Northumbria Healthcare NHS Foundation Trust

North Shields, United Kingdom

Northumbria Healthcare NHS Foundation Trust

North Shields, United Kingdom
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Rowan A.,Foundation Medicine | Bateman B.J.,Northumbria Healthcare NHS Foundation Trust
Archives of Disease in Childhood | Year: 2012

Objectives: To demonstrate the sensitivity of musculoskeletal (MSK) history taking. Design: Prospective study: consecutive children attending outpatient clinics. Setting and patients: Paediatric rheumatology clinic (n=45; girls n=28; median age 12 years, range 3-18), acute general paediatric assessment unit (n=50; girls n=21; median age 8 years, range 3-16). Intervention: Pro forma recording abnormal joint involvement from history taking and then following MSK examination completed by clinicians. Main outcome measures: Sensitivity of MSK history taking compared with clinical examination. Results: Paediatric rheumatology clinic: 135 abnormal joints identified in 34 children; 53/135 (39%) by history alone, 82/135 (61%) detected on examination resulting in MSK history sensitivity 53%, specificity 98%. Acute paediatric unit: 29 abnormal joints identified in 17 children; 18/29 identified on history (sensitivity 62%). Conclusions: MSK history taking failed to identify a large number of abnormal joints which were detected on physical examination, emphasising the need for all joints to be examined as part of a screening examination as a minimum.

Baker P.N.,Northumbria University | Rushton S.,Northumbria University | Jameson S.S.,Durham University | Reed M.,Northumbria Healthcare NHS Foundation Trust | And 2 more authors.
Bone and Joint Journal | Year: 2013

Pre-operative variables are increasingly being used to determine eligibility for total knee replacement (TKR). This study was undertaken to evaluate the relationships, interactions and predictive capacity of variables available pre- And post-operatively on patient satisfaction following TKR. Using nationally collected patient reported outcome measures and data from the National Joint Registry for England and Wales, we identified 22 798 patients who underwent TKR for osteoarthritis between August 2008 and September 2010. The ability of specific covariates to predict satisfaction was assessed using ordinal logistic regression and structural equational modelling. Only 4959 (22%) of 22 278 patients rated the results of their TKR as 'excellent', despite the majority (71%, n = 15 882) perceiving their knee symptoms to be much improved. The strongest predictors of satisfaction were post-operative variables. Satisfaction was significantly and positively related to the perception of symptom improvement (operative success) and the post-operative EuroQol-5D score. While also significant within the models pre-operative variables were less important and had a minimal influence upon post-operative satisfaction. The most robust predictions of satisfaction occurred only when both pre- And post-operative variables were considered together. These findings question the appropriateness of restricting access to care based on arbitrary pre-operative thresholds as these factors have little bearing on postoperative satisfaction. © 2013 The British Editorial Society of Bone & Joint Surgery.

Savaridas T.,Northern Deanery Orthopedic Training Programme | Serrano-Pedraza I.,Complutense University of Madrid | Khan S.K.,Northumbria Healthcare NHS Foundation Trust | Martin K.,Northumbria Healthcare NHS Foundation Trust | And 2 more authors.
Acta Orthopaedica | Year: 2013

Background and purpose Our unit started to use routine multimodal techniques to enhance recovery for hip and knee arthroplasty in 2008. We have previously reported earlier discharge, a trend toward a reduction in complications, and a statistically significant reduction in mortality up to 90 days after surgery. In this study, we evaluated the same cohort to determine whether survival benefits were maintained at 2 years. Patients and methods We prospectively evaluated 4,500 unselected consecutive total hip and knee replacements. The first 3,000 underwent a traditional protocol (TRAD) and the later 1,500 underwent an enhanced recovery protocol (ER). Mortality data were collected from the Office of National Statistics (UK). Results There was a difference in death rate at 2 years (TRAD vs. ER: 3.8% vs. 2.7%; p = 0.05). Survival probability up to 3.7 years post surgery was significantly better in patients who underwent an ER protocol. Interpretation This large prospective case series of unselected consecutive patients showed a reduction in mortality rate at 2 years following elective lower-limb hip and knee arthroplasty following the introduction of a multimodal enhanced recovery protocol. This survival benefit supports the routine use of an enhanced recovery program for hip and knee arthroplasty. © 2011 Nordic Orthopaedic Federation.

Sarma J.B.,Northumbria Healthcare NHS Foundation Trust | Ahmed G.U.,Assam University
Indian Journal of Medical Microbiology | Year: 2010

The risk of healthcare-associated infections (HCAIs) in developing countries can exceed 25% compared to developed countries. Lack of awareness and institutional framework to deal with patient safety in general and HCAI in particular perpetuates the culture of acceptance of avoidable risks as inevitable. Most HCAIs are avoidable and can be prevented by relatively simple means. It is no longer acceptable to put patients at risk of avoidable infections. The World Health Organization (WHO)-led World Alliance for Patient Safety launched a worldwide campaign on patient safety focusing on simple means like hand hygiene to combat HCAIs. To drive necessary changes to deliver sustainable improvement in clinical care requires strategic approach and clinical leadership. This article reviews the scale of the problem, the WHO recommended interventions and improvement strategies in institutional setup in developing and transitional countries.

Sarma J.B.,Northumbria Healthcare NHS Foundation Trust | Ahmed G.U.,Assam University
Indian Journal of Medical Microbiology | Year: 2010

Purpose: A point prevalence study was carried out in a teaching hospital in Assam to determine the prevalence, sensitivity profile and risk factors for acquisition of extended spectrum -lactamase (ESBL) producing enterobacteriacae vis - vis amount and pattern of antibiotic use. Materials and Methods: ESBL was detected by double disc synergy method. Defined daily dose and bed-days were calculated. Result: Colonisation rate of ESBL producing enterobacteriacae ranged from 14% (n=73) in medicine to the highest 41% (n=29) in orthopaedic with an intermediate 23% (n=80) in surgery. Presence of ESBL was found to be strongly associated with resistance to specific classes of antimicrobials. Exposure to cefotaxime and gentamicin, and surgery were risk factors for acquiring ESBL producing enterobacteriacae. Non-ESBL producing community isolates were found to be considerably more sensitive to different antibiotics with no resistance detected to trimethoprim, co-trimoxazole, ciprofloxacin and aminoglycosides. Conclusion: The study confirms the role of certain ′high risk′ antimicrobials in acquisition of ESBL producing Enterobacteriaceae and shows that periodic cohort studies could be an effective strategy in surveillance of antimicrobial resistance in hospitals of resource poor countries to inform antibiotic policy and treatment guidelines.

Khan S.K.,Northumbria Healthcare NHS Foundation Trust | Malviya A.,Northumbria Healthcare NHS Foundation Trust | Muller S.D.,Northumbria Healthcare NHS Foundation Trust | Carluke I.,Northumbria Healthcare NHS Foundation Trust | And 3 more authors.
Acta Orthopaedica | Year: 2014

Background and purpose Enhanced Recovery (ER) is a well-established multidisciplinary strategy in lower limb arthroplasty and was introduced in our department in May 2008. This retrospective study reviews short-term outcomes in a consecutive unselected series of 3,000 procedures (the "ER" group), and compares them to a numerically comparable cohort that had been operated on previously using a traditional protocol (the "Trad" group). Methods Prospectively collected data on surgical endpoints (length of stay (LOS), return to theater (RTT), re-admission, and 30- and 90-day mortality) and medical complications (stroke, gastrointestinal bleeding, myocardial infarction, and pneumonia within 30 days; deep vein thrombosis and pulmonary embolism within 60 days) were compared. Results ER included 1,256 THR patients and 1,744 TKR patients (1,369 THRs and 1,631 TKRs in Trad). The median LOS in the ER group was reduced (3 days vs. 6 days; p = 0.01). Blood transfusion rate was also reduced (7.6% vs. 23%; p < 0.001), as was RTT rate (p = 0.05). The 30-day incidence of myocardial infarction declined (0.4% vs. 0.9%; p = 0.03) while that of stroke, gastrointestinal bleeding, pneumonia, deep vein thrombosis, and pulmonary embolism was not statistically significantly different. Mortality at 30 days and at 90 days was 0.1% and 0.5%, respectively, as compared to 0.5% and 0.8% using the traditional protocol (p = 0.03 and p = 0.1, respectively). Interpretation This is the largest study of ER arthroplasty, and provides safety data on a consecutive unselected series. The program has achieved a statistically significant reduction in LOS and in cardiac ischemic events for our patients, with a near-significant decrease in return to theater and in mortality rates.

Atchia I.,Northumbria Healthcare NHS Foundation Trust | Atchia I.,Northumbria University | Kane D.,Northumbria University | Reed M.R.,Northumbria Healthcare NHS Foundation Trust | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Background Intra-articular injection is effective for osteoarthritis, but the best single injection strategy is not known, nor are there established predictors of response. The objectives of this study were to assess and predict response to a single ultrasound-guided injection in moderate to severe hip osteoarthritis. Methods: 77 hip osteoarthritis patients entered a prospective, randomised controlled trial, randomised to one of four groups: standard care (no injection); normal saline; non-animal stabilised hyaluronic acid (durolane) or methylprednisolone acetate (depomedrone). Main Outcome Measures Numerical rating scale (NRS 0-10) 'worst pain', Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain/function. Potential predictors of response (including radiographic severity, ultrasound synovitis and baseline symptom severity) were examined using univariate logistic regression analysis and Fisher's exact test. Results: NRS pain, WOMAC pain and function improved signifi cantly for the steroid arm alone. Effect sizes at week 1 were striking: NRS pain 1.5, WOMAC pain 1.9 and WOMAC function 1.3. Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society responder criteria identifi ed 22 responders (intention-to-treat): steroid 14 (74%; number needed to treat, two); saline, four (21%); durolane, two (11%); and no injection, two (10%; ?2 test between groups, p<0.001). Corticosteroid arm response was maintained over 8 weeks (summary measures analysis of variance, p<0.002 for NRS pain). Synovitis was a signifi cant predictor of response at weeks 4 and 8 (p<0.05, Fisher's exact test; week 4 OR 16.7, 95% CI 1.4 to 204). Conclusions: Ultrasound-guided corticosteroid injections are highly effi cacious; furthermore synovitis on ultrasound is a biomarker of response to injection.

Sarma J.B.,Northumbria Healthcare NHS Foundation Trust | Ahmed G.U.,Northumbria Healthcare NHS Foundation Trust
Indian Journal of Medical Microbiology | Year: 2010

Purpose: A point prevalence study was carried out in a teaching hospital in Assam to characterise S. aureus strains, establish the rate of colonisation of methicillin resistant S. aureus (MRSA) and associated risk factors for its acquisition. Materials and Methods: Antibiogram-Resistogram profile was done by BSAC standardized disc sensitivity method; Phage and RFLP typing were carried out by the PHLS, London. Results: Single MRSA strain resistant to multiple classes of anti-staphylococcal antibiotics dominated the hospital. The MRSA colonisation rate was found to be 34% (n=29) and 18% (n=80) in orthopaedics and surgery, respectively and only ~1% (n=73) in the medical units. Exposure to ciprofloxacin and surgery were risk factors but duration of hospital stay was not. In contrast, meticillin sensitive S. aureus (MSSA) strains were usually distinct strains and sensitive to most of the anti-staphylococcal antibiotics including 18% to penicillin. Conclusions: The MRSA strain prevalent in the hospital phenotypically resembles the predominant Asian strain viz., Brazilian/Hungarian strains (CC8-MRSA-III). Duration was not a risk factor, which suggests that in absence of exposure to specific antimicrobials, even in a hospital with no or little infection control intervention, a vast majority remain free from MRSA. This underlines the importance of rational prescribing empirical antibiotics.

Malviya A.,Northumbria Healthcare NHS Foundation Trust | Reed M.R.,Northumbria Healthcare NHS Foundation Trust | Partington P.F.,Northumbria Healthcare NHS Foundation Trust
Injury | Year: 2011

Peri-articular knee fractures in osteoporotic or osteoarthritic bone present a challenge to fixation, mobilisation or non-operative management. We present a series of 15 proximal tibial and 11 distal femoral fractures treated with total knee arthroplasty at over mean follow-up period of 38.8 months. The mean age of the patients was 80 years. The choice of the implant and level of constraint was determined as per the nature of injury and preference of the surgeon dealing with the fracture. Patients were allowed rapid mobilisation with immediate full weight-bearing. Good clinical results were achieved with fracture healing, sound fixation and well-aligned flexible knees. Mean Knee Society knee score was 90.2; Knee Society function score was 35.5; Oxford Knee score was 39.5; and Short Form (SF)-36 physical function score was 37.3 and mental score 50.6. Good correlation was noted between Knee society knee score and SF-36 physical function score (Pearson's 0.76, p = 0.001), suggesting that generic health would dictate the final function achieved, whilst high knee scores suggest the satisfactory results of the operation. Analogous to arthroplasty for hip fractures, this technique should be considered as a treatment option in elderly peri-articular knee fractures with osteoporosis and/or osteoarthritis. © 2011 Elsevier Ltd. All rights reserved.

Shiue I.,Northumbria University | Shiue I.,Northumbria Healthcare NHS Foundation Trust
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2016

Background Little is known on the health service use for allergy. Therefore, the aim of this study was to investigate the hospital episode rates in allergy by sex and across age groups in order to understand whether and how the health service use for allergy might have changed in recent years in north-east of England. Methods Hospital episode data in mid-2010 to mid-2015 covering five full calendar years were extracted from Northumbria Healthcare NHS Foundation Trust, which is serving nearly half of a million population and free from central government control. Hospital episode rates were calculated from all admissions divided by annual and area-specific population size for each sex and age group, presented with per 100 000 person-years using Microsoft Excel. Results Health service use for allergy in adults for both men and women has increased, with large increases in young adults aged 40-49 (both male and female), 50-59 (female) and 60-69 (male). In children, there were decreases in those aged 0-9, but increases in those aged 10-19. Emergency admissions due to allergy were only minimal. Higher admissions were observed in spring and autumn than in summer and winter. Conclusion Allergy admissions have increased in adults. For future research, local health policy could benefit from annual clinical records on health service use due to allergy. For clinical practice, in addition to increasing and improving the role of health and nursing professionals to reduce burden and rehabilitation, public awareness, attitude and knowledge should be continuously raised and improved as well. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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