Multi-institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures.
Author(s): Sgourakis G; Departament of General Surgery, Royal Blackburn Hospital et al.
Source: Journal of hepato-biliary-pancreatic sciences, 2022 Feb 05.
Abstract: Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single-stage management of choledocholithiasis. Based on this multicenter survey, LBDE is a safe and effective approach when performed by experienced teams. The generalization of LBDE will be based on developing training programs.
An analysis of publicly available National Health Service information leaflets for patients following an upper arm break
Author(s): May, P., Yeowell, G., Connell, L. and Littlewood, C.
Affiliation: East Lancashire Hospitals NHS Trust.
Faculty of Health, Psychology and Social Care, Manchester Metropolitan University.
Allied Health Research Unit, University of Central Lancashire/Rakehead Rehabilitation Centre, East Lancashire Hospitals NHS Trust.
Source: Musculoskeletal Science and Practice, June 2022 59
Abstract: Recovery following an upper arm break can be prolonged and cause loss of independence. Appropriate information provision to empower and enable active participation in rehabilitation is vital to achieve the best clinical outcomes. Current information leaflets made available for patients following upper arm breaks are not fit for purpose and are written in a way that the general population would not readily understand. There is an urgent need to understand the information needs of patients and present such information in an accessible way to optimise clinical outcomes following upper arm breaks.
'You know where we are if you need us.' The role of primary care in supporting patients following pancreaticoduodenectomy for cancer: a qualitative study.
Author(s): Taylor AK. School of Medicine, Leeds Institute of Health Sciences.
Kausar A; Department of General Surgery, Royal Blackburn Hospital.
Chang D; Department of General Surgery, Royal Blackburn Hospital.
Phelan A; School of Medicine, Keele University.
Chew-Graham CA; Academic Clinical Fellow in Psychiatry, School of Medicine, Leeds Institute of Health Sciences.
Source: BJGP open, 2022 Jan 19.
Abstract: Ten percent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. It is known that these patients have unmet psychological support needs, and GPs are key in enabling effective coordination of care for people living with life-shortening conditions. Aim: To explore patients' perspectives on the role of primary care in their management, and their sources of support. Conclusion: Patients may feel a 'burden' to both healthcare professionals and their own support networks following pancreaticoduodenectomy. Primary care is in a key position to proactively offer psychological support.
Author(s): Seethamraju RR; From the NICU, Lancashire Women and Newborn Center (R.R.S.), Burnley General Hospital, East Lancashire et al.
Source: Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2022 Feb 01; Vol. 17 (1), pp. e122-e127.
Abstract: The PediSTARS Faculty Development Program is a novel approach for simulation faculty training with an aim to increase the pool of trained simulation faculty in India and neighboring countries that could then facilitate simulation-based training, both at their own workplaces and in the PediSTARS simulation-based workshops that provide training in pediatric and neonatal emergencies. This commentary describes the evolution of the faculty development program, the initial process, the feedback obtained, the changes undertaken, the progress made to date, and the challenges ahead. There is also an emphasis on the key generalizable principles that can be applicable to other low-resource settings.
Augmented trabeculectomy-outcomes of first hundred versus second hundred surgeries of a fellowship-trained glaucoma surgeon.
Author(s): Rattanasirivilai P; Department of Ophthalmology, East Lancashire Hospitals NHS Trust.
Ali ZC; Manchester Royal Eye Hospital, University of Manchester.
Khoo DI; Department of Ophthalmology, East Lancashire Hospitals NHS Trust.
Shankar V; Department of Ophthalmology, East Lancashire Hospitals NHS Trust.
Source: European journal of ophthalmology, 2022 Jan; Vol. 32 (1), pp. 300-308.
Abstract: We aim to compare the outcomes of trabeculectomy with mitomycin-C by a fellowship-trained glaucoma surgeon in the first hundred compared to second hundred surgeries. We found no statistical difference between the first hundred and second hundred patient's postoperative IOP at week 4 ( p = 0.17), 3 months ( p = 0.74), 6 months ( p = 0.46), 12 months ( p = 0.47), 18 months ( p = 0.13) or at final follow up ( p = 0.53). The mean final follow up period was 3.6 ± 0.7 years. Mean IOP reduction in Group 1 was from 27.1 ± 10.8 to 12.6 ± 7.1 ( p < 0.0001) and Group 2 from 22.8 ± 8.4 to 11.3 ± 4.2 ( p < 0.0001). Kaplan-Meier graphs showed no significant difference in complete success ( p = 0.0693) or qualified success ( p = 0.0866) between Group 1 and Group 2. Bleb interventions were not statistically significant between two groups. There was a significantly higher rate of complications with the first hundred patients ( p < 0.0001).; Conclusion: Both first hundred and second hundred patient groups achieved statistically similar outcomes in long term IOP control. Significant reduction of complications was achieved in the second group of patients.
Author(s): Mudiganty, S., Hughes, L., Choudry, Q. and Bokhari, A. s, Barts Health NHS Trust and East Lancashire Hospitals NHS Trust.
Source: SICOT-J, Vol 8, p 2 (2022)
Abstract: Periprosthetic fractures are associated with significant morbidity and mortality. The “hub and spoke model” consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractures at a large general district hospital, the Royal Blackburn Hospital.
Author(s): McEvoy, M. Department of Anesthesiology, Vanderbilt University School of Medicine.
Raymond, Britany L. Hi-RiSE Perioperative Optimization Clinic, Vanderbilt University Medical Center.
Krige, A. Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital.
Source: Anesthesiology Clinics March 2022 40(1):35-58
Abstract: Opioid-based analgesia in the perioperative period can provide excellent pain control, but this approach exposes the patient to avoidable side effects and possible harm. Optimal analgesia, an approach that targets the fastest functional recovery with adequate pain control while minimizing side effects, can be achieved with opioid minimization. Many different options for nonopioid multimodal analgesia exist and have been shown to be efficacious, with certain modalities being more beneficial for specific surgeries. This review will present the evidence and practical tips for these management strategies.
Author(s): Matthews R; Department of Post-Graduate Medical Education, Royal Blackburn Teaching Hospital.
Ali Z; Department of Post-Graduate Medical Education, Salford Royal Foundation Trust.
Source: Clinical and experimental dermatology,2022 Jan; Vol. 47 (1), pp. 24-29.
Abstract: The term 'pemphigus' refers to chronic autoimmune skin disorders that cause blistering erosions on the skin and oral mucosa. The two major clinical forms are pemphigus vulgaris and pemphigus foliaceus. Although rare, they confer a stark symptomatic burden upon patients that significantly impacts daily life. Comorbid mental health issues are not routinely screened for in patients with pemphigus, and current UK guidance provides no formal provision for the identification and treatment of psychological issues. This review is the first of its kind, to our knowledge, to systematically examine the available evidence on mental health issues in pemphigus.
Author(s): Lamb R; Department of Clinical Radiology, East Lancashire Hospitals Trust
Kahlon A; Department of Clinical Radiology, East Lancashire Hospitals Trust
Sukumar S; Department of Clinical Radiology, University Hospital of South Manchester
Layton B; Department of Clinical Radiology, East Lancashire Hospitals Trust
Source: Clinical radiology, 2022 Jan 07
Abstract: Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through herniation of the internal layers of the bowel wall through the muscularis propria. Peri-ampullary duodenal diverticula are a well-recognised example; however, the importance of more distal SBD in the jejunum and ileum is underappreciated, and they are under-reported on cross-sectional imaging. SBD are a known cause of anaemia, malabsorption, and diarrhoea, and there are myriad complications of SBD and Meckel's diverticula, which range in severity from inflammation and perforation to haemorrhage, tumour formation, and obstruction. Before the advent of computed tomography (CT), SBD were readily diagnosed on fluoroscopic oral contrast studies; however, radiologists are less comfortable with their cross-sectional imaging appearances. This imaging review combines our experience of multiple proven cases, with illustrative diagrams and radiological images of SBD to provide distinct imaging characteristics, allowing for confident diagnosis of SBD and their numerous complications. We discuss the importance of SBD as a cause of benign, non-surgical pneumoperitoneum. We additionally provide important pitfalls to be aware of such as SBD masquerading as other abnormalities.
Patient-Specific Three-Dimensional Planning for Head and Neck Reconstruction: Paradigm Shift and Refuted Myths
Author(s): Kyzas, P. Department of Oral and Maxillofacial Surgery, Royal Blackburn Teaching Hospital
Source: Plastic and Reconstructive Surgery. Feb 01, 2022 149(2):359e-361e
Abstract: Patient-specific planning and three-dimensional printing have revolutionized head and neck reconstruction. Tumor resection/flap harvesting are guided by laboratory-made guides using the patient’s scan data. This leads to the downfall of many surgical myths, five of which are debunked in this article.
Author(s): Krige A; Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital
Kelliher LJS; Department of Anaesthetics, Royal Surrey County Hospital NHS Foundation Trust
Source: Anesthesiology clinics, 2022 Mar; Vol. 40 (1), pp. 91-105
Abstract: This article will focus on the perioperative management of hepatic resection for colorectal cancer (CRC) liver metastases (CLRMs) (the liver is the dominant metastatic site for CRC) within the context of the Enhanced Recovery After Surgery (ERAS) paradigm. It discusses the epidemiology and outcomes along with the history of hepatic resection surgery and pertinent anatomy.
The effect of motor imagery on quality of movement when performing reaching tasks in healthy subjects: A proof of concept
Author(s): Kolářová, Barbora; Richards, Jim; Haltmar, Hana; Lippertová, Klára; Connell, Louise; Chohan, Ambreen
Affiliation: Faculty of Health Sciences, Palacký University Olomouc, Czech Republic
Kinesiology Laboratory, Rehabilitation Department, University Hospital, Olomouc, Czech Republic
Allied Health Research Unit, University of Central Lancashire, Preston, United Kingdom
Faculty of Physical Culture, Palacký University Olomouc, Czech Republic
East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
Source: Journal of Bodywork & Movement Therapies, Jan2022; 29: 161-166.
Abstract: The use of motor imagery (MI) has been shown to offer significant improvements in movement performance in sports, and is now receiving a lot of attention as a relatively new therapeutic approach which can be applied in rehabilitation. However, the effects of MI on the quality of movement is still unclear. This study explored the immediate effect of MI on reaching tasks in healthy subjects. The results indicate that the use of MI just after physical practice appears to have an immediate effect on the muscle activity and kinematics during a reaching task, which may suggest an improved quality of movement. This proof of concept study shows the potential for MI to improve the quality of performing reaching task and offers a possible therapeutic option for Stroke survivors and other neuromuscular disorders.
Author(s): Khudr, J; Hughes, L; Younis, F.
Affiliation: Department of Vascular Surgery, Royal Liverpool & Broadgreen Hospitals NHS Trust.
Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust.
Source: British Journal of Hospital Medicine (17508460) 83(1), pp. 1-10
Abstract: Wide awake local anaesthesia no tourniquet, also known as WALANT, is the practice of performing surgery under local anaesthetic in the absence of a tourniquet. This technique uses the vasoconstrictive effects of adrenaline and the local anaesthetic effects of lignocaine to establish a Bier block with haemostatic control. Permitting active patient participation intraoperatively, wide awake local anaesthesia no tourniquet surgery improves patient compliance with rehabilitation and yields higher patient satisfaction. With reduced cost and equipment requirements, this method improves accessibility for patients and productivity for healthcare institutions. This is of particular benefit within the current COVID-19 climate, as wide awake local anaesthesia no tourniquet technique provides a means of overcoming restrictions to theatre access and anaesthetic support. This review delves into the current uses of wide awake local anaesthesia no tourniquet surgery, outlining the initial conception of the practice by Canadian surgeons. The advantages and disadvantages are considered, and potential future applications of this technique are discussed.
Author(s): Kelly L; Endoscopy Department, Burnley General Hospital, East Lancashire Hospital NHS Trust
Source: Nursing standard, 2022 Mar 08
Abstract: Colonoscopy is an invasive, endoscopic procedure undertaken to visualise the inner lumen of the colon and is used for a variety of diagnostic purposes. The procedure is increasingly performed by nurse endoscopists. This article provides an overview of the indications and contraindications for colonoscopy and describes various elements of the procedure, including consent, sedation and bowel preparation within the context of the evidence base. The article also discusses patient care before, during and after the procedure.
Author(s): Kelliher LJS; Department of Anaesthetics, Royal Surrey County Hospital NHS Foundation Trust
Krige A; Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital
Source: Anesthesiology Clinics, 11 Feb 2022, 40(1):107-117
Abstract: This article provides a broad perspective on the salient perioperative issues encountered when caring for patients undergoing pancreatic surgery in the setting of pancreatic cancer. It describes the epidemiology of pancreatic cancer, the indications for and evolution of pancreatic resection surgery, the challenges faced perioperatively including patient selection, optimization, anesthetic considerations, postoperative analgesia, fluid management, and nutrition and discusses some of the common complications and their management. It finishes by outlining the future directions for research and development required to continue improving outcomes for these patients.
10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification.
Author(s): Garg S; Department of Cardiology, Royal Blackburn Hospital et al.
Source: JACC.Cardiovascular Interventions 15(2), pp. 193-204
Abstract: The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation.
Author(s): Jubouri M; Hull York Medical School, University of York
Abdelhaliem A; Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital
Source: Journal of Cardiac Surgery, 2021 Dec
Abstract: The introduction of the single-step total arch replacement (TAR) with frozen elephant trunk (FET) has revolutionised the field of aortic surgery. TAR is indicated when the aortic arch is involved in aortic pathologies such as Type A aortic dissection and thoracic aortic aneurysms. Several FET devices are available commercially for global use, and example is the E-Vita Open NEO hybrid prosthesis (HP) developed by CryoLife-JOTEC. Unlike other FET devices available, this HP in particular features a design that puts it at a disadvantage as it does not incorporate gelatine or collagen in its structure, which makes it permeable to blood. Several studies have reported incidence of post-anastomotic blood oozing through the E-Vita Open NEO right after weaning from cardiopulmonary bypass. This commentary aims to discuss the recent study by Tan et al. which investigated E-Vita NEO device oozing as well as the implications of using BioGlue to overcome this serious complications.
Author(s): Garg S; East Lancashire Hospitals NHS Trust et al.
Source: PloS one, 2022 Jan 24; Vol. 17 (1), pp. e0262861.
Abstract: We sought to assess the impact of sex on in-hospital mortality of patients with COVID-19 infection in South Korea. The study recruited 5,628 prospective consecutive patients who were hospitalized in South Korea with COVID-19 infection, and enrolled in the Korea Centers for Disease Control and Prevention (KCDC) dataset between January 20, 2020, and April 30, 2020. The primary endpoint was in-hospital death from COVID-19. The cohort comprised of 3,308 women (59%) and 2,320 men (41%). In-hospital death was significantly lower in women than men (3.5% vs. 5.5%, hazard ratio (HR): 0.61; 95% confidence interval (CI): 0.47 to 0.79, p <0.001). Results were consistent after multivariable regression (HR: 0.59; 95% CI: 0.41 to 0.85, p = 0.023) and propensity score matching (HR: 0.51; 95% CI: 0.30 to 0.86, p = 0.012). In South Korea, women had a significantly lower risk of in-hospital death amongst those patients hospitalized with COVID-19 infection
Angiography-derived physiology guidance vs usual care in an All-comers PCI population treated with the healing-targeted supreme stent and Ticagrelor monotherapy: PIONEER IV trial design
Author(s): Garg S; Department of Cardiology, Royal Blackburn Hospital et al.
Source: American heart journal, 2022 Jan 03; Vol. 246, pp. 32-43.
Abstract: Current ESC guidelines recommend the use of intra-coronary pressure guidewires for functional assessment of intermediate-grade coronary stenoses. Angiography-derived quantitative flow ratio (QFR) is a novel method of assessing these stenoses, and guiding percutaneous coronary intervention (PCI). The PIONEER IV trial is a prospective, all-comers, multi-center trial, which will randomize 2,540 patients in a 1:1 ratio to PCI guided by angiography-derived physiology or usual care, with unrestricted use in both arms of the Healing-Targeted Supreme sirolimus-eluting stent (HT Supreme).
A randomized trial of endometrial scratching in women with PCOS undergoing ovulation induction cycles.
Clarke F; East Lancashire NHS Teaching Hospitals Trust
Hammond B; East Lancashire NHS Teaching Hospitals Trust
Milner M; East Lancashire NHS Teaching Hospitals Trust
Shankaralingaiah N; East Lancashire NHS Teaching Hospitals Trust
Source: Reproductive biomedicine online, 2022 Feb; Vol. 44 (2), pp. 316-323.
Abstract: An international, multicentre, randomized, sham-controlled trial across six fertility clinics in three countries (New Zealand, UK and Brazil). Women with a diagnosis of PCOS who were planning to commence ovulation induction cycles (at least three cycles) in order to conceive were randomly assigned to receive the pipelle (scratch) procedure or a sham (placebo) procedure in the first cycle of ovulation induction. No difference was detected in live birth rate for women with PCOS who received an endometrial scratch when trying to conceive using ovulation induction; however, uncertainty remains due to the small sample size in this study.
Author(s): Evans W; Department of Vascular Surgery, East Lancashire Hospitals NHS Trust
Buchanan J; Department of Vascular Surgery, East Lancashire Hospitals NHS Trust
Goel R; Department of Vascular Surgery, East Lancashire Hospitals NHS Trust
Hardy S; Department of Vascular Surgery, East Lancashire Hospitals NHS Trust
Source: Annals of vascular surgery, 2022 Jan; Vol. 78, pp. 321-327
Abstract: Omniflow II biosynthetic grafts are a commonly used alternative to autologous grafts in vascular bypass procedures. They are chosen for their purported resilience to infection, often in instances of existing graft failure or infection. We examined the short term, 1-3 year outcomes of Omniflow grafts in terms of patency, limb survival and mortality in a sample of 24 individuals.; Methods: This is a single centred retrospective study of Omniflow II grafts implanted between September 23, 2015 and April 05, 2018 in our department. We found that rates of primary patency and limb salvage for this graft type were markedly lower than in comparable studies. Further work in the form of a RCT is indicated.
Author(s): Cross B; East Lancashire Hospitals NHS Trust et al.
Source: The Psychiatric clinics of North America, 2022 Mar; 45(1): 29-43.
Abstract: Many patients with COVID-19 will experience acute or longer-term neuropsychiatric complications. The neurobiological mechanisms behind these are beginning to emerge; however, the neurotropic hypothesis is not strongly supported by clinical data. The inflammatory response to SARS-CoV-2 is likely to be responsible for delirium and other common acute neuropsychiatric manifestations. Vascular abnormalities such as endotheliopathies contribute to stroke and cerebral microbleeds, with their attendant neuropsychiatric sequelae. Longer-term neuropsychiatric syndromes fall into 2 broad categories: neuropsychiatric deficits occurring after severe (hospitalized) COVID-19 and "long COVID," which occurs in many patients with a milder acute COVID-19 illness.
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