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Levy D.,Whipps Cross University Hospital | Levy D.,Queen Mary, University of London
Practical Diabetes Care, Third Edition | Year: 2011

This new and completely revised third edition is a concise, systematic and highly practical guide to the care of patients with Type 1 and Type 2 diabetes. Clinically and problem-based, it covers emergency, inpatient and ambulatory diabetes care in the hospital and community, focusing particularly on difficult, grey and contentious areas of management, and seeks to guide advanced practitioners through problems that are not always emphasised. Up to date clinical trial results have been incorporated, as well as concise discussions of lifestyle approaches to diabetes management, and it includes a new chapter on psychological problems in diabetes. It is now fully referenced with PubMed PMID numbers and all HbA1c measurements are quoted in DCCT and IFCC units. It will be valuable for foundation year and specialist trainees in general medicine, diabetes and endocrinology; community and hospital diabetes specialist nurses and nurse practitioners; hospital-based ward staff in specialist and non-diabetes-specialist departments, especially cardiology and emergency medicine; and general practice diabetes leads and general practitioners with a specialist diabetes interest. It will be equally valuable for hands-on reference use in the clinical situation, and for clinicians in hospital medicine and general practice studying for postgraduate diplomas and examinations. © 2011 David Levy. Source


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. Source


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. Source


Mullins E.,London North West Hospitals NHS Trust | Agarwal N.,London North West Hospitals NHS Trust | Oliver R.,Whipps Cross University Hospital | Odejinmi J.F.,Whipps Cross University Hospital
International Journal of Gynecology and Obstetrics | Year: 2015

Abstract Objective To establish whether the finding of perihepatic adhesions (PHAs) at laparoscopy for ectopic pregnancy (EP) is associated with poor perioperative and reproductive outcomes. Methods A retrospective cohort study was undertaken of all cases of EP managed surgically at a teaching hospital in northeast London in 2003-2013. Data for symptoms, reproductive history, ultrasonography findings, blood parameters, and findings at surgery were compared between patients with and without perihepatic adhesions (PHAs) identified at laparoscopy. Results Among 802 women with EP, PHAs were identified during surgery for 60 (7.5%). Compared with women without PHAs, patients with PHAs were significantly more likely to have had previous pelvic inflammatory disease, previous EP, previous tubal surgery, and the finding of abnormal contralateral adnexa or other adhesions during laparoscopy (P ≤ 0.024 for all). They also had higher preoperative hemoglobin concentrations and smaller hemoperitoneum volumes (P ≤ 0.04 for both). Conclusion Women with PHAs at laparoscopy for EP had lower blood loss than did those without PHAs. The finding of PHAs was associated with an increased rate of recurrent EP, irrespective of a previous history of PID or EP. © 2015 International Federation of Gynecology and Obstetrics. Source


Sarkar S.,Imperial College London | Arora S.,Imperial College London | Lamb B.W.,Imperial College London | Lamb B.W.,Whipps Cross University Hospital | And 4 more authors.
Journal of Clinical Urology | Year: 2014

Objective: To improve communication and decision making between specialists, multidisciplinary teams (MDTs) were introduced with the premise they would improve cancer care for patients. Minimal evidence exists on MDT functionality. We investigated MDT members’ views on barriers to optimal functioning and explored their suggestions for improvements.Materials and methods: Twenty urology MDT members from seven hospitals including surgeons, oncologists, pathologists, radiologists and clinical nurse specialists took part in a semi-structured interview study. Interviews focused on information presentation, case discussion, factors affecting the multidisciplinary team meeting (MDM) and potential improvements. Interviews were transcribed and analysed through emergent theme analysis.Results: Factors negatively influencing the MDMs included insufficient time to prepare cases so that enough information is available to make appropriate decisions; absence of the clinician in charge or not knowing the patient; and lack of a systematic approach to case discussion. Recommendations included protected time for case preparation, focusing on performance and comorbidities of the patient, standardising the MDT meeting and improving case selection.Conclusions: MDTs in urology have contributed to advances in cancer care but there is significant scope for further improvement. Implementing recommendations from team members on the front line may help drive quality in this sensitive domain. © British Association of Urological Surgeons 2014. Source

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