Bebington, United Kingdom
Bebington, United Kingdom

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Geurtzen R.,Radboudumc Amalia Childrens Hospital | van Heijst A.F.J.,Radboudumc Amalia Childrens Hospital | Babarao S.,Wirral University Teaching Hospitals | Molloy E.,Royal College of Surgeons in Ireland | And 3 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

There is no international consensus on content and process regarding antenatal counseling in extreme prematurity. The need for adequate training is increasingly recognized. This descriptive study evaluates current practice in antenatal counseling amongst European trainees using an online survey. Focusing on the process, the majority of respondents did not have a medical consensus guideline. Seven percent of the trainees received some formal training. Focusing on the content, about half of the subjects did not mention any statistics about mortality. Conclusion: We observed wide variation in actual content and organization in antenatal counseling in Europe amongst European trainees in neonatology. © 2016 Taylor & Francis.


Unnikrishnan P.N.,Wirral University Teaching Hospitals | Bhalaik V.,Wirral University Teaching Hospital Trust
Orthopaedics and Trauma | Year: 2014

Fractures of the metacarpals and phalanges are the commonest fractures of the upper limb. They can be incapacitating if not treated appropriately. Hand fractures can be complicated by deformity as a result of inadequate treatment, or stiffness from overzealous treatment, leading to poor results. It is important for the treating surgeon to diagnose and understand the management of these fractures. Immediate mobilization after adequate stabilization is the key to treating hand fractures. A comprehensive review of hand fracture management is outlined in this paper. © 2014 Elsevier Ltd.


Adams G.,Clatterbridge Center for Oncology Foundation Trust | Zekri J.,Clatterbridge Center for Oncology Foundation Trust | Wong H.,Clatterbridge Center for Oncology Foundation Trust | Walking J.,Wirral University Teaching Hospitals | Green J.A.,Clatterbridge Center for Oncology Foundation Trust
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

To evaluate the clinical benefit and toxicity of two regimens; single agent carboplatin (C) and a carboplatin/paclitaxel (CP) combination in early epithelial ovarian cancer. Design A retrospective review. Setting Single cancer centre serving a population of 2.1million in the northwest of England. Population All women treated with adjuvant chemotherapy for International Federation of Obstetrics and Gynecology stage Ia-IIc ovarian cancer between 2002 and 2005. Methods Case and operation notes were reviewed. Details of the surgery performed, performance status (PS), tumour histology, stage, grade, intended chemotherapy, chemotherapy received, acute and late toxicity, relapse and death were all recorded. Main outcome measures Overall survival (OS), relapse-free survival (RFS), acute and late toxicity. Results Sixty women received CP and 35 received C. Younger women (P<0.0001) and those with a better performance status (P=0.045) were more likely to receive CP. Median follow up was 38months (range 0-70). Five-year OS was 62% (95% CI 44-81%) for C and 73% (95% CI 61-85%) for CP P=0.316. For the subgroup with stage I disease and good PS (0/1) 5-year OS was 80% (59-100%) for C and 79% (63-95%) for CP; P=1.0. For those with stage 2 disease, 5-year OS was 29% (95% CI 0-62%) for C and 63% (95% CI 44-82%) for CP; P=0.025. Subgroup analyses by grade or histology showed no difference in OS. P was discontinued prematurely in nine (15%) women on account of toxicity, whereas C was not stopped early. P-related neuropathy (G1/2) was reported in ten (17%) women at 6months and in two (3%) at 1year. Conclusions Combination therapy is administered more often than carboplatin; especially in those with younger age, better PS and nonmucinous histology. Recurrence and death rates were similar with both treatments. Well-designed trials are needed to identify the optimum chemotherapy regimen in this group. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.


Bamber A.I.,Wirral University Teaching Hospitals | Fitzsimmons K.,Wirral University Teaching Hospitals | Cunniffe J.G.,Wirral University Teaching Hospitals | Beasor C.C.,Wirral University Teaching Hospitals | And 2 more authors.
British Journal of Biomedical Science | Year: 2012

The laboratory diagnosis of Clostridium difficile infection (CDI) needs to be accurate and timely to ensure optimal patient management, infection control and reliable surveillance. Three methods are evaluated using 810 consecutive stool samples against toxigenic culture: CDT TOX A/B Premier enzyme immunoassay (EIA) kit (Meridian Bioscience, Europe), Premier EIA for C. difficile glutamate dehydrogenase (GDH) (Meridian Bioscience, Europe) and the Illumigene kit (Meridian Bioscience, Europe), both individually and within combined testing algorithms. The study revealed that the CDT TOX A/B Premier EIA gave rise to false-positive and false-negative results and demonstrated poor sensitivity (56.47%), compared to Premier EIA for C. difficile GDH (97.65%), suggesting this GDH EIA can be a useful negative screening method. Results for the Illumigene assay alone showed sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of 91.57%, 98.07%, 99.03% and 84.44%, respectively. A two-stage algorithm using Premier EIA for C. difficile GDH/Illumigene assay yielded superior results compared with other testing algorithms (91.57%, 98.07%, 99.03% and 84.44%, respectively), mirroring the Illumigene performance. However, Illumigene is approximately half the cost of current polymerase chain reaction (PCR) methods, has a rapid turnaround time and requires no specialised skill base, making it an attractive alternative to assays such as the Xpert C. difficile assay (Cepheid, Sunnyvale, CA). A three-stage algorithm offered no improvement and would hamper workflow.


PubMed | Wirral University Teaching Hospitals
Type: Journal Article | Journal: British journal of biomedical science | Year: 2012

The laboratory diagnosis of Clostridium difficile infection (CDI) needs to be accurate and timely to ensure optimal patient management, infection control and reliable surveillance. Three methods are evaluated using 810 consecutive stool samples against toxigenic culture: CDT TOX A/B Premier enzyme immunoassay (EIA) kit (Meridian Bioscience, Europe), Premier EIA for C. difficile glutamate dehydrogenase (GDH) (Meridian Bioscience, Europe) and the Illumigene kit (Meridian Bioscience, Europe), both individually and within combined testing algorithms. The study revealed that the CDT TOX A/B Premier EIA gave rise to false-positive and false-negative results and demonstrated poor sensitivity (56.47%), compared to Premier EIA for C. difficile GDH (97.65%), suggesting this GDH EIA can be a useful negative screening method. Results for the Illumigene assay alone showed sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of 91.57%, 98.07%, 99.03% and 84.44%, respectively. A two-stage algorithm using Premier EIA for C. difficile GDH/Illumigene assay yielded superior results compared with other testing algorithms (91.57%, 98.07%, 99.03% and 84.44%, respectively), mirroring the Illumigene performance. However, Illumigene is approximately half the cost of current polymerase chain reaction (PCR) methods, has a rapid turnaround time and requires no specialised skill base, making it an attractive alternative to assays such as the Xpert C. difficile assay (Cepheid, Sunnyvale, CA). A three-stage algorithm offered no improvement and would hamper workflow.


To evaluate changes in bone mineral density (BMD), body composition, muscle strength and health-related quality of life (HRQL) during bicalutamide (150 mg) monotherapy in osteoporotic patients with non-metastatic locally advanced prostate cancer. Osteoporosis is prevalent in men presenting with prostate cancer and also a common side effect of treatment with luteinizing hormone-releasing hormone agonists, which are associated with decreased BMD and loss of lean body mass and suppress testosterone, unlike bicalutamide, which results in an increase in serum testosterone and oestrogen levels. Forty-two men with non-metastatic locally advanced prostate cancer and osteoporosis (T-score -2.5) were treated with bicalutamide (150 mg) monotherapy. BMD was measured at baseline and 1 year. HRQL was assessed 3-monthly using the RAND 36-Item Health Survey and University of California Los Angeles Prostate Cancer Index questionnaires. Bone turnover markers, liver function tests, prostate-specific antigen, testosterone, oestradiol and haemoglobin were measured at baseline, at 3 weeks and 3-monthly thereafter. Arm anthropometry and dynamometry assessed fat mass, skeletal muscle mass and quadriceps strength. BMD was maintained (+2.1% lumbar spine, +1.2% total hip and +1.1% forearm). Prostate-specific antigen decreased by 88% at 3 months. Testosterone and oestradiol had increased at 1 year by 58% and 42%, respectively. No increase in bone turnover markers was seen over 1 year. Quadriceps muscle strength was maintained. General and prostate cancer-specific HRQL were maintained throughout the study, with no significant reductions in physical or sexual function. Adverse events included breast pain and gynaecomastia. Bicalutamide preserves BMD, muscle strength and HRQL in osteoporotic men with non-metastatic locally advanced prostate cancer. It provides an alternative to medical castration for well informed men at high fracture risk and those wishing to retain physical and sexual activity, with luteinizing hormone-releasing hormone agonists being reserved for those failing to respond or relapsing.


PubMed | Wirral University Teaching Hospitals
Type: Journal Article | Journal: BJU international | Year: 2012

To evaluate the efficacy of zoledronic acid (ZA) in osteoporotic patients with prostate cancer receiving either luteinizing hormone-releasing hormone agonists (LHRHA, which accelerate bone loss) or bicalutamide (which preserves bone mineral density, BMD) as androgen-deprivation therapy is the mainstay of treatment for advanced prostate cancer, and many patients are osteoporotic at presentation, with others becoming so on treatment.Fifty-eight osteoporotic men with non-metastatic prostate cancer were followed for 3 years. Patients were randomly assigned to receive either LHRHA (29) or bicalutamide (29). All received 4 mg ZA 3-monthly for 1 year. BMD was measured by dual energy X-ray absorptiometry at four times: 1 year before ZA; immediately before ZA; after five infusions; and 1 year afterwards. Bone turnover markers (BTMs) were measured at 3-monthly intervals on ZA and 1 year later. All patients had radiography of the thoracolumbar spine at baseline and after ZA.Patients on LHRHA showed a 4.9% decrease in BMD before ZA, a 1.6% increase after ZA and a 3.0% decrease 1 year later, compared to 2.0% increase, 7.8% increase and 1.9% decrease, respectively, in those on bicalutamide. BTMs decreased significantly after ZA. Seven patients (12%) had vertebral fractures at baseline, with none deteriorating at 1 year; two (3.5%) developed mandibular osteonecrosis.Before ZA, BMD decreased on LHRHA, but was maintained on bicalutamide. Treatment with 3-monthly ZA increased BMD and suppressed BTMs in osteoporotic patients both on LHRHA and bicalutamide, but to a greater extent in the latter. However, 1 year after the last infusion, BMD declined, suggesting that annual administration is inadequate in these patients. The optimum frequency might be related to BMD at time of bisphosphonate initiation.

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