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Macclesfield, United Kingdom

Tonus C.,Asklepios Hospital North | Sellinger M.,Medical Practice for Gastroenterology Lusanum | Koss K.,Macclesfield District General Hospital | Neupert G.,Asklepios Hospital North
World Journal of Gastroenterology | Year: 2012

AIM: To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2 (faecal M2-PK) test for colorectal cancer (CRC) screening based on the currently available studies. METHODS: A literature search in PubMed and Embase was conducted using the following search terms: fecal Tumor M2-PK, faecal Tumour M2-PK, fecal M2-PK, faecal M2-PK, fecal pyruvate kinase, faecal pyruvate kinase, pyruvate kinase stool and M2-PK stool. RESULTS: Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies. The mean faecal M2-PK sensitivity was 80.3%; the specificity was 95.2%. Four studies compared faecal M2-PK head-to-head with guaiac-based faecal occult blood test (gFOBT). Faecal M2-PK demonstrated a sensitivity of 81.1%, whereas the gFOBT detected only 36.9% of the CRCs. Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma (n = 554), with the following sensitivities: adenoma < 1 cm in diameter: 25%; adenoma > 1 cm: 44%; adenoma of unspecified diameter: 51%. In a direct comparison with gFOBT of adenoma > 1 cm in diameter, 47% tested positive with the faecal M2-PK test, whereas the gFOBT detected only 27%. CONCLUSION: We recommend faecal M2-PK as a routine test for CRC screening. Faecal M2-PK closes a gap in clinical practice because it detects bleeding and non-bleeding tumors and adenoma with high sensitivity and specificity. © 2012 Baishideng.

Morapudi S.P.,Macclesfield District General Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2012

To report outcomes of 21 total wrist arthroplasties (TWA) using the Universal 2 prosthesis. Five men and 14 women aged 44 to 82 (mean, 62) years underwent 21 total wrist arthroplasties for rheumatoid arthritis (n=19) and post-traumatic arthritis (n=2) by a single surgeon using the Universal 2 prosthesis. Pre- and post-operative pain and function were assessed by a single surgeon using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the patient-rated wrist evaluation (PRWE) score. Range of motion, stability, dislocation rate, and neurovascular status were also assessed. Radiographs were evaluated for implant alignment and fit, screw positioning, and implant loosening. The mean time to assessment of the range of motion was 3.1 (range, 1.8-3.9) years, and the mean time to assessment of the PRWE score was 4.8 (range, 2.1-7.3) years. The range of motion in each direction and the mean DASH and PRWE scores improved significantly following TWA. Two patients had restricted range of motion, which was treated by manipulation under anaesthetic (after 6 months in one and 8 weeks in the other). One patient underwent excision of a palmar bony bridge. One patient endured extensor pollicis longus rupture and underwent tendon transfer after 5 months. Radiographs revealed no evidence of implant loosening, migration, or malalignment. There was no sign of osteonecrosis in the remaining carpals or metacarpals. The Universal 2 TWA achieved significant improvement in range of motion and functional outcome of the wrist, with reduced rates of early joint instability, dislocation, and implant loosening, compared to previous implants. The small implant size and cementless design reduce bone loss and osteonecrosis.

Metcalfe C.,Macclesfield District General Hospital
Journal of Diabetes Nursing | Year: 2016

Some evidence exists that suggests that residential camps and events for children and young people with diabetes are an excellent way of bringing together young people and healthcare professionals in an informal and fun environment. Although there is a lack of evidence for the impact of these events on outcomes, such as glycaemic control and adherence to medications, anecdotal evidence from healthcare professionals and the young people who attend the events suggests that the young people benefit greatly from being around other young people with diabetes. They grow in confidence and are able to talk to healthcare professionals in informal surroundings. Healthcare professionals also report that involvement in these events changes their clinical practice for the better as they are able to interact with young people in some real-life situations, rather than in a clinic setting. This article describes the care events run by Diabetes UK and discusses the benefits for all involved.

Banks D.S.,Macclesfield District General Hospital
Journal of the Intensive Care Society | Year: 2011

Acute kidney injury in the intensive care unit (ICU) requiring renal replacement therapy (RRT) is common and mortality is high. The dose delivered is important and is usually inadequate. Evidence for dose is quoted as clearance, but RRT is usually prescribed as pump flow rates. Accurately delivering an evidence-based dose to a patient is difficult because of inefficiencies of RRT, the complexity of its mathematics and poor understanding. Inadequate dose can result from inadequate prescribing, which should be by ideal body weight and possibly by indication. Inadequate delivery of a prescription can occur because the delivered dose depends not only on the dialysate and ultrafiltrate pump flow rates, but also blood flow rate, predilution inefficiency, fluid removal rate and downtime. To investigate the feasibility of using a web-based calculator to make prescribing by clearance easy and to predict and compensate for these factors, a web page with a RRT calculator using JavaScript was used. Data were collected from 19 treatments before the introduction of the calculator and 20 after. Results showed that dose delivery was significantly improved (p<0.001). There was an improvement in prescribing an evidence-based dose which did not reach statistical significance (p=0.056) but the standard deviation was significantly smaller, indicating more rational prescribing. The calculator significantly improved prescribing and delivery of RRT in our ICU. © The Intensive Care Society 2011.

Singh J.,Macclesfield District General Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2010

To assess the effects of tranexamic acid (TA) in patients undergoing total hip arthroplasty (THA) for osteoarthritis. 42 patients underwent primary THA for osteoarthritis by a single surgeon. 10 men and 11 women who did not receive TA were controls, whereas 9 men and 12 women who received TA constituted the treatment group. Both groups were matched for age, gender, body mass index, and American Society of Anesthesiologists grading. The type of prosthesis used (cemented or uncemented) was based on the surgeon's preference and patient age, activity level and demands. No hybrid prosthesis was used. 10 minutes prior to incision, a single dose of intravenous TA (10 mg per kg body weight) was given to patients in the treatment group. Comparison was made between both groups with regard to intra-operative blood loss, postoperative reduction in haemoglobin and haematocrit levels, blood transfusion, incidence of deep vein thrombosis, and the length of hospital stay. The mean intra-operative blood loss (489 [SD, 281] vs. 339 [SD, 184] ml, p = 0.048) and the decrease in haemoglobin level (38 [SD, 12] vs. 29 [SD, 10] g/l, p=0.014) were significantly higher in the control than the treatment group. Two patients among the controls received a transfusion, compared to none in the TA group (p = 0.49, Fisher's exact test). The 2 patients who needed blood transfusion had blood losses of 600 and 690 ml, compared to a mean of 489 ml in the whole group. No patient in either group developed deep vein thrombosis or pulmonary embolism up to 3 months. A single dose of intravenous TA (10 mg per kg body weight) given 10 minutes prior to THA is a cost-effective and safe means of minimising blood loss and reduction in haemoglobin concentrations as well as the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.

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