Luton, United Kingdom
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Sachdeva R.,University of Birmingham | Kannan T.R.,Luton and Dunstable Hospital | Mendonca C.,Coventry University | Patteril M.,Coventry University
Anaesthesia | Year: 2014

Summary The practice of checking the ability to mask ventilate before administering neuromuscular blocking drugs remains controversial. We prospectively evaluated the changes in the expired tidal volume during pressure-controlled ventilation (two-handed mask ventilation technique) as a surrogate marker to assess the ease of mask ventilation following administration of rocuronium. After informed consent, 125 patients were anaesthetised using a standard induction technique consisting of fentanyl, propofol and rocuronium, with anaesthesia then maintained with isoflurane in oxygen. The mean (SD) expired tidal volume before administration of rocuronium increased by 61 (13) ml at 2 min following onset of neuromuscular block (p < 0.001). This supports the concept that neuromuscular blockade induced by rocuronium facilitates mask ventilation. © 2014 The Association of Anaesthetists of Great Britain and Ireland.


Evgeniou E.,Wexham Park Hospital | Loizou P.,Luton and Dunstable Hospital
ANZ Journal of Surgery | Year: 2013

The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.


Thorburn K.,Alder Hey Childrens Hospital | Eisenhut M.,Luton and Dunstable Hospital | Riordan A.,Alder Hey Childrens Hospital
Minerva Anestesiologica | Year: 2012

Background. Respiratory syncytial virus (RSV) is one of the most common pathogens involved in nosocomial infection in children. The aim of the study was to determine the impact of nosocomial RSV infection on mortality and pediatric intensive care unit (PICU) morbidity of ventilated children. Methods. This is a prospective observational cohort study of all children ventilated with RSV infection in a tertiaryreferral PICU over a 10-year period. Determinants of the relationship of nosocomial (PICU-acquired and hospital ward-acquired) RSV infection to mortality and PICU morbidity were adjusted for by performing multiple regression analysis. Results. Of 525 RSV-positive children ventilated on PICU during the ten-year study period, 38 (7.2%) acquired their RSV infection following PICU admission and 38 (7.2%) had acquired RSV in hospital. Ten (26%) children that acquired RSV on PICU died (RR 6.4, 95%CI 3.2-12.9) and 11 (29%) with hospital ward-acquired infection died (RR 9.8, 95%CI 5.1-18.9), compared to 18 (4%) with community-acquired RSV infection. Nosocomial RSV infection was significantly and independently associated with death which was more strongly predicted by immunodeficiency and congenital heart disease (P<0.01). Nosocomial RSV infection was the strongest predictor for morbidity as reflected in duration of ventilation and length of stay on PICU (P<0.01). Conclusion. Nosocomial RSV infection was independently associated with increased mortality and was the strongest predictor of duration of ventilation and length of stay in children on PICU. Decreasing nosocomial RSV infection would reduce deaths in ventilated children. © 2012 EDIZIONI MINERVA MEDICA.


Wylie S.,Luton and Dunstable Hospital | Ravichandran D.,Luton and Dunstable Hospital
Annals of the Royal College of Surgeons of England | Year: 2013

Introduction: A significant proportion of elderly breast cancer patients in the UK have no surgical treatment recorded and appear to be treated with primary endocrine therapy (PET) only. Despite this, PET remains one of the poorly studied areas in breast cancer therapy and very little is known about the practice of PET in the UK. Methods: A questionnaire comprising 14 questions relevant to PET was sent to 489 breast surgeons who were members of the UK Association of Breast Surgery and returned questionnaires were analysed. RESULTS Overall, 228 questionnaires (47%) were returned. The vast majority (93%) of surgeons who responded use PET in early operable breast cancer in elderly women unfit for surgery or owing to patient preference but 7% would recommend PET to fit elderly patients. Most (76%) use letrozole. The percentage of elderly patients treated with PET varied from <10% to 70% between surgeons. The majority (77%) of respondents had not formally audited the outcome of their PET patients and over 70% underestimated the expected survival of an 80-year-old woman. Conclusions: Most UK breast surgeons use PET in elderly patients with surgically resectable breast cancer. While most use it in unfit, frail patients, a minority would treat even fit elderly women with PET. Most surgeons have not formally audited the outcome of their patients treated with PET and underestimate the expected survival of elderly patients, which might have an impact on their decision to offer PET rather than surgery.


Al-Hadithy N.,Luton and Dunstable Hospital | Domos P.,Luton and Dunstable Hospital | Sewell M.D.,Luton and Dunstable Hospital | Pandit R.,Luton and Dunstable Hospital
Journal of Shoulder and Elbow Surgery | Year: 2014

Background: Reverse shoulder arthroplasty (RSA) is an accepted treatment for patients with pseudoparalysis due to cuff tear arthropathy. There have been limited studies with midterm clinical and radiologic results. We present our results for a single surgeon from a district general hospital. Methods: Forty-one consecutive Delta III RSAs were performed by an anterosuperior approach in 37 patients (29 women and 8 men) with pseudoparalysis due to cuff tear arthropathy. The patients' mean age was 79years (range, 68-91years). The mean follow-up period was 5years. All patients were available for final review, and none were lost to follow-up. Results: The mean age-adjusted Constant and Oxford scores improved from 34.2 points to 71.0 points and 15 points to 33 points, respectively. Mean abduction and forward flexion improved from 64° to 100° and 55° to 110°, respectively. Scapular notching was seen in 68% of patients, but there was no deterioration in function or satisfaction scores. Stress shielding of the proximal humerus was seen in 10% of patients. One patient underwent revision to a hemiarthroplasty because of glenoid component failure after a fall. There were no early postoperative dislocations in our series. Conclusion: RSA for pseudoparalysis due to cuff tear arthropathy provides good functional results at 5years; however, there is a high rate of scapular notching, which does not seem to affect overall functional outcomes. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.


Galazis N.,University of Nottingham | Galazi M.,Luton and Dunstable Hospital | Atiomo W.,University of Nottingham
Gynecological Endocrinology | Year: 2011

Background. The pathogenesis of polycystic ovary syndrome (PCOS) has been linked to the development of insulin resistance and hyperinsulinemia. The objective of this study is to investigate the effects of insulin sensitising agents such as d-chiro-inositol (DCI) on ovulation and insulin resistance in women with PCOS. Methods. This was a systematic review done in an Academic Department of Obstetrics and Gynaecology in the UK of all studies published on PCOS and DCI up till May 2010. Patients were women with PCOS receiving DCI or where the relationship between insulin resistance and DCI had been investigated. Ovulation rates and changes in insulin sensitivity were the main outcome measures. Results. Less DCI-IPG was released in PCOS women compared to controls and this seems to correlate positively with insulin resistance and hyperinsulinemia evident in these patients. DCI administration had beneficial effects on ovulation, anthropometric and metabolic markers in PCOS women by enhancing insulin. The effects of metformin in improving insulin action in PCOS women was achieved though the release of DCI-IPG mediators. Conclusions. Heterogeneity observed in the methodologies of each study, the scarcity of relevant studies and the small sample sizes used prohibit reliable conclusions to be drawn. Therefore, more studies must be conducted in the future to evaluate accurately the effects of DCI in PCOS. © 2011 Informa UK, Ltd.


Tahseen S.,University of Leeds | Griffiths M.,Luton and Dunstable Hospital
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

Background Trial of vaginal birth after Caesarean (VBAC) is considered acceptable after one caesarean section (CS), however, women wishing to have trial after two CS are generally not allowed or counselled appropriately of efficacy and complications. Objective To perform a systematic review of literature on success rate of vaginal birth after two caesarean sections (VBAC-2) and associated adverse maternal and fetal outcomes; and compare with commonly accepted VBAC-1 and the alternative option of repeat third CS (RCS). Search strategy We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, Current Controlled Trials, HMIC Database, Grey Literature Databases (SIGLE, Biomed Central), using search terms Caesarean section, caesarian, C*rean, C*rian, and MeSH headings 'Vaginal birth after caesarean section', combined with second search string two, twice, second, multiple. Selection criteria No randomised studies were available, case series or cohort studies were assessed for quality (STROBE), 20/23 available studies included. Data collection and analysis Two independent reviewers selected studies and abstracted and tabulated data and pooled estimates were obtained on success rate, uterine rupture and other adverse maternal and fetal outcomes. Meta-analyses were performed using RevMan-5 to compare VBAC-1 versus VBAC-2 and VBAC-2 versus RCS. Main results VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel). Conclusions Women requesting for a trial of vaginal delivery after two caesarean sections should be counselled appropriately considering available data of success rate 71.1%, uterine rupture rate 1.36% and of a comparative maternal morbidity with repeat CS option. © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology.


Moore R.,Luton and Dunstable Hospital
Journal of Prosthetics and Orthotics | Year: 2016

Background Ever since their release, prosthetic feet with integrated hydraulic ankle units have proved a popular prescription choice among individuals with amputation, as quantified in previous studies. One theory is that these types of prosthetic feet lead to a more symmetrical gait pattern. To assess this, we decided to evaluate one of the parameters of gait, the duration of stance phase, and the difference in dominant and nondominant sides. Materials and Methods A mixture of 22 K2 and K3 individuals with amputation (US Centers for Medicare & Medicaid Services activity level scale) who were due to have their prosthetic feet upgraded to a foot with hydraulic ankle unit as part of their existing treatment had their gait assessed on the pressure plate to establish the difference in stance phase duration between their dominant and nondominant foot. The patients were then reassessed on the pressure plate after a 4-week trial on the feet with hydraulic ankle units. The difference in stance phase durations was again measured and compared with the initial readings. Results Of the 22 patients assessed, 6 were removed from the case series because of rejection of the device or incompatibility with the pressure measurement equipment. Of the remaining 16 patients, the difference in stance phase timing increased in 2 patients, remained unchanged in 2 patients, and decreased for the other 12 patients. Conclusion The results showed a statistically significant reduction in asymmetry of stance phase duration when using prostheses that included a foot with a hydraulic ankle unit. This improvement was irrespective of the patients' activity level. © 2015 Lippincott Williams & Wilkins.


Evgeniou E.,Wexham Park Hospital | Loizou P.,Luton and Dunstable Hospital
Journal of Surgical Education | Year: 2012

Introduction: The advances in Internet and computer technology offer many solutions that can enhance surgical education and increase the effectiveness of surgical teaching. E-learning plays an important role in surgical education today, with many e-learning projects already available on the Internet. Educational Theory: E-learning is based on a mixture of educational theories that derive from behaviorist, cognitivist, and constructivist educational theoretical frameworks. Can Educational Theory Improve E-learning? Conventional educational theory can be applied to improve the quality and effectiveness of e-learning. The theory of "threshold concepts" and educational theories on reflection, motivation, and communities of practice can be applied when designing e-learning material. E-learning in Surgical Education: E-learning has many advantages but also has weaknesses. Studies have shown that e-learning is an effective teaching method that offers high levels of learner satisfaction. Instead of trying to compare e-learning with traditional methods of teaching, it is better to integrate in e-learning elements of traditional teaching that have been proven to be effective. Conclusions: E-learning can play an important role in surgical education as a blended approach, combined with more traditional methods of teaching, which offer better face-to-interaction with patients and colleagues in different circumstances and hands on practice of practical skills. National provision of e-learning can make evaluation easier. The correct utilization of Internet and computer resources combined with the application of valid conventional educational theory to design e-learning relevant to the various levels of surgical training can be effective in the training of future surgeons. © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.


Haslam D.,Luton and Dunstable Hospital
BMC Medicine | Year: 2015

Government and societal efforts to combat obesity are aimed at prevention, although there is a generation for whom excess weight is the rule rather than the exception. Although measures to prevent a worsening of the current epidemic are important, management of obesity must also be prioritised. Obesity management is beset with problems ranging from attitudinal to clinical and pharmacological, and the individualisation of therapy. © 2014 Haslam; licensee BioMed Central Ltd.

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