Prescot, United Kingdom
Prescot, United Kingdom

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Jacob N.C.,St Helens and Knowsley NHS Trust | Zarugh A.,Southport and Ormskirk NHS Trust | Suraliwala K.H.,Southport and Ormskirk NHS Trust
Indian Journal of Plastic Surgery | Year: 2014

We report a case of a 29-year-old man with a background history of incomplete quadriplegia, who sustained a second degree thermal burn of the lower limb from prolonged proximity to the extractor fan of his laptop. We have also reviewed all other reported cases of thermal burns associated with laptop use. This literature review highlights the variability in the extent of injury and the subsequent management of laptop induced burns.


White H.D.,University of Liverpool | Goenka N.,Countess of Chester NHS Trust | Furlong N.J.,St Helens and Knowsley NHS Trust | Saunders S.,Warrington and Halton Hospitals NHS Trust | And 5 more authors.
Diabetic Medicine | Year: 2014

Aims: The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first UK-wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the adult service level audit are reported here. Methods: All centres providing continuous subcutaneous insulin infusion services to adults with diabetes in the UK were invited to participate. Audit metrics were aligned to technology appraisal 151. Data entry took place online using a DiabetesE formatted data collection tool. Results: One hundred and eighty-three centres were identified as delivering adult continuous subcutaneous insulin infusion services in the UK, of which 178 (97.3%) participated in the audit. At the time of the audit, 13 428 adults were using insulin pump therapy, giving an estimated prevalence of use of 6%. Ninety-three per cent of centres did not report any barriers in obtaining funding for patients who fulfilled NICE criteria. The mean number of consultant programmed activities dedicated to continuous subcutaneous insulin infusion services was 0.96 (range 0-8), mean whole-time equivalent diabetes specialist nurses was 0.62 (range 0-3) and mean whole-time equivalent dietitian services was 0.3 (range 0-2), of which 39, 61 and 60%, respectively, were not formally funded. Conclusions: The prevalence of continuous subcutaneous insulin infusion use in the UK falls well below the expectation of NICE (15-20%) and that of other European countries (> 15%) and the USA (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users. © 2013 Diabetes UK.


PubMed | University of Liverpool, Countess of Chester NHS Trust, Alder Hey Childrens Hospital, St Helens and Knowsley NHS Trust and Warrington and Halton Hospitals NHS Trust
Type: Journal Article | Journal: Diabetic medicine : a journal of the British Diabetic Association | Year: 2016

To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151).All centres in the UK, providing pump services to children and young people were invited to participate in an online audit. Audit metrics were aligned to NICE Technology Appraisal 151 and an electronic data collection tool was used.Of the 176 UK centres identified as providing pump services, 166 (94.3%) participated in the study. A total of 5094 children and young people were identified as using continuous subcutaneous insulin infusion (19% of all paediatric patients with Type 1 diabetes), with a median (range) of 16.9 (0.67-69.4)% per centre. Units had a median of 0.58 consultant sessions, 0.43 full-time equivalent diabetic specialist nurses, and 0.1 full-time equivalent dieticians delivering the pump service. The majority of this time was not formally funded. Families could access 24-h clinical and technical support (83% units), although the delivery varied between consultant, diabetic specialist nurse and company representatives. Only 53% of units ran, or accessed, structured education programmes for continuous subcutaneous insulin infusion use. Most units (86%) allowed continuous subcutaneous insulin infusion use for paediatric inpatients, but only 56% had written guidelines for this scenario. Nine percent of units had encountered funding refusal for a patient fulfilling NICE (Technology Appraisal 151) criteria.The number of children and young people on continuous subcutaneous insulin infusion therapy is consistent with numbers estimated by NICE. There is a worrying lack of funded healthcare professional time. The audit also identified gaps in the provision of structured education and absence of written inpatient guidelines.


Hallam C.,Royal Infirmary | Weston V.,St Helens and Knowsley NHS Trust | Denton A.,University of Huddersfield | Hill S.,The Christie NHS Foundation Trust | And 3 more authors.
Journal of Infection Prevention | Year: 2016

Vascular access is an important part of many patient care management plans but has some unwanted risks. Previous work published by Moureau et al. (2012) inspired a working group led by the UK Infection Prevention Society (IPS) to produce a vessel health and preservation (VHP) framework. This was with the intention of producing a resource for frontline staff to be able to assess and select the best vascular access device to meet the individual patient’s needs and to preserve veins for future use. The working group produced a framework that used available evidence, expert opinion and some small scale testing of the components of the framework. The work so far has received positive feedback but further work is required to formally evaluate the VHP framework in clinical practice to measure both staff knowledge and patient outcomes. © 2016, The Author(s) 2016.


Overend L.,St. Helens and Knowsley NHS Trust | Rose E.,North Cheshire Hospitals NHS Trust
Experimental and Clinical Cardiology | Year: 2012

Embolic myocardial infarction is an uncommon but increasingly recognised complication of infective endocarditis. This complication has a high mortality rate and is deemed a relative contraindication to thrombolytic therapy. The present article describes an episode of acute myocardial infarction associated with infective endocarditis. Systemic thrombolytic therapy was administered, which resulted in resolution of cardiac ischemia but was complicated by a fatal intracerebral bleed. There are a number of published cases describing the use of systemic thrombolysis, primary percutaneous intervention and early valvular surgery in this circumstance, but the optimal course of treatment for myocardial infarction in the context of infective endocarditis remains to be elucidated. Additional guidance for those who are likely to encounter this condition in clinical practice would be welcomed. ©2012 Pulsus Group Inc. All rights reserved.


Hargreaves A.C.,St. Helens and Knowsley NHS Trust | Mohamed M.,St. Helens and Knowsley NHS Trust | Audisio R.A.,St. Helens and Knowsley NHS Trust
Journal of Surgical Oncology | Year: 2014

The increasing incidence of breast cancer and advances in detection of small, impalpable cancers presents increasing challenges for the modern breast surgeon. Accurate localization and excision with adequate oncological margins to reduce loco-regional recurrence rates whilst minimizing volume deficit and maximizing aesthetics remains the "gold standard." We review the current techniques available and the developments within this field. © 2014 Wiley Periodicals, Inc.


Al Omar S.,University of Liverpool | Middleton D.,University of Liverpool | Marshall E.,Clatterbridge Center for Oncology | Porter D.,St Helens and Knowsley NHS Trust | And 4 more authors.
Human Immunology | Year: 2010

Killer immunoglobulin-like receptor (KIR) and human leukocyte antigen (HLA) genotypes were analyzed from panels of lung (non-small-cell lung cancer [NSCLC] and small-cell lung cancer [SCLC]), colon, and kidney cancer patients and compared with normal control subjects. No significant differences were noted between KIR gene frequencies in patients compared with normal subjects. When combinations of KIR genes and their HLA ligands were considered, there were significant decreases in frequencies of both KIR2DL2 and KIR2DL3 in homozygotes for their ligand HLA-C1, and an increase in the frequency of KIR3DL1 and its ligand HLA-Bw4 in kidney cancer patients compared with controls. Both associations were partly attributable to changes in ligand frequencies alone. NSCLC patients showed a significant increase in the frequency of KIR2DL1 and its ligand HLA-C2 and a corresponding decrease in frequency of KIR2DL3 and its ligand HLA-C1 in homozygotes. In NSCLC, the Ile80 form of HLA-Bw4 was decreased in KIR3DL1+ HLA-Bw4+ patients, whereas in SCLC the Ile80 form was increased and the Thr80 form decreased in KIR3DS1+ HLA-Bw4+ patients. These findings are consistent with increased co-expression of high-affinity inhibitory KIRs and their ligands, potentially resulting in decreased natural killer cell function, and hence with natural killer cells having a protective role in lung and kidney cancer but not colon cancer. © 2010 American Society for Histocompatibility and Immunogenetics.


Sathi N.,Wrightington Hospital | Chikura B.,Lincoln County Hospital | Kaushik V.V.,Lincoln County Hospital | Wiswell R.,St. Helens and Knowsley NHS Trust | Dawson J.K.,St. Helens and Knowsley NHS Trust
Clinical Rheumatology | Year: 2012

The current literature states the prevalence of methotrexate pneumonitis (MTX-P) to be 3.5-7.6%. This is based on retrospective data. Consequently, clinicians remain cautious in using methotrexate especially in patients with pre-existing lung disease. To get a true idea of the incidence of MTX-P we designed an ongoing prospective study, which is the largest to date. We recruited all patients starting low-dose methotrexate in our department, and followed them up for 2 years or until development of MTX-P. All patients had their pulmonary spirometry checked at baseline. Patients were excluded if they did not give consent for methotrexate therapy, or had a forced expiratory volume in 1 s (fev1) or full vital capacity (FVC) of less than 1 l. So far, 223 patients have been recruited of whom 223 have completed 6 months and 185 have finished 2 years of follow-up from commencing methotrexate. Only two patients developed MTX-P. This gave an incidence of one case every 192 patient years of MTX-P. The results of this ongoing prospective study suggest that MTX-P when diagnosed using Carson's criteria and Chest HRCT scanning, does not occur as often as previously thought. Also it would appear from our data that baseline spirometry rather than full pulmonary function tests can be used routinely as an immediate screening of lung function prior to commencement of methotrexate. Interestingly the patients who developed MTX-P did not have any specific abnormalities at baseline. © 2011 Clinical Rheumatology.


Idowu O.K.,St. Helens and Knowsley NHS Trust.
Journal of perioperative practice | Year: 2012

In spite of the widespread availability of image intensifier for fracture fixation and storage of images on a radiological computer system, routine check radiography is still a common practice. This is even so in situations with no clear indications such as fall or increasing patients' discomfort.


PubMed | St Helens and Knowsley NHS Trust
Type: Journal Article | Journal: International journal of colorectal disease | Year: 2016

Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes and prognosticators in patients with R1 resection of rectal cancer.Retrospective study of all patients operatively managed within our institution between April 2008 and April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival (OS), disease-free survival (DFS) and recurrence were the primary outcome measures.Overall, there were 306 primary rectal cancers. Seventy-six percent were grade T3/4 tumours. OS was 30months. R1 rate was 16% (48 patients). Thirty-one patients underwent APR and 17 AR. In patients who responded to neoadjuvant chemotherapy (NAC), overall survival was 55months, with no extramural venous invasion (EMV) seen in this cohort. In non-responders OS was 29months, with EMV in 48%. In patients who did not receive NAC, OS was 23months, with EMV in 74%. EMV is a strong predictor for poor survival following R1 (p=0.001). We also found a correlation between number of positive nodes and OS/DFS (p=0.004).In this small cohort of patients with R1 positive rectal cancers, response to NAC is the strongest predictor of poor overall and disease-free survival. In patients who respond to NAC, OS and DFS has been shown to be positive, with a reduced rate of EMV.

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