherapy or palliative resection of the primary lesion. In the absence of any randomized data the choice of initial treatment in stage IV colorectal cancer is not based on firm evidence. Method A search of MEDLINE, Pubmed, Embase and the Cochrane Library database was performed from 1980 to 2010 for studies comparing palliative resection in stage IV colorectal cancer with other treatment modalities. Audits and observational studies were excluded. Median survival was the primary outcome measure. The morbidity and mortality of surgical and nonsurgical treatments were compared. Results Twenty-one studies (no randomized controlled trials) were identified. Most demonstrated a survival benefit for patients who underwent palliative resection. Multivariate analysis indicates that tumour burden and performance status are both major independent prognostic variables. Selection bias, incomplete follow up and nonstandardized reporting of complications make the data difficult to interpret. Conclusion The studies indicate that there may be a survival benefit for primary resection of colorectal cancer in stage IV disease. The findings suggest that resection of the primary tumour should be based on tumour burden and performance status rather than on the presence or absence of symptoms alone. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.


Rutherford C.L.,Lancashire Teaching Hospitals NHS Trust
BMJ case reports | Year: 2013

A woman in her early 50s presented with a 2-week history of gradually worsening colicky abdominal pain with associated vomiting, loose stools and reduced appetite. There was no malaena or perrectal bleeding. On examination, there was tenderness in the epigastric region with an associated palpable fullness. Subsequent imaging revealed a substantial colo-colic intussusception with the lead point being a lipoma of the ascending colon. Subsequent colonic resection was undertaken with histology confirming a lipomatous polyp.


Moynihan C.,Institute of Cancer Research | Lewis R.,Institute of Cancer Research | Hall E.,Institute of Cancer Research | Jones E.,Institute of Cancer Research | And 2 more authors.
Trials | Year: 2012

Background: Evidence suggests that poor recruitment into clinical trials rests on a patient 'deficit' model - an inability to comprehend trial processes. Poor communication has also been cited as a possible barrier to recruitment. A qualitative patient interview study was included within the feasibility stage of a phase III non-inferiority Randomized Controlled Trial (RCT) (SPARE, CRUK/07/011) in muscle invasive bladder cancer. The aim was to illuminate problems in the context of randomization.Methods: The qualitative study used a 'Framework Analysis' that included 'constant comparison' in which semi-structured interviews are transcribed, analyzed, compared and contrasted both between and within transcripts. Three researchers coded and interpreted data.Results: Twenty-four patients agreed to enter the interview study; 10 decliners of randomization and 14 accepters, of whom 2 subsequently declined their allocated treatment.The main theme applying to the majority of the sample was confusion and ambiguity. There was little indication that confusion directly impacted on decisions to enter the SPARE trial. However, confusion did appear to impact on ethical considerations surrounding 'informed consent', as well as cause a sense of alienation between patients and health personnel.Sub-optimal communication in many guises accounted for the confusion, together with the logistical elements of a trial that involved treatment options delivered in a number of geographical locations.Conclusions: These data highlight the difficulty of providing balanced and clear trial information within the UK health system, despite best intentions. Involvement of multiple professionals can impact on communication processes with patients who are considering participation in RCTs. Our results led us to question the 'deficit' model of patient behavior. It is suggested that health professionals might consider facilitating a context in which patients feel fully included in the trial enterprise and potentially consider alternatives to randomization where complex interventions are being tested.Trial Registration: ISRCTN61126465. © 2012 Moynihan et al.; licensee BioMed Central Ltd.


Kelly J.G.,Lancaster University | Trevisan J.,Lancaster University | Scott A.D.,Colworth Science Park | Carmichael P.L.,Colworth Science Park | And 3 more authors.
Journal of Proteome Research | Year: 2011

Biospectroscopy is employed to derive absorbance spectra representative of biomolecules present in biological samples. The mid-infrared region (λ = 2.5 μm-25 μm) is absorbed to give a biochemical-cell fingerprint (ṽ = 1800-900 cm-1). Cellular material produces complex spectra due to the variety of chemical bonds present. The complexity and size of spectral data sets warrant multivariate analysis for data reduction, interpretation, and classification. Various multivariate analyses are available including principal component analysis (PCA), partial least-squares (PLS), linear discriminant analysis (LDA), and evolving fuzzy rule-based classifier (eClass). Interpretation of both visual and numerical results facilitates biomarker identification, cell-type discrimination, and predictive and mechanistic understanding of cellular behavior. Biospectroscopy is a high-throughput nondestructive technology. A comparison of biomarkers/mechanistic knowledge determined from conventional approaches to biospectroscopy coupled with multivariate analysis often provides complementary answers and a novel approach for diagnosis of disease and cell biology. © 2011 American Chemical Society.

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