Frenchay Hospital Research Articles

The cost of a hot drink scald

Approximately 6400 children per year are admitted to UK hospitals for treatment of burns [National Burn Care Review Committee Report (NBCRC). Standards and Strategy for Burn Care: a review of burn care in the British Isles. 2001.]. This paper investigates the financial costs involved in the management of uncomplicated, minor paediatric scalds. Three cases (2–4% TBSA scalds) were studied to quantify consumables used, services required during management and costs obtained from appropriate Purchasing Departments and Directorate Accountants. Management in all cases involved a general anaesthetic for cleaning of wounds, application of BioBrane ® (Bertek Pharmaceuticals) and dressings, observation on Children's Ward and discharge following wound review at 48 h. The calculated mean average cost per case was £1850. In the period 01/12/2002–30/11/2003, 144 children were admitted to Frenchay hospital, Bristol, for treatment of a minor burn or scald (less than 10%TBSA). This caseload is therefore estimated to currently cost £266,400 per year. These findings may facilitate improved planning for future resource allocation and could also contribute evidence towards the cost effectiveness of prevention strategies.

The Sturge-Weber Syndrome. By G. L. Alexander, M.D. (Edin.), F.R.C.S.E., F.R.C.S., Surgeon-in-Charge, Department of Neurological Surgery, Frenchay Hospital, Bristol; and R. M. Norman, M.D., M.R.C.P., Research Consultant in Neuropathology, The South Western Regional Hospital Board. 9½ × 6¾ in. Pp. 104 + viii, with 54 illustrations. 1960. Bristol: John Wright & Sons Ltd. 32s. 6d

The Sturge-Weber Syndrome. By G. L. Alexander, M.D. (Edin.), F.R.C.S.E., F.R.C.S., Surgeon-in-Charge, Department of Neurological Surgery, Frenchay Hospital, Bristol; and R. M. Norman, M.D., M.R.C.P., Research Consultant in Neuropathology, The South Western Regional Hospital Board. 9½ × 6¾ in. Pp. 104 + viii, with 54 illustrations. 1960. Bristol: John Wright & Sons Ltd. 32s. 6d

REVERSE STRETCH TEST IN BASAL CELL CARCINOMA

Department of Plastic and Reconstructive Surgery, Laser Center, Frenchay Hospital, Frenchay, Bristol, United Kingdom Correspondence to Mr. Govindan, 5 The Elms Malmains Drive, Frenchay, Bristol BS16, 1PZUnited Kingdom, [email protected]

Early diagnosis and treatment of toxic shock syndrome in paediatric burns

Young children with burns are at risk of developing toxic shock syndrome (TSS), which is an exotoxin mediated disease usually caused by Staphylococcus aureus ( S. aureus). The diagnosis of TSS is difficult because in the early stages the signs and symptoms resemble other common childhood illnesses such as scarlet fever. If the condition is not treated promptly it has a high mortality. The South West Regional Paediatric Burns Unit at Frenchay Hospital admits 150–200 burns per year. We have designed a protocol to facilitate the early diagnosis and treatment of TSS. We report our experience over a 3-year period in which almost one quarter of cases of TSS were admitted from home or another hospital. During this period all children with TSS survived and none needed ventilatory support. Typical cases presented within 2 days of thermal injury, in a child under 2 years old with a burn of less than 10% of body surface area (BSA).

Reduction in mortality from severe head injury following introduction of a protocol for intensive care management

To determine the effect of an intensive care management protocol on the intensive care unit (ICU) and hospital mortality of severely head-injured patients, we designed a longitudinal observational study of all patients admitted with a head injury between 1992 and 2000. A computerized patient database was used to identify all patients with severe head injury admitted to the ICU at Frenchay Hospital, Bristol, UK: a tertiary referral centre for the clinical neurosciences. We compared the ICU and hospital mortality and length of stay in patients before and after implementation of a protocol for their ICU management in 1997. Implementation of the protocol was associated with a significant reduction in ICU mortality from 19.95% to 13.5% (odds ratio 0.47; 95% CI 0.29-0.75), and in hospital mortality from 24.55% to 20.8% (odds ratio 0.48; 95% CI 0.31-0.74). This was achieved despite a significant increase in the median APACHE II score (14 vs 18) of patients admitted after implementation of the protocol. The median ICU and hospital length of stay remained constant over the study period. The introduction of an evidence-based protocol to guide the ICU management of patients with severe head injury has been associated with a significant reduction in both ICU and hospital mortality.

Rehabilitation Improves Coping Beliefs in COPD

N R Ambler, C A Langley Departments of Clinical Psychology and Respiratory Medicine, Frenchay Hospital, Bristol Introduction Achieving optimal fitness levels and a good understanding of the nature of COPD are key objectives of pulmonary rehabilitation. However these alone will often prove insufficient for patients to achieve their best possible levels of functioning. Many remain anxious and restricted because they still lack confidence in being able to cope with their symptoms. Hence understanding the attitudes adopted by different individuals towards their illness can help to explain why many appear in worse condition than its severity warrants. Information about patients’ beliefs and fears regarding COPD has several possible applications. It may show up an area where intervention is needed. It might be revealing of the treatment process. It could be used as an index of treatment success.

A 6 year prospective analysis of the diagnosis of malignant melanoma in a pigmented-lesion clinic: even the experts miss malignant melanomas, but not often

We investigated whether the pigmented-lesion clinic (PLC) run by the Department of Plastic and Reconstructive Surgery at Frenchay Hospital was effective in making and excluding the diagnosis of malignant melanoma, by looking at the pattern of referrals over time, the number of melanomas excised and melanomas in which the diagnosis was delayed or missed. We also investigated whether the PLC was having an effect on the thicknesses of melanomas excised. All 9968 patients attending the PLC between 1 January 1993 and 31 December 1998 were included in the study and 586 malignant melanomas were diagnosed; 24.7% of excisions led to the diagnosis of malignant melanoma. Seven invasive melanomas and two lentigo malignas were missed. There was one histological false negative. The PLC has a sensitivity of 98.5% and specificity of 89.2% for the diagnosis of melanoma; the negative predictive value is 99.9%. The PLC is effective in rapidly making or excluding the diagnosis of malignant melanoma, but has had no effect on the average thickness of melanomas excised over the 6 year study period.

Don't blame the iceberg.

At the above-mentioned study day, Lesley Fudge gave a colleague's paper on risk management. The colleague was Jill Ashley-Jones, then a Health Safety Manager at the Frenchay Hospital at the North Bristol NHS Trust, and she had been unable to attend the day. She had focused on the risk management issues associated with the sinking of the Titanic and had based it on the actual reports written following the disater. There was no mention of Leonardo or Kate, of course. It was also a clever approach when one looks at what happened, and inspired this article by Jim Miller. The mistakes were fundamental and the risk management issues are absolutely classic. Jill associated some of the lessons learnt with what is happening in the NHS, which can, in turn, be applied to a specific team, to a department or to an organisation.

Users’ perceptions of the impact of information provided by a Consumer Health Information service: an in-depth study of six users

This paper describes the impact of providing six users of the Health Facts Consumer Health Information Centre at Frenchay Hospital with health information. Comments from a previous user satisfaction questionnaire survey implemented by the researcher provided themes to explore. These were: (1) cognitive effects (2) affective effects (3) behavioural effects. Semi-structured interviews were conducted with six consecutive users of the centre asking about a health problem for themselves. Health Facts information improved knowledge and understanding, reduced anxiety, and helped respondents accept and self-manage illness, facilitated by quality of content and presentation. Everyone took some subsequent action in support of their condition. The centre saved users’ time searching for information elsewhere and staff were key players providing it. Information was shared with others, extending its impact. Increased publicity for the service was the main suggested improvement. Health Facts information was mostly rated higher than other information sources, and unexpectedly as high as information from doctors. Even well-informed users gained new understanding. Health Facts information is highly valued, and complements advice given by health professionals. Findings reflect recent literature and government policy to get patients more involved in their own health care. The methodology may help other health information services investigate this subject.

Asthma versus chronic obstructive pulmonary disease--exploring why 'reversibility versus irreversibility' is no longer an appropriate approach.

Clinical & Experimental AllergyVolume 29, Issue 6 p. 739-743 Asthma versus chronic obstructive pulmonary disease — exploring why ‘reversibility versus irreversibility’ is no longer an appropriate approach DOW, DOW Bristol University and Frenchay Hospital, Bristol, UKSearch for more papers by this author DOW, DOW Bristol University and Frenchay Hospital, Bristol, UKSearch for more papers by this author First published: 24 December 2001 https://doi.org/10.1046/j.1365-2222.1999.00589.xCitations: 8 Dow Frenchay Hospital, Bristol BS16 1LE, UK. Read 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 Citing Literature Volume29, Issue6June 1999Pages 739-743 RelatedInformation

A retrospective 5-year study on the accuracy of the barium enema examination performed by radiographers

Barium enema examinations have been undertaken by radiographers at the Frenchay Hospital for more than 10 years. We have performed a retrospective study to assess the accuracy of this radiographer service by reviewing those patients who have been examined by both Barium enema and colonoscopy/flexible sigmoidoscopy to determine agreement, and reasons for disagreement. This paper does not attempt to compare the two techniques. In the 5 years between 1992 and 1996, 595 patients had both barium enema and colonoscopy or flexible sigmoidoscopy. In 488 (82%) of these patients the barium enema examination was performed by a radiographer. Comparisons with endoscopy indicate that 96% of polyps > 1 cm, and 97% of carcinomas were detected radiologically. We conclude that radiographer performed barium enemas with double reporting produces a very high standard of examination with detection rates for significant lesions comparable with published data.

Clifford “Grant” Tulloh, phd, md, ms, do, frcs eng, 1926–97

Clifford “Grant” Tulloh was consultant ophthalmologist at Bristol Eye Hospital and Frenchay Hospital from 1963 until Parkinson’s disease necessitated his early retirement in 1981. He attended Newcastle Grammar School, followed...

Shoulder function following humeral nailing: S. Duff, G. Chakrabarty, R. Dodenhoff, P. P. Sarangi and N. Blewitt (Frenchay Hospital, Bristol, UK)

Shoulder function following humeral nailing: S. Duff, G. Chakrabarty, R. Dodenhoff, P. P. Sarangi and N. Blewitt (Frenchay Hospital, Bristol, UK)

The Speech and Language Therapy Research Unit at Frenchay Hospital, Bristol.

The Speech and Language Therapy Research Unit at Frenchay Hospital, Bristol.

Large format ink-jet poster production: a case report.

To complement the services offered by the Medical Illustration Department of Frenchay Hospital, Bristol, we decided to look at the possibility of producing posters using the ink-jet process. Our designers wanted to use the full scope of their computers and software to expand their design talents. The method of cutting and pasting sheets of paper onto card seemed old fashioned and denied clients the benefit of the exciting techniques that have become available. After seeking sponsorship, a drug company gave 8000 Pounds towards setting up the department's poster printing service. A Kodak DS1000 printer was installed together with Posterjet and Posterworks software and we went into production, servicing not only our hospital but others in the area who gave their support for the service. High quality photographic reproduction was achieved and clients and consultants were very pleased with the results. The designers were happy that their skills were being used and interest in this and other services in the department have increased. The resulting increased income has helped finance other projects. The printer has enabled us also to see output proofs before sending work off to be offset printed--a very useful tool and a cost-saving process.

Group work

Medical EducationVolume 31, Issue s1 p. 69-70 Group work Professor Richard West, Professor Richard West Postgraduate Medical Dean, Frenchay Hospital, Bristol, UKSearch for more papers by this author Professor Richard West, Professor Richard West Postgraduate Medical Dean, Frenchay Hospital, Bristol, UKSearch for more papers by this author First published: 29 January 2009 https://doi.org/10.1111/j.1365-2923.1997.tb02596.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. Volume31, Issues1December 1997Pages 69-70 RelatedInformation

Magnetic resonance imaging (MRI)

Sir: Broecke et al. suggested an alternative method for general anaesthesia for MR scans in children. We have not claimed that the technique described in our paper is the only technique available[1]. Indeed, we specifically referred to other techniques using propofol and/or the laryngeal mask. Whilst propofol may well be satisfactory as the sole anaesthetic agent, it requires an additional delivery system and initial venepuncture. The authors do not state the strength of their magnet. With a 1.5T MR scanner, we would need to place the infusion pump a long way from the child, requiring long lengths of extension tubing. We also prefer to offer the option of an inhalational or intravenous (i.v.) induction. If an i.v. induction is used, we find sodium thiopentone preferable to propofol since it causes no pain on injection. Moreover, since our study, we have found sevoflurane to be an equally, if not superior, inhalational induction agent to halothane. The authors also claim that they have a free airway 'guaranteed' by a laryngeal mask. We stand by our claim that an endotracheal tube provides a more secure airway, particularly in children less than 2 years of age (not studied by the authors). In addition, the RAE tube described is far less obtrusive than an LMA, an important consideration in positioning for some head scans and when the child is required to be in the face-down position. Furthermore, should the child require temporary or full artificial ventilation, this is better achieved with an endotracheal tube. We note that Broecke et al. do not appear to include expired carbon dioxide monitoring in their technique. We believe this to be a very important monitor in these children, since it also acts as a disconnect alarm, an essential feature in remote anaesthesia. A. E. R. YOUNG; J. S. M. ZORAB Department of Anaesthesia; Frenchay Hospital; Bristol BS16 1LE, UK

Cutaneous malignant melanoma in the young

Between the years 1967 and 1993, 3246 patients were diagnosed with malignant melanoma at Frenchay Hospital, Bristol. This paper reports 47 patients, 21 years of age or under, including 10 preadolescent cases under 14 years of age. It represents a further follow-up of a cohort originally published from this centre in 1986 in addition to 18 new cases. Most (89%) of the lesions occurred on the trunk and extremities, with females showing a predominance of lesions on the lower limbs. 83% of the melanomas were of the superficial spreading type; 72% invaded to Clark level III and IV. Thickness ranged from 0.29mm to 50.00mm (median 1.20 mm). Ulceration was present in 17% of cases and 32% of melanomas arose within a pre-existing small congenital melanocytic naevus. Overall 5-year survival was 81%, with a mean follow-up of 8.5 years. Ulceration and tumour thickness of greater than 1.5 mm were associated with a poor prognosis.

The Goslon yardstick applied to a consecutive series of patients with unilateral clefts of the lip and palate.

First described in 1987, the Goslon yardstick has been used since as a reliable and reproducible means of measuring dental arch relationships and, therefore, the quality of facial growth. The dental study models of a group of 32 consecutively treated patients with unilateral clefts of lip and palate, from the Frenchay Hospital, Bristol, U.K., were analyzed using the Goslon yardstick. More than 50% of the sample were in the unfavorable Goslon groups IV and V. Because of these results, we at Frenchay Hospital now base our related surgical procedures on the early vomerine closure of the anterior hard palate without nasal or alveolar repair at 3 months, followed by primary hard and soft palate closure at 6 months.

High frequency of apolipoprotein E ε2 in patients with cerebral hemorrhage due to cerebral amyloid angiopathy

Annals of NeurologyVolume 39, Issue 5 p. 682-682 Letter High frequency of apolipoprotein E ε2 in patients with cerebral hemorrhage due to cerebral amyloid angiopathy J. A. R. Nicoll, J. A. R. Nicoll Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorC. Burnett, C. Burnett Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorS. Love, S. Love Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorD. I. Graham, D. I. Graham Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorJ. W. Ironside, J. W. Ironside Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorH. V. Vinters, H. V. Vinters Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this author J. A. R. Nicoll, J. A. R. Nicoll Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorC. Burnett, C. Burnett Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorS. Love, S. Love Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorD. I. Graham, D. I. Graham Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorJ. W. Ironside, J. W. Ironside Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this authorH. V. Vinters, H. V. Vinters Department of Neuropathology Southern General Hospital Glasgow, UK Department of Neuropathology Southern Frenchay Hospital Bristol, UK Department of Neuropathology Western Infirmary Edinburgh UK Department of Pathology and Laboratory Medicine (Neuropathology) UCLA Medical Center Los Angeles, CA 90095Search for more papers by this author First published: May 1996 https://doi.org/10.1002/ana.410390521Citations: 44AboutPDF 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.Citing Literature Volume39, Issue5May 1996Pages 682-682 RelatedInformation