Wood P.L.R.,Wrightington Hospital |
Karski M.T.,Wrightington Hospital |
Watmough P.,Royal Bolton Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2010
We describe the early results of a prospective study of 100 total ankle replacements (96 patients) at a single centre using the Mobility Total Ankle Replacement. At final review, six patients had died and five ankles (5%) had been revised, two by fusion and three by exchange of components. All remaining patients were reviewed at a minimum of three years. The mean follow-up was 43 months (4 to 63). The three-year survival was 97% (95% confidence interval (CI) 91 to 99). The four-year survival was 93.6% (95% CI 84.7 to 97.4). The portion of bony interface that was visible on plain radiograph was divided into 15 zones and a radiolucent line or osteolytic cavity was seen in one zone in 14 ankles. It was not seen in more than one zone. In five ankles it was > 10 mm in width. This study suggests that the early outcome of ankle replacement is comparable to that of other total joint replacements. ©2010 British Editorial Society of Bone and Joint Surgery.
Maxwell A.J.,Royal Bolton Hospital |
Pearson J.M.,Royal Bolton Hospital
Clinical Radiology | Year: 2010
Aim: To establish clinical and ultrasonic criteria by which needle sampling can be safely avoided in young women with solid breast masses. Materials and methods: The databases of a large hospital were searched for breast cancers, phyllodes tumours, and papillomas diagnosed in women below the age of 30 years. In addition, the clinical and sonographic findings in female patients less than 25 years of age presenting with a solid breast mass over a 1-year period were reviewed. Results: Nine women with breast cancer, seven with phyllodes, and six with papillomas were found. No delayed diagnoses in those who had ultrasound would have been made if the following criteria had been applied to avoid needle sampling: age less than 25 years; no known risk factors for breast malignancy; mass not rapidly enlarging; smooth discrete mobile mass on clinical examination, or lesion impalpable; well-defined homogeneously isoechoic or mildly hypoechoic solid mass; less than 3 cm in greatest dimension; ovoid shape, aligned parallel to the skin surface; smooth or gently lobulated contour (two or three lobulations only; no microlobulation); thin echogenic pseudocapsule; no calcification; no acoustic shadowing. Needle sampling could have been safely avoided in approximately two-thirds of the women reviewed below the age of 25 with a solid breast mass. Conclusion: Application of the proposed criteria would spare a significant number of young women unnecessary needle sampling. © 2010 The Royal College of Radiologists.
Henson C.C.,Royal Bolton Hospital
The Cochrane database of systematic reviews | Year: 2013
Across the developed world, an estimated 150,000 to 300,000 people are treated annually with pelvic radiotherapy and 80% will develop gastrointestinal (GI) symptoms during treatment. Acute GI symptoms are
DeSouza R.-M.,King's College |
Benjamin R. T. Jones,Royal Bolton Hospital |
Lowis S.P.,University of Bristol |
Kurian K.M.,University of Bristol
Frontiers in Oncology | Year: 2014
As advances in the molecular and genetic profiling of pediatric medulloblastoma evolve, associations with prognosis and treatment are found (prognostic and predictive biomarkers) and research is directed at molecular therapies. Medulloblastoma typically affects young patients, where the implications of any treatment on the developing brain must be carefully considered. The aim of this article is to provide a clear comprehensible update on the role molecular profiling and subgroups in pediatric medulloblastoma as it is likely to contribute significantly toward prognostication. Knowledge of this classification is of particular interest because there are new molecular therapies targeting the Shh subgroup of medulloblastomas. © 2014 DeSouza, Jones, Lowis and Kurian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).
Shetty S.K.,Royal Bolton Hospital
BMJ case reports | Year: 2010
A 3033g male infant was born to a healthy mother at 39 weeks gestation by normal vaginal delivery with Grade 1 meconium stained liquor. There was no prolonged rupture of membranes or any antenatal risk factors for sepsis. The immediate neonatal period was uneventful and the baby was discharged after two days. At 6 weeks of age the baby was admitted with an 8-hour history of inconsolable crying. He was pyrexial. Initially the possibility of intussuception was considered, however, the submandibular swelling became more obvious and tender. His airway was clear. Chest x-ray and abdominal x-ray were normal. Ultrasound of the submandibular region showed soft tissue swelling with no fluid collection. CRP was initially 0.7 but increased to 87 the next day. Blood cultures grew group B streptococcus. (GBS) He was treated for five days with appropriate intravenous antibiotics. He was discharged home and recovered fully.
Abul-Ainine A.A.,Victoria Hospital |
Abul-Ainine S.A.,Royal Bolton Hospital
Pediatric Diabetes | Year: 2014
Background: While childhood diabetes incidence is rising, especially in toddlers, once or twice-daily toddler-friendly insulin mixtures were withdrawn, imposing four to five miniscule injections, on needle-phobic toddlers. Although more injections may mean more needle-dribbling, such potential dose-loss is unstudied. Objective: Study insulin loss in toddlers' dose range if one-drop dribbled during injection from half-unit pens (SemiPens). Drop-loss is assessed relative to current insulin dose adjustment, and if significant, propose solutions. Methods: The SemiPens, New HumaPen Luxura HD® (HumaPen) and NovoPen Junior® (NovoPen), with 31G-5mm BD-MicroFine needles were used to study drop size or dose-fraction lost if one drop dribbled in dose range 0.5-10 units. Results: HumaPen and NovoPen produced sizable drops mean standard deviation (SD) 0.30 (0.05) and 0.36 (0.06) units/drop (p<0.001). This constituted progressively increasing proportion of the toddlers' doses, 10-fold higher percentage from 6 to 60% or 7.2 to 72%, as the dose gets smaller from 5 to 0.5 units. Discussion: Insulin dose-adjustments are usually done therapeutically within 5-20% dose-changes, while one-step reduction by >20% is hardly required. Therefore, the unintentional dosing change if a drop dribbles is clinically important particularly on using multiple doses below 6 units, compared with fewer larger daily injections. We propose using U20 insulin in disposable SemiPens to make DeciPen, with fivefold-reduction in insulin loss if a drop is lost through dribbling or skin-leak. Conclusion: The one-drop insulin loss is statistically significant, clinically important, and potentiates glycemic variability. Disposable DeciPen may minimize insulin dribbling and leaking and fivefold improve dose accuracy and precision; and ensure reproducibility without prolonging injection time. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Darbyshire D.,Royal Bolton Hospital |
Baker P.,North Western Deanery and Royal Bolton Hospital
Medical Humanities | Year: 2012
The use of cinema in medical education has the potential to teach students about a variety of subjects, for instance by illustrating a lecture on communication skills with a clip of Sir Lancelot Spratt (Doctor In The House, 1954) demonstrating a paternalistic, doctor-centred approach to medicine or nurturing an ethical discussion around palliative care and dying using the cinematic adaptation of American playwright Margaret Edson's Wit (2001). Much has been written about this teaching method across several medical academic disciplines. It is the aim of this review to assimilate the various experiences in order to gain an insight into current expertise. The results are presented by the following headings under which the articles were examined: the source journal, year of publication, article type, theme, content, target, authors, if a clip or the entire film was used, and if any feedback was documented. This is followed by a chronological account of the development of the literature. Such an approach will allow the reader to gather specific information and contextualise it. This review does not critically appraise the quality of the evidence nor does it determine its validity, rather it is hoped that having read the review educators will know where to locate previous accounts of work that will help them develop more engaging pedagogy.
Burns J.,Royal Bolton Hospital
Nursing Older People | Year: 2016
Ensuring patients are adequately hydrated is a fundamental part of nursing care, however, it is clear from the literature that dehydration remains a significant problem in the NHS with implications for patient safety. The development of dehydration is often multifactorial and older age is an independent risk factor for the condition. However, the media often blame nursing staff for simply not giving patients enough to drink. This article discusses the scale of the problem in acute care settings and aims to raise awareness of the importance of hydration management and accurate documentation in nursing practice. It suggests that intentional hourly rounding may provide an opportunity for nurses to ensure older patients are prompted or assisted to take a drink. © 2016 RCNi Ltd.
Sutton P.A.,Royal Bolton Hospital
BMJ case reports | Year: 2013
Non-permanent, non-woven options for the closure of an open abdomen have previously been limited to biologics such as Permacol or Strattice. Gore Bio-A is constructed from biocompatible synthetic fibres, the use of which has only been described in the repair of inguinal hernia, hiatal hernia and fistula-in-ano. A 60-year-old male underwent emergency laparotomy, partial gastrectomy and formation of a feeding jejunostomy for a strangulated and perforated intrathoracic hiatus hernia. His abdominal wall subsequently dehisced for which he underwent laparostomy and subsequent early closure with a Gore Bio-A mesh, secured in an onlay manner with 2/0 vicryl. Functional and cosmetic outcomes were satisfactory and the patient was discharged home. The use of Gore Bio-A is a safe, feasible and cost effective alternative to traditional biologics for the closure of a laparostomy, deployment of which is safe within a contaminated field. Further prospective data is needed to clarify its role.
Parris R.J.,Royal Bolton Hospital
Trauma | Year: 2012
Emergency department (ED) staff confront death more frequently than any other specialty except oncology. These deaths are often traumatic, sudden, unexpected and occur in a younger age group. As a consequence, bereaved survivors have a greater risk of an abnormal grief reaction. [Walters DT, Tupin JP (1991) Family grief in the emergency department. Emergency Medicine Clinics of North America 9(1): 189-206.] Whilst the severity or timing of traumatic injuries may preclude medical attempts to influence patient survival, the approach of the same resuscitation team to the bereaved before death, during resuscitation and after death may have profound influences on subsequent grief in the bereaved. Despite this, it can be argued that Emergency Medicine within the UK has given little thought and time for reflection upon how we treat the bereaved. That the care of the dying and the bereaved within the ED matters is greatly reinforced by the Scottish Government's 2010 Consultation document on bereavement that states: 'There is ... evidence that the way [the] bereaved experience events around the time of death will influence their grief. Where health services get it right ... bereaved people are supported to accept the death ... Conversely if the health services get it wrong, then bereaved people may experience additional distress, and that distress will interfere with their successful transition through the grieving process'. © The Author(s) 2011.