Central Manchester University Hospitals NHS Research Articles

Variation in reporting of the Frey pancreatico-jejunostomy: Current world experience

Introduction: In 1987 Frey and Smith described their operation for chronic pancreatitis which involved an extended lateral pancreaticojejunostomy combined with removal by coring of the parenchyma in the anterior aspect of the head of the gland. The Frey pancreaticojejunostomy has now been reported from centres across the world. However, unlike more clearly defined procedures such as pancreatoduodenectomy, there is no standardization of the Frey operation resulting in potential heterogeneity. This study is an overview of the current world experience of the Frey operation with emphasis on variance in reporting. Methods: A search of the literature was performed using the Scopus database for publications between 1st January 1970 and January 2018. The keyword and MESH heading “chronic pancreatitis”, was used together with the term “Frey Pancreaticojejunostomy”. The risk of bias was assessed using the Cochrane collaboration’s tool for assessing risk of bias in non-randomized studies of interventions. The protocol was reviewed by the research and development department of Central Manchester University Hospitals NHS Foundation Trust. There were 34 reports of the Frey pancreaticojejunostomy and these constitute the study population Results: Data are affected by selection bias and reporting bias. In terms of assessing the morphology of the gland being operated, maximum antero-posterior diameter of the main pancreatic duct was reported in 19 (56%) of reports, antero-posterior diameter of pancreatic head in 13 (38%). Portal vein patency was confirmed in 4 (12%). The presence or absence of a concomitant biliary stricture was reported in 22 (65%) and a duodenal stricture in 14 (41%). Conclusion: The Results demonstrate that there is substantial variation between centres in reporting of the Frey operation. This variance compromises the value of comparative outcomes of this procedure and highlights the need for better standardization of the reporting of outcomes of surgery for chronic pancreatitis.

How events in emergency medicine impact doctors’ psychological well-being

BackgroundEmergency medicine is a high-pressured specialty with exposure to disturbing events and risk. We conducted a qualitative study to identify which clinical events resulted in emotional disruption and the impact...

UK-South Asian patients' experiences of and satisfaction toward receiving information about biologics in rheumatoid arthritis.

BackgroundRheumatoid arthritis (RA) causes painful joint inflammation and is incurable, but treatments control RA. Drug regimens are complex, and patients often do not take their medication as expected. Poor medication adherence can lead to poorly controlled disease and worse patient outcomes. Biologics treatments are expensive and require full engagement from patients. We have previously shown that patients from Black ethnic minority backgrounds do not fully engage into treatment plan. This study explored the patients’ experiences in and satisfaction toward receiving information about biologics and future support preferences in South Asian patients with RA.MethodsTwenty South Asian patients with RA from Royal Wolverhampton Hospitals NHS Trust and Central Manchester University Hospitals NHS Foundation Trust participated in individual semistructured interviews. Interviews were transcribed and data were analyzed by using thematic analysis approach.ResultsFour overarching themes describe the patients’ experience in and satisfaction toward receiving information on biologics: 1) current provision of information regarding the “biologics journey” and understanding of RA: in this theme, non-English-speaking patients expressed heightened anxiety about stepping up to biologics; 2) experience and perceptions of biologics: many patients were positive about the biologic experience; however, there were patient-perceived delays in getting on to the biologics; 3) factors influencing willingness to try biologics: in this theme, a number of factors were identified including seeking advice from doctors abroad; and 4) recommendations on the desired information to fully understand the use of biologics: some patients valued group discussions, while others suggested receiving RA and biologic information through a video interaction.ConclusionThis novel study provides insight into South Asian RA patients’ experiences in and satisfaction toward receiving information about biologics. South Asian patients with RA reported a range of perceptions about biologics and support preferences, many of which may not be shared with the non-South Asian population.

Role model: Louise Theodosiou

The child and adolescent psychiatrist at Central Manchester University Hospitals NHS Foundation Trust speaks to Anne Gulland

Assessing and documenting fluid balance.

Concerns about inadequate patient hydration and suboptimal monitoring of fluid balance have been documented in recent reports. The Fluid Balance Improvement Project at Central Manchester University Hospitals NHS Foundation Trust was undertaken to identify risk factors influencing hydration and to implement a revised process to manage these risks, resulting in the development of a hydration pathway. This new approach to monitoring patient hydration, together with staff education and support, has resulted in improved compliance with fluid balance monitoring standards, as well as significant improvements in identifying patients at risk of dehydration, and an increase in patients with acute kidney injury commencing appropriate fluid balance monitoring.

Endoscopy Lower.

Endoscopy Lower.

On the right track.

Sarah Ingleby, lead nurse for the acute care and hospital at night teams at Central Manchester University Hospitals NHS Foundation Trust (CMFT), says the Patientrack handheld electronic system has helped staff to identify, manage and treat sepsis.

Warfarin Management in Practice

OPEN ACCESSOctober 7, 2015Warfarin Management in Practice Jane Graham, Rob Noble, Jecko Thachil, MRCP, FRCPath Jane Graham Central Manchester University Hospitals NHS Foundation Trust Google Scholar More articles by this author , Rob Noble Central Manchester University Hospitals NHS Foundation Trust Google Scholar More articles by this author , Jecko Thachil, MRCP, FRCPath Central Manchester University Hospitals NHS Foundation Trust Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10234 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This team-based learning (TBL) session was developed to equip clinicians and undergraduates with the background knowledge and practical skills to manage patients on warfarin who present with bleeding, potential bleeding, or a high international normalized ratio in the absence of bleeding. The resource was developed in response to identification of patient safety issues and poor compliance to recommended guidelines surrounding the management of patients on warfarin. Methods: The prereading material contained in the resource is provided to students approximately 1 week before the session. During the session, students engage in an individual readiness assurance test before being grouped into teams where they complete a group readiness assurance test and a series of team application exercises. Results: This session has been successfully implemented in various formats to a broad range of practicing United Kingdom clinicians. Learner reactions to the session, as evidenced by anonymous feedback and verbal comments to faculty, have been positive. The session works well for both large and small groups and for those with differing clinical backgrounds and experience. Analysis of readiness assurance testing results (both individual and group) demonstrates evidence of knowledge acquisition relating to the session's defined learning objectives. Group interaction with the team application scenarios and interteam debates provides evidence of increased analytical skills and clinical application of the learning objectives to real-life practice. Discussion: TBL is well established within undergraduate and postgraduate medical education, ensuring knowledge acquisition, application of knowledge to real-life cases, and development of auxiliary skills such as teamwork. This resource has been developed to be a highly versatile tool. The content is relevant to both undergraduate and postgraduate education, enabling delivery of clinically relevant continuing education to practicing clinicians. The session has been designed to enable applicability to a global audience. Educational Objectives By the end of this module, learners will be able to: Describe the pharmacological actions, interactions, and monitoring of warfarin.Appropriately prescribe and administer treatment for a patient on warfarin with actual or potential major bleeding, including prothrombin complex concentrate, and vitamin K.Define major bleeding.Manage patients on warfarin with minor bleeding.Appropriately action a high international normalized ratio in the absence of bleeding.Assess which patients on warfarin are at highest risk of bleeding. ReferencesHaidet P, Levine RE, Parmelee DX, et al. Guidelines for reporting team-based learning activities in the medical and health sciences education literature, Acad Med.2012;87(3):292–299. http://dx.doi.org/10.1097/ACM.0b013e318244759eMedline, Google ScholarKhogali SE. Team-based learning: a practical guide: guide supplement 65.1—viewpoint, Med Teach.2013;35(2):163–165. http://dx.doi.org/10.3109/0142159X.2013.759199Medline, Google ScholarParmelee DX, Michaelsen LK. Twelve tips for doing effective team-based learning (TBL), Med Teach.2010;32(2):118–122. http://dx.doi.org/10.3109/01421590903548562Medline, Google ScholarParmelee DX, Michaelsen LK, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no. 65, Med Teach.2012;34(5):e275–e287. http://dx.doi.org/10.3109/0142159X.2012.651179Medline, Google ScholarTeam-Based Learning Collaborative Web site. http://www.teambasedlearning.org/. Accessed August 12, 2015.Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Preparatory Material Warfarin.docx RAT Warfarin Tutor.docx RAT Warfarin Student.docx IRAT Answer Sheet.docx tAPP Warfarin Tutor.doc tAPP Warfarin Student.doc tAPP Answer Cards.docx Resource Template Warfarin.docx 1. Warfarin-Chest 2012.docx 2. Warfarin Reversal-ASH 2011.pdf 2. Warfarin Reversal-BCSH 2011.pdf 2. Warfarin Reversal-Chest 2012.docx 3. PCC-eMC Beriplex.docx 3. PCC-eMC Octaplex.docx 3. PCC-FDA Kcentra.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationGraham J, Noble R, Thachil J. Warfarin Management in Practice. MedEdPORTAL. 2015;11:10234. https://doi.org/10.15766/mep_2374-8265.10234 Copyright & Permissions© 2015 Graham et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsEducationBlood Coagulation FactorsClinical Laboratory TechniquesTeam-Based LearningLearningAnticoagulantsWarfarinHemorrhageTBL Disclosures None to report. Funding/Support None to report. tabs.loading

040. Combining Lifestyle and Metabolic Predictors of Incident Inflammatory Polyarthritis in the Epic-2-Noar Study

Jamie C. Sergeant, Suzanne M. M. Verstappen, Catharine Morgan, Robert N. Luben, Amit Bhaniani, Serena Anuj, RA-MAP consortium, Alex J. MacGregor, Nick Wareham, Deborah P. M. Symmons, Kay-Tee Khaw and Ian N. Bruce Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge and Norwich Medical School, University of East Anglia, Norwich, UK

The quality review – asking staff and patients to inform quality strategy in Central Manchester

Central Manchester University Hospitals NHS Foundation Trust, like many Trusts, asked itself a number of searching questions in the wake of the reports into appalling standards of care in a number of UK care settings between 2006 and 2009. In order to seek assurance on the quality of care being provided and to be very clear about where improvements were needed, the Board of Directors commissioned a comprehensive peer review into standards of care provided. The resulting exercise involved over 200 staff being trained in review techniques and participating in a comprehensive Trust wide quality improvement programme. The output of this exercise was a detailed plan to improve quality of care, increased recognition of excellence, shared learning across multiple specialties, and increased staff engagement and expertise.

Systemic maternal immunity differs throughout gestation based on fetal sex

s / Placenta 35 (2014) A1eA112 A60 P1.158. SYSTEMIC MATERNAL IMMUNITY DIFFERS THROUGHOUT GESTATION BASED ON FETAL SEX Douglas Creedon , Elizabeth Ann Enninga , Wendy Nevala , Svetomir Markovic , Shernan Holtan b Mayo Clinic, Rochester, MN, USA; University of Minnesota, Minneapolis, MN, USA Objectives: There are many documented complications during pregnancy that have fetal sex disproportions. We tested whether the maternal immune milieu based on fetal sex contributes to these differences. Methods: Maternal blood samples were collected from fifty first time healthy women each month during pregnancy and at the postpartum visit. Cytokine, hormone and growth factor levels were assayed in the samples and fetal sex based differences assessed using Wilcoxon rank sum tests. Results: Mothers carrying a male fetus had high levels of pro-inflammatory cytokines G-CSF, IL-12p70, IL-21 and IL-33 and pro-angiogenic factors PlGF and VEGF-A throughout gestation, while mothers carrying a female fetus had higher levels of chronic inflammatory cytokines IL-5, IL-9, IL-27 and IL-25 (p 0.001). Transcription factor analysis showed many upregulated proteins from male fetuses are controlled by c-Jun, NF-kB, SP1 and CREB1, while seemed to regulatemany of the factors that were increased in maternal serum with female fetuses are regulated by NFAT and STAT3. IL27 increased throughout gestation, dropping dramatically post-partum (p<0.001), but there was no difference based on fetal sex. Any sex based differences in factor levels were no longer apparent in the postpartum samples. Conclusions: Male fetuses are associated with a pro-inflammatory cytokine and pro-angiogenic markers in maternal serum while female fetuses are associated with chronic inflammatory serum markers. These findings serve as the basis for future mechanistic studies and give us a deeper understanding of fetal-maternal tolerance as related to fetal sex. P1.159. HUMAN DNK AND REGULATORY T CELLS COMMUNICATION IN THE FETAL-MATERNAL INTERFACE: A CELLULAR IDENTITY AND EXPLANATION OF PREECLAMPSIA Jianhong Zhang , Caroline E. Dunk , Rebecca L. Jones , Lynda K. Harris , Sarah Keating , Stephen J. Lye , Stephen J. Lye f a LunenfeldTanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada; Departments of Obstetrics & Gynecology, University of Toronto, Toronto, Canada; c Institute of Human Development, University of Manchester, Manchester, UK; d St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Departments of Pathology, University of Toronto, Toronto, Canada; Departments of Physiology, University of Toronto,

Arrived safely? Audit of documentation of successful transfer into adult care of young people attending paediatric rheumatology clinics

Arrived safely? Audit of documentation of successful transfer into adult care of young people attending paediatric rheumatology clinics

Value of biomedical scientists providing on-site specimen adequacy assessment for fine-needle aspirations

ABSTRACTFine-needle aspiration (FNA) is accepted as a first-line investigation in patients with superficial or deep-seated mass lesions. One of the fundamental principles of successful aspiration is harvesting sufficient numbers of cells that are representative of the lesion being investigated. Central Manchester University Hospitals NHS Foundation Trust provides FNA services to Christie Hospital, including non-attended and biomedical scientist-attended aspirations, some of which are assessed on-site for specimen adequacy. This study audits the FNA coverage provided to Christie Hospital by exploring the contribution of biomedical scientist on-site specimen adequacy assessment to successful aspirations and identifies potential areas for service improvement such that unsatisfactory sampling is reduced. Satisfactory sampling rates varied between biomedical scientist-attended (79%) and non-attended (70%) procedures. Within the former group, 100% satisfactory sampling was achieved with on-site assessment, falling to 77% without on-site assessment. The highest unsatisfactory sampling rate was identified at 33% for thyroid aspirations in endocrinology, while rates elsewhere varied between 21% and 23%. This audit demonstrated the value of on-site specimen adequacy assessment as the ultimate goal of any FNA is to negate the need for more invasive procedures. In terms of flexibility and economic value, having adequately trained biomedical scientists to perform on-site assessment is quite feasible. Extending this biomedical scientist-led service to other departments would reduce unsatisfactory sample rates and the requirement for more invasive procedures.

News and Views–February 2012

News and Views is the newsletter of the British Nuclear Medicine Society. It comprises articles and up to date, relevant information for those working within the nuclear medicine community both nationally and internationally. Readers are invited to submit material, meeting announcements and training opportunities to the Editor: Dr Jackie James, Central Manchester Nuclear Medicine Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL. Tel: +44 161 276 4780, E-mail: [email protected]

NEWS AND VIEWS JANUARY 2012

News and Views is the newsletter of the British Nuclear Medicine Society. It comprises articles and up to date, relevant information for those working within the nuclear medicine community both nationally and internationally. Readers are invited to submit material, meeting announcements and training opportunities to the Editor: Dr Jackie James, Central Manchester Nuclear Medicine Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL. Tel: +44 161 276 4780, E-mail: [email protected]

NEWS AND VIEWS

News and Views is the newsletter of the British Nuclear Medicine Society. It comprises articles and up to date, relevant information for those working within the nuclear medicine community both nationally and internationally. Readers are invited to submit material, meeting announcements and training opportunities to the Editor: Dr Jackie James, Central Manchester Nuclear Medicine Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL. Tel: +44 161 276 4780, E-mail: [email protected]

Response to Manjaly and Smith

Clinical OtolaryngologyVolume 36, Issue 4 p. 394-394 CORRESPONDENCE: LETTERS Response to Manjaly and Smith R.J. List, R.J. List Southampton University Hospitals NHS TrustSearch for more papers by this authorD. Siau, D. Siau University Hospital of South Manchester NHS Foundation TrustSearch for more papers by this authorT.J. Woolford, T.J. Woolford Central Manchester University Hospitals NHS Foundation Trust.E-mail: richlist@gmail.comSearch for more papers by this author R.J. List, R.J. List Southampton University Hospitals NHS TrustSearch for more papers by this authorD. Siau, D. Siau University Hospital of South Manchester NHS Foundation TrustSearch for more papers by this authorT.J. Woolford, T.J. Woolford Central Manchester University Hospitals NHS Foundation Trust.E-mail: richlist@gmail.comSearch for more papers by this author First published: 18 August 2011 https://doi.org/10.1111/j.1749-4486.2011.02345.xRead 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 No abstract is available for this article. Volume36, Issue4August 2011Pages 394-394 RelatedInformation

NEWS AND VIEWS

News and Views is the newsletter of the British Nuclear Medicine Society. It comprises articles and up to date, relevant information for those working within the nuclear medicine community both nationally and internationally. Readers are invited to submit material, meeting announcements and training opportunities to the Editor: Dr Jackie James, Central Manchester Nuclear Medicine Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL. Tel: +44 161 276 4780, E-mail: [email protected]

NEWS AND VIEWS

News and Views is the newsletter of the British Nuclear Medicine Society. It comprises articles and up to date, relevant information for those working within the nuclear medicine community both nationally and internationally. Readers are invited to submit material, meeting announcements and training opportunities to the Editor: Dr Jackie James, Central Manchester Nuclear Medicine Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL. Tel: +44 161 276 4780, e-mail: [email protected]

News and Views

News and Views is the newsletter of the British Nuclear Medicine Society. It comprises articles and up to date, relevant information for those working within the nuclear medicine community both nationally and internationally. Readers are invited to submit material, meeting announcements and training opportunities to the Editor: Dr Jackie James, Central Manchester Nuclear Medicine Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL. Tel: +44 161 276 4780, e-mail: [email protected]