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Stockport, United Kingdom

Manning C.J.,Stepping Hill Hospital | Delaney R.,Wrightington Hospital | Hayton M.J.,Wrightington Hospital
Journal of Hand Surgery: European Volume | Year: 2014

In clinical trials, treating Dupuytren's contracture with collagenase injection involves manipulation the day after injection, without local anaesthesia. We evaluated the efficacy and tolerability of manipulation 2 days after injection with local anaesthesia. Forty-five patients received 50 injections into cords contracting metacarpophalangeal and proximal interphalangeal joints; follow-up visits were at 3 and 14 weeks. For the metacarpophalangeal joints there were >90% reduction in contracture at both visits. The proximal interphalangeal joints that improved spontaneously after metacarpophalangeal injection or received direct injections showed 51-55% reduction in contracture. Changes in scores on the Patient Evaluation Measure suggest that patients perceived improvements in their hand function was good and they were satisfied with the procedure. Collagenase and local anaesthesia injections were well tolerated; adverse events were localized to the injection site and were mild and transient in nature. These findings provide another viable option for practising surgeons and may help with the logistics of patient care. © The Author(s) 2013. Source

Davies A.,Stepping Hill Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2014

Fever is the raising of body temperature above the normal daily variation. In practice, this is -38°C (rectal or tympanic),37.5°C (oral) or 37.2°C (axillary). It is part of a systemic inflammatory response by the immune system to infection. Source

Khanbhai M.,University of Manchester | Yap K.H.,Royal Infirmary | Mohamed S.,Stepping Hill Hospital | Dunning J.,James Cook University
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

A best evidence topic was written according to a structured protocol. The question addressed was whether cryoanalgesia improves post-thoracotomy pain and recovery. Twelve articles were identified that provided the best evidence to answer the question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were pain scores, additional opiate requirements, incidence of hypoesthesia and change in lung function. Half of the articles reviewed failed to demonstrate superiority of cryoanalgesia over other pain relief methods; however, additional opiate requirements were reduced in patients receiving cryoanalgesia. Change in lung function postoperatively was equivocal. Cryoanalgesia potentiated the incidence of postoperative neuropathic pain. Further analysis of the source of cryoanalgesia, duration, temperature obtained and extent of blockade revealed numerous discrepancies. Three studies utilized CO2 as the source of cryoanalgesia and four used nitrous oxide, but at differing temperatures and duration. Five studies did not reveal the source of cyroanalgesia. The number of intercostal nerves anaesthetized in each study varied. Seven articles anaesthetized three intercostal nerves, three articles used five intercostal nerves, one article used four intercostal nerves and one used one intercostal nerve at the thoracotomy site. Thoracotomy closure and site of area of chest drain insertion may have a role in postoperative pain; but only one article explained method of closure, and two articles mentioned placement of chest drain through blocked dermatomes. No causal inferences can be made by the above results as they are not directly comparable due to confounding variables between studies. Currently, the evidence does not support the use of cryoanalgesia alone as an effective method for relieving post-thoracotomy pain. © 2013 The Author. Source

Carle C.,Critical Care Medicine | Alexander P.,University of Manchester | Columb M.,University of Manchester | Johal J.,Stepping Hill Hospital
Anaesthesia | Year: 2013

We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FIO2/P aO2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment. © Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland. Source

Govindraj R.,Stepping Hill Hospital
Journal of laparoendoscopic & advanced surgical techniques. Part A | Year: 2010

Imaging of early postoperative complications after mesh repair has shown "foldings" of the prosthetic mesh, leading to displacement and associated hernia recurrence. A rectangular two-dimensional mesh introduced into the abdomen and fitted into a concave three-dimensional cavity does not lie evenly and is susceptible to crumpling. Hence, we propose to introduce a geometrically corrected mesh design that would allow easier placement and compliment the anatomic shape of the abdominal cavity. Source

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