Showing papers by "North Bristol NHS Trust published in 2002"
TL;DR: Daily use of the Flutter device in the home is as effective as ACBT in patients with non-cystic fibrosis bronchiectasis and has a high level of patient acceptability.
Abstract: AUTHOR:e-mail address please Background: Airway clearance techniques are an important part of the routine care of patients with bronchiectasis. The use of the Flutter, a hand held pipe-like device causing oscillating positive expiratory pressure within the airways, has been proposed as an alternative to more conventional airway clearance techniques. Methods: A randomised crossover study was performed in 17 stable patients with non-cystic fibrosis bronchiectasis at home, in which 4 weeks of daily active cycle of breathing technique (ACBT) were compared with 4 weeks of daily physiotherapy with the Flutter device. Results: No significant differences between the two techniques were found. Median weekly sputum weights were similar with a median treatment difference of 7.64 g (p=0.77) and there was no evidence of treatment order or order interaction effects (p=0.70). Health status (Chronic Respiratory Disease Questionnaire) and ventilatory function did not change significantly during either treatment period. There was no significant change in peak expiratory flow rate or in breathlessness (Borg score) after individual physiotherapy sessions with either technique. A questionnaire indicated subjectively that patients preferred the Flutter (11/17) to ACBT for routine use. Conclusions: Daily use of the Flutter device in the home is as effective as ACBT in patients with non-cystic fibrosis bronchiectasis and has a high level of patient acceptability.
103 citations
TL;DR: The validity of using floor scales to measure cricoid force applied by anaesthetic assistants is assessed and their use to an established training technique is compared.
Abstract: The application of cricoid pressure is an effective means of preventing regurgitation of gastric contents when correctly applied. A force of 30 N (3 kg) is recommended for an unconscious patient. This study assesses the validity of using floor scales to measure cricoid force applied by anaesthetic assistants and compares their use to an established training technique. Forty subjects applied pressure to a cricoid model in a blinded manner, on three test occasions. For each test, cricoid pressure was maintained for 1 min and the highest and lowest forces recorded on the model were noted. The first test was before any instruction. The second test followed a period of practice on the cricoid model. For the final test, subjects stood upon a set of floor scales and noted their weight. Force was applied to the cricoid model until the weight on the floor scales reduced by 3 kg. Performance improved both following practice on the model and using the floor scales. Applying cricoid force while standing on floor scales and using the change in weight as a guide resulted in a predictable force on the cricoid model. The use of floor scales is a useful method of demonstrating the forces needed for effective cricoid pressure.
91 citations
TL;DR: The self help intervention was acceptable but ineffective when implemented during routine antenatal care, andidated smoking cessation rates among pregnant women are substantially lower than the self reported rates on which current smoking policy is based.
Abstract: Objectives: To evaluate the effectiveness of a self help approach to smoking cessation in pregnancy. Design: Pragmatic cluster randomised controlled trial with community midwife as the unit of randomisation. Setting: Three NHS hospital trusts in England. Participants: 1527 women who smoked at the start of pregnancy. Intervention: A series of five self help booklets comprising a step by step programme to increase motivation for quitting smoking and to teach strategies for cessation and relapse prevention. The first booklet was given to the women by a midwife at the earliest opportunity in antenatal care, together with a booklet for partners, family members, and friends. The remaining four booklets were mailed directly to the women. Main outcome measures: The primary outcome was smoking cessation validated by cotinine measurement at the end of the second trimester of pregnancy. Other outcomes were self reported smoking status and cigarette consumption among daily smokers. Qualitative data exploring the acceptability of the intervention and the way that smoking cessation advice was delivered in both trial arms were also collected. Results: Smoking cessation rates were low: the cotinine validated rates were 18.8% (113/600) in the intervention group and 20.7% (144/695) in the normal care group (difference 1.9%, 95% confidence intervals −3.5% to 7.3%). Self reported quit rates were higher. In the intervention group, 156 (25.6%) women reported not smoking for at least seven days, compared with 207 (29.1%) in the normal care group. In both groups, median self reported daily cigarette consumption among daily smokers was 10 cigarettes per day. Pregnant women and midwives approved of the intervention, but the way in which it was delivered varied considerably. For the primary smoking outcome, the degree of clustering at the midwife level was non-trivial (intracluster correlation coefficient 0.031). Conclusion: The self help intervention was acceptable but ineffective when implemented during routine antenatal care. More intensive and complex interventions, appropriately targeted and tailored, need to be developed and evaluated. Validated smoking cessation rates among pregnant women are substantially lower than the self reported rates on which current smoking policy is based. What is already known on this topic The most recent systematic review evidence suggests that self help interventions designed specifically for pregnant smokers can be effective in increasing cessation rates These reviews, however, are based mainly on efficacy trials involving staff who are specifically employed to provide the intervention In other attempts to assess the effectiveness of such an approach within routine antenatal care, it has been difficult to implement scientifically rigorous evaluations What this study adds A low cost, self help intervention was ineffective when implemented during routine antenatal care, even though it was acceptable to midwives and pregnant women Validated smoking cessation rates among pregnant women are substantially lower than the self reported rates on which current smoking policy is based
82 citations
TL;DR: Inverse relationship between alcohol consumption and active Helicobacter pylori infection: the Bristol Helicob bacteria project finds no clear relationship between consumption and infection.
81 citations
TL;DR: There was a wide variability and poor consensus with regard to post-dose vancomycin assay sampling times, target ranges and what constituted a toxic level.
Abstract: This study investigated vancomycin therapeutic drug monitoring (TDM) and issues related to patient management. Questionnaires were distributed to 310 participants in the UK National External Quality Assessment Scheme (NEQAS) for Antibiotic Assays. The response rate was 57.4%. The majority (76%) had an 'in-house' assay service based, almost exclusively, in the microbiology department, and a fluorescence polarization immunoassay (FPIA) was used by 97%. Almost half (48.7%) had an assay service available for 24 h/day, 7 days/week and 92.7% expected same-day results. The majority (80%) had issued guidelines for vancomycin use. A 12 hourly initial dosing regimen was used by 89%. Trough assay samples were taken or=10 mg/L as 'toxic' but 13 concentrations were quoted as toxic post-dose measurements. In conclusion, there was a wide variability and poor consensus with regard to post-dose vancomycin assay sampling times, target ranges and what constituted a toxic level.
65 citations
TL;DR: There were significant improvements on all measures at the end of intervention, which were maintained at 6-month follow-up, including social anxiety, appearance-related distress, general anxiety and depression.
Abstract: Rationale, aims and objectives The establishment and evaluation of a disfigurement support unit (Outlook), based in a district general hospital is described.
Methods The effectiveness of cognitive-behavioural interventions provided for 36 adults referred from a range of specialties was evaluated through the use of semistructured interviews, and standardized and visual analogue scales completed at initial assessment, at the end of intervention and at 6 months follow-up.
Results There were significant improvements on all measures at the end of intervention, which were maintained at 6-month follow-up, including social anxiety, appearance-related distress, general anxiety and depression. Clients also reported significant improvements in positive affect and satisfaction with life. They felt more confident with strangers and in dealing with new social situations. In addition, their perceptions of the noticeability of their condition, both to themselves and to others, had significantly reduced. Dendograms revealed two distinct groupings of clients, with one group showing greater improvements following intervention.
Conclusions The results suggest that Outlook represents a valuable addition to the current provision of surgical and medical care.
63 citations
TL;DR: In vitro pharmacokinetic models are excellent tools with which to study an antibacterial's pharmacodynamics (pD), being flexible, adaptable, low cost, and correlating well with animal and human systems.
54 citations
TL;DR: It is suggested that it is feasible to train healthcare professionals to use an AED with relatively little training, which should allow rapid deployment of AEDs in those areas of the hospital where cardiac arrests are infrequent and staff do not have rhythm recognition skills.
49 citations
TL;DR: The use of the buttress suture reduces the seroma rate following axillary dissection without axillary drainage, and this was designed to obliterate the axillary space after dissection.
42 citations
TL;DR: Routine histopathology may understage colorectal cancer by failing to detect involved lymph nodes, so the feasibility of dye staining those lymph nodes most likely to harbour metastases is examined.
Abstract: Objectives Routine histopathology may understage colorectal cancer by failing to detect involved lymph nodes. This study examined the feasibility of dye staining those lymph nodes most likely to harbour metastases.
Patients and methods Patent Blue V dye 2.5% was injected intra-operatively into left-sided colorectal carcinomas prior to resection in 19 patients.
Results Blue-stained nodes were found in 12/19 patients (63%). Examination of blue-stained nodes alone correctly identified overall nodal status in 11 (92%) of these 12 patients.
Conclusion The technique needs to be refined further. Nonetheless, intra-operative lymph node staining using blue dye offers the prospect of improving the ease and accuracy of nodal staging in colorectal cancer.
40 citations
TL;DR: The in vitro potency of BAL 9141, a new pyrrolidinone cephalosporin, was tested against non-duplicate strains of anaerobic bacteria and was not active against cefoxitin-resistant Bacteroides fragilis.
Abstract: The in vitro potency of BAL 9141, a new pyrrolidinone cephalosporin, was tested against non-duplicate strains of anaerobic bacteria. The MIC(50) was 1 mg/L against Actinomyces species, Clostridium species, Gram-positive anaerobic cocci, Porphyromonas species, Fusobacterium species, Lactobacillus species, Prevotella species and Veillonella species. The MIC(50) was 16 mg/L for Bacteroides fragilis and other Bacteroides species. BAL 9141 was not active against cefoxitin-resistant Bacteroides fragilis.
TL;DR: Significant differences are identified in pain radiation between those with and without MI and according to gender, particularly amongst women with MI.
TL;DR: There may be no extra demand on surgical facilities or other acute resources to treat hip fractures during the winter months in southern England, and other factors must be analysed when considering the aetiology of hip fractures in the elderly.
Abstract: Background: it is often assumed that hip fractures occur more commonly in winter, but the evidence is conflicting. It is important to clarify this issue to aid planning of health resources and understanding of the aetiology of these fractures in the elderly. Aim: to determine whether the incidence of fractures altered with the daily temperature, seasons or months of the year. Method: over a five-year period we studied 818 patients, over the age of 65, who presented to one district general hospital with a fracture of the proximal femur. Results: no significant difference was found in the incidence of fractures with different temperatures, changes of temperature, season or month of the year. Also, there was no significant difference in the characteristics of patients (age, sex, pre-injury mobility, residence, functional and mental scores) presenting in different seasons or temperature ranges. Patients presenting in winter months had a significantly longer inpatient stay, which may have been due to the strain on the social services over this time. Conclusion: other factors must be analysed when considering the aetiology of hip fractures in the elderly. There may be no extra demand on surgical facilities or other acute resources to treat hip fractures during the winter months in southern England.
TL;DR: The use of primary protein reference material CRM 470/RPPHS was intended to lead to reduced method-dependent variation in specific protein analyses, but observations from UK NEQAS indicate that this is true for most proteins, but not for ceruloplasmin.
Abstract: The use of primary protein reference material CRM 470/RPPHS (1) was intended to lead to reduced method-dependent variation in specific protein analyses. Observations from UK NEQAS for Specific Proteins indicate that this is true for most proteins, but not for ceruloplasmin. Because the measurement of ceruloplasmin is an important part of the initial screening procedure for Wilson disease, we deemed it important to publicize this anomaly to the clinical chemistry community, including both analysts and the diagnostic industry.
UK NEQAS distributes specimens for chosen analytes to be analyzed by participating laboratories by their usual laboratory methods as though they were patient specimens. For the Specific Proteins Scheme, monthly distributions are made of material derived from pooled human donor serum stored at 4 °C; the pools reported here contained sodium azide (1 g/L) as preservative. The method used by each laboratory is recorded by UK NEQAS so that results may be studied for method-related differences. Data are analyzed by both method principle (e.g., turbidimetry) and then by the instrument or reagent used. All participants classified under nephelometric method A used …
TL;DR: Tandem mass spectrometry (TMS) is a powerful and effective diagnostic technique and its main advantages are improved accuracy, sensitivity and specificity over existing methods, and its suitability for cost-effective multidisease IEM mass screening.
Abstract: The early diagnosis of inborn errors of metabolism (IEM) by laboratory-based mass screening is a prime example of preventive medicine. However, several factors restrict the range of IEM that can be screened for, and the numbers of people to whom it can be made available. Mass screening in the United Kingdom is limited primarily to that for phenylketonuria and congenital hypothyroidism. Ideally, extension of mass screening of neonates for additional clinically significant IEM is a desirable strategy. Tandem mass spectrometry (TMS) is a powerful and effective diagnostic technique and has been proposed as a means to realise this aim. Its main advantages are improved accuracy, sensitivity and specificity over existing methods, and its suitability for cost-effective multidisease IEM mass screening. The evolution, principles and applications of TMS are described, and the practical and clinical implications of extending diagnostic services for IEM using TMS are discussed.
TL;DR: The reliability study found that SLTs could be trained to be consistent in their use of the TOM for benchmarking purposes, and it was found that training was important for consistency and to eradicate bias.
Abstract: Benchmarking is one approach to quality improvement by comparing best practice, which requires appropriate process and outcome indicators. A benchmarking study to identify best practice was designed to investigate the use of Therapy Outcome Measure (TOM) as an outcome indicator. To ensure comparison of like with like, one study objective was to establish the reliability of the speech and language therapists (SLTs) using the TOM. This article describes this important aspect. One hundred and twenty-five SLTs from eight services, spanning seven National Health Service Trusts, participated in both the TOM training and interrater reliability assessments, where they independently rated 10 cases using composite case histories and videotape recordings. The acceptable level of reliability for participating in this benchmarking study was set as substantial (ˇ- 0.61) using an interclass correlation and was met on 52/53 TOM dimensions. On well-being, one adult team's reliability was below the required level, but this...
TL;DR: It is concluded that vascular surgical firms can provide a good introduction to surgical skills and those undergoing basic surgical training might benefit from an attachment to the DCU early in their rotations.
Abstract: The logbooks of 5 senior house officers (SHOs) were audited to determine progression of surgical skills on a single vascular firm. Total surgical experience and, in particular, experience in varicose vein and arterio-venous fistula surgery, performed in the day-case unit (DCU), were examined. Trainees were divided into those undertaking their first surgical SHO post (group 1, n = 2) and those who had had previous surgical exposure (group 2, n = 3) on the basic surgical training rotation. SHOs were exposed to a mean of 273 (+/- 41 SD) operative cases in 6 months. Emergency work comprised 15% (+/- 7%) of workload. Day cases accounted for 35% (+/- 3%) of elective workload. A mean of 66 (+/- 5) varicose vein and AVF cases were undertaken in the DCU. This represented 82% (+/- 6%) of day-case operative experience for the firm. SHOs undertook 12 (+/- 6) VV/AVF cases unassisted, 35 (+/- 5) cases with senior assistance, and 20 (+/- 11) as first assistance in the DCU. All SHOs progressed to being able to perform arterial bypass and amputation (with senior assistance) during their time on the firm. There was no significant difference in experience or progression to major vascular surgery between group 1 and group 2 in this study except in lower limb amputation procedures. It is concluded that vascular surgical firms can provide a good introduction to surgical skills. Most experience as first operator was gained in the DCU and we suggest that those undergoing basic surgical training might benefit from an attachment to the DCU early in their rotations.
TL;DR: It is important that gastrointestinal bleeding secondary to thrombolytic therapy for myocardial infarction is always investigated for an underlying cause.
Abstract: Haemorrhagic complications of thrombolytic therapy for myocardial infarction are common. A 68 year old man presented with a myocardial infarction and was started on tissue plasminogen activator. Soon after he experienced rectal bleeding and a barium enema showed a small carcinoma in the colon, which was treated surgically. It is important that gastrointestinal bleeding secondary to thrombolysis is always investigated for an underlying cause.
TL;DR: Paediatric and neonatal maintenance and resuscitation fluid requirements are reviewed and fluid therapy is addressed in specific trauma circumstances including head injury, burns, and near drowning.
Abstract: Trauma is the most common cause of death in children over one year of age. Hypovolaemic shock is a life-threatening consequence following trauma. Hypovolaemia may be difficult to identify in children, with hypotension being a late and critical sign. Delayed capillary refill time is a useful clinical adjunct to identify hypovolaemic shock in children. This article reviews paediatric and neonatal maintenance and resuscitation fluid requirements. Fluid therapy is addressed in specific trauma circumstances including head injury, burns, and near drowning. Methods of gaining circulatory access and complications of fluid therapy are also discussed.
TL;DR: In this article, three sizes of keyhole were tested-3x10mm holes, 12x5mm, and 48x2-the surface area of the defects created were the same in each group.
Abstract: Aseptic loosening of the acetabular component is the main reason for revision hip arthroplasty surgery with loosening rates reported at 25% at 12–15years. The optimum method of acetabular preparation and cementation technique has not been fully evaluated. Clinical follow-up studies suggest multiple keyholes improve survival rates. Keyholes increase penetration of cement and torsional resistance of the bone-cement interface. Some studies support the traditional three 1/2 inch keyholes other studies have shown multiple smaller holes improve stability. The optimum size and number of holes to provide the strongest fixation has yet to be determined. Using an established 54mm diameter acetabular model, mahogany, three sizes of keyhole were tested-3x10mm holes, 12x5mm, and 48x2.5mm- the surface area of the defects created were the same in each group. The model acetabulum was filled with cement and a metal central bar inserted through which torque could be applied using an Instron machine. Six specimens from each group were tested. Three 10mm holes produced a significantly stronger resistance to torque when compared to 2.5mm (p≤0.017) and 5mm holes (p≤0.001). There was no significant difference between 2.5mm and 5mm holes (p≤0.139). Each addition of a further 10mm hole significantly increased the torque strength until the model was destroyed at six holes. In laboratory testing larger key holes provide a stronger cement-acetabular interface.
TL;DR: This is a follow-on study to assess the change over the 5 years since a systematic review looking at the trends in original research over a 14 year period and confirms a continued decrease in the proportion of publications from the UK in JAC and AAC.
Abstract: Sir, There is increasing concern about the problems of antimicrobial resistance. In the words of the House of Lords’ report published in 1998, ‘Resistance to antibiotics . . . constitutes a major threat to public health and ought to be recognized as such more widely than at present’. Despite this, there is a feeling that the UK’s contribution to the science of antimicrobial chemotherapy is still in decline. Five years ago a systematic review looking at the trends in original research over a 14 year period was published. It showed that over the study period the number of publications from the UK declined. This is a follow-on study to assess the change over the 5 years since that publication. Original articles published in this journal (JAC) and Antimicrobial Agents and Chemotherapy (AAC) in 1999 were reviewed. Information was collected on the country of origin of first author, type of paper published and the number of authors. For papers published from the UK first author, the name, number of groups and type of institution involved were noted, as well as the funding source. These data were then compared with data published in 1996, which looked at publications from 1980 to 1994. Of the 805 papers published in 1999, 243 were from JAC and 562 from AAC. The percentage of papers with a UK first author in JAC was 18% (44/243) and in AAC 5.3% (30/562). This compares with 23% in JAC and 4.7% in AAC in 1994 and a total number of papers of 247 and 531, respectively. Using the first author to define country of origin, most papers in AAC were from the USA (41%), with France and Japan providing most of the rest. In JAC, although most papers were from the UK (18%), 16% were from the USA, and France, Japan, Spain and Italy together provided 26%. The most common publication sub-type published in JAC was susceptibility testing (30%), experimental therapeutics was the next most common subtype (11%). In AAC the number of papers published on mechanisms of resistance was 30%, and susceptibility testing made up 21%. The proportion of papers published by JAC on susceptibility testing has decreased from 44.4, 36.9, 19.7 to 34.6% over the years 1980, 1985, 1990 and 1994; papers on mechanisms of resistance have increased marginally from 9.8, 10.8, 11.8, 11.5 to 15% over the same time periods. Of the papers published in JAC on susceptibility testing half were from the UK. For the UK papers, the institution of origin was classified into four groups according to first author. In JAC, hospitalbased research made up 61% of the papers, and universitybased research 35%, whilst industry only 4%. This is similar to the previous findings where hospital-based research made up 61%, with a continued increase in university publications from 7% in 1980 to 30% in 1994 to 35% in 1999. Whereas in AAC, university-based research made up 60% of publications from the UK, an area previously dominated by hospital-based research. The categories of publication were similar from the hospitaland university-based departments. The number of papers published by individual research groups was assessed for the first authors of the UK papers. In total, 30 groups published 73 papers; of this, 37% were published by two NHS groups. When number of groups involved in each project was assessed, 40% were from single groups or departments, 32% from two groups and 12% from four groups or more. The number of authors per paper was 4.3 in JAC and 4.5 in AAC. This is similar to the findings in 1994 (JAC 4.4 and AAC 5.1). Funding, which was not assessed in the 1996 paper, was assessed on this occasion, and it was found that in JAC 52% of papers were funded by industry and in AAC 43% of papers. Although these data are limited, they confirm a continued decrease in the proportion of publications from the UK in JAC and no increase in the publications in AAC. There are more papers coming from a larger number of institutions than previously, although more than a third of the papers are coming from only two institutions. Unfortunately the conclusions are similar to those reached 5 years ago. There is no room for complacency about the state of UK antimicrobial research and with increasing clinical workloads and difficulties in finding funding, this area continues to be a cause for concern; despite recent initiatives there is as yet no detectable strengthening of the UK research base in antimicrobial chemotherapy.