Royal Surrey County Hospital NHS Foundation Trust

Guildford, United Kingdom

Royal Surrey County Hospital NHS Foundation Trust

Guildford, United Kingdom
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Livingstone C.,Royal Surrey County Hospital NHS Foundation Trust | Livingstone C.,University of Surrey
Clinical Science | Year: 2013

IGF-I (insulin-like growth factor-I) is a peptide hormone, produced predominantly by the liver in response to pituitary GH (growth hormone), which is involved in a wide variety of physiological processes. It acts in an endocrine, paracrine and autocrine manner to promote growth. The production of IGF-I signals the availability of nutrients needed for its anabolic actions. Recently, there has been growing interest in its role in health and disease. IGF-I has long been known to be regulated by nutrition and dysregulated in states of under- and over-nutrition, its serum concentrations falling in malnutrition and responding promptly to refeeding. This has led to interest in its utility as a nutritional biomarker. A considerable evidence base supports utility for measurement of IGF-I in nutritional contexts. Its concentration may be valuable in providing information on nutritional status, prognosis and in monitoring nutritional support. However, it is insufficiently specific for use as a screening test for under nutrition as its serum concentration is influenced by many factors other than nutritional status, notably the APR (acute-phase response) and endocrine conditions. Concentrations should be interpreted along with clinical findings and the results of other investigations such as CRP (C-reactive protein). More recently, there has been interest in free IGF-I which holds promise as a nutritional marker. The present review covers nutritional regulation of IGF-I and its dysregulation in disease, then goes on to review recent studies supporting its utility as a nutritional marker in clinical contexts. Although not currently recommended by clinical guidelines, it is likely that, in time, measurement of IGF-I will become a routine part of nutritional assessment in a number of these contexts.

Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: Fission-2013-5.1.1 | Award Amount: 1.86M | Year: 2013

Medical exposures for radiological examinations represent the highest and fastest growing contribution to manmade radiation exposure in the EU underlying the need for medical physics experts (MPEs), regulators and scientists in industry to bring in new research results and expertise and to deploy resources in addressing this important issue. The EC recognized the urgency and the EU tender European guidelines for the Medical Physics Expert (MPE) (TREN/H4/1672009) was issued to develop and update the role of MPEs in Europe. The final report has been approved by the EC and includes an agreed mission statement and key activities for MPEs. The new qualification framework defines the MPE as an MP who, through planned advanced training and CPD, achieves the highest level possible (i.e., European Qualifications Level 8) in her/his specialty. However, it is recognized that few Member States have the expertise and facilities to provide the necessary training. A preliminary survey among National Organisations of MP and medical device companies showed that a dedicated training scheme has become a necessity. Three end-users were identified: the hospital MPE, the scientist in industry and regulators assessing exposures in Diagnostic and Interventional Radiology. The EUTEMPE-RX consortium will develop, put into practice and evaluate a new pilot EFTS for the MPE in Diagnostic and Interventional Radiology, which includes both face-to-face and on-line teaching. The aim is to ensure that candidates become knowledgeable about all current issues in radiation safety culture in hospitals and to make the MPE a radiation protection advocate for patients. The course will address the themes identified in the MELODI strategic research agenda, DoreMi and EMAN projects. A business plan will be developed for the sustainability of the network, which would provide a template for the development of similar programmes in the other specialties of medical physics.

Fraser C.G.,University of Dundee | Allison J.E.,University of California at San Francisco | Allison J.E.,Kaiser Permanente | Halloran S.P.,Royal Surrey County Hospital NHS Foundation Trust | Young G.P.,Flinders University
Journal of the National Cancer Institute | Year: 2012

Fecal immunochemical tests for hemoglobin are replacing traditional guaiac fecal occult blood tests in population screening programs for many reasons. However, the many available fecal immunochemical test devices use a range of sampling methods, differ with regard to hemoglobin stability, and report hemoglobin concentrations in different ways. The methods for sampling, the mass of feces collected, and the volume and characteristics of the buffer used in the sampling device also vary among fecal immunochemical tests, making comparisons of test performance characteristics difficult. Fecal immunochemical test results may be expressed as the hemoglobin concentration in the sampling device buffer and, sometimes, albeit rarely, as the hemoglobin concentration per mass of feces. The current lack of consistency in units for reporting hemoglobin concentration is particularly problematic because apparently similar hemoglobin concentrations obtained with different devices can lead to very different clinical interpretations. Consistent adoption of an internationally accepted method for reporting results would facilitate comparisons of outcomes from these tests. We propose a simple strategy for reporting fecal hemoglobin concentration that will facilitate the comparison of results between fecal immunochemical test devices and across clinical studies. Such reporting is readily achieved by defining the mass of feces sampled and the volume of sample buffer (with confidence intervals) and expressing results as micrograms of hemoglobin per gram of feces. We propose that manufacturers of fecal immunochemical tests provide this information and that the authors of research articles, guidelines, and policy articles, as well as pathology services and regulatory bodies, adopt this metric when reporting fecal immunochemical test results. © 2012 The Author.

Murphy J.A.,Nightingale | Milner T.D.,Royal Surrey County Hospital NHS Foundation Trust | O'Donoghue J.M.,Royal Infirmary
The Lancet Oncology | Year: 2013

Recent studies have shown that the number of women undergoing risk-reducing mastectomy has increased rapidly in the USA in the past 15 years. Although a small rise in the number of bilateral risk-reducing procedures has been noted in high-risk gene mutation carriers who have never had breast cancer, this number does not account for the overall increase in procedures undertaken. In patients who have been treated for a primary cancer and are judged to be at high risk of a contralateral breast cancer, contralateral risk-reducing mastectomy is often, but not universally, indicated. However, many patients undergoing contralateral risk-reducing mastectomy might not be categorised as high risk and therefore any potential benefit from this procedure is unproven. At a time when breast-conserving surgery has become more widely used, this sharp increase in contralateral risk-reducing mastectomy is surprising. We have reviewed the literature in an attempt to establish what is driving the increase in this procedure in moderate-to-low-risk populations and to assess its justification in terms of risk-benefit analysis. © 2013 Elsevier Ltd.

Scott B.,Royal Surrey County Hospital NHS Foundation Trust
Journal of perioperative practice | Year: 2012

Some patients recovered in the post anaesthetic care unit (PACU) will require airway management and close monitoring to prevent any post operative complications. Ineffective airway management will lead rapidly to hypoxaemia, and will ultimately compromise patient care. This article discusses physiological principles and monitoring of airway management in the PACU, an understanding of which is essential when providing appropriate care for patients emerging from anaesthesia.

Brigstocke G.H.O.,Royal Surrey County Hospital NHS Foundation Trust | Hearnden A.,Royal Surrey County Hospital NHS Foundation Trust | Holt C.,University of Cardiff | Whatling G.,University of Cardiff
Journal of Hand Surgery: European Volume | Year: 2014

The dart thrower's motion is a wrist rotation along an oblique plane from radial extension to ulnar flexion. We report an in-vivo study to confirm the use of the dart thrower's motion during activities of daily living. Global wrist motion in ten volunteers was recorded using a three-dimensional optoelectronic motion capture system, in which digital infra-red cameras track the movement of retro-reflective marker clusters. Global wrist motion has been approximated to the dart thrower's motion when hammering a nail, throwing a ball, drinking from a glass, pouring from a jug and twisting the lid of a jar, but not when combing hair or manipulating buttons. The dart thrower's motion is the plane of global wrist motion used during most activities of daily living. Arthrodesis of the radiocarpal joint instead of the midcarpal joint will allow better wrist function during most activities of daily living by preserving the dart thrower's motion. © The Author(s) 2012.

Kelliher L.,Royal Surrey County Hospital NHS Foundation Trust
Journal of perioperative practice | Year: 2011

The concept of 'enhanced recovery' following elective surgery is becoming increasingly prominent in the world of perioperative practice. Enhanced recovery pathways (ERP) are being implemented in more and more trusts throughout the UK, and in multiple different surgical specialties. But what does enhanced recovery actually mean and how does it impact upon both patients and healthcare professionals? Our unit has been using an ERP in colorectal surgery since 2007 and we are currently in the process of implementing a pathway for both our orthopaedic and gynaecological patients. This article comprises some background information on the evolution of enhanced recovery, a summary of its key elements and a review of the evidence, including a look at our unit's experience.

Butler-Manuel S.,Royal Surrey County Hospital NHS Foundation Trust | Lippiatt J.,Royal Surrey County Hospital NHS Foundation Trust | Madhuri T.K.,Royal Surrey County Hospital NHS Foundation Trust
Gynecologic Oncology | Year: 2014

Objective. We present a novel surgical approach to ovarian cancer debulking using neutral argon plasma (PlasmaJet™). Case history. A 48 year-old woman diagnosed with FIGO stage IVB grade 3 serous epithelial ovarian carcinoma received three cycles of neoadjuvant chemotherapy with carboplatin and paclitaxel. Operative technique. Dissection and radical debulking surgery were performed using PlasmaJet™ as previously described [1,2]. This included diaphragmatic and abdominal peritoneal stripping, supra-colic omentectomy, tumour ablation on the small and large intestines and mesentery, pelvic and para-aortic lymphadenectomy. Results. The only post-operative complication was a superficial wound breakdown, which healed by secondary intention. She remains well two years after surgery, with no sign of recurrence. Conclusion. In this case, PlasmaJet™ facilitated diaphragmatic peritoneal stripping as well as dissection of tissue close to bowel and major vessels. Further study is required to assess whether this device can reduce the need for bowel resection while achieving complete cytoreduction. © 2014 Elsevier Inc. All rights reserved.

Stebbing J.F.,Royal Surrey County Hospital NHS Foundation Trust
Best Practice and Research: Clinical Gastroenterology | Year: 2011

This chapter reflects on how England has led the world in service development and quality assurance of endoscopy. It draws out themes of leadership, strategic vision and organisational culture. It emphasises the pivotal importance of focussing service improvement on enhancing the quality of a patient's experience of endoscopy. It describes the processes used here for quality assurance of endoscopy units and how these have dovetailed with other strands of work in transforming the English endoscopy service. The chapter presents discussion of the responses to accreditation processes and how the design of the JAG Accreditation process maximises its effectiveness. © 2011 Elsevier Ltd. All rights reserved.

Davies A.,Royal Surrey County Hospital NHS Foundation Trust
European Oncology and Haematology | Year: 2014

Cancer pain presents a significant clinical challenge. Even when background pain is effectively controlled, patients often experience episodes of breakthrough cancer pain (BTcP), which typically reach maximum intensity in 10 minutes and last for 60 minutes. Immediate-release opioids are often used to treat BTcP, but only produce analgesia after 20-30 minutes and their full analgesic effect after 60-90 minutes, so transmucosal formulations of fentanyl citrate have been developed that produce analgesia more rapidly. A new sublingual transmucosal formulation (the FE tablet) utilises a unique three-layer structure and is available in dosages from 67 μg to 800 μg. This review summarises available data on the new formulation. In phase I trials, it has demonstrated dose proportionality, absolute bioavailability of approximately 70 % and higher plasma fentanyl concentrations than an oral transmucosal fentanyl citrate lozenge. In a prospective, randomised, double-blind, crossover study to evaluate efficacy and safety, pain relief was recorded from 6 minutes after administration onwards and lasted for up to 60 minutes. © Touch medical media 2014.

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