Blandford C.M.,Royal Devon and Exeter Hospital |
Gupta B.C.,Frenchay Hospital |
Montgomery J.,Anaesthesia and Critical Care |
Stocker M.E.,South Devon Healthcare NHS Foundation Trust
Anaesthesia | Year: 2011
Patients are frequently told new information in the early postoperative period and may retain little of it. Two hundred patients undergoing general anaesthesia for day surgery procedures were randomly allocated into two equal groups, 'Early' and 'Late'. Both groups were asked to undertake a simple memory test either in the early or late postoperative phase of their recovery. A list of five objects was verbally presented and recall of these five objects was tested after 30 min. A control group of 100 patients performed the same test. Patients in the control group received no sedative medications. Statistically significant differences (p < 0.001) in recall ability were demonstrable between each of the three groups. Twenty-three percent of patients in the 'Early' group had total amnesia of any test information given. Only 1% of the 'Late' group were unable to remember any information; a mean interval of 40 min separated the two groups. We recommend that verbal information given postoperatively be delayed until a recovery interval of at least 40 min, and should be supported with written material. You can respond to this article at © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.
Taggart F.,University of Warwick |
Donnelly P.,South Devon Healthcare NHS Foundation Trust |
Dunn J.,University of Warwick
BMC Cancer | Year: 2012
Background: Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer.Method: A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1-4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions.Results: Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival.Conclusions: Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed. © 2012 Taggart et al.; licensee BioMed Central Ltd.
PubMed | The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, Guys And St Thomas Nhs Foundation Trust, University of Nottingham and 8 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017
91 Background: Several drugs can now improve survival in mCRPC after docetaxel, including cabazitaxel, a next generation taxane. TROPIC (NCT00417079) showed an overall survival benefit of 2.4 months for cabazitaxel compared with mitoxantrone for mCRPC. The UK EAP provided patients access to cabazitaxel; detailed QOL and safety data were recorded. Interim analysis suggested improvements in QOL, particularly pain scores and a good safety profile. We report final QOL and updated safety data.108 patients recruited at 12 centres received cabazitaxel 25mg/mAccording to EQ-5D and VAS scores, QOL was stable with an overall trend towards improvement in patients who continued treatment. Paired within patient analyses also support this trend. Improved pain was noted more frequently than deterioration at all time points and pain scores were at least stable in 96% of patients at cycle 10. A median of 6 cycles were given. 34 patients (31%) received 10 or more cycles. Grade 3/4 adverse events were uncommon, the most frequent being fatigue (9.3%), diarrhoea (2.8%) and neutropenic sepsis (1.9%). 85% received prophylactic granulocyte colony stimulating factor.Almost 1/3 of patients completed 10 or more cycles in the UK EAP. QOL was stable with trends to improved EQ-5D and VAS scores. Improved or stable pain was observed in the majority of patients continuing therapy. The UK EAP provides the first data on QOL benefit with cabazitaxel in mCRPC post docetaxel and demonstrates manageable toxicity. Final safety data will be available for presentation.NCT01254279. [Table: see text].
Bardhan K.D.,The Rotherham NHS Foundation Trust |
Simmonds N.,Luton and Dunstable Hospital NHS Foundation Trust |
Royston C.,The Rotherham NHS Foundation Trust |
Dhar A.,County Durham and Darlington NHS Foundation Trust |
Edwards C.M.,South Devon Healthcare NHS Foundation Trust
Journal of Crohn's and Colitis | Year: 2010
Background: Inflammatory bowel disease (IBD), a paradigm of chronic illness, requires for its safe clinical management ready access to complete information, not always possible using paper records. Aim: To develop an IBD database (DB) for both individual patient management and collating information across centres. Methods: Access® based, with a minimum dataset. Results: Prospectively collected data for 11,432 patients from 21 centres. Profile Diagnosis: Ulcerative colitis (UC) 56%, Crohn's disease (CD) 40%, indeterminate colitis 4%. M:F ratio: UC 1.08:1, CD 0.72:1. Median age at diagnosis: UC 39, CD 30. years. Operated: UC 16%, CD 47%. Thiopurine use: UC 16%, CD 29%. IBD related mortality: 0.74%. Discussion: A snapshot of this large IBD cohort shows the disease profile across the UK is similar to other large series. Unexpected gaps, sometimes large emerged (e.g. data on smoking and immunosuppression) highlighting the need for clear definition, consistency and completeness of data collection. Clinical management is made easier by the 'at a glance' summary, automated clinic letters, and facility for monitoring and audit, but the time required limited its 'real-time' use. Conclusion: Our experience shows it is possible to collect data from centres across the country which truly reflects clinical practice. We have learned as much from the process itself as from the data, principally, information needs to be well defined, validated at entry, and updated at every visit, a time consuming sequence which we had underestimated. Our lessons learned may help inform the development of a national database, and support national IBD standards and audit. © 2010 European Crohn's and Colitis Organisation.
Islam K.A.,South Devon Healthcare NHS Foundation Trust |
Blake S.M.,South Devon Healthcare NHS Foundation Trust
Annals of the Royal College of Surgeons of England | Year: 2013
The painful total hip arthroplasty requires careful evaluation and investigation. This is usually focused on the prosthesis and adjacent anatomical structures. We present a case report of a 64-year-old man who had a Birmingham hip resurfacing procedure for primary osteoarthritis. His hip pain worsened following the procedure and was under systematic investigation for this. Subsequent investigation for vascular disease revealed a total infrarenal aortic occlusion. An aortobifemoral bypass improved the hip pain and function dramatically, and the patient now has an excellent quality of life.
Neale J.R.,South Devon Healthcare NHS Foundation Trust |
Basford P.J.,Southampton General Hospital
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2015
Higher specialist training in general internal medicine (GIM) and the medical specialties has been subject to many changes and increasing subspecialisation in recent years. The 'Shape of Training' review proposes 'broad-based specialty training', shortening of training by one year, and subspecialisation to be undertaken after the certificate of specialty training is obtained. All higher level gastroenterology trainees based in the UK were invited to complete an online survey between July and September 2012 to assess their experience of gastroenterology and GIM training. Overall, 72.7% of trainees expressed satisfaction with their training in gastroenterology but significantly fewer (43.5%) expressed satisfaction with their training in GIM. Satisfaction with gastroenterology training thus is good, but satisfaction with GIM training is lower and levels of dissatisfaction have increased significantly since 2008. Up to 50% of trainees are not achieving the minimum recommended number of colonoscopy procedures for their stage of training. Experience in GIM is seen as service orientated, with a lack of training opportunities. There is a worrying difficulty in gaining the minimum required experience in endoscopy. If the length of specialist training is shortened and generalised, training in key core specialist skills such as endoscopy may be compromised further. © Royal College of Physicians 2015. All rights reserved.
Salmon H.A.,University of Exeter |
Chalk D.,University of Exeter |
Stein K.,University of Exeter |
Frost N.A.,South Devon Healthcare NHS Foundation Trust
Eye (Basingstoke) | Year: 2015
BackgroundKeratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus.MethodsWe constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters.ResultsCollagen crosslinking is cost effective compared with standard management at an incremental cost of £3174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £33 263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness-to-pay threshold of £30 000 per QALY.ConclusionUVA collagen crosslinking is very likely to be cost effective, compared with standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond 5 years is desirable. © 2015 Macmillan Publishers Limited.
Duncan F.,Manchester Metropolitan University |
Day R.,South Devon Healthcare NHS Foundation Trust |
Haigh C.,Manchester Metropolitan University |
Gill S.,Welsh Deanery |
And 3 more authors.
Pain Medicine (United States) | Year: 2014
Background: Pain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity. Objectives: The objectives of this article are 1) to describe current pain service provision and activity 2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice. Methods: Phase 1: Surveys were conducted in two phases during 2010-2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011. Results: Results indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N=29,080, 0.22%). Conclusions: Prospective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities. © 2014 Original Research Article Wiley Periodicals, Inc.
Boocock P.,South Devon Healthcare NHS Foundation Trust
Health estate | Year: 2011
Paul Boocock, director of estates and facilities management at the South Devon Healthcare NHS Foundation Trust, explains how he and Jonathan Gilmore, a director at not-for-profit healthcare sector improvement organisation, BIRCH, and the Collaborative Working Centre, with wide-ranging experience in the construction and EFM sectors, have worked with the Trust's estates and facilities management team to bring a "leaner" approach to its activities, in the process improving efficiencies and reducing waste at the Torbay Hospital.
Samra A.,South Devon Healthcare NHS Foundation Trust |
Ramtahal J.,South Devon Healthcare NHS Foundation Trust
Journal of Medical Case Reports | Year: 2012
Introduction. Chronic relapsing inflammatory optic neuropathy is a recently described form of recurrent isolated subacute optic neuropathy. The condition is highly responsive to systemic steroid treatment and prone to relapse on steroid withdrawal. A complete work up for demyelination, autoimmune disease and sarcoidosis must be made before considering chronic relapsing inflammatory optic neuropathy. Case presentation. We describe the case of a 52-year-old Caucasian woman who presented with isolated subacute optic neuropathy. There was no evidence of demyelination, autoimmunity or sarcoidosis. There was an abrupt and prompt response to systemic corticosteroids and a relapse of the condition on steroid withdrawal. Conclusions: Chronic relapsing inflammatory optic neuropathy requires careful consideration and differentiation from demyelinating optic neuritis and ischemic optic neuropathy since the treatment is different and the outcome without treatment is likely to be poor. The importance of identifying these patients has considerable clinical implications as the condition is highly responsive to steroids. © 2012 Samra and Ramtahal; licensee BioMed Central Ltd.