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Stockport, United Kingdom

Kirkham D.,Stockport NHS Foundation Trust
Medical Teacher | Year: 2012

A teaching programme for newly qualified doctors is necessary for their continuing professional development and education. However, guidelines for the logistics and content of such teaching programmes are limited. These 12 tips provide advice and guidance for the creation and development of a successful programme. This article is intended for readers who are involved in teaching; programme directors, administrators, tutors and trainee doctors themselves. The principles included will also be useful for those involved in developing other types of teaching programmes. Engagement of trainees, the education department and other staff in the hospital is crucial for the success of teaching programmes. A culture of attendance and feedback may take time and effort to establish but is absolutely essential for long-term programme viability. Innovative approaches to teaching, a range of teaching staff and coverage of varied clinical and non-clinical topics, all contribute to a strong programme. © 2012 Informa UK Ltd All rights reserved. Source


Khan W.S.,University of Manchester | Johnson D.S.,Stockport NHS Foundation Trust | Hardingham T.E.,University of Manchester
Knee | Year: 2010

Cartilage is frequently damaged but only shows a limited capacity for repair. There are a number of treatment strategies currently available for the repair of articular cartilage defects including abrasion chondroplasty, subchondral drilling, microfracture and mosaicplasty but these show variable results. For the younger patients, there is great interest in the potential of cell-based strategies to provide a biological replacement of damaged cartilage using autologous chondrocytes. The results of clinical studies using these cell-based techniques do not conclusively show improvement over conventional techniques. These techniques also do not consistently result in the formation of the desired hyaline cartilage rather than fibrocartilage. Mesenchymal stem cells present a promising cell source for cartilage repair. Mesenchymal stem cells have been isolated from a number of adult tissues including the bone marrow and the synovial fat pad. These cells have the ability to proliferate in culture and differentiate down different pathways including the chondrogenic pathway. In the first instance, differentiated stem cells can be used for the repair of localised cartilage defects by producing hyaline cartilage. In the future, this strategy has the potential to be extended to treat more generalised cartilage defects, especially as the cell source is not a limiting factor. The use of cell-based therapies also allows the versatility of using scaffolds and growth factors, with recombinant proteins or gene therapy. A number of challenges however still need to be overcome including further work on identifying the optimal source of stem cells, along with refining the conditions that enhance expansion and chondrogenesis. © 2009 Elsevier B.V. Source


Rn P.B.,Stockport NHS Foundation Trust | Hardiker N.,University of Salford
Studies in Health Technology and Informatics | Year: 2016

This paper describes the evaluation of a computerized clinical decision support system (CCDSS) for Emergency Department (ED) triage. The CCDSS for triage was developed as a means to improve ED quality and safety. Whilst there is significant research on the role of CCDSS in health care, their role in EDs remains under-investigated. In this study, a CCDSS for ED triage was developed and evaluated using a quasi-experimental interrupted time-series design. Data was collected at four time points before and after the introduction of the CCDSS to assess key aspects of quality and safety within the ED. The results demonstrated a statistically significant improvement in triage prioritization (p<0.001), pain scoring (p<0.001) and pain management (p<0.001). This study clearly identifies the positive clinical impact that a CCDSS can have on quality and safety for ED patients and provides a unique contribution to the current knowledge base. © 2016 IMIA and IOS Press. Source


Jacob J.V.,Stockport NHS Foundation Trust
BMJ Case Reports | Year: 2015

A 76-year-old woman with significant cardiovascular comorbidities was investigated under general surgery for weight loss and change in bowel habit. Endoscopic investigations revealed a large ulcer extending from the ileocaecal valve to the ascending colon. Histology of the biopsies from this site revealed chronic inflammation and reactive changes. However, considering the history and suspicious radiological and endoscopic findings, decision was made at a multidisciplinary meeting to offer laparoscopic right hemicolectomy. Owing to complications, the procedure was converted to an open surgery. Postoperatively, histology of resected bowel revealed chronic in flammation and no evidence of malignancy. In light of an 8-year history of nicorandil therapy, the histological changes were thought to represent nicorandil-induced colonic ulceration. © 2015 BMJ Publishing Group. All rights reserved. Source


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. Source

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