Worcester, United Kingdom
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Davis S.,University of Sheffield | Pitcher D.,Worcestershire Acute Hospitals NHS Trust | Petkar S.,Hull and East Yorkshire Hospitals NHS Trust
Europace | Year: 2012

Aims To assess the cost-effectiveness of implantable loop recorders (ILRs) in people with transient loss of consciousness (TLoC), which, after initial assessment and specialist cardiovascular assessment, is either suspected to be arrhythmic in origin or remains unexplained. This analysis was conducted to inform clinical guideline recommendations made by the National Institute for Health and Clinical Excellence (NICE) on the management of TLoC. Methods and resultsDecision analytic modelling was used to estimate the costs and benefits of using ILRs compared with a strategy of no further diagnostic testing. Diagnostic outcomes were estimated from a systematic review and used to populate a decision tree model. To capture the main consequences of diagnosis, the costs and benefits of treatment for several clinically significant arrhythmias were estimated within the model. We used a cost-utility approach, in which benefits are measured using quality adjusted life years (QALYs), and took a UK National Health Service (NHS) and personal social services perspective. The cost per QALY was £17 400 in patients with unexplained syncope and £16 400 in patients with suspected arrhythmic syncope. Sensitivity analysis found that the cost-effectiveness estimates are fairly robust despite the areas of uncertainty identified in the evidence and assumptions used to inform the model. ConclusionsImplantable loop recorder monitoring is likely to be a cost-effective strategy in people presenting to the UK NHS who are experiencing infrequent episodes of TLoC which either remain unexplained or are suspected to be arrhythmic after initial assessment and specialist cardiovascular assessment. Implantable loop recorder monitoring has been recommended by NICE for these populations. © The Author 2011.


Sullivan J.G.,Worcestershire Acute Hospitals NHS Trust | Sullivan J.G.,Bristol Urological Institute | Swithinbank L.,Southmead Hospital | Abrams P.,Southmead Hospital
Neurourology and Urodynamics | Year: 2012

Aims Establishing accurate initial resting pressures is an important step in quality control at the start of a urodynamics test. We therefore carried out a prospective study to establish the initial resting pressures achievable with careful quality control. Methods Consecutive patients undergoing urodynamics were recruited. Initial resting pressures were recorded in lying, sitting, and standing positions for each patient. The detrusor pressure values obtained before filling were then compared with the pressures obtained during filling. Results Initial resting abdominal and intravesical pressures were similar and at least 95% lay in the following ranges: lying 0-18cmH 2O, sitting 15-40cmH 2O, standing 20-50cmH 2O: these data gave initial resting detrusor pressure readings between -5 and +5 cmH 2O in 97%, 97%, and 96%, respectively. Comparison of initial resting pressure readings with those obtained during filling showed that the narrow range of pressures was maintained during the urodynamic test. Conclusions This study provides detailed prospective data on achievable initial resting pressures in urodynamics. In this study, p det was normally at or close to zero, and distributed more or less evenly either side. This suggests a range that differs from existing ICS GUP guidelines, and could be incorporated in future ICS guidelines. Copyright © 2012 Wiley Periodicals, Inc.


Fowell C.J.,Coventry University | Earl P.,Worcestershire Acute Hospitals NHS Trust
British Journal of Sports Medicine | Year: 2013

Despite bone healing and the management options of facial fractures being reported at length, there is a lack of evidence-based return-to-play criteria for sportspeople who have sustained these fractures. This shortage of evidence has resulted in a lack of consensus among health professionals. A prospective study of 20 cases of sportsmen who have returned to competitive play 3 weeks after injury or treatment for facial fractures is reported. The risks and benefits of early return-to-play are discussed and return-to-play guidelines for these patients are proposed.


Hicks N.,Worcestershire Acute Hospitals NHS Trust | Gupta S.,James Paget University Hospital
Scandinavian Journal of Urology | Year: 2016

Objective: The primary aim of this study was to assess the complication rate after elective scrotal surgery for benign conditions, following the observation that a higher than expected number of patients were requiring intervention for complications of their surgery. The secondary aim was to assess how different risk factors affected the complication rate, therefore identifying areas for improvement in clinical practice. Materials and methods: All patients from April 2008 to September 2013 who underwent an elective hydrocele repair, epididymal cyst excision or epididymectomy at a UK district general hospital were included. Patient notes were reviewed and risk factors for surgery and postoperative complications recorded. Results: In total, 222 patients were included. The overall complication rate was 27.4%. Complications included haematoma (9.0%), infection (5.0%), recurrence of swelling (7.2%) and chronic pain (0.2%). The only risk factor to have a significant relationship to complication rate was a body mass index of 30 kg/m² or greater (χ² = 6.698, p = 0.010). Conclusions: The most common complications after scrotal surgery for benign conditions were haematoma formation, infection and recurrence or persistence of swelling. The only risk factor identified as having a potentially adverse effect on complication rate was a raised body mass index of 30 or greater. © 2016 Acta Chirurgica Scandinavica Society


Muir A.,Worcestershire Acute Hospitals NHS Trust | Holden C.,Worcestershire Acute Hospitals NHS Trust | Sexton E.,Worcestershire Acute Hospitals NHS Trust | Gray J.W.,Worcestershire Acute Hospitals NHS Trust
Journal of Pediatric Gastroenterology and Nutrition | Year: 2014

Patients receiving home parenteral nutrition (HPN) are at particularly high risk of meticillin-sensitive Staphylococcus aureus (MSSA) catheter-related bloodstream infections (CRBSI). We developed a multidisciplinary enhanced care pathway encompassing a number of minimal cost interventions involving line/exit site care, training for staff and parents, multidisciplinary discharge planning, and monitoring compliance. Implementation reduced the mean rates of MSSA CRBSI (from 0.93, 95% CI 0.25-1.61, to 0.23, 95% CI -0.06 to 0.52, per 1000 parenteral nutrition [PN] days) and all-cause CRBSI (from 1.98, 95% CI 0.77-3.19, to 0.45, 95% CI 0.10-0.80, per 1000 PN days). A similar approach could be applied to preventing health care-associated infections in other complex, vulnerable patient groups. Copyright © 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Nkwam N.,Worcestershire Acute Hospitals NHS Trust | Chen T.F.,Worcestershire Acute Hospitals NHS Trust
International Journal of Surgery Case Reports | Year: 2013

Introduction: Non-muscle invasive transtitional cell carcinoma (TCC) with metastases is exceedingly rare. Presentation of Case: We report the case of a 78-year old man with an incidental finding of a non-muscle invasive TCC of the left distal ureter during treatment for Duke's B Colon cancer. Following laparoscopic nephro-ureterectomy (LNU) he had two further superficial recurrences in the bladder over a 14-month period which underwent transurethral resection (TUR). On surveillance imaging for his colorectal cancer follow-up a lung nodule was detected and video-assisted thoracic surgical (VATS) resection of the lesion showed it to be TCC in origin. He was referred to oncology for chemotherapy and remains clinically well. Discussion: A Literature search found only three other such cases and the ureteric TCC is the most likely source of the metastasis. Conclusion: This occurrence is exceedingly rare. © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.


Chamberlain D.,Worcestershire Acute Hospitals NHS Trust
Health Information and Libraries Journal | Year: 2014

Background: Health organisations are often driven by specific targets defined by mission statements, aims and objectives to improve patient care. Health libraries need to demonstrate that they contribute to organisational objectives, but it is not clear how nurses view that contribution. Objectives: To investigate ward nursing staff motivations, their awareness of ward and organisational objectives; and their attitudes towards the contribution of health library services to improving patient care. Method: Qualitative research using focus group data was combined with content analysis of literature evidence and library statistics (quantitative data). Data were analysed using thematic coding, divided into five group themes: understanding of Trust, Ward and Personal objectives, use of Library, use of other information sources, quality and Issues. Four basic social-psychological processes were then developed. Results: Behaviour indicates low awareness of organisational objectives despite patient-centric motivation. High awareness of library services is shown with some connection made by ward staff between improved knowledge and improved patient care. Conclusion: There was a two-tiered understanding of ward objectives and library services, based on level of seniority. However, evidence-based culture needs to be intrinsic in the organisation before all staff benefit. Libraries can actively engage in this at ward and board level and improve patient care by supporting organisational objectives. © 2014 Health Libraries Group.


Southall D.,Worcestershire Acute Hospitals NHS Trust
Palliative Medicine | Year: 2013

Background: The modes of communication which patients use are seen as important within the sphere of palliative care and have been the focus of much research. Aim: This literature review aims to identify and analyse one particular mode of patient expression, namely that of the figure of speech (trope) 'metaphor', and ask questions regarding metaphor's therapeutic usefulness when engaging with the life-limited patient. Data Sources: The investigation revolves around a literature review of academic papers which focus on the metaphorical ways in which patients speak of their condition. Results: This paper provides the theoretical foundations for the patient's metaphoric utterances. It also delineates the variety and diversity of metaphors used by patients and categorises them into broad groupings which encompass metaphors of war, journeying, personhood, the natural world and existential concepts. Conclusions: The papers reviewed suggest that metaphoric communication allows sensitive subjects to be dealt with and provides benefits for patients. The results suggest that engaging with patients at the metaphoric level enables them to create new ways of viewing their situation and opens up the possibilities of new coping strategies. Finally, some developmental trajectories emanating from the reviewed papers are suggested, which will allow the efficacy of metaphor to be explored further within a palliative care setting. © The Author(s) 2012.


Morris L.,Worcestershire Acute Hospitals NHS Trust
Wounds UK | Year: 2011

The 'Your Skin Matters' section of the High Impact Actions (HIAs) for Nursing and Midwifery (2009) largely focuses on preventing pressure ulcers. However, moisture lesions or incontinence-associated dermatitis (IAD) can be of equal distress to the patient as a pressure ulcer. This condition often results in pain from breakdown of the skin, increased risk of infection and length of hospital inpatient stay, as well as affecting patient dignity from the embarrassment of faecal/urinary incontinence. Like pressure ulcers, moisture lesions can often be prevented. This paper describes an intervention for faecal incontinence that can help to prevent and manage this condition and, thus, has an impact on patient safety, clinical-effectiveness and patient experience.


Thomson A.J.M.,Worcestershire Acute Hospitals NHS Trust
Journal of Minimally Invasive Gynecology | Year: 2013

Electricity is the flow of electrons through a conductor. The amount of current (amps) is related to the voltage (volts) pushing the electrons and the degree of resistance to flow (ohms). During their flow around a circuit, electrons can be used to create a number of useful byproducts such as heat and light. As electrons flow, they alter the charge of the matter they flow through, which may also generate electromagnetic effects. © 2013 AAGL.

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