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Singh I.,University Hospital Llandough | Gallacher J.,University of Cardiff | Davis K.,University of Wales | Johansen A.,University of Wales | And 2 more authors.
Age and Ageing | Year: 2012

Background: multidisciplinary rehabilitation is of proven benefit in the management of older inpatients. However, the identification of patients who will do well with rehabilitation currently lacks a strong evidence base. Objectives: the aims of this study were to compare the importance of chorological age, gender, co-morbidities and frailty in the prediction of adverse outcomes for patients admitted to an acute geriatric rehabilitation ward. Design: prospective observational cohort study. Subjects and setting: two hundred and sixty-five patients admitted consecutively to an acute geriatric rehabilitation ward at a tertiary care teaching hospital. Methods: frailty status was measured by an index of accumulated deficits, giving a potential score from 0 (no deficits) to 1.0 (all 40 deficits present). Patients were stratified into three outcomes: good (discharged to original residence within 28 days), intermediate (discharged to original residence but longer hospital stay) and poor (newly institutionalised or died). Results: patients were old (82.6±8.6 years) and frail (mean frailty index (FI) 0.34±0.09). Frailty status correlated significantly with length of stay and was a predictor of poor functional gain. The odds ratio of intermediate and poor outcome relative to a good outcome was 4.95 (95% CI+3.21, 7.59; P<0.001) per unit increase in FI. Chronological age, gender and co-morbidity showed no significant association with outcomes. Conclusion: frailty is associated with adverse rehabilitation outcomes. The FI may have clinical utility, augmenting clinical judgement in the management of older inpatients. © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

Stacey R.,University Hospital Llandough | Thomas L.,Singleton Hospital
Surgery (United Kingdom) | Year: 2014

Ulcerative colitis and Crohn's disease are common conditions, which are seen frequently in both gastroenterology and surgical clinics, and are a significant burden on inpatient work. They are diseases with systemic manifestations and management of these patients can be difficult in complex cases. There is a wide variety of management options available, including management with medications, dietary modifications and surgery. We outline the current options available to clinicians. © 2014 Elsevier Ltd. All rights reserved.

Willis E.A.,University of Wales | Datta B.N.,University Hospital Llandough
Annals of Clinical Biochemistry | Year: 2013

Background: Previous studies have shown that of all the tests requested of hospital laboratories, 25-40% are thought to be unnecessary. Our hospital laboratory observed that a significant number of requests from the medical admissions unit (MAU) were probably inappropriate. In an attempt to improve requesting behaviour this observation was investigated and an educational intervention employed. Methods: We performed a survey of requesting behaviour by the MAU and a local protocol was designed as an audit standard. The influence of the educational intervention on requesting behaviour was audited. Results: The generation of local guidelines and an educational intervention to promote them, significantly changed requesting behaviour. The main effect was the reduction in requesting of thyroid function tests, lipid profiles and coagulation screens. Conclusions: This process highlighted inappropriate requesting behaviour from the MAU which, following a process of investigation and education, resulted in a significant change with an associated cost benefit.

Stacey R.,University of Cardiff | Stacey R.,University of South Wales | Green J.T.,University Hospital Llandough
Therapeutic Advances in Chronic Disease | Year: 2014

Ionizing radiation is commonly used to treat a number of malignancies. Although highly effective and now more targeted, many patients suffer side effects. The number of cancer survivors has increased and so there are more patients presenting with symptoms that have arisen as a result of radiotherapy. Radiation damage to small bowel tissue can cause acute or chronic radiation enteritis producing symptoms such as pain, bloating, nausea, faecal urgency, diarrhoea and rectal bleeding which can have a significant impact on patient's quality of life. This review outlines the pathogenesis of radiation injury to the small bowel along with the prevention of radiation damage via radiotherapy techniques plus medications such as angiotensin-converting enzyme inhibitors, statins and probiotics. It also covers the treatment of both acute and chronic radiation enteritis via a variety of medical (including hyperbaric oxygen), dietetic, endoscopic and surgical therapies. © The Author(s), 2013.

Haldar K.,University Hospital Llandough | Giamougiannis P.,Addenbrookes Hospital | Crawford R.,University of Cambridge
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Objectives To assess the significance of peritoneal washing cytology at the time of laparoscopic salpingo-oophorectomy. Design: Retrospective study. Setting: Cambridge University Hospital. Population: Four hundred and nine women who underwent laparoscopic salpingo-oophorectomy by the gynaecology oncology team between 2004 and December 2009 were included. One hundred and thirteen women had risk-reducing salpingo-oophorectomy, 103 women had salpingo-oophorectomy as part of breast cancer management, 59 had simple ovarian cysts, 111 had complex ovarian cysts and 23 had the procedure done for other reasons. Methods: Histology and cytology results were reviewed and all hospital records were checked for subsequent malignancy. Sensitivity and specificity of peritoneal washing cytology was calculated. Main outcome measures: Malignant peritoneal cytology in the absence of cancer on histopathology. Results: Eleven of the 409 women in our study had occult malignancy on histopathological examination and three of them had positive peritoneal washings. One woman had positive washings from metastatic breast cancer. Thirteen women developed different malignancies subsequently but none had primary peritoneal or ovarian cancer within a median follow-up interval of 34 months. Conclusions: Peritoneal lavage cytology did not pick up any additional malignancy in the study population. Based on the evidence presented, we suggest that peritoneal washing cytology during laparoscopic salpingo-oophorectomy is of limited value and should not be practised routinely. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

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