Leeds Teaching Hospitals Trust Research Articles

A4 Sentinel node imaging: a drain on resources?

Leeds Teaching Hospital Trust, UK Abstracts for the Autumn Meeting of the British Nuclear Medicine Society Glasgow University, UK, 8–9 September 2005

Nerve Blocks in Palliative Care

It was a pleasure to review this book on nerve blocks in palliative care, written by two renowned specialists, Fiona Hicks, who is a consultant in palliative medicine at Leeds Teaching Hospitals Trust and Karen Simpson, a consultant in pain medicine within the same trust. Nerve Blocks in Palliative Care has been composed primarily for those who are not familiar with the full potential and risks of nerve blocks in patients with neoplastic disease. As such, the book is aimed primarily at those involved in the day-to-day specialist care of cancer patients such as palliative care doctors, oncologists and specialist nurses, as opposed to pain medicine anaesthetists. This is not a ‘cook book' as to how to perform the procedures, rather it is an excellent guide on how and when to refer a patient and as such should probably be compulsory reading for those who assess patients for referral to specialist pain teams. The book starts with a very general section on the philosophy behind the use of interventional blocks. I was amused by the paragraphs on team issues and communications. Many of the problems that are alluded to in these paragraphs are all too familiar to those of us who perform pain medicine interventions. Reading this book prior to referral would help prevent some of the many misunderstandings that pain specialists come across in our practice of pain medicine. The miracle pain relieving injection with no risks does not exist! Similarly, there is no such thing as a ‘simple injection'. Team members can disagree on what is the best way of managing a particular problem and they need to be involved in discussions, in addition to the patient and the relatives. There is also a very good chapter on the assessment of pain, which is something that is often poorly performed by the nonpain specialist when you take into account the multiple pain mechanisms that may be present at any one time. There now is a wealth of information about the aetiologies and underlying mechanisms of pain in cancer patients and to try and summarise this in a chapter was obviously difficult. The chapter on pain syndromes covers this area well for the nonpain specialist. The central part of the book then proceeds to cover individual invasive procedures, ranging from trigger point injections through to the more complex neurolytic blocks and intrathecal infusions. These chapters have involved a significant amount of thought and work. Each technique is introduced by comments on specific indications and contraindications; it could be argued that these are the most important points for a non-specialist in pain medicine to take on board. Understanding the limits of any procedure and the complications that may occur are also vital. The limits and complications need to be discussed by a sympathetic person prior to referral to a pain specialist, as the patient needs to be prepared to participate in a discussion with the pain specialist in greater depth. Currently, it is not uncommon for the pain specialist to have to break the news that severe complications can occur and that there is a failure rate; the myth of the ‘miracle risk free injection' is broken, which may result in profound disappointment and occasionally increased patient distress. Finally, the book finishes with a chapter, albeit brief, on the ethics involved in pain medicine and the terminally ill. Once more, we are urged to consider not only the potential benefits but also the risks. At the end of the day, those performing the procedures are best suited to tackle the issues around interventions for pain management. However, it is important that the potential for improved pain relief and reduced suffering are not missed by those involved in the day-to-day management of cancer patients. Also, patients need to have an understanding of what may be involved prior to meeting the pain team. Recently, I have been asked to give a talk on invasive procedures to our palliative care team. I have responded by asking that they read this book on nerve blocks in palliative care – I feel that would provide them with more education than I could provide in an hour. My talk will be around this excellent book!

The amalgamation of two breast imaging units in Leeds

Within the United Leeds Teaching Hospitals Trust there are two main breast imaging units providing symptomatic breast services. They provide a facility for two different teams of breast surgeons and historically operate with some differences in protocols. There are now plans for the reconfiguration of the breast service within the United Leeds Teaching Hospital, which is hopefully to take place early in 2005, with the amalgamation of the two breast imaging units on one site. Prior to this, many changes are required for the merge to be successful. The proposal for this proffered poster is to outline the plan for the amalgamation of the differing protocols. We aim to identify some of the major differences, outline the method of change in practice through the development of new joint protocols and determine implementation pathways

Use of in vivo-generated biofilms from hemodialysis catheters to test the efficacy of a novel antimicrobial catheter lock for biofilm eradication in vitro.

This biofilm study was conducted to assess the in vitro activity of tetrasodium EDTA on catheters that had been routinely removed from hemodialysis patients at Leeds Teaching Hospitals Trust due to maturation of fistula. Catheters were screened by culture of through-catheter flush, and isolates were identified by standard methodologies; 20 isolates were found to be biofilm positive. Initial biofilm cell count levels averaged above 10(5) CFU/1-cm catheter section. Bacteria identified in the biofilms were gram-negative (1 isolate), gram-positive (11 isolates), or mixed species (8 isolates). After a 24-h lock, 40 mg of tetrasodium EDTA per ml was effective at eradicating the total biofilm viable count in almost all cases. The efficacy of tetrasodium EDTA as a catheter lock potentially shows that this agent could substantially reduce catheter-related infections and be used to treat patients with limited access.

Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachers.

To describe the perceptions of medical students and clinical teachers of teaching and learning in the clinical setting. Qualitative study of focus groups with undergraduate medical students and semistructured interviews with hospital consultant clinical teachers. The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK. Fourth year medical students and consultant clinical teachers. Analysis of narratives to identify students' perceptions of clinical teaching and consultants' views of their delivery of undergraduate clinical teaching. Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be 'teaching' by students. While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills.

The academic and clinical unit for musculoskeletal nursing – a future direction?

This paper describes the background to and the establishment in Leeds of an Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN). This venture is a tripartite collaboration between the Academic Unit of Musculoskeletal and Rehabilitation Medicine of the University of Leeds, the School of Healthcare Studies – also at the University of Leeds, and the Division of Head, Neck and Musculoskeletal Services within the Leeds Teaching Hospitals Trust. The aim of ACUMeN is to generate, disseminate and apply knowledge for the improvement of nursing practice and patient outcomes and to evaluate its effects. Initially the unit will focus on rheumatology nursing as this is where expertise is currently located, but nursing does not function in isolation and multidisciplinary care will be included. It is also anticipated that the programme of work will expand into other areas of musculoskeletal nursing, such as orthopaedics and paediatric rheumatology.

Provision of safe potable water for immunocompromised patients in the Leeds Teaching Hospital Trust

Provision of safe potable water for immunocompromised patients in the Leeds Teaching Hospital Trust