Staff Publication

Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries (2014)

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Type of publication:
Journal article

Author(s):
*Singh R, *Manoharan G, *Moores TS, *Patel A

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achilles tendon rupture in a 46-year-old man. There have been no previous reports of Achilles tendon rupture with Nintendo Wii usage; it is a relatively uncommon mode of injury and is rare in terms of epidemiology of motion sensing video game injuries. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-202657.abstract

 

Primary uterine osteosarcoma presenting synchronously with bilateral breast carcinomas (2014)

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Type of publication:
Journal article

Author(s):
*Powell G, Barth L, Todd R, Ganesan R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Primary uterine sarcomas are infrequent neoplasms and most commonly leiomyosarcomas or endometrial stromal sarcomas. We report a rare case of primary uterine osteosarcoma discovered in a woman in her 60s following staging CT imaging for bilateral breast carcinomas. Examination of the subsequent hysterectomy specimen showed a tumour composed of malignant spindle cells and osteoclast-like giant cells associated with osteoid and neoplastic bone, in keeping with primary uterine osteosarcoma. Distinction of osteosarcoma from the more common carcinosarcoma is important due to the worse prognosis impacting on treatment decisions. In addition, synchronous presentation of this unusual tumour with bilateral breast carcinomas raises the possibility of a mutual genetic pathogenesis. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://bmj-casereports.highwire.org/content/2014/bcr-2013-201502.abstract

Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: is it common? (2014)

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Type of publication:
Journal article

Author(s):
Mohammed I, *Zaatari MS, Tyrogalas N, Khalid MI

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction. The patient was completely well, stable and asymptomatic and he was rushed immediately to the coronary care unit via emergency ambulance. The patient was subjected to a battery of urgent investigations which were all normal. Also an urgent coronary angiogram was undertaken which showed completely normal coronary anatomy. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-202586.abstract

Unusual fracture combination in a paediatric acute ankle (combined medial talar compression fracture with medial malleolus fracture in an immature skeleton): a case report. (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, Rhee SJ, *Wagner WW

Citation:
Journal of Surgical Case Reports, 2014, vol./is. 2014/10, 2042-8812;2042-8812 (2014)

Abstract:
Talar compression fractures are uncommon orthopaedic injuries, especially in the immature skeleton. Fractures of the talar body constitute >5% of all foot and ankle fractures. The combination of a medial compression fracture and corresponding medial malleolar fracture is rare and not previously reported injury in the literature. We present a case report of a skeletally immature 15-year-old Caucasian male who sustained a medial malleolar and corresponding medial talus fracture after being ejected from his pushbike. This report outlines the potential difficulties in diagnosing an unusual fracture combination and the importance of initial management including necessary diagnostic imaging to identify such injuries. Through this case, we aim to highlight the need for having high suspicions of underlying fractures in paediatric trauma cases. The long-term complications and risks of osteonecrosis of the talus can have detrimental effect on a patient’s outcome; therefore, we also emphasize the need for regular monitoring and long-term follow-up. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. The Author 2014.

Association of primary care factors with hospital admissions for epilepsy in England, 2004-2010: National observational study (2014)

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Type of publication:
Journal article

Author(s):
Calderon-Larranaga A, Soljak M, Cowling TE, Gaitatzis A, *Majeed A

Citation:
Seizure, September 2014, vol./is. 23/8(657-61), 1059-1311;1532-2688 (2014 Sep)

Abstract:
PURPOSE: There has been little research on the accessibility and quality of primary care services for epilepsy and emergency hospital admissions for epilepsy.
METHODS: We examined time trends in admissions for epilepsy in England between 2004-2005 and 2010, and the association of admission rates with population and primary care factors. The units of analysis were the registered populations of 8622 general practices. We used negative binomial regression to model indicators from the Quality and Outcomes Framework, the UK's primary care pay for performance scheme, to measure the accessibility and quality of care for epilepsy, and supply of general practitioners, after adjustment for population factors.
RESULTS: The mean indirectly standardised admission rate decreased from 122.9 to 102.6 (-16.5%; P<0.001) over the study period, while the mean percentage of patients seizure free increased from 65.3% to 74.9% (P<0.001). In the multivariable analysis, a one unit increase in the percentage of seizure free adult patients on epilepsy drugs predicted a 0.20% decrease (IRR=0.9980; 95% CI: 0.9974-0.9986) in admission rate. The percentage of patients who were able to book a GP appointment over two days ahead predicted a 0.12% decrease (IRR=0.9988; 95% CI: 0.9982-0.9994). The deprivation score of practice populations (IRR=1.0179; P<0.001) and general practitioner supply (IRR=1.0022; P<0.001) were both positively associated with admission rates.
CONCLUSION: Patient access to primary care appointments and percentage of patients who have been recorded as seizure free for 12 months were associated with lower admission rates. However the effect sizes are small relative to that of population deprivation.

Achieving standards for unscheduled surgical care (2014)

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Type of publication:
Journal article

Author(s):
McArdle, Kirsten, *Leung, Edmund, Cruickshank, Neil, Laloe, Veronique

Citation:
Clinical Governance: An International Journal, 01 March 2014, vol./is. 19/1(21-29), 14777274

Abstract:
Purpose — The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations. Design/methodology/approach — A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines. Findings — A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate .5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission. Originality/value — To the authors’ knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.

Student nurses perceptions of spirituality and competence in delivering spiritual care: A European pilot study. (2014)

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Type of publication:
Journal article

Author(s):
Ross, Linda, van Leeuwen, R, Baldacchino, Donia, Giske, Tove, *McSherry, Wilfred, Narayanasamy, Aru, Downes, Carmel, Jarvis, Paul, Schep-Akkerman, Annemiek

Citation:
Nurse Education Today, 01 May 2014, vol./is. 34/5(697-702), 02606917

Abstract:
Summary: Background: Spiritual care is expected of nurses, but it is not clear how undergraduates can achieve competency in spiritual care at point of registration as required by nursing/midwifery regulatory bodies. Aims: To describe undergraduate nurses’/midwives’ perceptions of spirituality/spiritual care, their perceived competence in delivering spiritual care, and to test out the proposed method and suitability of measures for a larger multinational follow-on study. Design: Cross-sectional, multinational, descriptive survey design. Methods: Author administered questionnaires were completed by 86% of the intended convenience sample of 618 undergraduate nurses/midwives from 6 universities in 4 European countries in 2010. Results: Students held a broad view of spirituality/spiritual care and considered themselves to be marginally more competent than not in spiritual care. They were predominantly Christian and reported high levels of spiritual wellbeing and spiritual attitude and involvement. The proposed method and measures were appropriate and are being used in a follow-on study. Conclusions: The following are worthy of further investigation: whether the pilot study findings hold in student samples from more diverse cultural backgrounds; whether students’ perceptions of spirituality can be broadened to include the full range of spiritual needs patients may encounter and whether their competence can be enhanced by education to better equip them to deliver spiritual care; identification of factors contributing to acquisition of spiritual caring skills and spiritual care competency.

Stabilisation and Transfer of Sick New-Borns Delivered in Stand-Alone Midwifery Led Units. (2014)

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Type of publication:
Conference abstract

Author(s):
*Tyler, W, Philpott, A, Brown, S, Rhodes, J

Citation:
Archives of Disease in Childhood — Fetal & Neonatal Edition, 02 June 2014, vol./is. 99/(0-0), 13592998

Abstract:
BACKGROUND: Women should be offered the choice of delivering at home, in midwife-led units (MLU) or obstetric units.(1) 20% of Shropshire mothers choose delivery in an MLU which refer into Shrewsbury and Telford NHS Trust (SaTH) obstetric/neonatal unit for additional care. The West Midlands neonatal transfer service (WMNTS) is not commissioned to transfer babies from MLUs; any transfer required is performed by the MLU midwife and the West Midlands Ambulance Service (WMAS). These staff must be confident in recognising, stabilising and transferring babies requiring a higher level of care at or immediately after delivery. AIM: To develop an educational package for midwives and paramedics caring for sick newborns. PROJECT: Representatives from midwifery, neonatal care, WMAS and WMNTS met to develop a training package. They were informed by the Scottish Transport Team who deliver a course for their remote maternity units. Support for the project was given by SaTH, WMAS and WMNTS. A one day programme was delivered at Shrewsbury MLU in December 2013. FEEDBACK: 16 midwives and 4 paramedics attended the course. All lectures, workshops and simulations were rated as good (20%) or excellent (80%). The course was rated as excellent (95%) or good (5%). FURTHER DEVELOPMENTS: Dates are set for three additional courses. All staff supporting stand-alone MLUs will access this training on a two-yearly basis. This programme will be offered to other MLUs in the West Midlands. REFERENCE: National Institute for Clinical Excellence. Intrapartum care. 2007. http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf.

A prospective evaluation of undiagnosed joint hypermobility syndrome in patients with gastrointestinal symptoms. (2014)

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Author(s):
Fikree A, Grahame R, *Aktar R, Farmer AD, Hakim AJ, Morris JK, Knowles CH, Aziz Q

Citation:
Clinical Gastroenterology & Hepatology, 10 2014, vol./is. 12/10(1680-87.e2), 1542-3565;1542-7714 (2014 Oct)

Abstract:
BACKGROUND & AIMS: The Joint Hypermobility Syndrome (JHS) is a common connective tissue disorder characterized by joint hyperflexibility, dysautonomia, and chronic pain. Gastrointestinal (GI) symptoms are reported in JHS patients attending rheumatology clinics, but the prevalence and symptom pattern of previously undiagnosed JHS in GI clinics are unknown.METHODS: By using validated questionnaires, a prospective cross-sectional study in secondary care GI clinics estimated the prevalence of JHS in new consecutively referred patients, compared GI symptoms in patients with and without JHS, and by using multiple regression determined whether the burden of GI symptoms in JHS patients was dependent on chronic pain, autonomic, psychological, and medication related factors. A positive control group consisted of JHS patients referred from rheumatology clinics with GI symptoms (JHS-Rh).RESULTS: From 552 patients recruited, 180 (33%) had JHS (JHS-G) and 372 did not (non-JHS-G). Forty-four JHS-Rh patients were included. JHS-G patients were more likely to be younger, female with poorer quality of life (P = .02) than non-JHS-G patients. After age and sex matching, heartburn (odds ratio [OR], 1.66; confidence interval [CI], 1.1-2.5; P = .01), water brash (OR, 2.02; CI, 1.3-3.1; P = .001), and postprandial fullness (OR, 1.74; CI, 1.2-2.6; P = .006) were more common in JHS-G vs non-JHS-G. Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors.CONCLUSIONS: JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations. Copyright 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.