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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.

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.

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.

Brims F.J.H.,University College London | Arif M.,Portsmouth Hospitals NHS Trust | Chauhan A.J.,Portsmouth Hospitals NHS Trust
Clinical Respiratory Journal | Year: 2012

Introduction: Thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anaesthesia, conscious sedation and a rigid thoracoscope. Objectives: We sought to evaluate the safety and outcome of thoracoscopy in Portsmouth Hospitals, UK, a dockyard city with high previous asbestos usage. Methods: Retrospective casenote, radiology and laboratory result analysis of patients undergoing thoracoscopy in our institution over a 12-month period. Results: Fifty-seven of 58 casenotes were available for analysis. Median (interquartile range) age was 73.0 (66.5-79.0) years and 44 (77.2%) were male. Median time with chest drain post-procedure was 3.0 (2.0-5.0) days, and length of stay (LOS) was 4.0 (2.0-8.0) days. Malignant histology was reported in 40 (70.2%), with 25 (62.5%) cases of mesothelioma. There were no deaths related to the procedure. Hospital-acquired infection (HAI) occurred in six (10.5%: pneumonia four, empyema two), all had malignancy. The presence of HAI significantly prolonged the LOS 9.0 (7.5-23.5) vs no HAI 4.0 (2.0-7.0) days; P=0.006). Four patients died within 1 month of the procedure, three had a malignant diagnosis, all had suffered HAI. Trapped lung (persistent hydropneumothorax 5 days post-procedure) occurred in 11 (19.2%), six of whom had benign histology. Performance status (European Cooperative Oncology Group) prior did not differ with reported histological type: benign 2.0 (2.0-2.0), malignant 2.0 (2.0-3.0), P=0.170. Conclusions: Serious complications following thoracoscopy are rare. HAI is associated with malignancy and prolonged hospital stay. Benign histology may still confer significant morbidity. Please cite this paper as: Brims FJH, Arif M and Chauhan AJ. Outcomes and complications following medical thoracoscopy. © 2011 Blackwell Publishing 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.

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