Liverpool, United States
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Dubois V.D.-P.,University of Liverpool | Bastawrous A.,Mersey Deanery | Bastawrous A.,London School of Hygiene and Tropical Medicine
Cochrane Database of Systematic Reviews | Year: 2017

Background: Cataract is the leading cause of world blindness. The only available treatment for cataract is surgery. Surgery requires highly-trained individuals with expensive operating facilities. Where these are not available, patients go untreated. A form of treatment that did not involve surgery would be a useful alternative for people with symptomatic cataract who are unable or unwilling to undergo surgery. If an eye drop existed that could reverse or even prevent progression of cataract, then this would be a useful additional treatment option. Cataract tends to result from oxidative stress. The protein, L-carnosine, is known to have an antioxidant effect on the cataractous lens, so biochemically there is sound logic for exploring L-carnosine as an agent to reverse or even prevent progression of cataract. When applied as an eye drop, L-carnosine cannot penetrate the eye. However, when applied to the surface of the eye, N-acetylcarnosine (NAC) penetrates the cornea into the front chamber of the eye (near to where the cataract is), where it is metabolised into L-carnosine. Hence, it is possible that use of NAC eye drops may reverse or even prevent progression of cataract, thereby improving vision and quality of life. Objectives: To assess the effectiveness of NAC drops to prevent or reverse the progression of cataract. Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), Allied and Complementary Medicine Database (AMED) (January 1985 to June 2016), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 28 June 2016. We handsearched the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS) meetings from 2005 until September 2015. Selection criteria: We planned to include randomized or quasi-randomised controlled trials where NAC was compared to control in people with age-related cataract. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Main results: We identified two potentially eligible studies from Russia and the United States. One study was split into two arms: the first arm ran for six months, with two-monthly follow-up; the second arm ran for two years with six-monthly follow-up. The other study ran for four months with a data collection point at the start and end of the study only. A total of 114 people were enrolled in these studies. The ages ranged from 55 to 80 years. We were unable to obtain sufficient information to reliably determine how both these studies were designed and conducted. We have contacted the author of these studies, but have not yet received a reply. Therefore, these studies are assigned as 'awaiting classification' in the review until sufficient information can be obtained from the authors. Authors' conclusions: There is currently no convincing evidence that NAC reverses cataract, nor prevents progression of cataract (defined as a change in cataract appearance either for the better or for the worse). Future studies should be randomized, double-masked, placebo-controlled trials with standardised quality of life outcomes and validated outcome measures in terms of visual acuity, contrast sensitivity and glare, and large enough to detect adverse effects. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.


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.


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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