Hampshire, United Kingdom
Hampshire, United Kingdom

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Cleland S.J.,Royal Hampshire County Hospital | Fisher B.M.,Royal Infirmary | Colhoun H.M.,University of Dundee | Sattar N.,University of Glasgow | Petrie J.R.,University of Glasgow
Diabetologia | Year: 2013

In this review, we explore the concept of 'double diabetes', a combination of type 1 diabetes with features of insulin resistance and type 2 diabetes. After considering whether double diabetes is a useful concept, we discuss potential mechanisms of increased insulin resistance in type 1 diabetes before examining the extent to which double diabetes might increase the risk of cardiovascular disease (CVD). We then go on to consider the proposal that weight gain from intensive insulin regimens may be associated with increased CV risk factors in some patients with type 1 diabetes, and explore the complex relationships between weight gain, insulin resistance, glycaemic control and CV outcome. Important comparisons and contrasts between type 1 diabetes and type 2 diabetes are highlighted in terms of hepatic fat, fat partitioning and lipid profile, and how these may differ between type 1 diabetic patients with and without double diabetes. In so doing, we hope this work will stimulate much-needed research in this area and an improvement in clinical practice. © 2013 The Author(s).


Dryden M.,Royal Hampshire County Hospital | Johnson A.P.,Public Health England | Ashiru-oredope D.,Public Health England | Sharland M.,St Georges Hospital
Journal of Antimicrobial Chemotherapy | Year: 2011

Everyone prescribing antibiotics should consider both their clinical and public health responsibilities. The objective should be to provide optimal patient care while at the same time seeking to minimize selective pressure that may result in the emergence and spread of antibiotic resistance. To this end, in 2008 the European Centre for Disease Control initiated the annual European Antibiotic Awareness Day (EAAD) to take place on 18 November, when Europe-wide activities are undertaken to highlight the critical importance of prudent antibiotic prescribing. This year activities in England will focus on the optimal management of infections in secondary care, and will have two inter-related aims. The first is to improve the quality of the initial decision to prescribe an antibiotic (including making an informed choice of empirical drug and dose) in particular ensuring rapid prescribing and administration in presumed sepsis. This is deliberately combined with a second focus on the critical importance of formally reviewing antibiotic therapy at 48 h, based on the patient's clinical response and the availability of microbiology test results. This should lead to a clear decision to stop, switch to oral, switch to outpatient antibiotic therapy (OPAT) or change antibiotic, if possible to a narrower spectrum. The EAAD campaign in England will highlight the need to 'Start Smart-Then Focus'. The aim is that patients receiving antibiotics should receive the right drug at the right time at the right dose for the right duration. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Gray A.,University of Oxford | Dryden M.,Royal Hampshire County Hospital | Charos A.,Pfizer
Journal of Antimicrobial Chemotherapy | Year: 2012

Objectives: To evaluate potential costs and savings from implementing an evaluation tool that uses bedside review of antibiotic use and infection management to assess whether patients with infections in acute medical and surgical wards could have their antibiotic regimen changed and be safely managed out of hospital. Methods: The tool was implemented in 30 acute wards in five UK hospital trusts. Data were collected on demographic variables, diagnosis, social situation, hospital stay and all current antibiotic prescribing for 291 patients. A physician and pharmacist assessed antibiotic therapy and feasibility of discharge. Resource use was measured for each patient, unit costs attached, and mean and total costs of implementing recommendations were calculated. Results: Implementation of these recommendations could reduce total inpatient days by 494 at a saving of £186 731, and save £20 215 from adjustment of antibiotic therapy. Additional costs were associated with implementation of the assessment (£2468), community support (£6227) and outpatient parenteral antimicrobial therapy (£5616). As a result, the net potential savings would be £192 635 in total or £662 (95% CI: £393, £930) for every patient assessed. Excluding eight patients with the highest potentially avoidable inpatient stays (>15 days), mean savings would fall to £363 per patient assessed but remain highly significant (95% CI: £261, £465). Conclusions: Careful assessment of antibiotic use in acute wards has the potential to reduce the use and cost of antibiotics, and length of stay. Added costs of assessment and out-of-hospital support services would offset a small proportion of these potential savings. Randomized studies are now needed to test these results. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Dryden M.S.,Royal Hampshire County Hospital
Journal of Antimicrobial Chemotherapy | Year: 2011

Linezolid has been widely used in the treatment of Gram-positive infections for more than a decade. It is unique amongst antibiotics active against most multiply-resistant Gram-positive bacteria in that there is an oral preparation with 100% bioavailability and an extensive volume of distribution. This review examines pharmacokinetic data relating to linezolid use in different patient groups (obesity, enteral feeding, renal failure, neonates, and paediatrics) and in different clinical conditions (sepsis syndrome, skin and soft tissue infection, diabetic foot infection, pneumonia, bone and joint infection, infection of the central nervous system, eye infection, and neutropenic sepsis). © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Dailly S.,Royal Hampshire County Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2012

Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided.


Aldington D.,Royal Hampshire County Hospital
Current Opinion in Supportive and Palliative Care | Year: 2012

Purpose of review: The purpose of this review is to look at the options available for the management of pain in victims of conflict, from the point of wounding, through a chain of evacuation, to rehabilitation in the home country. This is relevant for all healthcare workers as any could find themselves treating veterans and having a clear understanding of what occurred will help. Recent findings: The article will discuss developments in the prehospital environment, the field hospital, during repatriation and back in the home country to include neurostimulation in cases of refractory pain. Evidence when available is provided and the difficulties in conducting research in this environment are touched upon. Summary: The current agents, routes and techniques found in any civilian medical service can be brought to bear with great benefit. However, the secret appears to lie in a robust approach to the importance of treating pain, encouraged in all healthcare professionals, and the recognition of the role of integrating the healthcare package throughout the chain of evacuation. Research remains difficult. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Dryden M.S.,Royal Hampshire County Hospital
Journal of Antimicrobial Chemotherapy | Year: 2010

Skin and soft tissue infections (SSTIs) are common, and complicated SSTIs (cSSTIs) are the more extreme end of this clinical spectrum, encompassing a range of clinical presentations such as deep-seated infection, a requirement for surgical intervention, the presence of systemic signs of sepsis, the presence of complicating co-morbidities, accompanying neutropenia, accompanying ischaemia, tissue necrosis, burns and bites. Staphylococcus aureus is the commonest cause of SSTI across all continents, although its epidemiology in terms of causative strains and antibiotic susceptibility can no longer be predicted with accuracy. The epidemiology of community-acquired and healthcare-acquired strains is constantly shifting and this presents challenges in the choice of empirical antibiotic therapy. Toxin production, particularly with Panton-Valentine leucocidin, may complicate the presentation still further. Polymicrobial infection with Gram-positive and Gram-negative organisms and anaerobes may occur in infections approximating the rectum or genital tract and in diabetic foot infections and burns. Successful management of cSSTI involves prompt recognition, timely surgical debridement or drainage, resuscitation if required and appropriate antibiotic therapy. The mainstays of treatment are the penicillins, cephalosporins, clindamycin and co-trimoxazole. β-Lactam/β-lactamase inhibitor combinations are indicated for polymicrobial infection. A range of new agents for the treatment of methicillin-resistant S. aureus infections have compared favourably with the glycopeptides and some have distinct pharmacokinetic advantages. These include linezolid, daptomycin and tigecycline. The latter and fluoroquinolones with enhanced anti-Gram-positive activity such as moxifloxacin are better suited for polymicrobial infection. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.


White G.,Royal Hampshire County Hospital
Annals of Clinical Biochemistry | Year: 2010

Background: The aim of the study was to assess the incidence of undetected potassium EDTA contamination in routine blood samples submitted for biochemical analysis. Methods: Over a seven-day period, serum EDTA concentrations were measured in all blood samples submitted for routine biochemical analysis. Results: EDTA contamination was detected in 22 of 4789 samples submitted for analysis (0.46%), of which only seven (0.15%) would have been detected by staff using subjective methods. Detection of low but significant concentrations of EDTA was not necessarily associated with hyperkalaemia or hypocalcaemia. Haemolysis remains the leading cause of non-reporting of analyte results. Conclusion: The presence of EDTA in serum does not always result in spurious hyperkalaemia or hypocalcaemia. Routine measurement of serum EDTA concentrations has the potential to reveal contamination which is not obvious using subjective measures and its routine measurement has the potential to identify minimally contaminated samples.


Wallis D.,Royal Hampshire County Hospital
Current Opinion in Rheumatology | Year: 2014

Purpose of review: The management of inflammatory arthritis has been revolutionized by the use of biologic therapy. However, an important safety issue has been identified with regard to the risk of serious and opportunistic infections with biologic therapy. This review aims to summarize the most recent data available in the field. Recent findings: The risk of infection in inflammatory arthritis is partly determined by the nature of the underlying disease, comorbidities and other immunosuppressive treatments, in particular glucocorticoids. Data are conflicting with regard to the absolute risk of infection with biologic agents, as a result of differing study methodologies, classification of outcomes and patient populations. There appear to be some differences in risk of infection between biologic agents, which relate to their varying modes of action. Summary: Long-term observational data about the risk of infection and biologic therapy continue to emerge, although there are inherent limitations with this type of data. The process of determining the risk of infection for an individual patient should incorporate a range of factors, which may contribute to the infection risk. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Sneddon C.,Royal Hampshire County Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2011

This article describes the introduction of volunteers in a small district general hospital to assist patients with their meals. Training provided to prospective volunteers, the introduction of mealtime volunteers to the wards and their effect on patients' mealtime experience are outlined. The article also discusses issues that arose during this process, how these issues were resolved and plans to expand the service in the future.

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