Swamy M.,Durham University |
Venkatachalam S.,North Tyneside General Hospital |
McLachlan J.,Durham University
BMC Medical Education | Year: 2015
Background: Over recent years, wide ranging changes have occurred in undergraduate medical curricula with reduction of hours allocated for teaching anatomy. Anatomy forms the foundation of clinical practice. However, the challenge of acquiring sufficient anatomical knowledge in undergraduate medical education for safe and competent clinical practice remains. The purpose of this study is to identify clinically most valuable orthopaedic anatomy components that are relevant to current clinical practice in order to reinforce anatomy teaching. Methods: Modified Delphi technique with three rounds involving twenty currently practicing orthopaedic consultants and senior speciality orthopaedic registrars (StR, year six and above) was conducted. Anatomical components applied in corresponding clinical situations were generated from the opinions of this expert panel in the first round and the clinical importance of each of these components were rated with a four point Likert scale in the subsequent two rounds to generate consensus. Percentage agreement was utilised as outcome measure for components rated as considerably/very important with consensus of more than 94%. Results: Response rates were 90% for the first round and 100% for the next two rounds. After three Delphi rounds, thirty four anatomy components applied in general/ specific clinical conditions and clinical tests were identified as clinically most valuable following iteration. Conclusions: The findings of this study provide clinicians opinions regarding the current required essential anatomical knowledge for a graduating medical student to apply during their orthopaedic clinical encounters. The information obtained can be utilised to encourage further development of clinical anatomy curriculum reflecting the evolving nature of health care. © 2014 Swamy et al.; licensee BioMed Central Ltd.
Staley H.,North Tyneside General Hospital |
McCallum I.,Durham University |
Bruce J.,University of Warwick
Breast | Year: 2014
This review aimed to assess the effects of postoperative Tamoxifen following surgical resection of ductal carcinoma in situ (DCIS). Data on local DCIS recurrence, new invasive carcinoma, distant disease, mortality and adverse effects were extracted from randomised controlled trials (RCTs) comparing Tamoxifen after surgery for DCIS (regardless of oestrogen receptor (ER) status), with or without adjuvant radiotherapy. Meta-analysis was performed using the fixed-effect model and the results expressed as relative risks (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs). Two RCTs which recruited 3375 women were included. Tamoxifen after surgery for DCIS reduced recurrence of ipsilateral DCIS (HR 0.75; 95% CI 0.61-0.92) and contralateral DCIS (RR 0.50; 95% CI 0.28-0.87). Contralateral invasive cancer was reduced (RR 0.57; 95% CI 0.39-0.83), and there was a trend towards decreased ipsilateral invasive cancer (HR 0.79; 95% CI 0.62-1.01). The number needed to treat in order for Tamoxifen to have a protective effect against all breast events is 15. There was no evidence of a difference in all-cause mortality (RR 1.11; 95% CI 0.89-1.39). Only one trial involving 1799 participants followed-up for 163 months (median) reported on adverse events with no significant difference in event rate between Tamoxifen and placebo groups, but there was a non-significant trend towards more endometrial cancer in the Tamoxifen group. This review concludes that while Tamoxifen after local excision for DCIS, with or without adjuvant radiotherapy, reduced the risk of recurrent DCIS, it did not reduce the risk of all-cause mortality. © 2014 Elsevier Ltd.
Hughes J.C.,Newcastle University |
Hughes J.C.,North Tyneside General Hospital
Current Opinion in Psychiatry | Year: 2015
This review aims to set out the recent writings relevant to acquired cognitive impairment in an attempt to reveal some of the underlying conceptual issues. RECENT FINDINGS: The huge strides being taken to diagnose Alzheimer's and other dementias early, including pre-symptomatically, raise important ethical issues. But there are broader conceptual issues too, around the notion of normal ageing. New techniques, such as deep brain stimulation, raise further ethical concerns, but may be relevant to deeper philosophical issues. Meanwhile, capacity continues to be of interest to researchers in the field of cognitive impairment, but the 'United Nations Convention on the Rights of Persons with Disabilities' is raising questions about our understanding of the nature of capacity. These new ideas reflect shifts in our understanding of personhood. How we think about the person is relevant to how we think about dilemmas over artificial nutrition and is also pertinent to debates about rational suicide in response to a diagnosis of dementia. A person-centred view allows us to think more broadly about cognitive impairment. SUMMARY: Cognitive impairment challenges us to think broadly, to see such impairment as something to be dealt with in the context of our multifaceted life-worlds. © 2015 Wolters Kluwer Health, Inc.
Galmiche J.-P.,University of Nantes |
Hatlebakk J.,University of Bergen |
Attwood S.,North Tyneside General Hospital |
Ell C.,Dr Horst Schmidt Hospital |
And 5 more authors.
JAMA - Journal of the American Medical Association | Year: 2011
Context: Gastroesophageal reflux disease (GERD) is a chronic, relapsing disease with symptoms that have negative effects on daily life. Two treatment options are longterm medication or surgery. Objective: To evaluate optimized esomeprazole therapy vs standardized laparoscopic antireflux surgery (LARS) in patients with GERD. Design, Setting, and Participants: The LOTUS trial, a 5-year exploratory randomized, open, parallel-group trial conducted in academic hospitals in 11 European countries between October 2001 and April 2009 among 554 patients with well-established chronic GERD who initially responded to acid suppression. A total of 372 patients (esomeprazole, n=192; LARS, n=180) completed 5-year follow-up. Interventions: Two hundred sixty-six patients were randomly assigned to receive esomeprazole, 20 to 40 mg/d, allowing for dose adjustments; 288 were randomly assigned to undergo LARS, of whom 248 actually underwent the operation. Main Outcome Measure: Time to treatment failure (for LARS, defined as need for acid suppressive therapy; for esomeprazole, inadequate symptom control after dose adjustment), expressed as estimated remission rates and analyzed using the Kaplan-Meier method. Results: Estimated remission rates at 5 years were 92% (95% confidence interval [CI], 89%-96%) in the esomeprazole group and 85% (95% CI, 81%-90%) in the LARS group (log-rank P=.048). The difference between groups was no longer statistically significant following best-case scenario modeling of the effects of study dropout. The prevalence and severity of symptoms at 5 years in the esomeprazole and LARS groups, respectively, were 16% and 8% for heartburn (P=.14), 13% and 2% for acid regurgitation (P<.001), 5% and 11% for dysphagia (P<.001), 28% and 40% for bloating (P<.001), and 40% and 57% for flatulence (P<.001). Mortality during the study was low (4 deaths in the esomeprazole group and 1 death in the LARS group) and not attributed to treatment, and the percentages of patients reporting serious adverse events were similar in the esomeprazole group (24.1%) and in the LARS group (28.6%). Conclusion: This multicenter clinical trial demonstrated that with contemporary antireflux therapy for GERD, either by drug-induced acid suppression with esomeprazole or by LARS, most patients achieve and remain in remission at 5 years. Trial Registration clinicaltrials.gov Identifier: NCT00251927. ©2011 American Medical Association. All rights reserved.
Sundeep S.,Freeman Hospital |
Cleeve V.,North Tyneside General Hospital
Journal of Infection | Year: 2011
Here we describe the case of a young man who sustained a seal bite to his hand and developed a seal finger. The symptoms of seal finger include pain, swelling, discharge, and in some cases there is joint involvement.1 The organism isolated from the lesion was identified as a Bisgaardia hudsonensis and we believe this is the first case of a seal bite caused by B. hudsonensis which is a new member of the family Pasteurellaceae and as yet unpublished. © 2011 The British Infection Association.
Walker R.W.,North Tyneside General Hospital |
Chaplin A.,Wansbeck General Hospital |
Hancock R.L.,Northumbria University |
Rutherford R.,Northumbria University |
Gray W.K.,North Tyneside General Hospital
Movement Disorders | Year: 2013
The incidence of hip fracture and outcomes from hip surgery for people with Parkinson's disease (PD) are thought to be poorer than for people without PD. The aim of this audit of a prospective hip-fracture database was to establish the incidence of, and outcomes from, hip fracture in people with and without PD living in North East England. The number of people with PD living in the study area was estimated using data from two previous prevalence studies in the same geographical area. Using data collected prospectively for the National Hip Fracture Database for Northumbria Healthcare National Health Service Foundation Trust in the UK, the annual incidence of hip fracture in people with and without PD was calculated. Type of fracture, time to surgery, time to discharge, and 30-day outcomes from surgery were compared. Annual incidence of hip fracture was significantly higher in people with PD across all age bands. In those 60 years of age and over, it was 2,171 (95% confidence interval [CI]: 2,082-2,264) per 100,000 in people with PD and 551 (95% CI: 506-598) in people without PD. The experience of PD and non-PD patients within hospital was remarkably similar. However, PD patients had poorer mobility before hip fracture, took longer to be discharged to the community, and were less mobile postsurgery. Specific guidelines for managing people with PD who sustain a hip fracture may help to improve awareness of the potential complications of the condition and improve outcomes. © 2012 Movement Disorder Society.
Dyson J.K.,North Tyneside General Hospital |
Rutter M.D.,University Hospital of North Tees
World Journal of Gastroenterology | Year: 2012
The association between inflammatory bowel disease (IBD) and colorectal cancer (CRC) has been recognised since 1925 and still accounts for 10%-15% of deaths in IBD. IBD-associated CRC (IBD-CRC) affects patients at a younger age than sporadic CRC. The prognosis for sporadic CRC and IBD-CRC is similar, with a 5-year survival of approximately 50%. Identifying at risk patients and implementing appropriate surveillance for these patients is central to managing the CRC risk in IBD. The increased risk of colorectal cancer in association with IBD is thought to be due to genetic and acquired factors. The link between inflammation and cancer is well recognised but the molecular biology, immune pathobiology and genetics of IBD-CRC are areas of much ongoing research. This review examines the literature relating to IBD-CRC, focusing on the incidence of IBD-CRC and examining potential risk factors including age at diagnosis, gender, duration and extent of colitis, severity of inflammation, family history of sporadic CRC and co-existent primary sclerosing cholangitis (PSC). Confirmed risk factors for IBD-CRC are duration, severity and extent of colitis, the presence of co-existent PSC and a family history of CRC. There is insufficient evidence currently to support an increased frequency of surveillance for patients diagnosed with IBD at a younger age. Evidence-based guidelines advise surveillance colonoscopy for patients with colitis 8 to 10 years after diagnosis, with the interval for further surveillance guided by risk factors (extent of disease, family history of CRC, post-inflammatory polyps, concomitant PSC, personal history of colonic dysplasia, colonic strictures). There is a move away from using random colonic biopsies towards targeted biopsies aimed at abnormal areas identified by newer colonoscopic techniques (narrow band imaging, chromoendoscopy, confocal microendoscopy). © 2012 Baishideng.
Steer J.,North Tyneside General Hospital |
Norman E.M.,North Tyneside General Hospital |
Afolabi O.A.,North Tyneside General Hospital |
Gibson G.J.,Northumbria University |
And 2 more authors.
Thorax | Year: 2012
Background: Rates of mortality and readmission are high in patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In this population, the prognostic value of the Medical Research Council Dyspnoea Scale (MRCD) is uncertain, and an extended MRCD (eMRCD) scale has been proposed to improve its utility. Coexistent pneumonia is common and, although the CURB-65 prediction tool is used, its discriminatory value has not been reported. Methods: Clinical and demographic data were collected on consecutive patients hospitalised with AECOPD. The relationship of stable-state dyspnoea severity to inhospital mortality and 28-day readmission was assessed. The discriminatory value of CURB-65, MRCD and eMRCD, in the prediction of in-hospital mortality, was assessed and compared. Results: 920 patients were recruited. 10.4% died inhospital and 19.1% of the 824 survivors were readmitted within 28 days of discharge. During their stable state prior to admission, 34.2% of patients were too breathless to leave the house. Mortality was significantly higher in pneumonic than in non-pneumonic exacerbations (20.1% vs 5.8%, p<0.001). eMRCD was a significantly better discriminator than either CURB-65 or the traditional MRCD scale for predicting in-hospital mortality, and was a stronger prognostic tool than CURB- 65 in the subgroup of patients with pneumonic AECOPD. Conclusions: The severity of dyspnoea in the stable state predicts important clinical outcomes in patients hospitalised with AECOPD. The eMRCD scale identifies a subgroup of patients at a particularly high risk of in-hospital mortality and is a better predictor of mortality risk than CURB-65 in exacerbations complicated by pneumonia.
Rushton P.R.,North Tyneside General Hospital |
Reed M.R.,North Tyneside General Hospital |
Pratt R.K.,North Tyneside General Hospital
The bone & joint journal | Year: 2015
The Nottingham Hip Fracture Score (NHFS) was developed to assess the risk of death following a fracture of the hip, based on pre-operative patient characteristics. We performed an independent validation of the NHFS, assessed the degree of geographical variation that exists between different units within the United Kingdom and attempted to define a NHFS level that is associated with high risk of mortality. The NHFS was calculated retrospectively for consecutive patients presenting with a fracture of the hip to two hospitals in England. The observed 30-day mortality for each NHFS cohort was compared with that predicted by the NHFS using the Hosmer-Lemeshow test. The distribution of NHFS in the observed group was compared with data from other hospitals in the United Kingdom. The proportion of patients identified as high risk and the mortality within the high risk group were assessed for groups defined using different thresholds for the NHFS. In all 1079 hip fractures were included in the analysis, with a mean age of 83 years (60 to 105), 284 (26%) male. Overall 30-day mortality was 7.3%. The NHFS was a significant predictor of 30-day mortality. Statistically significant differences in the distribution of the NHFS were present between different units in England (p < 0.001). A NHFS ≥ 6 appears to be an appropriate cut-point to identify patients at high risk of mortality following a fracture of the hip. ©2015 The British Editorial Society of Bone & Joint Surgery.
Staley H.,North Tyneside General Hospital
Cochrane database of systematic reviews (Online) | Year: 2012
Ductal carcinoma in situ (DCIS) is a non-invasive carcinoma of the breast. The incidence of DCIS has increased substantially over the last twenty years, largely as a result of the introduction of population-based mammographic screening. The treatment of DCIS tumours involves surgery with or without radiotherapy to prevent recurrent DCIS and invasive carcinoma. However, there is clinical uncertainty as to whether postoperative hormonal treatment (tamoxifen) after surgery confers benefit in overall survival and incidence of recurrent carcinoma. To assess the effects of postoperative tamoxifen in women having local surgical resection of DCIS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), the Cochrane Breast Cancer Group's Specialised Register, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) on 16 August 2011. Published and unpublished randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing tamoxifen after surgery for DCIS (regardless of oestrogen receptor status), with or without adjuvant radiotherapy. Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the fixed-effect model and the results were expressed as relative risks (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs). We included two RCTs involving 3375 women. Tamoxifen after surgery for DCIS reduced recurrence of both ipsilateral (same side) DCIS (HR 0.75; 95% CI 0.61 to 0.92) and contralateral (opposite side) DCIS (RR 0.50; 95% CI 0.28 to 0.87). There was a trend towards decreased ipsilateral invasive cancer (HR 0.79; 95% CI 0.62 to 1.01) and reduced contralateral invasive cancer (RR 0.57; 95% CI 0.39 to 0.83). The number needed to treat in order for tamoxifen to have a protective effect against all breast events is 15. There was no evidence of a difference detected in all cause mortality (RR 1.11; 95% CI 0.89 to 1.39). Only one study, involving 1799 participants followed-up for 163 months (median) reported on adverse events (i.e. toxicity, mood changes, deep vein thrombosis, pulmonary embolism, endometrial cancer) with no significant difference between tamoxifen and placebo groups, but there was a non-significant trend towards more endometrial cancer in the tamoxifen group. While tamoxifen after local excision for DCIS (with or without adjuvant radiotherapy) reduced the risk of recurrent DCIS (in the ipsi- and contralateral breast), it did not reduce the risk of overall mortality.