Liverpool, United States
Liverpool, United States

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Horsburgh B.,Mersey Deanery | Singh G.,Southport and Ormskirk Hospital NHS Trust
BMJ Case Reports | Year: 2014

A 62-year-old woman presented 3 weeks following vaginal hysterectomy and anterior repair with exquisite urethral pain, incontinence and complete urethral prolapse. Following examination under anaesthesia and cystoscopy, anterior vaginal repair sutures were removed with spontaneous reduction of the prolapse. At a 5-week follow-up appointment, the patient was asymptomatic with resolution of the urethral prolapse. Copyright 2014 BMJ Publishing Group. All rights reserved.

Rautenbach P.,Mersey Deanery | Rautenbach P.,Conquest | Wilson A.,Conquest | Gouws P.,Conquest
Eye | Year: 2010

Aims The instillation of a combined flourescein-anaesthetic eye drop is common practice in most ophthalmology clinics. Chauvin Pharmaceuticals produce unpreserved proxymethacaine 0.5% and flourescein 0.25% in a Minims ® vial (PFM) intended for single application only. Our aim was to determine whether the reuse of these eye drops for multiple applications has the potential for bacterial transmission.Methods Samples were collected from doctors in general outpatient clinics. Each sample constituted a blood agar plate inoculated with the initial drop of fluid from a PFM as a control. The vial was then used for multiple applications on consecutive patients. One of the last remaining drops was then inoculated onto an alternate marked site on the same plate to serve as the test sample. The samples were immediately transported to the Microbiology laboratory and incubated at 37°C for 48 h. The results were interpreted thereafter by a Microbiologist.Results A total of 41 samples were collected by eight Samplers. In all, 7/41(17%) samples showed growth of normal conjunctiva and lid flora on the test area. These were coagulase negative Staphylococciand Corynebacteriumspp.Conclusions The reuse of single application of PFM should be questioned due to the potential risk of transmitting pathogens. A change to a single use only policy would result in a projected threefold increase in the annual budget for these drops. © 2010 Macmillan Publishers Limited All rights reserved.

Rogers S.N.,University of Liverpool | Rogers S.N.,Edge Hill University | Palmer N.O.A.,Mersey Deanery | Lowe D.,Edge Hill University | Randall C.,North West Medicines Information Center
British Journal of Oral and Maxillofacial Surgery | Year: 2015

We aimed to record all new patients who presented to departments of oral surgery, oral medicine, and oral and maxillofacial surgery, and to dental hospitals in the UK, with avascular necrosis of the jaws including bisphosphonate-related necrosis (BRONJ) over a 2-year period (1 June 2009-31 May 2011). They were eligible irrespective of age, cause, or coexisting conditions. Data on incidence, clinical characteristics, risk factors, and coexisting conditions were collected. A total of 383 cases were registered: 369 were described as BRONJ, 5 as avascular necrosis, and 9 were unknown. Bisphosphonates had been given orally in 207 (56%), intravenously in 125 (34%), both orally and intravenously in 27 (7%), and was unknown in 9 (2%); one had been given denosumab. The main risk factor was dental extraction, and the mandible was commonly affected. The median duration of administration until onset of BRONJ was 3 years in those treated intravenously and 4 years in those treated orally. Levels of engagement with the study varied between regions, and extrapolation from the 2 most involved (Merseyside and Northern Ireland) found around 8.2-12.8 cases/million/year, which is 508-793 patients/year across the UK. To our knowledge this is one of the first studies to estimate national rates of BRONJ. It confirms that the risk and incidence are low. With changes in trends for antiresorptive bone medication, and increasing numbers of elderly people, it would be useful to repeat the registration in the future. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Bidwai A.S.,Mersey Deanery
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2013

Trapeziectomy and Weilby ligament reconstruction is a recognized treatment for osteoarthritis of the trapeziometacarpal joint. Studies published using this procedure have limited follow-up post-surgery. In this series of 24 cases assessed objectively and 36 subjectively with a minimum follow-up of five years, patients continue to have pain relief and function comparable to the opposite non-operated hand. Patient satisfaction is high at 92% and the rate of complications is low. Despite these encouraging results the need for interposition arthroplasty and/or ligament reconstruction in addition to trapeziectomy alone is discussed.

Rutherford M.E.,University of Otago | Hill P.C.,University of Otago | Triasih R.,Gadjah Mada University | Sinfield R.,Mersey Deanery | And 2 more authors.
Tropical Medicine and International Health | Year: 2012

Young children living with a tuberculosis patient are at high risk of Mycobacterium tuberculosis infection and disease. WHO guidelines promote active screening and isoniazid (INH) preventive therapy (PT) for such children under 5years, yet this well-established intervention is seldom used in endemic countries. We review the literature regarding barriers to implementation of PT and find that they are multifactorial, including difficulties in screening, poor adherence, fear of increasing INH resistance and poor acceptability among primary caregivers and healthcare workers. These barriers are largely resolvable, and proposed solutions such as the adoption of symptom-based screening and shorter drug regimens are discussed. Integrated multicomponent and site-specific solutions need to be developed and evaluated within a public health framework to overcome the policy-practice gapand provide functional PT programmes for children in endemic settings. © 2012 Blackwell Publishing Ltd.

Manara J.R.,Mersey Deanery | Taylor J.,Mersey Deanery | Nixon M.,Countess of Chester Hospital
Journal of Shoulder and Elbow Surgery | Year: 2015

Background: Shoulder pain after a cerebrovascular accident or traumatic brain injury is a common but often under-recognized problem. It is due to a number of causes including inferior subluxation, spasticity, adhesive capsulitis, and heterotopic ossification. Many of these are amenable to surgical intervention. Methods: Literature review of current evidence. Results: This article shows that there are multiple treatment options in this group of patients, and it is important to understand these as clinicians in delivering quality care to this complex group of patients. Conclusion: This review article describes how careful clinical assessment can differentiate between causes of shoulder pain and guide best management. © 2015.

Moreton A.,Health Education North West | Jackson E.,Health Education North West | Ahmed-Little Y.,Mersey Deanery
Journal of Health, Organisation and Management | Year: 2014

Purpose: Designing and running robust junior doctor rotas is a challenging task and much previous advice has been based on consensus or anecdote. This paper aims to discern the most frequently occurring problems with trainee working patterns and produce evidence-based guidance for implementing and running contract-compliant rotas. Design/methodology/approach: A total of 35 secondary care trusts in North West England were invited to supply information on pay banding appeals requested under the New Deal junior doctor contract. Of these, 15 (43 per cent) participated with data from 35 appeals between 2004 and 2012. A thematic analysis was undertaken to discern the commonly occurring causes of contractual breaches. Findings: A total of 83 per cent (n=29/35) of appeals were based on data showing the rota to be non-compliant with the contract (band 3), with the remainder being compliant with the contract but not in keeping with the pay banding currently assigned. Inability to take adequate natural breaks was the most frequently cited cause of rota non-compliance. Where underlying reasons were given for breaches of hours/rest limits they clustered around 20 themes, the top four being poor or absent dialogue between HR and doctors, excessive workload, inappropriately timed ward rounds, and inadequate or non-existent bleep policies. Originality/value: This is the first analysis of banding appeals under the UK junior doctor contract. The findings show that problems with rotas cluster around specific themes. The authors provide recommendations to target these so as to avoid financially detrimental contract breaches and trainee dissatisfaction. © Emerald Group Publishing Limited.

This research aimed to define and agree a consensus on the overall aims, educational objectives and assessments for extended GP training. It used a modified Delphi technique to achieve a consensus of opinions from a representative group of stakeholders and assessment content experts. Existing curriculum gaps that could be developed further in a period of extended training were defined. The study showed a very strong consensus for a 'gateway' assessment-to-a-standard1 at the current ST3 endpoint before progression to extended GP training with those years of extended training giving 'added value'. The current MRCGP summative components of the applied knowledge test (AKT) and clinical skills assessment (CSA) are considered fit for purpose as an appropriate 'gateway' standard; with more robust workplace-based assessments to demonstrate continued progression during extended training. The results informed and provided the evidence base for the development of a proposed programmatic assessment model, which has been critically appraised.2 This paper reports in detail on the Delphi study and comments on the importance of further work developing assessments. © 2013 Radcliffe Publishing Limited.

The authors describe a case of a 43-year-old lady who developed bilateral cataracts, seizures and a unilateral cystic lesion of the basal ganglia following low-dose carbon monoxide (CO) exposure over 7 years. Cataract formation may result from sustained oxidative stress as a result of chronic environmental CO exposure.

Mills L.S.,Warrington and Halton Hospitals NHS Foundation Trust | Craig Unwin,Mersey Deanery
Journal of Diabetes Nursing | Year: 2011

People with diabetes are more likely to have sexual dysfunction than the general population. The management of sexual dysfunction has dramatically changed in the past decade with the widespread use of pharmacological and physical options for men with erectile problems. There is now growing recognition of female sexual dysfunction, although there is little evidence of the efficacy of any treatment. Questions about sexual dysfunction should be part of routine diabetes assessment. This article, the fourth in a series exploring the pathophysiology of vascular complications in diabetes, provides an overview of the underlying mechanisms of sexual dysfunction and describes the treatment options.

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