Cheshire, United Kingdom
Cheshire, United Kingdom

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Chiam P.J.,Leighton Hospital | Chiam P.J.,Royal Infirmary
Cornea | Year: 2015

Purpose: To determine the refractive effects of paired opposite clear corneal incisions (OCCIs) on with-the-rule (WTR) and against-the-rule (ATR) astigmatism at 1 and 6 months postoperatively. Methods: This is a retrospective cohort study. Consecutive eyes from different patients who had OCCIs for keratometric astigmatism of 1.5 to 2.5 diopters (D) were included. They were divided into group A with the steepest meridian at 90 ± 20 and groups B and group C with the steepest meridian at 180 ± 20 degrees. The keratome width used for groups A and B was 3.2 mm and for group C was 3.5 mm. Keratometry by partial coherence interferometry, manifest refraction, and visual acuities were measured at 1 and 6 months postoperatively. Results: Twenty-eight eyes were included in each group. The median of surgically induced astigmatism (SIA) magnitude at 1 month postoperatively for groups A, B, and C were 1.7, 1.1, and 1.7 D, respectively (P < 0.001). A post hoc test showed that SIAs of groups A and C were significantly greater than that of group B. Six months postoperatively, the medians were 1.6, 0.8, and 1.5 D (P < 0.001). The change was significantly different from 1 month for groups B and C (P 0.001 and P 0.006, respectively). The median uncorrected distant visual acuity was better for groups A and C compared with group B at 1 month (P 0.016). Conclusions: A paired OCCI has a significantly greater refractive effect on WTR than ATR astigmatism correction. The SIA for ATR astigmatism reduces significantly more than for WTR astigmatism correction at 6 months. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Cossins L.,University of Liverpool | Okell R.W.,Leighton Hospital | Cameron H.,Rehabilitation and Assessment Directorate | Simpson B.,University of Wales | And 2 more authors.
European Journal of Pain (United Kingdom) | Year: 2013

Complex regional pain syndrome (CRPS) is a disabling pain condition with sensory, motor and autonomic manifestations. Uncertainty remains about how CRPS can be effectively managed. We conducted a systematic review of randomized controlled trials (RCTs) for treatment and prophylactic interventions for CRPS published during the period 2000-2012, building on previous work by another group reviewing the period 1966-2000. Bibliographic database searches identified 173 papers which were filtered by three reviewers. This process generated 29 trials suitable for further analysis, each of which was reviewed and scored by two independent reviewers for methodological quality using a 15-item checklist. A number of novel and potentially effective treatments were investigated. Analysing the results from both review periods in combination, there was a steep rise in the number of published RCTs per review decade. There is evidence for the efficacy of 10 treatments (3× strong - bisphosphonates, repetitive transcranial magnetic stimulation and graded motor imagery, 1× moderate and 6× limited evidence), and against the efficacy of 15 treatments (1× strong, 1× moderate and ×13 limited). The heterogeneity of trialled interventions and the pilot nature of many trials militate against drawing clear conclusions about the clinical usefulness of most interventions. This and the observed phenomenon of excellent responses in CRPS subgroups would support the case for a network- and multi-centre approach in the conduct of future clinical trials. Most published trials in CRPS are small with a short follow-up period, although several novel interventions investigated from 2000 to 2012 appear promising. © 2012 European Federation of International Association for the Study of Pain Chapters.


Chiam P.J.,Leighton Hospital
BMJ case reports | Year: 2013

This case illustrates an overlooked metastatic lung carcinoma to the orbit. The rapid onset of symptoms and oedema mimicked a cellulitis. The patient was initially treated with a broad-spectrum topical and intravenous antibiotic therapy. The white blood cell count (WBC) and C reactive protein (CRP) were normal. Compressive optic neuropathy and serous retinal detachment ensued. The initial chest x-ray revealed lung shadows; however, this was not reviewed. Eventually, CT of the chest was organised and showed a lung mass. The management of such a case remains a challenge for the uninitiated, and high index of suspicion is required to ensure early appropriate management. Despite complete resolution of the swelling with sequential chemotherapy (cisplatin and etoposide) and radiotherapy, the visual prognosis remained grim.


Heald A.,Leighton Hospital
European Psychiatry | Year: 2010

In the management of schizophrenia, mental health outcomes are the principal focus of treatment. The objective is to control the psychotic symptoms while minimising negative features of the illness, to achieve an overall improvement in the societal functioning of patients. Physical health is also important because if it is compromised, many of the benefits of improved mental health will be offset. Compared with the general population, schizophrenia patients are at increased risk of weight gain, abdominal obesity, diabetes, metabolic syndrome, and cardiovascular disease. These physical health problems can contribute to the decreased quality of life, lowered self-esteem and reduced life expectancy commonly reported in schizophrenia. For these reasons there is a pressing need to improve both the monitoring and the management of physical health in patients with schizophrenia as a part of their overall care. A consensus for metabolic monitoring of patients receiving treatment with antipsychotic drugs is available. However, the practicing clinician requires guidance about management of physical health in routine clinical practice. This should include recommendations for measurements that have strong predictive value about physical health risks yet are easy to make, and about the use of medications that have the least effect on physical health parameters. This article will review the gravity of the physical health risks facing schizophrenia patients. © 2010 Elsevier Masson SAS.


Hanchanale V.S.,Leighton Hospital | Javle P.,Leighton Hospital
Urologia Internationalis | Year: 2010

Introduction: Complex surgical procedures are associated with higher mortality and morbidity. There is a paucity of data supporting a volume-outcome relationship in the United Kingdom. We analysed Hospital Episode Statistics (HES) to contemplate the association of hospital provider volume and short-term outcomes (mortality rate and hospital stay) for 3 radical urological procedures in England. Materials and Methods: The HES database was extracted for radical prostatectomy (RP), radical cystectomy (RC) and radical nephrectomy (RN) using ICD-10 and OPCS-4 codes for 7 years. Hospitals were divided into quartiles depending on the annual hospital volume. The impact of hospital provider volume was analysed for outcomes. Results: Overall 43,946 patients were included in the study. RP patients had the lowest mortality rate (0.2%) and shorter in-patient stay (7 days). Mortality from RC and RN were 475 (5.3%) and 537 (2.6%), respectively. There was no significant difference for mortality following RP in four volume groups (p = 0.76). The mortality rate for RC decreased from 6.9% in the very low-volume group to 4.1% in the high-volume group (p < 0.001) without change in the in-hospital stay. The proportion of patients treated at high-volume centres for RP, RC and RN has increased from 0 to 42, 22 to 35 and 10 to 38%, respectively, over a 7-year study period. Conclusion: In England, hospital provider volume has a significant impact on outcome measures for radical pelvic urological procedures with a lower mortality (RC) and shorter in-patient stay (RP). Thus HES data from England support the hospital volume-outcome relationship and emphasise the centralisation of care for radical urological procedures. Copyright © 2010 S. Karger AG.


Hanchanale V.S.,Leighton Hospital | McCabe J.E.,Leighton Hospital | Javle P.,Leighton Hospital
Urology Journal | Year: 2010

Purpose: As there is paucity of data on radical prostatectomy (RP) as a primary treatment for patients with localized prostate cancer, we analyzed the trends in the RP practice in England. Materials and Methods: This study was carried out on 14 300 patients who underwent RP for carcinoma of the prostate. Database was prepared from hospital episode statistics of the Department of Health in England. National trends in RP practice were summarized as well as volume outcome analysis. Results: Annual number of RPs exponentially increased from 972 (1998 to 1999) to 3092 (2004 to 2005). Laparoscopic RPs increased from 2 to 257 over the study period. Median waiting duration increased by more than 10 days (13 days). Significant decrease in median length of hospital stay from 8 (range, 7 to 10) days to 6 (range, 5 to 8) days was observed (P < .001). More than 90% mortality was seen in patients of ≥ 60 years of age. Significant inverse correlation was found between the hospital volume (Odds Ratio: 0.40) and in-hospital mortality rate following RP. High volume surgeons (≥ 16) and high volume hospitals (≥26) had significantly lower mortality (Odds Ratio: 0.32) and shorter in-hospital stay in comparison to low volume surgeons and hospitals. Conclusion: There is an exponential increase in the number of RPs with an increasing trend towards laparoscopic RP in England. This study showed a significant inverse correlation between provider volume (hospital and surgeon) and outcome (in-hospital mortality and hospital stay) for RP in England; thus, supporting the recommendations for centralization of care for complex radical procedures, including RP.


Owen D.J.,Leighton Hospital | Harrod I.,Leighton Hospital | Ford J.,Leighton Hospital | Luckas M.,Leighton Hospital | Gudimetla V.,Leighton Hospital
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Although the transversus abdominis plane (TAP) block has an established role in providing postoperative analgesia following caesarean section, the technique is not widely used by obstetric anaesthetists. The conventional TAP block is associated with significant technical difficulties and risk of peritoneal, hollow viscus and organ perforation. We report a much simpler technique in which the obstetric surgeon, during open surgery, is able to introduce the TAP block via an intra-abdominal approach, which is technically easier and also obviates the risks associated with the conventional TAP procedure. We believe our technique may be easier, safer and equally effective. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.


Iskander M.,Leighton Hospital
Medical Teacher | Year: 2015

Effective feedback on performance is an integral part of clinical training. It allows the trainee to critically reflect on their development, as well as enable the teacher to chart progress and detect areas for development. In order to provide effective feedback, we need to take into account the performance itself, but also the setting where feedback is offered, and the expected outcomes of the encounter. As ever, negative feedback remains more difficult to give and receive, and as such requires a greater degree of delicacy to produce a positive result. © 2015 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.


Heseltine T.D.,Leighton Hospital
BMJ case reports | Year: 2014

We describe the case of a 65-year-old patient who was admitted to our tertiary centre with cardiac sounding chest pain and inferior ST elevation. Coronary angiography revealed mild plaque disease in the left anterior descending artery. The right coronary artery was smooth with no plaques with the exception of an occluded distal branch with no flow. The left ventriculogram revealed a ballooned and akinetic apex typical of Takotsubo syndrome (TS). We suspected a coronary embolus secondary to TS. A serial rise and fall in biomarkers of myocardial necrosis was noted. The patient was treated for acute coronary syndrome and discharged home 72 h from admission. Distal thromboembolism has been described in the literature before. On a search of PubMed there are no examples of coronary artery embolus in the context of TS.


Sawalha S.,Peterborough City Hospital | Sawalha S.,Leighton Hospital | Parker M.J.,Peterborough City Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2012

We compared 5341 patients with an initial fracture of the hip with 633 patients who sustained a second fracture of the contralateral hip. Patients presenting with a second fracture were more likely to be institutionalised, female, older, and have lower mobility and mental test scores. There was no significant difference between the two groups with regards to the change in the level of mobility or return to their original residence at one year follow-up. However, the mortality rate in the second fracture group was significantly higher at one year (31.6% vs 27.3%, p = 0.024). In two thirds of patients, the second fracture was in the same anatomical location as the first. In an analysis of 293 patients, approximately 70% of second fractures occurred within three years of the first. This is the largest study to investigate the outcome of patients who sustain a second contralateral hip fracture. Despite the higher mortality rate at one year, the outcome for surviving patients is not significantly different from those after initial hip fractures. ©2012 British Editorial Society of Bone and Joint Surgery.

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