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Oldham, United Kingdom

Humphreys J.,Royal Oldham Hospital
Trends in Anaesthesia and Critical Care | Year: 2014

As a medical professional we have committed ourselves to a career of lifelong learning, and although one can never underestimate the importance of experience, there are some situations that may happen less than once in an anaesthetists career, such as the management of malignant hyperthermia or anaphylaxis. Nonetheless as doctors in anaesthesia we need to be adequately prepared to deal with these scenarios if and when they arrive. To do this successfully the medical profession has developed algorithms for various critical incidents. These algorithms are tested in postgraduate exams and after that for many it is up to the individual to keep abreast with the latest changes and remain current in their knowledge. Simulation is one way these scenarios can be covered with many schools of anaesthesia including critical incident training for their trainees and some hospitals providing simulation updates for their consultant body. We explore a growing alternative medium for continued professional development, the serious game. © 2014 Elsevier Ltd. Source


Ashraf M.O.,Royal Oldham Hospital | Devadoss V.G.,Rochdale Infirmary
European Journal of Orthopaedic Surgery and Traumatology | Year: 2014

Background: de Quervain's tenosynovitis is a painful condition of the wrist which leads to difficulties in performing activities of daily living. Aims: This systematic review was conducted to examine the effectiveness of steroid injection therapy as compared to splinting for treatment of de Quervain's tenosynovitis in adults. Methods: The following databases were searched for relevant studies, MEDLINE, EMBASE, CINAHL, AMED and PsycINFO (via NHS Evidence), and Cochrane Library (via Cochrane Collaboration). Synonyms and free texts were used to locate studies. The reference lists of articles were checked for related papers. Hand searching was performed for important relevant journals. All searches found 89 studies, out of which 14 were relevant. Two studies were selected according to the inclusion criteria of the systematic review. Data were extracted and analysed for the two selected randomised trials using a fixed effect model at 95 % confidence intervals. Results: The meta-analysis demonstrated that the total effect estimate was 3 with a narrow 95 % confidence interval (1.89, 4.77). z score for overall effect was 4.66 which was highly significant (p < 0.01). Moderate heterogeneity with I-square test was found to be 64 % but was not significant (p > 0.05). Number needed to treat was 2, which showed that for every two persons treated with steroid injections, one person gets the benefit. Conclusion: Steroid injection is an effective form of conservative management for de Quervain's disease although more research is needed to establish the full benefits of the treatment. © 2013 Springer-Verlag France. Source


Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by distinct radiological features. Common precipitants of this disorder include acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy and chemotherapy. We present the case of a patient with advanced ovarian carcinoma who developed PRES shortly after receiving bevacizumab (Avastin), an inhibitor of vascular endothelial growth factor. The patient's medical history and clinical presentation both suggest bevacizumab as the precipitator for PRES. This agent has been often overlooked as a possible cause of this rare neurological syndrome. Source


The autonomous right of competent adults to decide what happens to their own body and the corresponding right to consent to or refuse medical treatment are cornerstones of modern health care. For minors the situation is not so clear cut. Since the well-known case of Gillick, mature children under the age of 16 can agree to proposed medical treatment. However, those under the age of 18 do not enjoy any corresponding right to refuse medical treatment. Can this separation of the right to agree to treatment and the right to refuse treatment for those under 18, regardless of capacity, be justified? This paper evaluates the key cases in this area of the law. Changes to the current law are then proposed which aim to make the law more consistent and reasonable. Source


Breast carcinoma in males is rare although a 4-fold increased incidence is reported in HIV-infected men. Herein we report a case of invasive breast carcinoma in a HIV-positive man on antiretroviral therapy. The carcinoma was associated with features of florid gynecomastia, atypical ductal hyperplasia, ductal carcinoma in situ, and columnar cell change. This combination of morphological changes has not previously been reported in the context of male breast carcinoma and their etiopathological associations are discussed. © SAGE Publications. Source

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