2015

The role of ultrasound scanning (USS) in right iliac fossa (RIF) pain: Is USS imaging delaying emergency appendicectomies? (2015)

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Type of publication:
Conference abstract

Author(s):
*Sukha A., *Luke D.

Citation:
International Journal of Surgery, November 2015, vol./is. 23/(S114)

Abstract:
Aim: This project investigates USS results from patients who had undergone appendicectomies to assess the sensitivity and specificity in detecting a histology positive acute appendicitis. We also investigated whether the decision to USS delayed an emergency procedure. Methods: Retrospective data collection between January-June 2014. Data was collected from Theatre log books, Pathology/PACS systems. Results: Between January-June 2014, 226 appendectomies were performed on the emergency-operating list. 15% (n = 34) ha d undergone pre-operative USS (74% Female, Mean age = 27 years). 76% (n = 26) of those who had a scan went onto have a diagnostic laparoscopy and appendicectomy, 24% (n = 8) had an open appendicectomy.53% (n = 18) were found to have a histology proven positive appendicitis. USS as an investigation to detect acute appendicitis demonstrated a sensitivity of 22.2% an d specificity of 68.8%, PPV of 44.4% and a NPV of 44.0%. A mean delay of 0.97 days was observed from admission to operation due to USS. Conclusion: US S result often does not change the definitive management in patients with ongoing RIF pain. Diagnostic laparoscopy can be therapeutic even in the absence of appendicitis. With USS delaying time to theatre and increasing hospital stay we conclude the USS has a limited role in investigating RIF pain in a patient presenting with the classic acute appendicitis.

Smoking cessation and best medical therapy (BMT) how well are vascular surgeons doing? (2015)

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Type of publication:
Conference abstract

Author(s):
Slade R., *Sukha A., *Sykes T.

Citation:
International Journal of Surgery, November 2015, vol./is. 23/(S131)

Abstract:
Aim: BMT is a key component in the management of patients with vascular disease. The aim of this study is to determine how well BMT is documented in the correspondence to primary care with particular reference to the preoperative clinic letter and discharge summary following a surgical intervention. Methods: Patients between Jan-Jun 2014 were identified from a prospectively maintained vascular-database and the corresponding clinic letters and discharge summaries were retrieved. Results: 107 patients underwent vascular surgery between Jan-Jun 2014. The operations identified were: AAA repair n=21,Carotid endarterectomy n=23,Femoral endarterectomy n= 12,Vascular bypass n=43 and Revision surgery n=8. Overall, antiplatelet therapy was documented in 79%(n=85) of pre: operative clinic letters and 96%(n=103) of discharge summaries. Similarly, lipid-lowering therapy was recorded in 79%(n=85) and 92%(n=98). Smoking status was recorded in 32 %(n=34) of pre-operative clinic letters; 21%(n=23) were smokers and all identified smokers were offered advice to stop smoking. Conclusion: Documentation of smoking status and advice is poorly recorded in the pre and post -operative correspondence to primary care and unrecorded in the discharge summary. Similarly, pre-operative anti platelet and lipid lowering therapy documentation is suboptimal. 'Best Medical Therapy,' has been implemented into a standardised clinic template and a 'smoking status/advice' section in the electronically generated discharge summary has been implemented.

Ultrasound guided musculoskeletal interventions: professional opportunities, challenges and the future of injection therapy (2015)

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Type of publication:
Journal article

Author(s):
Sue Innes, Mark Maybury, Alison Hall, *Gordon Lumsden

Citation:
Sonography (2015) 2(4): 84-91

Abstract:
The demand for ultrasound guided injections for musculoskeletal presentations has increased in recent years as practitioners and patients seek verification of needle position. Musculoskeletal management pathways regularly include injection therapy for pain relief and are sometimes indicated as a single intervention but may need to be supported by rehabilitation. Workload in radiology departments has expanded in volume and complexity as radiologists perform new interventional procedures that require medical expertise. Innovative responses are required to meet the demand for ultrasound guided musculoskeletal injections; one option is offering appropriate education to musculoskeletal sonographers, enabling them to extend their current scope of practice. The role of the extended scope physiotherapist in the United Kingdom provides evidence that role diversification can produce excellent patient outcomes whilst preserving financial resources. The professional, legal and clinical requirements of extending service provision to include new clinical staff presents challenges that have to be met with strong leadership and the provision of high quality education in ultrasound guided interventions. There are many indicators that the patient experience is enhanced by guiding musculoskeletal injections, and access to this service has impact on patients’ confidence in their treatment pathway.

Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study (2015)

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Type of publication:
Journal article

Author(s):
*Papoutsis D., *Underwood M ., *Parry-Smith W., *Panikkar J.

Citation:
Archives of Gynecology and Obstetrics, May 2015, vol./is. 292/6(1329-1337)

Abstract:
Purpose: To determine any risk factors for cytology recurrence in women after cold coagulation ablative treatment for cervical intraepithelial neoplasia (CIN). Methods: This was a retrospective observational study of a cohort of women having had cold coagulation between 2001 and 2011 in the colposcopy unit of an NHS hospital. We retrospectively collected data from our colposcopy unit database. Women with previous cervical treatment were excluded. Results: 559 eligible women we re identified with a mean age of 28.7 +/- 6.2 years. Nulliparous women were 66.3 % with smokers involving 35.3 %. Referral cytology, pretreatment cervical punch biopsies and colposcopy were high grade in 51.9, 71.9 and 45.8 % of women. Endocervical crypt involvement (ECI) on pretreatment cervical punch biopsy involved 9.7 % of women. Mean follow-up was 3.1 +/- 2.4 years. Overall cytology recurrence (mild/moderate/severe dyskaryosis) at 6 and 12 months follow-up was 7.4 and 5 %. High-grade cytology recurrence (moderate/severe dyskaryosis) involved 2.7 % of women over the entire follow-up period . Multiple regression analysis showed that ECI on pretreatment cervical pun ch biopsy was a risk factor for high-grade cytology recurrence (HR 3.72; 95 %CI 1.18-11.71; p = 0.024). There were no risk factors identified for overall cytology recurrence. However, when cytology tests with borderline nuclear changes at follow-up were pooled with mild/moderate/severe dyskaryosis cytology tests, then parity >2 was a risk factor for abnormal cytology (HR 1.71; 95 %CI 1.08-2.69; p = 0.022). Conclusions: Endocervical crypt involvement on pretreatment cervical punch biopsy and multiparity >2 are risk factors that increase the likelihood of abnormal cytology following cold coagulation. These two risk factors should be taken in consideration when performing cold coagulation cervical treatment for CIN pathology.

Practical Otolaryngology for Junior Doctors (2015)

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Type of publication:
Book

Author(s):
Thomas Frederick Charles Saunders, Editors: Alistair Mitchell-Innes and *Duncan Bowyer

Citation:
Doctors Academy Publications; 1st edition
ISBN-13: 978-9380573076

Abstract:

This book is designed to guide the junior doctor through an Otolaryngology (ENT) rotation from the first referrals to the practical procedures carried out on a daily basis. ENT departments throughout the world will have different ways of managing particular conditions; however, this book will give the user a framework to deliver good quality clinical care and develop skills with confidence wherever one is working. All information is presented in an easy to digest format to give a handy reference guide on how to manage the hugely varied conditions that are dealt with by Otolaryngology. This makes the book an ideal companion to keep in an on-call bag or clinic room. The advice provided in this book is practical and very clear, with good explanations about simple procedures for settling difficult situations. Information is also provided about looking after patients on the ward following common ENT/Head and Neck operations. An ENT junior doctor should feel more confident quickly after checking through this book for advice, as well as knowing when to escalate a problem to a more knowledgeable senior doctor, if the patient is not improving.

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial (2015)

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Type of publication:
Randomised controlled trial

Author(s):
Laver L, *Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov;23(11):3383-92

Abstract:
PURPOSE:
Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.
METHODS:
Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.
RESULTS:
All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (+/-8.9) and 59.6 (+/-12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.
CONCLUSIONS:
Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain.
LEVEL OF EVIDENCE: II.