Whipps Cross University Hospital
Whipps Cross University Hospital
Khozoee B.,University of Edinburgh |
Mafi P.,Whipps Cross University Hospital |
Mafi R.,University of Oxford |
Khan W.S.,University of Cambridge
Current stem cell research & therapy | Year: 2017
Mechanical stimulation is a key factor in articular cartilage generation and maintenance. Bioreactor systems have been designed and built in order to deliver specific types of mechanical stimulation. The focus has been twofold, applying a type of preconditioning in order to stimulate cell differentiation, and to simulate in vivo conditions in order to gain further insight into how cells respond to different stimulatory patterns. Due to the complex forces at work within joints, it is difficult to simulate mechanical conditions using a bioreactor. The aim of this review is to gain a deeper understanding of the complexities of mechanical stimulation protocols by comparing those employed in bioreactors in the context of tissue engineering for articular cartilage, and to consider their effects on cultured cells. Allied and Complementary Medicine 1985 to 2016, Ovid MEDLINE[R] 1946 to 2016, and Embase 1974 to 2016 were searched using key terms. Results were subject to inclusion and exclusion criteria, key findings summarised into a table and subsequently discussed. Based on this review it is overwhelmingly clear that mechanical stimulation leads to increased chondrogenic properties in the context of bioreactor articular cartilage tissue engineering using human cells. However, given the variability and lack of controlled factors between research articles, results are difficult to compare, and a standardised method of evaluating stimulation protocols proved challenging. With improved standardisation in mechanical stimulation protocol reporting, bioreactor design and building processes, along with a better understanding of joint behaviours, we hope to perform a meta-analysis on stimulation protocols and methods. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
McGlynn B.,Ayr Hospital |
Johnston M.,Imperial College London |
Green J.,Whipps Cross University Hospital
Journal of Clinical Urology | Year: 2017
Objectives: The urology-oncology service in NHS Ayrshire and Arran (AA) is nurse-led, with a multidisciplinary team (MDT) process at its core. Here, we assess the efficacy of this nurse-led service against similar services and consider it in the context of the new NHS cancer strategy. Materials and methods: Audit data regarding the management of patients with urological malignancies published by the West of Scotland Cancer Network (WoSCAN) were compared against pre-determined quality performance indicators. These data were used to assess the efficacy of the NHS AA service against the other WoSCAN centres. Results: All parameters analysed were comparable, except for the following performance indicators for which the NHS AA data appeared to show significant improvement compared with the other WoSCAN centres: the number of patients with bladder cancer with recorded TNM clinical staging (p = 0.012); the proportion of patients with prostate cancer who underwent transrectal ultrasound-guided prostate biopsy for histological diagnosis where a minimum of 10 cores are received by pathology (p = 0.043); and the number of patients with metastatic prostate cancer who underwent immediate hormone therapy (p = 0.031). Conclusion: Our analysis demonstrates that the NHS AA urology-oncology nurse-led MDT-based service is a highly efficient and well-functioning structure. © 2017, © British Association of Urological Surgeons 2017.
Lamb B.,St Marys Hospital |
Lamb B.,Whipps Cross University Hospital |
Green J.S.A.,Whipps Cross University Hospital |
Vincent C.,St Marys Hospital |
Sevdalis N.,St Marys Hospital
Surgical Oncology | Year: 2011
Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients. © 2011 Elsevier Ltd. All rights reserved.
Jalil R.,Imperial College London |
Jalil R.,Whipps Cross University Hospital |
Ahmed M.,Imperial College London |
Green J.S.A.,Whipps Cross University Hospital |
And 2 more authors.
International Journal of Surgery | Year: 2013
Background: It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. Methods: Semi-structured interviews were carried out with expert MDT members of Urological and Gastro-Intestinal tumours of 3 London (UK) hospitals. The standardised interview protocol assessed MDT experts' views on decision-making, barriers to reaching a decision and implementing it into care, and interventions to improve this process. All interviews were audio-taped, transcribed verbatim and analysed using a standardised approach. Emergent themes were identified by 2 clinical coders and tabulated. Results: Twenty-two participants participated in the study and data collection achieved 'saturation' (i.e., similar themes raised by different participants). Barriers to clinical decision-making included: inadequate clinical information; lack of investigation results; non-attendance of key members; teleconferencing failures. Barriers to implementation of MDT recommendations included: non-consideration of patients' choices or co-morbidities; disease progression at the time of implementation. Proposed interventions included improving the information available for the discussion through a standardised proforma; improving video-conferencing; reducing the MDT caseload (e.g., via selective MDT review of certain patients); and including patients more in the decision process. Conclusions: There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care. © 2013.
Karim R.,University of Sydney |
Sykakis E.,Whipps Cross University Hospital |
Lightman S.,University College London |
Fraser-Bell S.,University of Sydney
Clinical Ophthalmology | Year: 2013
Background: Uveitic macular edema is the major cause of reduced vision in eyes with uveitis. Objectives: To assess the effectiveness of interventions in the treatment of uveitic macular edema. Search strategy: Cochrane Central Register of Controlled Trials, Medline, and Embase. There were no language or data restrictions in the search for trials. The databases were last searched on December 1, 2011. Reference lists of included trials were searched. Archives of Ophthalmology, Ophthalmology, Retina, the British Journal of Ophthalmology, and the New England Journal of Medicine were searched for clinical trials and reviews. Selection criteria: Participants of any age and sex with any type of uveitic macular edema were included. Early, chronic, refractory, or secondary uveitic macular edema were included. We included trials that compared any interventions of any dose and duration, including comparison with another treatment, sham treatment, or no treatment. Data collection and analysis: Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected. Conclusion: More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments. The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic macular edema, and is clinically now rarely used. Interventions showing promise in this disease include dexamethasone implants, immunomodulatory drugs and anti-vascular endothelial growth-factor agents. When macular edema has become refractory after multiple interventions, pars plana vitrectomy could be considered. The disease pathophysiology is uncertain and the course of disease unpredictable. As there are no clear guidelines from the literature, interventions should be tailored to the individual patient. © 2013 Karim et al, publisher and licensee Dove Medical Press Ltd.
Makki D.,Whipps Cross University Hospital |
Haddad B.Z.,Whipps Cross University Hospital |
Mahmood Z.,Whipps Cross University Hospital |
Shahid M.S.,Barnet and Chase Farm Hospitals |
And 2 more authors.
Foot and Ankle International | Year: 2012
Background: The aim of this prospective study was to assess the effectiveness of a single ultrasound-guided steroid injection in the treatment of Morton's neuromas and whether the response to injection correlates with the size of the neuroma. Methods: Forty-three patients with clinical features of Morton's neuroma underwent ultrasound scan assessment. Once the lesion was confirmed in the relevant web space, a single corticosteroid injection was given using 40 mg of methylprednisolone along with 1% lidocaine. All scans and injections were performed by a single musculoskeletal radiologist. Patients were divided into two groups on the basis of the size of the lesion measured on the scan. Group 1 included patients with neuromas of 5 mm or less and group 2 patients had neuromas larger than 5 mm. A visual analog scale (VAS) for pain (scale 0 to 10), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Johnson satisfaction scale were used to assess patients before injection and then at 6 weeks, 6 months, and 12 months following the injection. Thirty-nine patients had confirmed neuromas. Group 1 (lesion ≤ 5 mm) included 17 patients (mean age, 30 years) (7 males, 10 females) and group 2 (lesion >5 mm) had 22 patients (mean age, 33 years) (8 males, 14 females). Results: VAS scores, AOFAS scores, and Johnson scale improved significantly in both groups at 6 weeks (p < .0001). At 6 months postinjection, this improvement remained significant only in group 1 with all scores (p < .001). At 12 months, there was no difference between both groups and outcome scores nearly approached preinjection scores. At the final review, two patients in group 1 and four patients in group 2 had severe recurrent symptoms and therefore underwent surgical excision of the neuroma after they rejected the offer for a repeat injection (p = 0.6). Conclusion: A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm. Copyright © 2012 by the American Orthopaedic Foot & Ankle Society.
Solanki K.,Whipps Cross University Hospital |
Pisesky A.,Whipps Cross University Hospital |
Frecker P.,Whipps Cross University Hospital
International Journal of Surgery | Year: 2013
Objective: Recent changes to the structure of medical training have placed increasing pressure on foundation year 1 (FY1) doctors to decide upon careers earlier. The deadline for application to core surgical training (CST) at the start of the foundation year 2 (FY2) may deter doctors from pursuing careers in surgery due to insufficient experience and confidence in its practical aspects. We piloted a four-week basic surgical skills (BSS) programme near the start of the FY1 year to a small cohort of FY1s and assessed its impact on confidence in basic surgical competencies and attitudes to a career in surgery. Methods: FY1 doctors at Whipps Cross University Hospital (WXUH) were selected to participate in a four week BSS programme within three months of starting their posts. We devised the BSS programme based on relevant key competencies in the Intercollegiate Surgical Curriculum Programme (ISCP). Using questionnaires we assessed confidence in basic surgical skills, competencies and attitudes to surgery before, immediately after and at 8 months after completion of the course and compared this with non-participating FY1s. Results: Out of 31 FY1 doctors, 14 (4 males, 10 females) participated in the BSS programme and 17 (10 males, 7 females) were non-participants (control group). Using the Mann-Whitney test, there was a statistically significant increase in confidence at 8 month follow-up of course participants (versus control group) in tying knots (p=0.0112), suturing skills (p=0.0455) performing fine needle aspiration (FNA) cytology (p=0.0017), obtaining tru-cut biopsy samples (p=0.0031), suturing lacerations in accident and emergency (A&E) (p=0.0009), incising and draining abscesses (p=0.0034), performing skin closure (p=0.0042), surgical sharps handling (p=0.0402) and surgical instrument handling (p=0.0066). Course participants were significantly more likely than non-participants to receive additional training in BSS from senior members of the team (p=0.0076). Importantly, they also demonstrated a statistically significant increase in interest in a career in surgery at 8 month follow-up in comparison to non-participants (p=0.0016). Conclusions: A structured, challenging BSS teaching programme early on during the FY1 year increases confidence in key surgical skills and competencies and can increase interest in surgery as a career. © 2013 Surgical Associates Ltd.
Sankaran S.,Whipps Cross University Hospital |
Odejinmi F.,Whipps Cross University Hospital
Journal of Obstetrics and Gynaecology | Year: 2013
With technological advancement and increasing skill in minimal access surgery, laparoscopic myomectomy is increasingly performed for the management of symptomatic fibroids in appropriately selected women. We present a series of 125 consecutive laparoscopic myomectomies to assess whether the number, size and location of fibroids affect the length of hospital stay. Total of 462 myomas were removed from 125 patients. The mean size of fibroids removed was 7.6 cm and the mean number of fibroids was 3.69. None of our patients had major intraoperative complication involving bladder or bowel. Our laparotomy conversion rate was 1.6% (2 out of 125). There was no significant difference based on size, number or weight of fibroids removed in relation to the day of discharge in our series. We conclude that the size and number of fibroids removed do not affect the day of discharge. © 2013 Informa UK, Ltd.
Lascar M.,Whipps Cross University Hospital |
Freer J.,Whipps Cross University Hospital |
Phiri E.,Whipps Cross University Hospital
British Journal of Hospital Medicine | Year: 2015
Introduction: Routine HIV testing in areas of high HIV prevalence has been shown to be both cost effective and to avert downstream morbidity and mortality from 'late' HIV diagnosis (defined as CD4 cell count <350 cells/ml). In the London borough of Waltham Forest in 2010, late HIV diagnoses were resulting in high morbidity with associated lengthy and costly hospital admissions. Methods: A retrospective analysis of all new HIV diagnoses was undertaken within a two-phased quality improvement project 2010-13. Newly diagnosed patients in 2010 were characterized, including immunological state, presence of HIV-related illness and department where they presented. After an intervention to set up an opt-out, walk-in rapid HIV testing service in outpatients, an analysis was conducted of numbers of tests, prevalence and immunological state of newly diagnosed patients in 2013. Results: A total of 91 patients were diagnosed with HIV, January-December 2010, 70% of which were a late diagnosis, including 48% defined as 'very immunosuppressed' (CD4 count <100 cells/ml). Of these, 51 out of 91 patients (56%) had attended hospital services in the 5 years before diagnosis, including 204 outpatient department attendances. After the intervention, rates of late diagnosis in 2013 had reduced to 46%, and rates of those diagnosed 'very immunosuppressed' had reduced from 48% to 8%. Conclusions: HIV testing in outpatients is feasible and acceptable to patients and can be offered alongside routine outpatient care. The rate of positive HIV tests in this group of patients in the authors' setting has been much higher than the HIV positivity rate of larger scale HIV testing interventions in other hospital settings. This approach also provides a model for more integrated care of HIV-positive patients. © 2015 MA Healthcare Ltd.
O'Dwyer A.J.,Whipps Cross University Hospital |
Pridgeon S.,Whipps Cross University Hospital |
Green J.S.A.,Whipps Cross University Hospital
Journal of Clinical Urology | Year: 2015
Background: Late surgical cancellations adversely impact patients and efficient use of hospital resources. Non-clinical reasons have a cancellation rate of 0.77%, but when including clinical reasons this rate rises to 13%–15%.1–4 Objectives: The objectives of this article are to identify reasons for cancellations of elective urological procedures at a single centre across different procedure types and to make recommendations for prevention. Methods: Rates and reasons for late cancellation of urological surgery were retrospectively audited for the period April 2009 to April 2012. For each cancellation, reasons were classified: Patient-related, Facility-related, Work-up, Change in medical condition, Process-related, Miscellaneous. Results: During the study period, 9039 elective operations were reviewed to find 2804 cancellations: 580, 450, 1774 (rates = 15.6%, 21.7% and 29.3%) for inpatient, day case and procedure-room cases, respectively. Thirty per cent of inpatient cancellations were due to process-related factors, and 35% due to change in medical condition, of which 78% were urinary tract infection (UTI). Patient-related factors accounted for the majority (52%) of day case and procedural cancellations. Conclusions: Causes for cancellations vary according to procedure type, suggesting tailored strategies are needed for prevention. Change in medical condition caused similar rates of cancellation across procedure type (35%, 28% and 25%). Inpatient procedures were prone to process-related cancellations especially over-run theatre sessions. Patient surveys and reminders closer to time of operation, improvements in preoperative UTI detection and treatment and further process mapping is recommended to identify exact reasons behind and decrease cancellations. © 2015, © British Association of Urological Surgeons 2015.