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Ethunandan M.,St Richards Hospital | Ethunandan M.,Poole General Hospital | Markus A.F.,Poole General Hospital
Cleft Palate-Craniofacial Journal | Year: 2011

Objective: To document the frequency and nature of associated anomalies in cleft lip and/or palate patients from a craniofacial center in India. Setting: Craniofacial Surgery & Research Centre, SDM College of Dental Sciences & Hospital, Dharwad, India. Patients/Participants: A total of 1623 consecutive patients with cleft lip and/or cleft palate treated in a 40-month period. Main Outcome Measure: Frequency and nature of associated anomalies, analyzed according to the cleft type and principal organ system and/or area affected. Results: The overall male to female ratio was 1.8:1. Unilateral cleft lip with cleft palate (41%) was the most frequent cleft subtype, followed by cleft lip and/ or cleft alveolus (33%); isolated submucous cleft palate (1%) was the least frequent. A total of 240 (14.8%) patients had associated anomalies, and these were more frequent in males (M:F = 1.4:1). Per patient, anomalies were most frequent in the submucous cleft group (mean, 0.53) and least common in the cleft lip with or without cleft alveolus (mean, 0.14). Anomalies were most frequent in the facial region (21%), followed by the ocular (17%), central nervous (15%), gastrointestinal (3%), and urogenital (2%) systems. Thirty-four patients (2%) had recognized nonchromosomal syndromes; this was more common in the cleft palate group. Conclusions: Associated anomalies are not uncommon in patients with cleft lip and/or palate, though the frequency varies with the cleft type and organ system affected.


Dabare D.,Poole General Hospital | Lo T.T.H.,William Harvey Hospital | McCormack D.J.,London Chest Hospital | Kung V.W.S.,Royal London Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

A best-evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether screening asymptomatic individuals for an abdominal aortic aneurysm (AAA) is feasible and improves disease-free survival. Seven studies presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and limitations of the studies are tabulated. In total, four randomized population-based studies have evaluated ultrasound screening for AAA: two British studies, Multicentre Aneurysm Screening Study (MASS) and the Chichester trial, and one each in Viborg County, Denmark and Western Australia. Participants were randomized to receive an invitation to screen or not. The MASS trial randomized 67 770 men, followed participants over 10 years and concluded that screening would almost half AAA-related deaths in men aged 65-74 years. The smaller Chichester trial included only 6040 men but demonstrated a 42% reduction in AAA-related mortality at 5 years, with ongoing benefit at 15 years (11% reduction). The Viborg County trial recruited 12 639 men aged 64-73 years, showed a 66% reduction in AAA-related mortality over 14 years. Finally, the Western Australia trial evaluated 41 000 men but included an older population of 65-83 years old. No benefit was seen in this age group but subgroup analysis of men aged 65-74 showed a significant mortality benefit. Only a small or insignificant benefit in all-cause mortality was seen in any of these studies. A recent meta-analysis of these trials has shown a significant benefit in AAA-related mortality in the long term and concluded that AAA screening is superior to other established screening programmes. The cost-effectiveness of screening was assessed in the MASS and Viborg County trials and was found to be substantially below the cost threshold set by the National Institute of Clinical Excellence for acceptance of interventions. Quality of life was assessed in the MASS and in a case-control study and showed no adverse effects that outweigh the benefits. We concluded that ultrasound screening for AAAs has met all the criteria to become a screening programme and would substantially reduce disease-related death with no adverse effect on quality of life. © The Author 2012.


Nelson S.C.,Poole General Hospital | Wedgwood J.T.A.,3 Medical Regiment
Journal of the Royal Army Medical Corps | Year: 2015

Introduction Morphine auto-injectors are issued to all British soldiers on operations in Afghanistan who deploy forward of Camp Bastion, the main British base. Previous studies have reviewed the effectiveness of various prehospital analgesics, but there is no record of the knowledge and confidence of the relatively medically untrained soldiers who carry and use intramuscular morphine on the battlefield. The aim of this study was to assess soldiers’ knowledge and confidence of the morphine auto-injector with a view to guiding further training. Methods Structured questionnaire distributed to soldiers in two patrol bases in Helmand Province during Op HERRICK 17. Results 232 questionnaires were completed by a range of ranks and trades. 100% had received mandatory training on the auto-injector and over 70% had received more advanced training. Confidence in using the auto-injector was high, with 47% rating their confidence level as 10/ 10. Overall, factual knowledge was good with the mean score for the questionnaire being 7.9/10; 95% of respondents knew how to document the use of morphine and 79% knew when a second dose could safely be administered. Some misunderstanding of contraindications was revealed: 9% of answers were incorrect, and 47% wrongly answered that administering morphine to a patient changes the triage category. Conclusions The majority of soldiers received far more than the minimum required training on the use of the morphine auto-injector. Confidence in using the device is high and generally knowledge is good. The authors suggest that deployed medical personnel in forward locations maintain regular training to soldiers on the morphine auto-injector in order to ensure that casualties receive analgesia appropriately and promptly. © 2015, Royal Army Medical College. All rights reserved


PubMed | Southampton Childrens Hospital, UCL Institute of Education, Private University of Santa Cruz de la Sierra, University of Western Australia and 4 more.
Type: Journal Article | Journal: Sleep | Year: 2016

To compare polysomnographic parameters in high altitude (HA) native Andean children with low altitude (LA) native peers in order to explain the nocturnal oxyhemoglobin saturation (SpO2) instability reported in HA native children and to study the effect on sleep quality.Ninety-eight healthy children aged 7-10 y and 13-16 y were recruited at LA (500 m) or HA (3,650 m) above sea level. Physical examination was undertaken and genetic ancestry determined from salivary DNA to determine proportion of European ancestry, a risk factor for poor HA adaptation. Attended polysomnography was carried out over 1 night for 58 children at their resident location.Of 98 children recruited, 85 met inclusion criteria, 58 of 85 (68.2%) completed polysomnography, of which 56 were adequate for analysis: 30 at LA (17 male) and 26 at HA (16 male). There were no altitude differences in genetic ancestry, but a high proportion of European admixture (median 50.6% LA; 44.0% HA). SpO2 was less stable at HA with mean 3% and 4% oxygen desaturation indices greater (both P < 0.001) than at LA. This was not explained by periodic breathing. However, more obstructive hypopnea was observed at HA (P < 0.001), along with a trend toward more central apnea (P = 0.053); neither was explained by clinical findings. There was no difference in sleep quality between altitudes.HA native Andean children have more respiratory events when scoring relies on SpO2 desaturation due to inherent SpO2 instability. Use of American Academy of Sleep Medicine scoring criteria may yield false-positive results for obstructive sleep-disordered breathing at HA.


Zhengang X.,Chinese Academy of Sciences | Colbert S.,Poole General Hospital | Brennan P.A.,Queen Alexandra Hospital | Xue B.,Chinese Academy of Sciences | And 4 more authors.
International Journal of Oral and Maxillofacial Surgery | Year: 2013

The surgical management of advanced cervical metastases with carotid artery involvement in patients with primary squamous cell carcinoma of the head and neck can be difficult. The authors retrospectively reviewed 73 patients over a 15-year period comparing the outcomes of carotid artery resection versus peeling the tumour off the carotid artery. Based on these findings, the authors suggest that in the absence of carotid wall involvement, nodal metastatic tumour should be peeled off the carotid artery where possible. This practice appears to have a lower morbidity than that associated with arterial reconstruction. Steps to minimize cerebrovascular injury are discussed. © 2012 International Association of Oral and Maxillofacial Surgeons.


Naik S.,Royal Bournemouth Hospital | Kerr D.,Royal Bournemouth Hospital | Begley J.,Poole General Hospital | Morton J.,Royal Bournemouth Hospital
Diabetes Technology and Therapeutics | Year: 2012

Aims: The aim of this study was to determine whether changes in local skin temperature over which the infusion catheters pass when using insulin pump therapy and the choice of rapid-acting insulin analog influence the risk of catheter occlusion. Subjects and Methods: Twenty healthy volunteers were assigned to wear insulin pumps primed with insulin glulisine and insulin aspart in a randomized order each for a duration of 5 days and a temperature probe (taped to the skin near the insulin catheter). To reproduce the effect of subcutaneous infusion, the insulin catheter was inserted into an absorbent sponge in a plastic bag strapped to the subject's abdomen. Basal infusion rates were programmed at 0.2IU/h, and 2-IU boluses were given three times a day with meals. Results: Average skin temperature ranged between 33.5°C and 36.68°C for insulin glulisine and 32.35°C and 35.28°C for insulin aspart, with no difference in skin temperature between treatments or between the first and second week of the study. Nine occlusions were seen in eight subjects with an overall rate of occlusion of 22.5% (95% confidence interval, 21.9-61.3%) and were more likely to occur in the second week. On an individual level the risk of occlusion was similar for insulin glulisine and insulin aspart (odds ratio, 0.87%; P=0.6). Conclusions: Overall, in this small study simulating subcutaneous insulin infusion, the rate of catheter occlusion was low and unaffected by local fluctuations in ambient skin temperature. There was no significant difference between the two rapid-acting insulin analogs tested. Where occlusions occurred, they were more likely to happen beyond the manufacturer's recommended 72-h limit for catheter use. © Mary Ann Liebert, Inc.


PubMed | Royal Bournemouth Hospital and Poole General Hospital
Type: Journal Article | Journal: Perspectives on medical education | Year: 2016

Medical students preparing for final exams need practical and theoretical knowledge. We evaluated a junior doctor led integrated programme delivering theoretical and practical teaching.An 8-week junior-doctor led teaching programme was set up for final year medical students. Theory, OSCE and bedside teaching on selected weekly clinical themes were run. Satisfaction was evaluated using a questionnaire survey.Almost all agreed that the programme was useful and that an integrated approach to teaching was more beneficial than separate and unrelated lectures and practical teaching. The majority agreed that theory sessions and practical sessions had improved their confidence for finals and agreed they felt more prepared for work as a doctor. Most agreed that the Facebook group provided an easily accessible platform for communication and sharing learning resources. Some comments, however, highlighted limitations particularly in the ability to answer difficult questions.Integrated teaching by junior doctors in small groups appeared to be an efficient teaching method (for theoretical and clinical skills) for medical students, improving their confidence for finals and life as a doctor and provided useful opportunities for junior doctors to develop as clinical teachers. This can be a useful blueprint for other hospitals.


Pratt T.,Poole General Hospital | Bromilow J.,Poole General Hospital
Anaesthesia and Intensive Care | Year: 2011

Percutaneous dilatational tracheostomy is a common bedside procedure in critical care for patients requiring prolonged mechanical ventilation. The traditional technique requires withdrawal of the endotracheal tube to a proximal position to facilitate tracheostomy insertion, but this carries the risk of inadvertent extubation and does not prevent cuff rupture. Use of a supraglottic airway such as the laryngeal mask airway may avoid these risks and could provide a safe alternative to the endotracheal tube. We present an appraisal of the literature to date. We found reasonable evidence to show improved ventilation and bronchoscopic visualisation with the laryngeal mask airway, but this has not been translated into improved outcome. There is currently insufficient evidence to draw conclusions about the safety of the laryngeal mask airway during percutaneous dilatational tracheostomy.


Marks T.O.M.,Poole General Hospital | Kelsall N.K.R.,Poole General Hospital | Southgate J.J.,Poole General Hospital
EMA - Emergency Medicine Australasia | Year: 2011

Luxatio erecta is the rarest form of shoulder dislocation, accounting for 0.5% of all glenohumeral dislocations. Bilateral cases are rarer still with only 12 accounts described in medical literature. We describe an unusual case and its management. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.


PubMed | Poole General Hospital
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

Proximal humeral fractures associated with vascular compromise are extremely rare in children. We describe the presentation, diagnosis and management of one such injury in a child.

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