University Hospital Aintree Research Articles

3 Derivation and internal validation of a clinical decision rule to guide whole body computed tomography scanning in trauma

BackgroundThere are no widely accepted validated clinical decision rules for the use of WBCT in trauma. Given the potential risks and costs, there is a clear need for a clinical...

Patients’ experience of the monitoring of free flaps after reconstruction for oral cancer

Regular monitoring of free flaps is essential after microvascular free tissue transfer, but the frequency and duration of the observations vary between units and there is no consensus nationally. Best practice can be informed by the feedback of patients, but as we know of no such studies, we did a cross-sectional survey of a consecutive group of patients after free tissue transfer to find out what they thought about monitoring. We designed a study-specific questionnaire after consultation with the patient and carer forum, and sent it to 150 patients who had had free tissue transfer in the maxillofacial department at Aintree University Hospital during 2015 and 2016. A total of 106 (71%) responded, and a quarter (30/106, 28%) would have liked more information about monitoring. Generally, patients were worried little by the observations (91/106, 86%), but one-third (34/106, 32%) reported disturbed sleep. Just over half (n=55/104, 53%) were relieved when the monitoring changed from hourly to four-hourly, and almost all (99/101, 98%) were not worried by this. Nearly half (47/105, 45%) would have preferred fewer observations when asleep. In conclusion, our findings could help to inform a leaflet for patients about monitoring. Consideration could be given to reducing its frequency, for example, the checks at 1, 3, and 5am could be omitted during the second night, which could make a substantial difference to the patient. However, its impact on salvage needs to be audited.

Evaluation of lipid management in secondary prevention of ACS patients with reference to Non-HDL-cholesterol reduction-a UK cardiac centre experience

Aim: Some evidence indicates that lipid therapy to prevent further cardiac event in ACS patients is suboptimal. NICE guideline (CG-181-2014) recommends greater than 40% reduction in Non-HDL-C, 3 months after treatment for ACS. We assessed the lipid management of patients admitted into Aintree University Hospital in Liverpool after ACS.

Impact of subarachnoid haemorrhage Canadian clinical decision rules for investigation of acute headache: a retrospective case note review

BackgroundPhysicians often face a dilemma to investigate alert and neurologically intact patients presenting with acute headache to emergency departments. Two Canadian prospective cohort studies evaluated high-risk clinical characteristics for subarachnoid haemorrhage in such patients and proposed clinical decision rules (Canadian rules 1, 2, 3, and Ottawa) for investigation of acute headache. We aimed to determine investigation rates for subarachnoid haemorrhage in a cohort of neurologically intact patients presenting with acute headache. MethodsWe performed a retrospective case note review of alert and neurologically intact patients presenting with acute headache to Aintree University Hospital, Liverpool, UK, between Jan 1 and March 1, 2013. The case notes of these patients were independently reviewed by two investigators to determine clinical characteristics. Criteria for inclusion were: age over 18 years, fully alert (Glasgow coma scale 15), new acute headache with no recent history of head injury (14 days), absence of focal neurological deficit or papilloedema, and absence of known cerebral aneurysm, brain neoplasm, or hydrocephalus. Canadian rules were applied retrospectively to determine the specificity, sensitivity, and negative predictive values for subarachnoid haemorrhage. Two-tailed Fisher's exact test and McNemar's test were used to determine differences. Findings403 patients presented with acute headache, of whom 162 patients satisfied the criteria for inclusion. In three (1·9%) of these 162 patients subarachnoid haemorrhage was diagnosed by CT, 11 (6·8%) had a final diagnosis of other cerebral disease, and 148 (91·3%) were diagnosed with benign causes of headaches. 69 patients (42·6%) had unenhanced CT, 28 (17·3%) had a lumbar puncture, and 25 (15·4%) had both investigations. There were no re-admissions with a subarachnoid haemorrhage for patients not fully investigated in our practice. Retrospective application of Canadian rules 1, 2, 3, and Ottawa to our cohort would have increased CT investigation rates to 54·3%, 64·8%, 50·0%, and 61·7%, respectively, compared with 42·6% in our practice (p<0·0001). If rule 3 was applied, one patient who had suffered a subarachnoid haemorrhage would have been classifed as low risk and not investigated, leading to a missed diagnosis. InterpretationThe rates of subarachnoid haemorrhage in our study were lower than those in the Canadian studies. In our smaller group of neurologically intact patients, retrospective application of the Canadian rules would have led to a significantly higher investigation rate and longer hospital stay. This study also highlights the need for further large scale prospective studies in the UK before adopting rigid decision rules for investigation of acute headache in neurologically intact patients in the National Health Service. FundingNone.

The Place of Wishes and Feelings in Best Interests Decisions: Wye Valley NHS Trust v Mr B

In Wye Valley NHS Trust v Mr B the Court of Protection decided that it was not in the best interests of Mr B to receive amputation surgery against his will, notwithstanding that he would die without the treatment. The judge met with Mr B in person and his best interests decision placed significant weight on Mr B's wishes and feelings. This case note considers this influential case in the context of ongoing debate about the place of wishes and feelings in best interests decisions under the Mental Capacity Act 2005. It considers the history of the best interests principle, its interpretation by the Supreme Court in Aintree University Hospitals NHS Foundation Trust v James, ongoing debates about its compatibility with Article 12 of the United Nations Convention on the Rights of Persons with Disabilities, and recent proposals by the Law Commission for statutory amendments to the Mental Capacity Act.

Why I became a cancer surgeon

Graeme Poston speaks to Roshaine Gunawardana, Managing Commissioning Editor: Graeme Poston (DSc MB BS, MS, FRCS[Eng], FRCS[Ed]) is a consultant hepatobiliary surgeon at the University Hospital Aintree, Liverpool, UK and Professor of Surgery at the University of Liverpool. He enjoys an international reputation in hepatobiliary surgery. To date, he has personally performed over 900 major hepatobiliary resections. His unit at University Hospital Aintree is one of the largest tertiary resectional hepatobiliary practices in the UK, having performed over 2000 liver resections over the last 20 years. He gained his undergraduate medical training at St Georges Hospital Medical School, London, and postgraduate training at The Hammersmith Hospital and St Mary's Hospital, London and University of Texas Medical Branch, Galveston, TX, USA. He is a past President of the European Society of Surgical Oncology, the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, and the British Association of Surgical Oncology. He is Chair of National Health Service England, Hepato Pancreato Biliary Specialized Commissioning, Chair of the NICE Colorectal Cancer Guideline Development Group and Quality Standards Committee, and past Chair of the Cancer Services Committee of the Royal College of Surgeons of England. He is a principal investigator of a number of ongoing national and international clinical trials in hepatobiliary surgery, and co-author of numerous national and international guidelines for the management of hepatobiliary cancers, nine textbooks of surgery, and over 230 papers. Honors and distinctions include a Doctorate of Science honoris causa of King George V University, Lucknow; Ernest Miles Medal of the Royal Marsden Surgical Society; Olaf ac Acrel Medal of the Swedish Surgical Association; Stanford Cade Medal of the Royal College of Surgeons of England; Kilroe Medal of the Christie Hospital, Manchester; N K Misra Medal of the Indian Association of Surgical Oncology; Honorary Fellow of the Association of Surgeons of India and the College of Surgeons of Sri Lanka; Hunterian Professor of the Royal College of Surgeons of England; and numerous international visiting professorships. In what little spare time he has, he enjoys trekking in high places (climbed Kilimanjaro, trekked to Everest and Annapurna Base Camps, and crossed the Lakya La).

Audit of tracheostomy practice in oral squamous cell carcinoma surgery at Aintree University Hospital

Audit of tracheostomy practice in oral squamous cell carcinoma surgery at Aintree University Hospital

Reorganisation of regional oral & maxillofacial trauma services at Aintree University Hospital

Reorganisation of regional oral & maxillofacial trauma services at Aintree University Hospital

Specialist service

Maria Guerin, a clinical nurse specialist at Aintree University Hospital NHS Foundation Trust, began her career in the 1980s. Since then, she has helped to identify the need for specialist nurses and, earlier this year, was elected vice chair of the International Thoracic Oncology Nursing Forum. Here, she talks to Clare Lomas about her career to date

Scoliosis deformity correction: Patients pre-operative anxiety and the desire for more information

s / International Journal of Surgery 23 (2015) S15eS134 S84 0401: NECK OF FEMUR INFECTIONS: RETROSPECTIVE STUDY 2013/2014 F. Ibram, J. Fountain. Aintree University Hospital, UK Aim: Wound infections in post-operative neck of femur (NOF) patients increase morbidity and mortality. Given a recent surge in NOF infections at Aintree University Hospital (AUH), the aims of this studywere to assess our NOF infection rates compared to national standards and identify trends in current practice. Methods: Retrospective study of NOF patients with confirmed surgical site infections (SSI) during July 2013eSeptember 2014. Data collected from notes, Sigma & JAC. National SSI data obtained from Public Health England. Results: During July 2013eJune 2014, 8NOF patients developed SSIs (2.5%) compared to national standard (1.6%). An additional 3 cases (2.8%) were reported during JulyeSeptember 2014, however this data could not be compareddue to unavailable national standards. Of these 11 SSIs, 82%were deep and 18%were superficial. Deep infections were all eventually treated with girdlestones, either as primary (44%) or secondary procedure (56%). Girdlestones performed as a primarymeasure reduced hospital admission by 35 days and antibiotic duration by 20 days suggesting deep NOF infections should be treated with this intervention as first line therapy. Conclusion: AUH NOF infections were 1.6-fold higher compared to national standards. Girdlestone procedures in deep infections are most effective if performed initially. 0496: SCOLIOSIS DEFORMITY CORRECTION: PATIENTS PRE-OPERATIVE ANXIETY AND THE DESIRE FOR MORE INFORMATION S. Ismael, M. Kazeem, A. Gibson. The Royal National Orthopaedic Hospital,

P53 can be stabilised by a combination of Nutlin-3 and irradiation in human papillomavirus-positive oropharyngeal carcinoma cells, with no apparent effect on cell growth or clonogenic survival

P53 can be stabilised by a combination of Nutlin-3 and irradiation in human papillomavirus-positive oropharyngeal carcinoma cells, with no apparent effect on cell growth or clonogenic survival

Editorial introductions

Editorial introductions

Do mandatory nasal interventions after epistaxis just delay discharge?--Our experience in 90 adults.

Clinical OtolaryngologyVolume 40, Issue 5 p. 486-490 Correspondence: Our Experience Do mandatory nasal interventions after epistaxis just delay discharge? – Our experience in 90 adults A.S. Lau, Corresponding Author A.S. Lau orcid.org/0000-0002-6489-204X Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKCorrespondence: A. Lau, Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool L9 7AL, UK. Tel.: +44 151 525 5980; Fax: +44 151 529 5237; e-mail: andrew.lau@liverpool.ac.ukSearch for more papers by this authorK. Smith, K. Smith Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorL. Mealey, L. Mealey Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Rylands, J. Rylands Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Heseltine, J. Heseltine Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorS.P. Williams, S.P. Williams Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorA.C. Swift, A.C. Swift Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this author A.S. Lau, Corresponding Author A.S. Lau orcid.org/0000-0002-6489-204X Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKCorrespondence: A. Lau, Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool L9 7AL, UK. Tel.: +44 151 525 5980; Fax: +44 151 529 5237; e-mail: andrew.lau@liverpool.ac.ukSearch for more papers by this authorK. Smith, K. Smith Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorL. Mealey, L. Mealey Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Rylands, J. Rylands Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorJ. Heseltine, J. Heseltine Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorS.P. Williams, S.P. Williams Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this authorA.C. Swift, A.C. Swift Department of ENT and Head and Neck Surgery, University Hospital Aintree NHS Foundation Trust, Liverpool, UKSearch for more papers by this author First published: 09 March 2015 https://doi.org/10.1111/coa.12411Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume40, Issue5October 2015Pages 486-490 RelatedInformation

Withdrawing or withholding life-sustaining treatment

The previous article in this column considered a patient's right to demand or refuse treatment for their heart condition. This article considers the cardiac team's rights and responsibilities when considering withdrawing or withholding life-sustaining treatment. It focuses on the UK Supreme Court judgment in Aintree University Hospitals Foundation Trust v. James [2013] and considers the impact of the ruling on a cardiac nurse's practice.

PWE-429 Development of a gastroenterology handbook for junior doctors

<h3>Introduction</h3> Every 4–6 months new junior doctors rotate through Gastroenterology departments across the UK. The General Medical Council recommends that induction and support mechanisms are in place so that junior doctors are able to deliver “safe, effective and efficient care to patients as soon as they start a new job.”¹We developed a Gastroenterology handbook containing relevant and important clinical information to be used nationally as part of the induction process for junior doctors. <h3>Method</h3> In order to establish the need for such a resource we surveyed consultants and junior doctors from across the UK, and solicited advice on its content. We developed a first draft and sought the endorsement of the Trainees Section of the British Society of Gastroenterology (BSG), who agreed to support the production of the handbook and verify its content. The content included resources for management of acute Gastroenterology conditions based on up-to-date consensus guidelines, and sections on procedural skills. Feedback from a focus group of junior doctors attending the BSG Gastroenterology Taster Conference was extremely positive. A second draft has been piloted on six junior doctors in the Gastroenterology department at Aintree University Hospital Liverpool. <h3>Results</h3> Prior to developing the handbook, 22 Gastroenterology consultants from 16 NHS trusts were surveyed as to the perceived ‘need’ for such a resource as well as suggested content. 73% of departments had an induction meeting for new junior doctors, with 32% having pre-existing written induction material. A significant proportion (18%) had no induction for junior doctors. 68% of consultants felt that a national Gastroenterology handbook would improve the induction process at their trust. 12 junior doctors (FY1-CT2 level) in several trusts were also surveyed. 41% had no induction on starting their Gastroenterology rotation, and 75% were apprehensive about managing acutely unwell patients. All of the trainees believed that the Gastroenterology handbook would be a valuable resource. Survey responses suggested that the most important clinical scenarios to include were acute GI bleed, decompensated liver disease, and acute colitis. <h3>Conclusion</h3> A standardised national clinical induction handbook for junior Doctors working in Gastroenterology does not already exist, and there is considerable appetite amongst junior doctors and Gastroenterology consultants for such a resource. We created a handbook with the aim of easing the transition of junior doctors joining Gastroenterology departments, and improving patient care. We intend to introduce the handbook nationally for the intake of doctors in August 2015. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> GMC guidance, Induction and Mentoring; http://www.gmc-uk.org/guidance/ethical_guidance/11825.asp; accessed on 25.02.2015

Assessing best interests in end-of-life care for a patient in a minimally conscious state

The legal basis and principles for the lawful withholding of life-sustaining treatment from people in a minimally conscious state have been laid out in the Supreme Court judgment in Aintree University Hospitals NHS Foundation Trust (Respondent) vs James (Appellant) [2013]. This was the first case under the Mental Capacity Act 2005 to come before the Supreme Court and hence it is of legal importance. The case involved a 68-year-old man who had multiple physical co-morbidities and who was diagnosed as being in a minimally conscious state. This article discusses the Supreme Court case and the approach taken by the Court of Protection and the Court of Appeal in applying the Mental Capacity Act 2005 when assessing whether withholding life-sustaining treatment is ever in a person9s best interests. It also outlines two similar cases from 2014. In so doing it demonstrates how the courts assess best interests in end-of-life care for people in minimally conscious states and how this differs legally from those in a persistent vegetative state.

Anaesthesia for Massive Retrosternal Thyroidectomy in a Tertiary Referral Centre

*Department of Anaesthesia and Critical Care and †Department of Head and Neck Surgery/Otolaryngology, University Hospital Aintree NHS Foundation Trust and; ‡Liverpool CR-UK Centre, Institution of Translational Medicine, Liverpool, United Kingdom

Efficacy and safety of liraglutide 3.0 mg for weight management in overweight and obese adults: The SCALE Obesity and Prediabetes, a randomised, double-blind and placebo-controlled trial

Joseph Proietto1,∗, Carel W. le Roux2, Xavier Pi-Sunyer3, Arne Astrup4, Ken Fujioka5, Frank Greenway6, Alfredo Halpern7, David C.W. Lau8, Rafael Violante Ortiz 9, Alana Philips 10, Soren Kruse Lilleore11, John Wilding12 1 Endocrinology Department, Austin Health Repatriation Hospital, Heidelberg West, Vic, Australia 2 Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland 3 St Luke’s — Roosevelt Hospital Center, Columbia University, New York, NY, USA 4 Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark 5 Division of Endocrinology, Department of Nutrition and Metabolic Research, Scripps Clinic, La Jolla, CA, USA 6 Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA 7 Obesity & Metabolic Syndrome Unit, Division of Endocrinology & Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil 8 Departments of Medicine and Biochemistry & Molecular Biology, University of Calgary, Calgary, Alberta, Canada 9 Departamento Endocrinologia, Instituto Mexicano del Seguro Social, Hospital Regional num. 6, Madero, Tamaulipas, Mexico 10 Novo Nordisk Pharmaceuticals, Sydney, NSW, Australia 11 Novo Nordisk A/S, Soborg, Denmark 12 Department of Obesity and Endocrinology, University Hospital Aintree, Liverpool, UK

Liraglutide 3.0 mg improves body weight and cardiometabolic risk factors in overweight or obese adults without diabetes: The SCALE Obesity and Prediabetes randomised, double-blind, placebo-controlled 56-week trial

Gary Wittert 1,∗, Carel W. le Roux2, Arne Astrup3, Ken Fujioka4, Frank Greenway5, Alfredo Halpern6, David C.W. Lau7, Rafael Violante Ortiz 8, John Wilding9, Sabina Furber10, Soren Kruse Lilleore11, Xavier Pi-Sunyer12 1 Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, SA, Australia 2 Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland 3 Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark 4 Division of Endocrinology, Department of Nutrition and Metabolic Research, Scripps Clinic, La Jolla, CA, USA 5 Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA 6 Obesity & Metabolic Syndrome Unit, Division of Endocrinology & Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil 7 Departments of Medicine and Biochemistry & Molecular Biology, University of Calgary, Calgary, Alberta, Canada 8 Departamento Endocrinologia, Instituto Mexicano del Seguro Social, Hospital Regional num. 6, Madero, Tamaulipas, Mexico 9 Department of Obesity and Endocrinology, University Hospital Aintree, Liverpool, UK 10 Novo Nordisk Pharmaceuticals, Sydney, NSW, Australia 11 Novo Nordisk A/S, Soborg, Denmark 12 St Luke’s—Roosevelt Hospital Center, Columbia University, New York, NY, USA

Aintree University Hospital NHS Foundation Trust rolls out new electronic medical records system to improve the quality of patient care

Summary of speech: o In the context of the Government’s QIPP agenda and Jeremy Hunt’s challenge to the NHS to be paperless by 2018, scanning paper medical records has gained in popularity as Trusts seek to solve seemingly mutually exclusive challenges – remove a unsustainable paper process, improve the quality of patient care, enhance operational productivity while reducing cost. o A variety of approaches have been taken to try to achieve this: o Some Trusts have invested heavily creating in-house scanning bureaus; o Others have digitised the whole record but paid little attention to navigation so clinicians are faced with hundreds of pages of notes in an unwieldy PDF. o With 86,000 emergency admissions every year, 330,000 outpatient visits and 77,000 inpatient day cases – some 4,200 paper files moved daily Aintree University Hospital couldn’t 100% guarantee availability with clinicians complaining that finding information took too long. o To address this, the Trust has implemented an electronic medical records system to provide clinicians instant access to patient information, guarantee notes availability, improve efficiency, and reduce the costs, risks and space associated with paper handling and storage. o The EDMS solution cost £1.5 million, with the Trust realising annual savings of £1 million. o Professor Mike Pearson, consultant physician and the clinical lead on the project, will talk about the project – its goals, the solution deployed, what has been achieved, and how the project was successfully managed so that others both clinicians and operational staff can benefit from Aintree’s experience. o Ultimately it is not the actual software or the underlying technologies which have ensured success, but the careful application of them along with an understanding of the accompanying organisational and medical processes. This mandates a partnership between the suppliers and the Trust as all have to deliver which has been the case on this project. o Outlined below is comprehensive detail which it is hoped the King’s Fund will find useful as it selects speakers for the International Digital Health and Care Congress 2014 [Innovations in technology category]. International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116504– http://www.ijic.org/