Portsmouth Hospitals NHS Trust

Portsmouth, United Kingdom

Portsmouth Hospitals NHS Trust

Portsmouth, United Kingdom

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Doran S.J.,University of Surrey | Doran S.J.,Institute of Cancer Research | Yatigammana D.N.B.,University of Surrey | Yatigammana D.N.B.,Portsmouth Hospitals NHS Trust
Physics in Medicine and Biology | Year: 2012

Optical computed tomography has now become a well-established method for making empirical measurements of 3D dose distributions in radiotherapy treatment verification. The requirement for effective refractive index matching as part of the scanning process has long been an inconvenience for users, limiting the speed of sample throughput. We propose a new method for reconstructing data that takes explicit account of the refracted path of the light rays and demonstrate theoretically the conditions under which there are sufficient data to create a good reconstruction. Examples of the performance of the algorithm are given. For smoothly varying data, reconstructed images of very high quality are obtained, with RMS deviation of under 1% from the original, provided that the irradiated region lies entirely within a critical radius. For the dosimeter material PRESAGE, this critical value is approximately 0.65 of the sample radius. Regions outside this are not reconstructed successfully, but we argue that there are many cases where this disadvantage is outweighed by the benefits of the technique. © 2012 Institute of Physics and Engineering in Medicine.

Nangalia V.,University College London | Prytherch D.R.,Portsmouth Hospitals NHS Trust | Smith G.B.,Portsmouth Hospitals NHS Trust | Smith G.B.,Bournemouth University
Critical Care | Year: 2010

Recent developments in communications technologies and associated computing and digital electronics now permit patient data, including routine vital signs, to be surveyed at a distance. Remote monitoring, or telemonitoring, can be regarded as a subdivision of telemedicine - the use of electronic and telecommunications technologies to provide and support health care when distance separates the participants. Depending on environment and purpose, the patient and the carer/system surveying, analysing or interpreting the data could be separated by as little as a few feet or be on different continents. Most telemonitoring systems will incorporate five components: data acquisition using an appropriate sensor; transmission of data from patient to clinician; integration of data with other data describing the state of the patient; synthesis of an appropriate action, or response or escalation in the care of the patient, and associated decision support; and storage of data. Telemonitoring is currently being used in community-based healthcare, at the scene of medical emergencies, by ambulance services and in hospitals. Current challenges in telemonitoring include: the lack of a full range of appropriate sensors, the bulk weight and size of the whole system or its components, battery life, available bandwidth, network coverage, and the costs of data transmission via public networks. Telemonitoring also has the ability to produce a mass of data - but this requires interpretation to be of clinical use and much necessary research work remains to be done. © 2010 BioMed Central Ltd.

Smith G.B.,Bournemouth University | Prytherch D.R.,Portsmouth Hospitals NHS Trust | Prytherch D.R.,University of Portsmouth | Meredith P.,Portsmouth Hospitals NHS Trust | And 4 more authors.
Resuscitation | Year: 2013

Introduction: Early warning scores (EWS) are recommended as part of the early recognition and response to patient deterioration. The Royal College of Physicians recommends the use of a National Early Warning Score (NEWS) for the routine clinical assessment of all adult patients. Methods: We tested the ability of NEWS to discriminate patients at risk of cardiac arrest, unanticipated intensive care unit (ICU) admission or death within 24. h of a NEWS value and compared its performance to that of 33 other EWSs currently in use, using the area under the receiver-operating characteristic (AUROC) curve and a large vital signs database (n= 198,755 observation sets) collected from 35,585 consecutive, completed acute medical admissions. Results: The AUROCs (95% CI) for NEWS for cardiac arrest, unanticipated ICU admission, death, and any of the outcomes, all within 24. h, were 0.722 (0.685-0.759), 0.857 (0.847-0.868), 0.894 (0.887-0.902), and 0.873 (0.866-0.879), respectively. Similarly, the ranges of AUROCs (95% CI) for the other 33 EWSs were 0.611 (0.568-0.654) to 0.710 (0.675-0.745) (cardiac arrest); 0.570 (0.553-0.568) to 0.827 (0.814-0.840) (unanticipated ICU admission); 0.813 (0.802-0.824) to 0.858 (0.849-0.867) (death); and 0.736 (0.727-0.745) to 0.834 (0.826-0.842) (any outcome). Conclusions: NEWS has a greater ability to discriminate patients at risk of the combined outcome of cardiac arrest, unanticipated ICU admission or death within 24. h of a NEWS value than 33 other EWSs. © 2013 Elsevier Ireland Ltd.

Prytherch D.R.,Portsmouth Hospitals NHS Trust | Smith G.B.,Portsmouth Hospitals NHS Trust | Smith G.B.,Bournemouth University | Schmidt P.E.,Portsmouth Hospitals NHS Trust | And 3 more authors.
Resuscitation | Year: 2010

Aim of study: To develop a validated, paper-based, aggregate weighted track and trigger system (AWTTS) that could serve as a template for a national early warning score (EWS) for the detection of patient deterioration. Materials and methods: Using existing knowledge of the relationship between physiological data and adverse clinical outcomes, a thorough review of the literature surrounding EWS and physiology, and a previous detailed analysis of published EWSs, we developed a new paper-based EWS - VitalPAC™ EWS (ViEWS). We applied ViEWS to a large vital signs database (n= 198,755 observation sets) collected from 35,585 consecutive, completed acute medical admissions, and also evaluated the comparative performance of 33 other AWTTSs, for a range of outcomes using the area under the receiver-operating characteristics (AUROC) curve. Results: The AUROC (95% CI) for ViEWS using in-hospital mortality with 24. h of the observation set was 0.888 (0.880-0.895). The AUROCs (95% CI) for the 33 other AWTTSs tested using the same outcome ranged from 0.803 (0.792-0.815) to 0.850 (0.841-0.859). ViEWS performed better than the 33 other AWTTSs for all outcomes tested. Conclusions: We have developed a simple AWTTS - ViEWS - designed for paper-based application and demonstrated that its performance for predicting mortality (within a range of timescales) is superior to all other published AWTTSs that we tested. We have also developed a tool to provide a relative measure of the number of " triggers" that would be generated at different values of EWS and permits the comparison of the workload generated by different AWTTSs. © 2010 Elsevier Ireland Ltd.

Layfield D.M.,University of Southampton | Agrawal A.,Portsmouth Hospitals NHS Trust | Roche H.,Southampton General Hospital | Cutress R.I.,University of Southampton
British Journal of Surgery | Year: 2011

Background: Sentinel lymph node biopsy (SLNB) reduces the morbidity of axillary clearance and is the standard of care for patients with clinically node-negative breast cancer. The ability to analyse the sentinel node during surgery enables a decision to be made whether to proceed to full axillary clearance during primary surgery, thus avoiding a second procedure in node-positive patients. Methods: Current evidence for intraoperative sentinel node analysis following SLNB in breast cancer was reviewed and evaluated, based on articles obtained from a MEDLINE search using the terms 'sentinel node', 'intra-operative' and 'breast cancer'. Results and conclusion: Current methods for evaluating the sentinel node during surgery include cytological and histological techniques. Newer quantitative molecular assays have been the subject of much recent clinical research. Pathological techniques of intraoperative SLNB analysis such as touch imprint cytology and frozen section have a high specificity, but a lower and more variably reported sensitivity. Molecular techniques are potentially able to sample a greater proportion of the sentinel node, and could have higher sensitivity. Copyright © 2010 British Journal of Surgery Society Ltd.

Hewitt J.,Portsmouth Hospitals NHS Trust
Cochrane database of systematic reviews (Online) | Year: 2012

Acute kidney injury (AKI) is a common, serious, but potentially treatable condition. Because AKI is often associated with acidosis, it has become common practice to recommend administration of sodium bicarbonate to correct acid imbalance. To assess the benefits and harms of the use of sodium bicarbonate for people with AKI. The primary outcome measure was all-cause mortality, and secondary outcome measures were patients' need for renal replacement therapy; return to baseline kidney function; and overall survival. In November 2011 we searched the Cochrane Renal Group's Specialised Register using keywords relevant to this review. The register is populated using searches of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and handsearching records from renal-related journals and conference proceedings. All randomised controlled trials (RCTs) that investigated the use of sodium bicarbonate supplements, administered by any route, for the treatment of adults with AKI were to be included. The search strategy did not restrict inclusion based on an upper age limit or publication language. We did not consider inclusion of studies that investigated use of sodium bicarbonate for AKI prevention. All authors planned to independently assess and extracted information. Information was to be collected on methods, participants, interventions and outcomes. Results were to be expressed as risk ratios (RR) for dichotomous outcomes or as mean differences (MD) for continuous data with 95% confidence intervals (CI). Although our literature search identified four studies, none of these met our predetermined selection criteria. Hence, no suitable studies were identified for inclusion in this review. We found no RCT evidence - supportive or otherwise - for the use of sodium bicarbonate for people with AKI. We concluded that there is an urgent need for well conducted RCTs in this area.

Longcroft-Wheaton G.,Portsmouth Hospitals NHS Trust | Bhandari P.,Portsmouth Hospitals NHS Trust
Expert Review of Gastroenterology and Hepatology | Year: 2015

Submucosal gastrointestinal tumors represent a unique, diverse and challenging group of lesions found in modern medical practice. While management has traditionally been surgical, the development of advanced endoscopic techniques is challenging this approach. This review aims to investigate the role of endotherapy in treatment pathways, with a focus on carcinoid and gastrointestinal stromal tumors. In particular, we will discuss which lesions can be safely treated endoscopically, the evidence base behind such approaches and the limitations of the current evidence. The review will consider how these techniques may change the management of submucosal tumors in the future. © 2015 Informa UK, Ltd.

Kieffer W.K.M.,Portsmouth Hospitals NHS Trust | Kane T.P.C.,Portsmouth Hospitals NHS Trust
Annals of the Royal College of Surgeons of England | Year: 2012

A simple scoring system that enables surgeons to make an estimation of the likelihood of postoperative urinary retention (POUR) in patients undergoing lower limb total joint replacement would be a useful one. This would enable selection of high risk patients who merit pre-operative catheterisation in a clean theatre environment rather than risking urinary retention and its associated complications late at night on the ward by junior, inexperienced staff. The International Prostate Symptom Score (IPSS) is such a scoring system and we assessed its reliability in predicting those male patients likely to go into POUR. We selected all male patients undergoing lower limb total joint arthroplasty under spinal anaesthesia and calculated their IPSS. We found a statistically significant increase in the likelihood of POUR as IPSS rises (p=0.0002). We concluded that the IPSS is a quick and easy method of predicting those at risk of POUR, allowing them to be catheterised prophylactically, preventing possible complications.

Davies R.L.,Portsmouth Hospitals NHS Trust
Journal of the Royal Army Medical Corps | Year: 2016

When haemorrhage occurs on the battlefield, the soldier rapidly loses whole blood; it therefore stands to reason that the optimum fluid for resuscitation is whole blood. Indeed, this was the case for the first 250 years of transfusion practice, but since the 1970s component therapy has been used, with little evidence for that change. It is hardly surprising that ‘balanced’ component therapy, which seeks to replicate whole blood, has been found to offer the best results in resuscitation. This article explores the role of whole blood in resuscitation and how it may be useful in the contemporary military environment. © Journal of the Royal Army Medical Corps. All rights reserved.

Longcroft-Wheaton G.,Portsmouth Hospitals NHS Trust | Bhandari P.,Portsmouth Hospitals NHS Trust
Expert Review of Gastroenterology and Hepatology | Year: 2014

The practice of colonoscopy has changed considerably over the last decade. The growth of image-enhanced endoscopy have altered our concepts of how we perform colonoscopy. This article examines the evidence base behind these techniques and looks at where future research needs to be directed. © 2014 Informa UK, Ltd.

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