Hennis P.J.,University College London |
Meale P.M.,University College London |
Hurst R.A.,University of Hertfordshire |
O'Doherty A.F.,University College London |
And 8 more authors.
British Journal of Anaesthesia | Year: 2012
Background For several types of non-cardiac surgery, the cardiopulmonary exercise testing (CPET)-derived variables anaerobic threshold (AT), peak oxygen consumption (peak), and ventilatory equivalent for CO2 () are predictive of increased postoperative risk: less physically fit patients having a greater risk of adverse outcome. We investigated this relationship in patients undergoing gastric bypass surgery.Methods All patients (<190 kg) who were referred for CPET and underwent elective gastric bypass surgery at the Whittington Hospital NHS Trust between September 1, 2009, and February 25, 2011, were included in the study (n121). Fifteen patients did not complete CPET. CPET variables (peak, AT, and) were derived for 106 patients. The primary outcome variables were day 5 morbidity and hospital length of stay (LOS). The independent t-test and Fisher's exact test were used to test for differences between surgical outcome groups. The predictive capacity of CPET markers was determined using receiver operating characteristic (ROC) curves.Results The AT was lower in patients with postoperative complications than in those without [9.9 (1.5) vs 11.1 (1.7) ml kg-1 min-1, P0.049] and in patients with a LOS>3 days compared with LOS≤3 days [10.4 (1.4) vs 11.3 (1.8) ml kg-1 min-1, P0.023]. ROC curve analysis identified AT as a significant predictor of LOS>3 days (AUC 0.640, P0.030). The peak and were not associated with postoperative outcome.Conclusions AT, determined using CPET, predicts LOS after gastric bypass surgery. © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
PubMed | Whittington Hospital Physiotherapy, University of Hertfordshire and Whittington Health
Type: | Journal: Physiotherapy | Year: 2016
To investigate whether COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term and, if so, their experience of this.A mixed methodological approach using semi-structured telephone interviews, a focus group and observation of current PLB technique was used. Qualitative analysis was based on grounded theory.Participants were recruited from the two inner city London (UK) boroughs.A purposive sample of 13 patients with COPD taught PLB 6 to 24 months previously. 11 participants took part in the telephone interviews; focus group participation and observed PLB was 5/11 and 6/11 respectively.A thematic analysis of interviews and focus group; observation of PLB technique.Nine reported on-going use of PLB with 8 reporting definite benefit. Observed technique showed ongoing ability for PLB to reduce RR and increase SpOThis study found 9 of 13 of patients taught PLB continued with long-term use and 8 of 13 reporting definite benefit from PLB. The role of PLB in increasing patients confidence in their ability to manage their breathlessness and, use at night, were novel findings.
PubMed | Belfast City Hospital, Birmingham Womens Hospital, Airedale General Hospital, King's College and 2 more.
Type: Journal Article | Journal: Neurourology and urodynamics | Year: 2016
This paper reports on the publication of a joint statement on minimum standards for continence care in the UK.A multidisciplinary working party were tasked with creating standards for both training and education in continence care, as well as explicit standards for a framework of service delivery. This was done through a process of extensive consultation with relevant professional bodies.The standards suggest a modular structure to continence training, including basic, male, female, catheter care etc. Discussions on service provision cover primary care through to expert tertiary centres.This is the first attempt to standardise continence care and training for all health care professionals nationally. The document is available on the United Kingdom Continence Society website www.ukcs.uk.net.
PubMed | Mental Health, Copenhagen University, Federal University of Rio Grande do Sul, Psychiatric Research Unit and 2 more.
Type: Journal Article | Journal: Evidence-based mental health | Year: 2016
Banaschewski and colleagues from the European Attention Deficit Hyperactivity Disorder (ADHD) guideline group make a number of critical comments regarding our systematic review on methylphenidate for children and adolescents with ADHD. In this article, we present our views, showing that our trial selection was not flawed and was undertaken with scientific justification. Similarly, our data collection and interpretation was systematic and correct. We have followed a sound methodology for assessing risk of bias and our conclusions are not misleading. We acknowledge that different researchers might make risk of bias judgments at higher or lower thresholds, but we have been consistent and transparent in applying our pre-defined and per reviewed protocol. Although we made minor errors, we demonstrate that the effects are negligible and not affecting our conclusions. We are happy to correct such errors and to engage in debate on methodological and ethical issues. In terms of clinical implications, we are advocating that clinicians, patients and their relatives should weight carefully risks and benefits of methylphenidate. Clinical experience seems to suggest that there are people who benefit from this medication. Our systematic review does, however, raise questions regarding the overall quality of the methylphenidate trials.
PubMed | Royal Free Hospital NHS Trust, University College London and Whittington Health
Type: Journal Article | Journal: The International journal of pharmacy practice | Year: 2016
To evaluate the impact of a dedicated specialist critical care pharmacist service on patient care at a UK critical care unit (CCU).Pharmacist intervention data was collected in two phases. Phase 1 was with the provision of a non-specialist pharmacist chart review service and Phase 2 was after the introduction of a specialist dedicated pharmacy service. Two CCUs with established critical care pharmacist services were used as controls. The impact of pharmacist interventions on optimising drug therapy or preventing harm from medication errors was rated on a 4-point scale.There was an increase in the mean daily rate of pharmacist interventions after the introduction of the specialist critical care pharmacist (5.45 versus 2.69 per day, P < 0.0005). The critical care pharmacist intervened on more medication errors preventing potential harm and optimised more medications. There was no significant change to intervention rates at the control sites. Across all study sites the majority of pharmacist interventions were graded to have at least moderate impact on patient care.The introduction of a specialist critical care pharmacist resulted in an increased rate of pharmacist interventions compared to a non-specialist pharmacist service thus improving the quality of patient care.
PubMed | Imperial College London, Southampton Integrated COPD Service, Canterbury Christ Church University, British Lung Foundation and Whittington Health
Type: | Journal: NPJ primary care respiratory medicine | Year: 2016
There is growing interest in Singing for Lung Health (SLH), an approach where patients with respiratory disease take part in singing groups, intended to improve their condition. A consensus group was convened in early 2016 to address issues including: the specific features that make SLH distinct from other forms of participation in singing; the existing evidence base via a systematic review; gaps in the evidence base including the need to define value-based outcome measures for sustainable commissioning of SLH; defining the measures needed to evaluate both individuals responses to SLH and the quality of singing programmes. and core training, expertise and competencies required by singing group leaders to deliver high-quality programmes. A systematic review to establish the extent of the evidence base for SLH was undertaken. Electronic databases, including Pubmed, OVID Medline and Embase, Web of Science, Cochrane central register of controlled trials and PEDro, were used. Six studies were included in the final review. Quantitative data suggest that singing has the potential to improve health-related quality of life, particularly related to physical health, and levels of anxiety without causing significant side effects. There is a significant risk of bias in many of the existing studies with small numbers of subjects overall. Little comparison can be made between studies owing to their heterogeneity in design. Qualitative data indicate that singing is an enjoyable experience for patients, who consistently report that it helps them to cope with their condition better. Larger and longer-term trials are needed.
Rai G.S.,Whittington Health |
Abdulla A.,University of London
Clinical Risk | Year: 2012
Decisions to treat older people rely on accurate assessment of the patient, on clinical needs of the individual, based on risks and benefits of specific treatment and ethical principles, including the right of individuals to accept or refuse treatment. In those who lack capacity to make decisions, the physician tries to ensure that his decision is based on "best interests" principles set out in the Mental Capacity Act 2005. While no physician will admit to age discrimination, in reality there is evidence of inequalities in care and treatment in hospitals, and it is this fact that has led the Government to outlaw discrimination in healthcare under the new provision of the Equality Act 2010. This of course will not mean that all individuals with the same condition will have the right to receive the same treatment-decisions in each case will be based on an individual's clinical need-this fact alone may lead to difficult discussions with relatives and carers, particularly in relation to end-of-life care. This article provides an overview of the basis of management of older patients, and illustrates the importance of taking a holistic approach in the decision-making process.
Hunter M.,Whittington Health
British journal of community nursing | Year: 2015
Chronic oedema is a common problem in the UK and, given the country's ageing population, the numbers are predicted to rise. In an epidemiological study carried out in Derby, England, researchers found the prevalence of chronic oedema to be 3.99 in every 1000 people, with the prevalence increasing to 10.31 in those aged 65-74 years. Often, patients with untreated chronic oedema will develop an ulceration that can lead to further costs and hospital admissions. The cost of treating chronic wounds has been estimated at £2.3 billion-£3.1 billion a year. It is therefore surprising that given the number of patients living with these problems, there is still a lack of knowledge and skill among nurses when assessing patients with chronic oedema and associated ulceration. This article offers advice for nurses when assessing leg ulcers in patients with chronic oedema, detailing the visual skin changes most frequently seen in these patients. The article also discusses some of the treatment options available, briefly covering the advantages and disadvantages of each option.
Brennan E.J.,Whittington Health
British Journal of Nursing | Year: 2015
Heart failure affects 1-2% of the UK population with prevalence rates predicted to rise over the next decade. Ineffective education for patients with heart failure can lead to a failure to adhere to guidance, reduced self-care and increased hospital readmissions. The National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) have issued clear guidelines on patient-centred care in heart failure, particularly in relation to patients' cultural and linguistic needs. Patients with heart failure should have access to an interpreter or advocate if needed. Furthermore, heart failure educational materials should be tailored to suit the individual and be accessible to people who do not speak or read English. This article explores the practice recommendations for these patients with heart failure and provides an overview of current guidelines associated with optimal patient outcomes. It also includes practical advice on translation services, and information and educational materials available for patients with heart failure who do not speak English.
PubMed | Imperial College London, King's College, University of Sydney, University of Oxford and 2 more.
Type: | Journal: The American journal of cardiology | Year: 2016
For patients admitted with worsening heart failure (HF), early follow-up after discharge is recommended. Whether outcomes can be improved when follow-up is done by cardiologists is uncertain. We aimed to determine the association between cardiology follow-up and risk of death for patients with HF discharged from hospital. Using data from the National Heart Failure Audit (England and Wales), we investigated the effect of referral to cardiology follow-up on 30-day and 1-year mortality in 68,772 patients with HF and a reduced left ventricular ejection fraction discharged from 185 hospitals from 2007 to 2013. The primary analyses used instrumental variable analysis complemented by hierarchical logistic and propensity-matched models. At the hospital level, rates of referral to cardiologists varied from 6% to 96%. The median odds ratio (OR) for referral to cardiologist was 2.3 (95% confidence interval [CI] 2.1 to 2.5), suggesting that, on average, the odds of a patient being referred for cardiologist follow-up after discharge differed 2.3 times from one randomly selected hospital to another one. Based on the proportion of patients (per region) referred for cardiology follow-up, referral for cardiology follow-up was associated with lower 30-day (OR 0.70; 95% CI 0.55 to 0.89) and 1-year mortality (OR 0.81; 95% CI 0.68 to 0.95) compared with no plans for cardiology follow-up (i.e., standard follow-up done by family doctors). Results from hierarchical logistic models and propensity-matched models were consistent (30-day mortality OR 0.66; 95% CI 0.61 to 0.72 and 0.66; 95% CI 0.58 to 0.76 for hierarchical and propensity matched models, respectively). For patients with HF and a reduced left ventricular ejection fraction admitted to hospital with worsening symptoms, referral to cardiology services for follow-up after discharge is strongly associated with reduced mortality, both early and late.