Wainwright T.,The Royal Bournemouth Hospital |
Wainwright T.,Bournemouth University |
Middleton R.,The Royal Bournemouth Hospital |
Middleton R.,Bournemouth University |
Middleton R.,University of Warwick
Current Anaesthesia and Critical Care | Year: 2010
The use of enhanced recovery pathways within elective surgery has increased in recent years but uptake outside of specialist centres is still slow, despite the growing evidence base to support their introduction. This article will briefly outline what is meant by an enhanced recovery pathway (ERP) and outline the central characteristics and features which make up an ERP. The procedural details and results of an orthopaedic ERP which has been used in 2391 consecutive hip and knee joint replacement patients at a NHS district general hospital within the United Kingdom will then be outlined.The results of this unit illustrate that when a standardised, multi-disciplinary pathway is implemented and managed correctly, dramatic reductions to length of stay can be achieved. In combination, high levels of both staff and patient satisfaction are achieved along with good clinical outcomes. It is proposed that if such ways of working are implemented in other hospitals major economic and capacity savings could be realised at the same time as improving patient care. © 2010 Elsevier Ltd.
PubMed | Peterborough & Stamford NHS Trust., University of Leeds, The Royal Bournemouth Hospital, The Charles Clifford Dental Hospital and University of Bradford
Type: Journal Article | Journal: European journal of orthodontics | Year: 2015
To evaluate the clinical performance of APCII Victory Series (3M Unitek) brackets in direct orthodontic bonding with and without the use of primer.A single-operator, two-centre prospective, non-inferiority randomized controlled clinical trial.The Orthodontic departments at the Leeds Dental Institute and St Lukes Hospital, Bradford, UK.Ethical approval was granted by Leeds (East) Research Ethics Committee on 18th of December 2009 (Reference 09/H1306/102).The protocol was not published prior to trial commencement.Ninety-two patients requiring orthodontic treatment with fixed appliances were randomly allocated to the control (bonded with primer) or test groups (bonded without primer). Patients were randomly allocated to either the control or experimental group. This was performed by preparing opaque numbered sealed envelopes in advance using a random numbers table generated by a computer by an independent third party . Once the envelopes were opened, blinding of the operator and the patient was no longer possible due to the nature of the intervention. Patients were approached for inclusion in the trial if they qualified for NHS orthodontic treatment requiring fixed appliances and had no previous orthodontic treatment.Number of bracket failures, time to bond-up appliances, and the adhesive remnant index (ARI) when bracket failure occurred, over a 12-month periodFailure rate with primer was 11.1 per cent and without primer was 15.8 per cent. Bonding without primer was shown statistically to be non-inferior to bonding with primer odds ratio 0.95-2.25 (P = 0.08). Mean difference in bond-up time per bracket was 0.068 minutes (4 seconds), which was not statistically significant (P = 0.402). There was a statistically significant difference in the Adhesive Remnant Index - ARI 0 with primer 49.4 per cent, no primer 76.5 per cent, (P < 0.0001).As the study was only performed by one operator, the results can therefore only be truly be applied to their practice. Also this study was powered to ascertain if there was no difference between the 2 groups up to 5%, however orthodontists may consider a change in the bracket failure rate of 2% to be clinically significant.When bonding with APCII Victory Series brackets without primer was shown statistically to be non-inferior to bonding with primer (P =0.08). There was no significant difference in bond-up times. Bond failure was more likely to happen at the composite-enamel interface when bonded without a primer.No conflict of interest for all authors.No funding sources were used.Study was not registered on external databases.
Starks I.,Wrexham Maelor Hospital |
Wainwright T.W.,The Royal Bournemouth Hospital |
Wainwright T.W.,Bournemouth University |
Lewis J.,Dr Foster Intelligence London |
And 3 more authors.
Age and Ageing | Year: 2014
Background: Between August 2007 and May 2009, 2128 consecutive patients underwent either primary hip or knee joint replacement surgery at our institute on an enhanced recovery pathway. We aimed to investigate the potential benefits of this pathway in patients over the age of 85 years. Methods: Data extracted from Hospital Episode Statistics were analysed. This data are prospectively collected and independently collated. Results: In all patients median length of stay was reduced when compared with both our own data before the introduction of the pathway (6 to 4 days) and national averages over the same time period for both hip and knee replacements (5 to 4 days). Difference in length of stay was most pronounced in the group of patients aged 85 years and over (9 to 5 days for total hip replacement and 8 to 5 days for total knee replacement). Nearly all patients were discharged directly home (97.4%). Readmission rates were over 45% lower in patients aged 85 and over when compared with national averages (5.2 vs. 9.4%). Conclusions: This is the first series in the literature to assess the role of enhanced recovery pathways in the very elderly. This study not only shows that successful fast track rehabilitation can be achieved in the very elderly population undergoing elective joint replacement surgery, but that it is this cohort of vulnerable patients who have the most to gain from such multidisciplinary recovery programmes. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Mathieu S.,The Royal Bournemouth Hospital |
Craig G.,Queen Alexandra Hospital
Journal of the Intensive Care Society | Year: 2011
Levosimendan is a drug which increases the sensitivity of the heart to calcium and which opens potassium channels, resulting in inodilation. Clinical trial data from patients suffering from heart failure have demonstrated that it improves haemodynamics without increasing intra-cellular calcium or oxygen consumption. However, there is no consistent evidence of mortality reduction. This narrative review summarises the key trials of its use in acute heart failure, acute coronary syndrome, cardiogenic shock and septic shock.© The Intensive Care Society 2011.
Ballard A.J.,The Royal Bournemouth Hospital
Pathology Research and Practice | Year: 2015
The role of Epstein-Barr virus (EBV) in the pathogenesis of breast cancer is still unclear, although a growing body of evidence supports a link. The aim of this study was to investigate if EBV infection was more prevalent in invasive ductal carcinoma or invasive lobular carcinoma. An immunohistochemical marker for EBV (Epstein-Barr virus nuclear antigen 1 (EBNA1) clone E1-2.5) was applied to a tissue micro array section. The tissue micro array contained 80 cases of invasive ductal carcinoma, and 80 cases of invasive lobular carcinoma. Each case was scored as positive or negative for nuclear expression of EBNA1 in tumor cells using standard light microscopy.EBNA1 staining was evident in the tumor cells of 63 cases (39.4% of tumor cases). By tumor type (ductal/lobular) EBV infection was noted in 34 (42.5%) cases of invasive ductal carcinoma and 29 (36.2%) cases of invasive lobular carcinoma, this difference was not found to be significant (P = 0.518).This study indicates that EBV infection is equally distributed across the ductal and lobular tumor types. © 2015 Elsevier GmbH.
Sisak K.,The Royal Bournemouth Hospital |
Lloyd J.,The Royal Bournemouth Hospital |
Fiddian N.,The Royal Bournemouth Hospital
Knee | Year: 2011
Peripheral nerve blocks have found increased popularity in providing prolonged post-operative analgesia following total knee replacement surgery. They generally provide effective analgesia with fewer complications than epidurals.This report describes an acute low-energy knee dislocation after a well balanced, fixed bearing, cruciate-retaining primary total knee replacement performed under a spinal anaesthetic with combined complimentary femoral and sciatic nerve blocks. The dislocation was not accompanied by neurovascular compromise. Due to the subsequent instability and injury to both collaterals, the posterior cruciate ligament and posterolateral corner structures, the knee was treated with a rotating-hinge revision total knee replacement.The dislocation occurred whilst the peripheral nerve blocks (PNB) were still working. We review our incidence of PNB related complications and conclude that PNB remain a safe and effective analgesia for total knee replacements. However, we advocate that ward staff and patients should be sufficiently educated to ensure that unaided post-operative mobilisation is prevented until such a time that patients have regained complete voluntary muscle control. © 2009 Elsevier B.V.
Bhattee G.,The Royal Bournemouth Hospital |
Moonot P.,The Royal Bournemouth Hospital |
Govindaswamy R.,The Royal Bournemouth Hospital |
Pope A.,The Royal Bournemouth Hospital |
And 2 more authors.
Knee | Year: 2014
Background: The aim of our study was to identify whether there was any correlation between the outcome of secondary patellar resurfacing and malrotation of either the femoral or tibial component. Methods: We identified patients that underwent secondary patellar resurfacing following previous primary total knee arthroplasty (TKA) at a single, large orthopaedic department. Patients were reviewed for range of movement, satisfaction, health status and knee function. CT scanning was performed, assessing rotational alignment of the components. Results: Twenty-one patients (23 knees) were reviewed. Nine out of 21 (39%) were satisfied while 14 (61%) remained dissatisfied after the secondary patellar resurfacing. There were no complications after the secondary procedure. All knees were internally rotated. The mean femoral internal rotation in the satisfied group was 0.92°, and in the dissatisfied group was 2.88° of internal rotation. In the dissatisfied group eight out of 14 TKAs were in >. 3° femoral internal rotation compared with only one in nine TKAs in the satisfied group (p. <. 0.05). Conclusions: Investigation for malrotation should be considered in patients with post-operative pain, especially anteriorly, causing significant dissatisfaction amongst patients following TKA. This is especially true if the patella has not been primarily resurfaced and secondary resurfacing is being considered. Patients with more than 3° of femoral internal rotation undergoing secondary patella resurfacing should be warned of the possibility of a poor outcome. It may well be that if the underlying problem is component malrotation, revision knee replacement may lead to a more satisfactory outcome than secondary resurfacing alone. Level of Evidence: Level of Evidence III. © 2012 Elsevier B.V.
PubMed | International Livestock Research Institute, The Royal Bournemouth Hospital, Kenya International Livestock Research Institute and Center for Public Health and Ecosystem Research
Type: Journal Article | Journal: The American journal of tropical medicine and hygiene | Year: 2016
In Vietnam, Japanese encephalitis virus accounts for 12-71% of viral encephalitis (VE) cases followed by enteroviruses and dengue virus among identified pathogens. This study is the first attempt to evaluate the seasonality of VE and associated environmental risk factors in two provinces from 2004 to 2013 using a seasonal trend-decomposition procedure based on loess regression and negative binomial regression models. We found seasonality with a peak of VE in August and June in Son La and Thai Binh, respectively. In Son La, the model showed that for every 1C increase in average monthly temperature, there was a 4.0% increase in monthly VE incidence. There was a gradual decline in incidence rates as the relative humidity rose to its mean value (80%) and a dramatic rise in incidence rate as the relative humidity rose past 80%. Another model found that a 100 mm rise in precipitation in the preceding and same months corresponded to an increase in VE incidence of 23% and 21%, respectively. In Thai Binh, our model showed that a 1C increase in temperature corresponded with a 9% increase in VE incidence. Another model found that VE incidence increased as monthly precipitation rose to its mean value of 130 mm but declined gradually as precipitation levels rose beyond that. The last model showed that a monthly increase in duration of sunshine of 1 hour corresponded to a 0.6% increase in VE incidence. The findings may assist clinicians by improving the evidence for diagnosis.
PubMed | The Royal Bournemouth Hospital
Type: Journal Article | Journal: Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2016
AS G GRADE ward sister and F grade senior staff nurse, we were well established in senior positions, and had the trust and support of the staff when we considered job sharing.
PubMed | The Royal Bournemouth Hospital and Blackpool Victoria Hospital
Type: | Journal: BMJ case reports | Year: 2015
Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice. A plastic stent is usually inserted in patients with obstructive jaundice due to pancreatic cancer as a short-term procedure. Stent migration has been reported as a complication, although in most cases the stent will pass through or remain in the bowel lumen for a period of time. In rare cases, the stent may cause sigmoid perforation and pelvic abscess formation, especially in patients with sigmoid diverticulae or abdominal adhesions due to previous surgery. We present a patient with sigmoid perforation and pelvic abscess due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.