Salford Royal Foundation Trust

Salford, United Kingdom

Salford Royal Foundation Trust

Salford, United Kingdom
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Anipindi S.,Central Manchester Foundation Trust | Ibrahim N.,Salford Royal Foundation Trust
Anesthesiology and Pain Medicine | Year: 2017

Introduction: We present a case of paraplegia due to cord compression from epidural hematoma following an uneventful epidural catheter insertion in a patient with ankylosing spondylitis. Case Presentation: A 65-year-old gentleman was scheduled for a major laparotomy for abdominal wall reconstruction. He has a past medical history of mild asthma, ankylosing spondylitis, duodenal ulcer and a superior mesenteric artery thrombosis in the past which led to bowel ischemia and intestinal failure. His drug allergies included Oxycodone. The anaesthetic plan was to do an awake epidural with catheter insertion followed by a general anaesthetic. The insertion of the epidural and the catheter was uneventful with the space identified in first attempt and no bloody tap. Intra-operative analgesia was maintained by a continuous epidural infusion of low dose local anaesthetic and opioid. The total operative time was eight hours and the patient was extubated at the end of the surgery. Following extubation, the motor block was checked in recovery using the modified Bromage scale. A dense block was noted and the epidural infusion was stopped. An MR scan was performed immediately, which showed an epidural hematoma in T5 - T11 segments. An urgent decompressive laminectomy was performed to evacuate the haematoma. However, neurological recovery was minimal with persistent paraplegia. Conclusions: The increased incidence of epidural haematoma in patients with ankylosing spondylitis is well documented. Earlier detection and decompression can help in preserving neurological function. We recommend being more cautious when the decision for epidural analgesia is made in patients with higher grades of ankylosing spondylitis. If an epidural is considered necessary, use of x-ray guidance and some form of intra-operative neurological monitoring should be considered, particularly in prolonged surgeries which last over several hours. © 2017, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM).

Charlesworth B.,Adelphi Values | Pilling C.,Adelphi Values | Chadwick P.,Salford Royal Foundation Trust | Butcher M.,Northern Devon Healthcare Trust
ClinicoEconomics and Outcomes Research | Year: 2014

Background: Dressings are the mainstay of wound care management; however, adherence of the dressing to the wound or periwound skin is common and can lead to dressing-related pain and trauma. Dressing-related trauma is recognized as a clinical and economic burden to patients and health care providers. This study was conducted to garner expert opinion on clinical sequelae and resource use associated with dressing-related trauma in a UK setting. Methods: This was an exploratory study with two phases: qualitative pilot interviews with six wound care specialists to explore dressing-related trauma concepts, sequelae, and resource utilization; and online quantitative research with 30 wound care specialists to validate and quantify the concepts, sequelae, and resource utilization explored in the first phase of the study. Data were collected on mean health care professional time, material costs, pharmaceutical costs, and inpatient management per sequela occurrence until resolution. Data were analyzed to give total costs per sequela and concept occurrence. Results: The results demonstrate that dressing-related trauma is a clinically relevant concept. The main types of dressing-related trauma concepts included skin reactions, adherence to the wound, skin stripping, maceration, drying, and plugging of the wound. These were the foundation for a number of clinical sequelae, including wound enlargement, increased exudate, bleeding, infection, pain, itching/excoriation, edema, dermatitis, inflammation, and anxiety. Mean total costs range from £56 to £175 for the complete onward management of each occurrence of the six main concepts. Conclusion: These results provide insight into the hidden costs of dressing-related trauma in a UK setting. This research successfully conceptualized dressing-related trauma, identified associated clinical sequelae, and quantified resource utilization associated with a typical occurrence of each trauma concept. Further research is warranted into dressing-related trauma and the associated costs. © 2014 Charlesworth et al.

Selvanathan S.K.,Salford Royal Foundation Trust | Hammouche S.,University of Leeds | Salminen H.J.,Birmingham Childrens Hospital | Jenkinson M.D.,Walton Center for Neurology and Neurosurgery
Journal of Neuro-Oncology | Year: 2011

Anaplastic ganglioglioma (AGG) are rare central nervous system tumours. Patient and treatment factors associated with outcome are poorly defined and limited to small retrospective case series and single case reports. Using the Surveillance, Epidemiology, and End Results (SEER) cancer registry, we investigated potential clinicopathological factors that can affect outcome in patients with anaplastic ganglioglioma. Patients with anaplastic ganglioglioma diagnosed between 1973 and 2007 were identified from the SEER database. Kaplan-Meier survival analysis and Cox models were used to examine the effect of variables on overall survival. The variables analysed included patient age at diagnosis, gender, race, tumour location, uni-focal or multi-focal tumour, surgical resection and the use of adjuvant radiotherapy. Fifty-eight patients were identified, with a median age at diagnosis of 25.5 years. Ninety-three percent of patients underwent surgery and 36% received adjuvant radiotherapy. The median overall survival was 28.5 months. The most common tumour site was the temporal lobe (27%). Univariate and multivariate analysis identified surgery and uni-focal disease as important predictors of overall survival. Adjuvant radiotherapy did not influence overall survival. This study represents the largest analysis of anaplastic ganglioglioma to date. Furthermore it also emphasises the role of national tumour databases for furthering our understanding of rare brain tumours and determining management options. © 2011 Springer Science+Business Media, LLC.

Williamson L.,University of Manchester | New D.,Salford Royal Foundation Trust
BMJ Case Reports | Year: 2014

Serum creatinine is a widely used marker in the assessment of renal function. Elevated creatinine levels suggest kidney dysfunction, prompting the need for further investigation. This report describes a case in which the consumption of the bodybuilding supplement creatine ethyl ester resulted in raised serum creatinine in the absence of true underlying kidney pathology. The abnormalities reversed after discontinuation of the supplement. A case of pseudo renal failure was recognised and kidney function was concluded to be normal. This report aims to address the mechanisms by which the ingestion of creatine ethyl ester can mimic the blood results expected in advanced renal failure, and confronts the problems faced when relying on serum creatinine as a diagnostic tool. Copyright 2014 BMJ Publishing Group. All rights reserved.

Jones R.K.,University of Salford | Nester C.J.,University of Salford | Richards J.D.,University of Central Lancashire | Kim W.Y.,Salford Royal Foundation Trust | And 4 more authors.
Gait and Posture | Year: 2013

Increases in the external knee adduction moment (EKAM) have been associated with increased mechanical load at the knee and progression of knee osteoarthritis. Valgus knee braces and lateral wedged insoles are common approaches to reducing this loading; however no study has directly compared the biomechanical and clinical effects of these two treatments in patients with medial tibiofemoral osteoarthritis. A cross-over randomised design was used where each intervention was worn by 28 patients for a two week period. Pre- and post-intervention gait kinematic/kinetic data and clinical outcomes were collected to evaluate the biomechanical and clinical effects on the knee joint. The valgus knee brace and the lateral wedged insole significantly increased walking speed, reduced the early stance EKAM by 7% and 12%, and the knee adduction angular impulse by 8.6 and 16.1% respectively. The lateral wedged insole significantly reduced the early stance EKAM compared to the valgus knee brace (p=0.001). The valgus knee brace significantly reduced the knee varus angle compared to the baseline and lateral wedged insole. Improvements in pain and function subscales were comparable for the valgus knee brace and lateral wedged insole. There were no significant differences between the two treatments in any of the clinical outcomes; however the lateral wedged insoles demonstrated greater levels of acceptance by patients. This is the first study to biomechanically compare these two treatments, and demonstrates that given the potential role of knee loading in osteoarthritis progression, that both treatments reduce this but lateral wedge insoles appear to have a greater effect. © 2012 Elsevier B.V.

Al-Niaimi F.,Guys and St Thomas Hospital | Felton S.,Salford Royal Foundation Trust | Williams J.,Salford Royal Foundation Trust
Clinical and Experimental Dermatology | Year: 2014

Background. Vulval allergic contact dermatitis (ACD) may be a primary disorder or may be associated with an underlying vulval dermatosis. Few studies have looked at the incidence of ACD and the allergens responsible for it. Aims. We report the incidence of vulval ACD and the responsible allergens in 282 patients investigated over a 6-year period in a large teaching hospital. Methods. We performed a retrospective case notes review of all patients investigated for vulval symptoms in our tertiary referral contact dermatitis investigation unit. A total of 282 patients underwent patch testing. Results. The overall incidence of ACD was 54%. The age range of patients was 14-89 years. Pruritus was the most common presenting symptom. Nickel was the most commonly found allergen, but was usually not relevant. Fragrances and topical antibiotics/anaesthetics were less commonly detected, but were almost always relevant to the presentation. Positive reactions were more commonly found in patients who had long-standing symptoms and/or had used many products in the vulval area. Conclusions. Vulval ACD affects women of a wide age range, and presents with nonspecific symptoms such as pruritus and/or vulval irritation. Patients may have experienced symptoms for many years before presenting to a dermatologist. The diagnosis of vulval ACD is more common in those who have been exposed to many potential sensitizers. © 2014 British Association of Dermatologists.

Al-Niaimi F.,Salford Royal Foundation Trust
Expert Review of Dermatology | Year: 2011

Adverse drug reactions are common and can range from benign and self-limiting to life-threatening with a high morbidity and mortality. Prompt identification and accurate diagnosis of an adverse drug reaction is therefore essential in order to optimally manage the patient, averting possible significant complications. Many adverse reactions to drugs involve the skin, and therefore essential knowledge of such reactions by both dermatologists and nondermatologists is of paramount importance. In this article a comprehensive review is given on a wide range of cutaneous adverse drug reactions encompassing both benign and more serious reactions, in addition to some less common adverse reactions. The article provides a tabular summary of some of the main features of such reactions, in addition to a separate table with a list of the common culprit drugs identified for each cutaneous adverse reaction. © 2011 Expert Reviews Ltd.

Markides G.A.,Salford Royal Foundation Trust | Al-Khaffaf B.,Salford Royal Foundation Trust | Vickers J.,Salford Royal Foundation Trust
European Journal of Clinical Nutrition | Year: 2011

Nutritional support in patients undergoing oesophagectomy is of paramount importance in this usually malnourished patient group, but encountering significant clinical practice variation between units. Our aim was therefore to assess the strength of evidence behind nutritional support routes post-oesophagectomy. The Cochrane Library and Controlled Trials Registry, MEDLINE (Ovid) (1966-April 2009), PubMed, EMBASE (1966-April 2009), CINAHL, Web of knowledge and SCOPUS databases, were electronically searched for the highest level of evidence, with English language as a limit. Reference follow-up was also used. Studies were critically reviewed based on The NHS Public Health Resource Unit Critical Appraisal Skills Programme Tools. Five randomised control trials (RCTs) and one case-control trial, with 344 patients, were included in the review. There was a significant variation in the routes assessed (including intravenous fluid therapy, peripheral and central line nutrition, feeding jejunostomy, nasojejunal and nasoduodenal tubes) and the methodological quality of each study, with small patient numbers. No route was found to be superior over another in the RCTs. In the case-control trial, the combination of enteral parenteral nutrition led to shorter hospital stay compared with parenteral feeding alone. Nasojejunal and nasoduodenal tubes are associated with a significant rate of dislodgement. There is absence of strong direct evidence supporting a single feeding access route in oesophagectomy patients. Clinical decisions should be made based on available evidence from other types of gastrointestinal surgery, currently favouring enteral nutrition. If enteral feeding is chosen, feeding jejunostomy may be superior to nasojejunal or duodenal tubes. © 2011 Macmillan Publishers Limited. All rights reserved.

George K.,Salford Royal Foundation Trust
British Journal of Neurosurgery | Year: 2014

In 2006, NICE brought out guidance relating to prevention of vCJD through contaminated surgical instruments. This was with the aim of protecting patients born after 1997 who did not have any risk of developing vCJD through eating beef contaminated with BSE through the food chain. Many adult neurosurgical units did not pay much attention to this until 2013 when they were suddenly faced with these children who were now 16 and being admitted to the adult neurosurgical service rather than pediatric. The NICE guidance requires that most patients born after 1997 be operated on using a separate set of neurosurgical instruments than those born before this. This is proving to be a huge financial, as well as logistical, challenge and also a clinical risk as attention is being diverted to searching for the right kit when it should be spent on saving lives. It is now clear in 2013 that the risks that NICE feared were perhaps overstated as there is nowhere near the number of deaths from vCJD that NICE had feared would happen. Worldwide there have been only five cases whereby CJD was transmitted through contaminated neurosurgical instruments and the last case was in 1976. There have been no cases of vCJD transmission attributed to use of contaminated neurosurgical instruments. NICE should revisit this guidance urgently in view of these circumstances. © 2014 The Neurosurgical Foundation.

Brook S.,Salford Royal Foundation Trust
British Journal of Community Nursing | Year: 2014

This review explores dementia progression and links to how the nutritional status of a person with dementia may be affected. It will also consider what health professionals based in community can do to maximise the nutritional status of the person with dementia. Practical, holistic suggestions-covering small appetite, communication difficulties, mood changes, swallowing problems and aversive mealtime behaviour-will be covered. Existing literature and current guidelines will be explored, common practice points around the nutritional care of people with dementia will be discussed, and local initiatives to help tackle malnutrition, particularly in those with dementia, will be highlighted.

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