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Proctor R.D.,Royal Cornwall Hospitals NHS Trust | Rofe C.J.,University of Southampton | Bryant T.J.C.,University of Southampton | Hacking C.N.,University of Southampton | Stedman B.,University of Southampton
Clinical Radiology

Autoimmune pancreatitis (AIP) remains one of the rarer forms of pancreatitis but has become increasingly well recognized and widely diagnosed as it is an important differential, particularly due to the dramatic response to appropriate therapy. It is now best considered as part of a multisystem disease and the notion of "IgG4-related systemic sclerosing disease" has become widely recognized as the number of extra-pancreatic associations of AIP grows. More recently AIP has been classified into two subtypes: lymphoplasmacytic sclerosing pancreatitis (LPSP) and idiopathic duct-centric pancreatitis (IDCP) with distinct geographical, age and sex distributions for the two subtypes, in addition to different pathological characteristics. The role of imaging is crucial in AIP and should be considered in conjunction with clinical, serological, and histopathological findings to make the diagnosis. Radiologists are uniquely placed to raise the possibility of AIP and aid the exclusion of significant differentials to allow the initiation of appropriate management and avoidance of unnecessary intervention. Radiological investigation may reveal a number of characteristic imaging findings in AIP but appearances can vary considerably and the focal form of AIP may appear as a pancreatic mass, imitating pancreatic carcinoma. This review will illustrate typical and atypical appearances of AIP on all imaging modes. Emphasis will be placed on the imaging features that are likely to prove useful in discriminating AIP from other causes prior to histopathological confirmation. In addition, examples of relevant differential diagnoses are discussed and illustrated. © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. Source

Brown A.S.,Royal Cornwall Hospitals NHS Trust
Clinical Governance

Purpose - Risk management is becoming an increasingly important topic in healthcare. The dangers of conducting clinical trials were brought to the attention of the public by the media in 2006 with the TGN1412 phase 1 clinical trial. Clinical trials are however important for the development of new drugs. There are a number of gatekeepers for the safety of trials but risk assessment is now becoming an important aspect. This paper aims to focus on clinical trials. Design/methodology/approach - A new risk assessment tool was developed to collect data relating to the contributory factors and control measures associated with clinical trials. The responses to a series of 29 questions are then scored to inform a risk rating for the clinical trial Practical implications - The theoretical model was converted into a Microsoft Excel spreadsheet with drop down boxes for the responses to the questions. Research management staff have found the tool simple and quick to use. A printout of the assessment can be placed in the study folder as evidence. Highlighted risks are then flagged up to the organisation's corporate risk register and an action plan developed. Originality/value - The tool has been utilised to assess risks of all research projects from educational studies such as MSc, PhD to medical device trials and drug trials. Furthermore it has assessed risks in the acute, primary care and mental health sectors. © 2011 Emerald Group Publishing Limited. All rights reserved. Source

Newton H.,Royal Cornwall Hospitals NHS Trust
Wounds UK

Tackling healthcare-associated infections (HAIs) such as meticillin-resistant Staphylococcus aureus (MRSA) continues to be a key safety issue. As a result of surveillance, it was reported that the author's trust, a secondary care provider, had a poor rating for MRSA bacteraemias. From April 2008 to March 2009, 12 patients developed a bacteraemia that through root cause analysis was found to be associated with their wound. This article describes the strategic and educational plan developed to address this trust-wide issue and its impact in reducing wound-associated MRSA bacteraemias. It also acknowledges the resulting changes in clinical practice. Source

Willis H.,Royal Cornwall Hospitals NHS Trust
Emergency Medicine Journal

A short cut review was carried out to establish ultrasonography was as good as radiography at detecting fracture clavicles in children. 580 papers were found using the reported searches, of which 5 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is that ultrasonography is sensitive at detecting clavicular fractures in children. Source

Wells J.C.K.,University College London | Sharp G.,Royal Cornwall Hospitals NHS Trust | Steer P.J.,Imperial College London | Leon D.A.,London School of Hygiene and Tropical Medicine

Background:Ethnic groups differ significantly in adult physique and birth weight. We aimed to improve understanding of maternal versus paternal contributions to ethnic differences in birth weight, by comparing the offspring of same-ethnic versus mixed-ethnic unions amongst Europeans and South Asian Indians in the UK.Methodology and principal findings:We used data from the UK Office for National Statistics Longitudinal Study (LS) and the Chelsea and Westminster Hospital (CWH), London. In the combined sample at all gestational ages, average birth weight of offspring with two European parents was significantly greater than that of offspring with two Indian parents [Δ = 344 (95% CI 329, 360) g]. Compared to offspring of European mothers, the offspring of Indian mothers had lower birth weight, whether the father was European [Δ = -152 (95% CI -92, -212) g] or Indian [Δ = -254 (95% -315, -192) g]. After adjustment for various confounding factors, average birth weight of offspring with European father and Indian mother was greater than that of offspring with two Indian parents [LS: Δ = 249 (95% CI 143, 354) g; CWH: Δ = 236 (95% CI 62, 411) g]. Average birth weight of offspring with Indian father and European mother was significantly less than that of offspring with two European parents [LS: Δ = -117 (95% CI -207, -26) g; CWH: Δ = -83 (-206, 40) g].Conclusions/Significance:Birth weight of offspring with mixed-ethnic parentage was intermediate between that of offspring with two European or two Indian parents, demonstrating a paternal as well as a maternal contribution to ethnic differences in fetal growth. This can be interpreted as demonstrating paternal modulation of maternal investment in offspring. We suggest long-term nutritional experience over generations may drive such ethnic differences through parental co-adaptation. © 2013 Wells et al. Source

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