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Padmanabhan H.,Royal Wolverhampton NHS Trust | Brookes M.J.,Royal Wolverhampton NHS Trust | Iqbal T.,University of Birmingham
Nutrition Reviews | Year: 2015

Iron is a vital trace element essential for mammalian life. It is involved in numerous biological and cellular processes such as oxygen transport, oxidative phosphorylation, and DNA synthesis, as well as cell cycle progression and growth. Normal and neoplastic cells have similar qualitative requirements for iron. In addition, research shows that iron promotes cancer cell growth. An adequate balance of iron is, therefore, critical for health. In states of iron deficiency, anemia can develop, whereas iron excess increases oxidative stress in body tissues, leading to lipid, protein, and DNA damage via the Fenton reaction, which results in the synthesis of hydroxyl radicals and other oxidants. It is thought that some of these processes are implicated in the pathogenesis of colorectal cancer. This review provides the clinician with an up-to-date summary of the recent advances in this field using established in vitro and animal models. © The Author(s) 2015.

Acheson A.G.,Nottingham Digestive Disease Center | Brookes M.J.,Royal Wolverhampton NHS Trust | Brookes M.J.,University of Birmingham | Spahn D.R.,University of Zürich
Annals of Surgery | Year: 2012

OBJECTIVE: To determine the effect of allogeneic blood transfusion (ABT) on clinical outcomes in patients with colorectal cancer undergoing surgery. BACKGROUND: Perioperative ABTs may be associated with adverse clinical outcomes. METHODS: Systematic review of the literature with odds ratio (OR) and incidence rate ratio (IRR) meta-analyses of predefined clinical outcomes based on a MEDLINE search. RESULTS: In total, 20,795 colorectal cancer (CRC) patients observed for more than 59.2 ± 26.1 months (108,838 patient years) were included, of which 58.8% were transfused. ABT was associated with increased all-cause mortality OR = 1.72 (95% confidence interval [CI] 1.55 - 1.91, P < 0.001); I = 23.3% (0 - 51.1) and IRR = 1.31 (1.23 - 1.39, P < 0.001), I = 0.0% (0 - 37.0). ABT was also associated with increased ORs (95% CI, P) for cancer-related mortality of 1.71 (1.43 - 2.05, P <0.001), combined recurrence-metastasis-death 1.66 (1.41 - 1.97, P < 0.001), postoperative infection 3.27 (2.05 - 5.20, P < 0.001), and surgical reintervention 4.08 (2.18 - 7.62, <0.001). IRR (95% CI, P) was 1.45 (1.26 - 1.66, <0.001) for cancer-related mortality and 1.32 (1.19 - 1.46, <0.001) for recurrence-metastasis-death. Mean length of hospital stay was significantly longer in transfused compared with nontransfused patients (17.8 ± 4.8 vs 13.9 ± 4.7 days, P = 0.005). CONCLUSIONS: In patients with colorectal cancer (CRC) undergoing surgery, ABTs are associated with adverse clinical outcomes, including increased mortality. Measures aimed at limiting the use of ABTs should be investigated further. © 2012 Lippincott Williams & Wilkins, Inc.

Arora S.,Imperial College London | Cox C.,Royal Wolverhampton NHS Trust | Davies S.,Staffordshire University | Kassab E.,Imperial College London | And 5 more authors.
Annals of Surgery | Year: 2014

Objective: To evaluate the efficacy of an entire hospital simulation in imparting skills to expert healthcare providers, encompassing both retention and transfer to clinical practice. Background: Studies demonstrating the effectiveness of simulation do not concentrate upon expert multidisciplinary teams. Moreover, their focus is confined to a single clinical setting, thereby not considering the complex interactions across multiple hospital departments. Methods: A total of 288 participants (Attending surgeons, anesthesiologists, physicians, and nurses) completed this largest simulation study to date, set in the UK Defence Medical Services' Hospital Simulator and the conflict zone in Afghanistan. The simulator termed "Hospital Exercise" (HOSPEX) is a fully immersive live-in simulation experience that covers the entire environment of a military hospital with all departments. Participants undertook a 3-day training program within HOSPEX before deployment to war zones. Primary outcome measures were assessed with IMPAcT (the Imperial Military Personnel Assessment Tool). IMPAcT measures crisis management, trauma care, hospital environment, operational readiness, and transfer of skills to civilian practice. Reliability, skills learning, and retention in the conflict zone were assessed statistically. Results: Reliability in skills assessment was excellent (Cronbach α: nontechnical skills = 0.87-0.94; environment/patient skills = 0.83-0.95). Pre/post-HOSPEX comparisons revealed significant improvements in decision making (M = 4.98, SD = 1.20 to M = 5.39, SD = 0.91; P = 0.03), situational awareness (M = 5.44, SD = 1.04 to M = 5.74, SD = 0.92; P = 0.01), trauma care (M = 5.53, SD = 1.23 to M = 5.85, SD = 1.09; P = 0.05), and knowledge of hospital environment (M = 5.19, SD = 1.17 to M = 5.42, SD = 0.97; P = 0.04). No skills decayed over time when assessed several months later in the real conflict zone. All skills transferred to civilian clinical practice. Conclusions: This is the first study to describe the value of a full-hospital simulation across the entire patient pathway. Such macrosimulations may be the way forward for integrating the complex training needs of expert clinicians and testing organizational "fitness for purpose" of entire hospitals. Copyright © 2014 Lippincott Williams & Wilkins.

Harvey P.R.,Sandwell and West Birmingham Hospitals NHS Trust | Holt A.,Staffordshire University | Nicholas J.,Royal Wolverhampton NHS Trust | Dasgupta I.,NHS England
Journal of Nephrology | Year: 2013

Introduction: Hypertension is associated with left ventricular hypertrophy (LVH), a predictor of cardiovascular mortality in haemodialysis (HD) patients. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) blood pressure (BP) targets are pre-HD <140/90 mm Hg, post-HD <130/80 mm Hg. This study aims to assess 3-month mean inunit BP, pre- and post-HD, for correlations with left ventricular mass index (LVMI), a measure of long-term BP control. Methods: Of 648 HD patients, including those on HD >6 months, 262 had echocardiograms. Those with significant coronary artery disease, reduced ejection fraction or valvular disease were excluded, as were those without appropriate echocardiogram, leaving 100 patients. Data on BP and confounding factors for LVH were collected covering 3 months prior to echocardiogram. Results: Mean BP pre-HD was 147/77 ± 19/13 mm Hg, and post-HD, 133/71 ± 20/11 mm Hg; <50% of patients achieved NKF targets. Mean LVMI was 203.7 ± 74 g/m2; 88% of patients had LVH. On univariate analysis, mean pre- and post-HD systolic BP, mean arterial blood pressure (MAP) and post-HD diastolic and pulse pressure correlated with LVMI. On stepwise multiple regression analysis only post-HD MAP correlated with LVMI (p=0.000047, r=0.395). Conclusions: We conclude that long-term averages of in-unit post-HD BP measurements are useful in assessing BP control and cardiovascular risk, especially in the absence of routine ambulatory or home BP monitoring. © 2012 Società Italiana di Nefrologia - ISSN 1121-8428.

Eddison N.,Royal Wolverhampton NHS Trust | Chockalingam N.,Staffordshire University
Prosthetics and Orthotics International | Year: 2013

Background: There are a wide variety of ankle foot orthoses used in clinical practice which are characterised by their design, the material used and the stiffness of that material. Changing any of these three components will alter the effect of the ankle foot orthosis on gait. Objectives: The purpose of this article is to provide an overview on the available research on ankle foot orthosis-footwear combination tuning on the gait characteristics of children with cerebral palsy through a structured review. Study Design: Literature review. Methods: A thorough search of previous studies published in English was conducted within all major databases using relevant phrases without any limits for the dates. These searches were then supplemented by tracking all key references from the appropriate articles identified including hand searching of published books where relevant. Results: To date, there are 947 papers in the literature pertaining to the study of ankle foot orthosis. Of these, 153 investigated the use of ankle foot orthosis for children with cerebral palsy. All the studies included in this review were of a within-subjects design and the evidence levels were generally low. Conclusions: The overall results suggested that ankle foot orthosis-footwear combination tuning has the potential to improve the kinematics and kinetics of gait in children with cerebral palsy. However, the review highlights a lack of well-designed and adequately powered studies. © The International Society for Prosthetics and Orthotics 2012.

Merrick S.,Royal Wolverhampton NHS Trust
British Journal of Community Nursing | Year: 2014

Malnutrition in the UK is well documented and highlighted by the British Association of Parenteral and Enteral Nutrition, who advocate the use of a screening tool to facilitate the identification and subsequent management of undernutrition. Nurses are ideally placed to support this process, but their role has many conflicting priorities. For nurses working in the community, there also exists the problem of identifying those who are at risk of undernutrition but remain unknown to nursing services. This article provides a review of malnutrition and nutrition screening and aims to promote a pragmatic approach to the identification and management of undernutrition in the community. The article concludes with a brief review of current opportunities for improving nutritional care in the community. © 2014 MA Healthcare Ltd.

Benamer H.T.S.,Royal Wolverhampton NHS Trust
Neurological Disorders in the Arab World | Year: 2014

After graduating from Tripoli, Libya in 1990, Dr Benamer came to the United Kingdom in 1991 to further his training in medicine. He obtained the MRCP in 1994 and trained in neurology in Glasgow. He obtained a PhD and CCST in 2000 and was appointed a consultant neurologist in Wolverhampton and Birmingham the same year. He has been the lead neurologist in New Cross Hospital in Wolverhampton since 2006. Dr Benamer is a general neurologist with special interest in movement disorders.Dr Benamer is honorary clinical senior lecturer in Birmingham University and has an interest in medical education, in which he obtained a postgraduate certificate from Keele University in 2007. He has published more than 35 papers and two books. He is currently a senior editor of the Libyan Journal of Medicine. He was also an examiner of the MRCP Diploma from 2005 to 2009.Dr Benamer's publications relevant to the subject of the book:1. Benamer HT. 2007. Neurological disorders in Libya: an overview.Neuroepidemiology 29:143-92. Benamer HT. 2008. The ancestry of LRRK2 Gly2019Ser parkinsonism. Lancet neurology 7:769-70; author reply 70-13. Benamer HT, de Silva R, Siddiqui KA, Grosset DG. 2008. Parkinson's disease in Arabs: a systematic review. Movement disorders: official journal of the Movement Disorder Society 23:1205-104. Benamer HT, Ahmed ES, Al-Din AS, Grosset DG. 2009. Frequency and clinical patterns of multiple sclerosis in Arab countries: a systematic review. Journal of the neurological sciences 278:1-45. Benamer HT, Grosset D. 2009. Stroke in Arab countries: a systematic literature review. Journal of the neurological sciences 284:18-236. Benamer HT, Grosset DG. 2009. A systematic review of the epidemiology of epilepsy in Arab countries. Epilepsia 50:2301-47. Benamer HT, Shakir RA. 2009. The neurology map of the Arab world.Journal of the neurological sciences 285:10-28. Benamer HT. 2010. Neurology expertise and postgraduate training programmes in the Arab world: a survey. European neurology 64:313-89. Benamer HT, de Silva R. 2010. LRRK2 G2019S in the North African population: a review. European neurology 63:321-510. Benamer HT, Deleu D, Grosset D. 2010. Epidemiology of headache in Arab countries. The journal of headache and pain 11:1-311. Benamer HT. 2011. More epidemiological studies of neurological disorders are needed in the Arab countries. Neuroepidemiology 36:70. © 2014 Springer International Publishing Switzerland. All rights are reserved.

Chacko C.J.,Royal Wolverhampton NHS Trust | Gopal S.,Royal Wolverhampton NHS Trust
Journal of Anaesthesiology Clinical Pharmacology | Year: 2015

Background and Aims: We proposed a review of present literature and systematic analysis of present literature to summarize the evidence on the use of β-blockers on the outcome of a patient with severe sepsis and septic shock. Material and Methods: Medline, EMBASE, Cochrane Library were searched from 1946 to December 2013. The bibliography of all relevant articles was hand searched. Full-text search of the grey literature was done through the medical institution database. The database search identified a total of 1241 possible studies. The citation list was hand searched by both the authors. A total of 9 studies were identified. Results: Most studies found a benefit from β-blocker administration in sepsis. This included improved heart rate (HR) control, decreased mortality and improvement in acid-base parameters. Chronic β-blocker usage in sepsis was also associated with improved mortality. The administration of β-blockers during sepsis was associated with better control of HR. The methodological quality of all the included studies, however, was poor. Conclusion: There is insufficient evidence to justify the routine use of β-blockers in sepsis. A large adequately powered multi-centered randomized controlled clinical trial is required to address the question on the efficacy of β-blocker usage in sepsis. This trial should also consider a number of important questions including the choice of β-blocker used, optimal dosing, timing of intervention, duration of intervention and discontinuation of the drug. Until such time based on the available evidence, there is no place for the use of β-blockers in sepsis in current clinical practice.

Jones L.,Royal Wolverhampton NHS Trust | Fletcher J.,Welsh Wounds Innovation Center
Wounds UK | Year: 2014

An initial audit took place to examine current systems and practices involving alternating mattresses as part of the SSKIN pressure ulcer prevention programme. Following this, the Trust introduced 125 Dyna-Form™ Mercury Advance mattresses (Direct Health Services) to six inpatient wards. The wards included particularly complex patients, all of whom historically had been a very high risk of Trust-acquired pressure ulcers, despite positive changes in culture towards zero tolerance of pressure ulcer. Ten patients on each ward were randomly selected for 2 consecutive months for skin assessment monitoring and asked about their experience using the mattresses, from the time of admission to time on the pilot wards. In addition, the data relating to Trust-acquired pressure ulcer incidence over 6 months were compared to the previous 12-month period on these wards. This study found a measurable difference in patient outcomes, with a 39% reduction in pressure ulcer incidence. In addition to this, substantial cost savings were made following the new approach to support surfaces.

Kay P.,University of Liverpool | Yang Y.C.,Royal Wolverhampton NHS Trust | Paraoan L.,University of Liverpool
Journal of Cellular and Molecular Medicine | Year: 2013

The structural and functional integrity of the retinal pigment epithelium (RPE) is fundamental for maintaining the function of the neuroretina. These specialized cells form a polarized monolayer that acts as the retinal-blood barrier, separating two distinct environments with highly specialized functions: photoreceptors of the neuroretina at the apical side and Bruch's membrane/highly vascularized choriocapillaris at the basal side. The polarized nature of the RPE is essential for the health of these two regions, not only in nutrient and waste transport but also in the synthesis and directional secretion of proteins required in maintaining retinal homoeostasis and function. Although multiple malfunctions within the RPE cells have been associated with development of age-related macular degeneration (AMD), the leading cause of legal blindness, clear causative processes have not yet been conclusively characterized at the molecular and cellular level. This article focuses on the involvement of directionally secreted RPE proteins in normal functioning of the retina and on the potential association of incorrect RPE protein secretion with development of AMD. Understanding the importance of RPE polarity and the correct secretion of essential structural and regulatory components emerge as critical factors for the development of novel therapeutic strategies targeting AMD. © 2013 The Authors.

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