North Manchester Research Articles

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital.

Introduction Perioperative hypothermia is a common yet underreported complication of surgery. It results from various factors, including cold operating theaters, anesthetic effects, environmental exposure, exposed tissues, and the administration of cold intravenous or irrigation fluids. This study aims to determine the incidence of perioperative hypothermia in a district National Health Service hospital to assess the feasibility of a randomized controlled trial (RCT) for interventions to prevent hypothermia. Methods This retrospective study included the data of 200 elective surgical patients at North Manchester General Hospital from June 1, 2022, to August 1, 2022. Inclusion criteria were elective general surgery, urology, breast, and gynecology patients aged 18 to 60 years. Exclusion criteria included emergency cases and patients younger than 18 or older than 60. Temperature measurement data were collected from the anesthesia records of the patients at six phases: preoperative, pre-induction, intraoperative, post-procedure, recovery room, and post-recovery. Data collection included specialty, surgery duration, and the use of intraoperative fluid warmers. Statistical analysis was performed using StatsDirect software (StatsDirect Ltd, Wirral, UK). Results Among the 200 patients, the overall incidence of hypothermia was 4% preoperatively, 5% pre-induction, 12% intraoperatively, 11% postoperatively, 8% in recovery, and 6% post-recovery. Intraoperative hypothermia incidence was significant, given that active warming was applied to patients with preoperative hypothermia. Regression analysis showed no correlation between intraoperative temperature and the use of intraoperative fluid warmers. Pre-induction temperature was the most statistically significant predictor of intraoperative hypothermia. Conclusions This study highlights the need for active interventions to recognize and prevent perioperative hypothermia in elective surgical patients. Active pre-warming of patients, regardless of surgery type and duration, is feasible and potentially beneficial. Future research should include an RCT comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

Report on a novel approach to foundation year 1 doctor workforce planning

In early 2020, North Manchester General Hospital took steps to increase the number of doctors providing out-of-hours cover in response to the COVID-19 pandemic. This included introducing higher intensity rota patterns. Following positive feedback, it was decided that maintaining an increased level of staffing at foundation year 1 level across the site was beneficial for both patient safety and junior doctor working conditions. A new workplan was designed to maintain this higher level of out-of-hours cover by foundation year 1 doctors without an unmanageable financial impact on the trust, while complying with workforce regulations. In this model, foundation year 1 doctors work across multiple areas when providing out-of-hours cover, across medicine, surgery, urology and trauma and orthopaedics, rather than staying in their own current parent department. This whole-site model spanned the full 52-week period of the foundation year. In addition to increasing staffing numbers, this structure was also designed to provide foundation year 1 doctors with more stability in their rota pattern and monthly income, while improving their ability to prospectively plan their personal lives. The new model led to 20% additional cover during weekday evenings, 50% additional cover during nights and 60% additional cover on weekend daytimes, at an additional cost of £61 383 per year to the trust, excluding additional employer costs associated with a salary (‘on costs’). Foundation year 1 doctors reported that this model gave them educational opportunities and allowed them to take more breaks. This article describes this model, its implementation, key considerations and the potential to expand it across other NHS trusts.

730 An Audit of Antibiotic Prescription in Acute Pancreatitis

Abstract Aim To assess the prescription of antibiotics in the management of acute pancreatitis in North Manchester General Hospital and to determine adherence to NICE Guidelines (NG104). Method Retrospective analysis of patients admitted to North Manchester General Hospital, with a diagnosis of acute pancreatitis, between 1st January 2021 and 31st December 2021. Analysis performed by assessing case notes, electronic Prescribing and Medicines Administration (ePMA) system, radiological imaging, and blood test results. The Atlanta Classification was used to define the inclusion criteria for acute pancreatitis. Results A total of 98 patients were diagnosed with acute pancreatitis. Subsequently, 11 patients were excluded due to insufficient evidence to support their diagnosis. 65.5% of patients were prescribed antibiotics on admission. 12.1% of patients were prescribed antibiotics for necrosis, 12.14% for concurrent cholecystitis and 33.4% were prescribed antibiotics without indication. Conclusions Poor compliance with national guidelines on the recommended management of acute pancreatitis. Audit results and the recommended NICE Guidelines were disseminated to all members of the General Surgery team with further consolidation at the local governance meeting to improve knowledge and streamline practice.

Invitation strategies and participation in a community-based lung cancer screening programme located in areas of high socioeconomic deprivation

IntroductionAlthough lung cancer screening is being implemented in the UK, there is uncertainty about the optimal invitation strategy. Here, we report participation in a community screening programme following a population-based...

The junior doctor shadow board

Before 2020, North Manchester General Hospital had a history of poor feedback from junior doctors, regarding both their overall experience and access to non-clinical development opportunities. The circumstances of the COVID-19 pandemic resulted in the medical leadership team giving junior doctors the opportunity to lead the reorganisation of services and redeployment. The aim of this was to increase engagement, representation and development opportunities. This led to the formation of the Junior Doctor Leaders Group, using similar principles as the ‘shadow boards’ seen in the corporate sector. This article reviews the impact of the group. Analysis was conducted using internal key performance indicators, identifying improvement initiatives generated by the Junior Doctor Leaders Group and surveying group members. Initial results suggest that junior doctors felt their voices had gained recognition in the organisation, with 95% of group members stating that it increased junior doctor representation and 90% agreeing that the group made them feel more confident representing and advocating for their colleagues. Increased transparency and trust between junior and senior staff facilitated escalation of concerns to higher management, and the design and implementation of solutions. Members of the Junior Doctor Leaders Group also reported improvements to their work and educational experiences. In the first year after the group was established, members led or co-led a total of 14 organisation-wide improvement projects. Results from the General Medical Council training survey showed improvement across almost all indicators. Therefore, the authors believe that the Junior Doctor Leaders Group offers a novel approach to improving junior doctor engagement and experience, and can be beneficial to both the cohort of junior doctors and the wider organisation.

Assessment and management of secondary bacterial infections complicating Mpox (Monkeypox) using a telemedicine service. A prospective cohort study.

During spring 2022, an outbreak of Monkeypox (mpox) emerged as an infection of concern in Europe. Due to the overlapping clinical features of mpox and bacterial infections, diagnosis of concomitant bacterial infection is challenging. In this prospective cohort study, we report the incidence, severity, and progression of patients with secondary bacterial infection complicating mpox infection. Data were collected via a bespoke mpox telemedicine service provided by Infection services at North Manchester General Hospital, UK. A diagnosis of secondary bacterial infection was based on the history (balanitis, surrounding erythema, purulent discharge and nasal ulceration) and review of patient-collected medical photography. Patient were reviewed face-to-face where necessary. Secondary bacterial infection was diagnosed in 15 of 129 (11.6%) patients with mpox. Three patients with secondary bacterial infection (3/129, 2.3%) required admission to hospital and one patient underwent surgical debridement. Median healing (thus, isolation) times were longer in those with bacterial infection. In this prospective cohort study of patients with mpox, secondary bacterial infection was infrequent and predominantly mild. The virtual ward and telemedicine follow up allowed for the prompt recognition of secondary bacterial infections and timely antibiotic administration. Due to concerns regarding nosocomial transmission, mild clinical course and limited inpatient bed capacity, we believe this model of outpatient management for mpox (Clade II B.1 lineage) could be replicated in other low risk populations where suitable home isolation facilities exist.

10. Audit Reviewing the Accuracy of Coding for Temporal Artery Biopsies at a Large Teaching Hospital

North Manchester General Hospital (NMGH) has recently undergone a change in parent trust from the Pennine Acute Hospitals NHS Trust (PAT) to Manchester University NHS Foundation Trust (MFT). Temporal Artery Biopsy (TABx), a procedure not infrequently performed at the OMFS unit, follows urgent referral from Rheumatology colleagues for suspected Giant Cell Arteritis (GCA). A review of coding applied to these procedures is performed, aiming to establish whether payments been appropriate. The gold standard is met if the the correct code/correct payment are applied.

46. An audit of geographical distribution of zygomatico-maxillary-orbital complex fractures and the overall timeframe from injury to operation

Zygomatico-maxillary-orbital complex (ZMOC) fractures should be operated on within recommended time frames for optimal results. The OMFS department at North Manchester General Hospital (NMGH) treats all such fractures from several surrounding hospitals. Many referrals from other hospitals are usually not seen physically by the OMFS team at initial presentation but are assessed on trauma outpatient appointments subsequently. This can cause delay in time between injury and treatment. This audit aims to identify geographic patterns and the timeframes between injury and treatment and consider reasons for any possible delay.

Differential Effects on HbA1c Detection by HPLC and Capillary Electrophoresis in Five Types of Hb Variants in China.

Hemoglobin A1c (HbA1c) can be used to evaluate blood glucose control. Its measurement will be affected by many factors, but Hb variation is the most critical factor. This study aimed to explore the types of variants found in routine work and their impact on test results. Samples with abnormal HbA1c chromatograms found in routine testing were tested with high-performance liquid chromatography (HPLC) and capillary electrophoresis (CE) and then further tested with polymerase chain reaction (PCR) and sequencing. Five recessive heterozygous mutations were identified after PCR and sequencing. Hb Riccarton-II (a mutation in the HBA2 gene), Hb E, Hb G-Coushatta, Hb G-Taipei, and Hb North Manchester (a mutation in the HbB gene) were identified. All HbA1c values of these variants detected by HLC-723 G8 (HPLC method) were lower than those of Sebia Capillarys 2 FP (C2FP, CE method) with P < .0001. Five Hb mutations were identified in our routine HbA1c test, and their HPLC detection values were significantly lower than those obtained with the CE method.

Part of town as an independent factor: thenorth-forcemerger in Manchester

AbstractThis paper investigates the question of whether, as is often popularly believed, there may be systematic linguistic differences between different neighborhoods within a city by testing the independence of “part of town” as a factor separate from social class in thenorth-forcemerger in Manchester, UK, in a sample of 122 speakers. The phonemic contrast is explored in minimal-pair tests, Cartesian distance, and Pillai scores. In opposition to most dialects of English, thenorth-forcecontrast is still present in Manchester, displaying a pattern of fine social stratification, with lower socioeconomic levels having a stronger distinction. The merger is in progress in the city, but it is slower in north Manchester, showing a significantly greater distinction than the rest of the city, independent of social class. The results indicate a degree of social evaluation of the vowels, with implications for the question of the social meaning of a merger in progress.

Primary Care Referrals of Suspected Eating Disorders in Children and Young People in Greater Manchester Audit

AimsCurrent NICE guidance states that Children and Young People (CYP) with suspected Eating Disorders (EDs) should be immediately referred to specialist services on their first presentation to primary care. This audit assessed whether these standards were being met across Greater Manchester and what general practitioners felt would be helpful in supporting them to correctly refer patients. Aim 1: Analyse information from referral forms on all patients referred to Manchester Foundation Trust Community Eating Disorders Service (MFT-CEDS) from primary care between 17th December 2020 – 17th June 2021. Aim 2: Gain insight into how confident GPs in Greater Manchester feel identifying suspected EDs in CYP, their knowledge of guidelines regarding referral, and how they would like to be supported to improve referrals of suspected CYP-ED.MethodsQuantitative data on all primary care referrals made between 17th December 2020–17th June 2021 were analysed. Referrals were classified as correct if they were made both immediately and directly to the correct service. Subgroup analysis of data by geographic region of Greater Manchester was also undertaken. Qualitative data were collected through a survey which was sent to General Practitioners across Greater Manchester. The survey assessed knowledge of current guidelines and views on what training materials could be helpful to improve the referral process.ResultsA total of 69 patients were referred to MFT-CEDS by their GP between 17th December 2020 and 17th June 2021. 35% of GP referrals to MFT-CEDS were documented as being made correctly as per current guidelines. 43.5% of all referrals were not initially made to MFT-CEDS. 58% of referrals were documented as being made immediately. North and South Manchester had the lowest rates of correct referrals of 10% and 8% respectively. There were 10 survey respondents, of which the majority did not know current referral guidelines and did not feel confident in identifying suspected Eating Disorders in CYP.ConclusionThe majority of primary care referrals of CYP with suspected eating disorders to MFT-CEDS were not made in line with current NICE guidance.The following recommendations were made based on the findings of this audit:1) Create an information document and video regarding identification and referral guidelines for suspected EDs in CYP, 2) Design an easy-to-use referral template for GPs, 3) Conduct interviews with GPs working in North and South Manchester to help identify what additional support they need, 4) Re-audit referral data once quality improvement measures have been in place for 6 months.

P13 Development of a consult and antimicrobial stewardship service in Manchester Foundation Trust

ObjectivesTo prospectively audit the first year of the North Manchester infectious diseases AMS and Consult service June 2020 to June 2021 to: (i) characterize the number of patients who had antibiotic treatment narrowed, duration reduced and/or switch to oral options; (ii) assess documentation of indication and duration of antibiotic prescriptions; (iii) determine whether or not the appropriate microbiological specimens have been performed and with the lab; (iv) identify the impact on antibiotic consumption measured in defined daily dose (DDDs); and (v) establish whether base teams act on the advice given by the Consult/AMS team (data over a 6 week period).MethodsOn weekdays an electronic prescribing list of all patients prescribed piperacillin/tazobactam, meropenem and ciprofloxacin was generated, and the consults team performed either a bedside or notes review. Data was collected prospectively on 730 patients on which infection was treated, which specialty managed the patient, microbiology samples sent, duration and indication of treatment documentation, and advice given by consults team. Data was then collected over a further 6 weeks looking at whether the base specialty carried out the advice of the AMS team.ResultsThe main indication for broad spectrum antibiotic use was urinary tract infection (151/720) and hospital acquired pneumonia (104/720). Poor documentation of antimicrobial indication and duration was observed across all specialties (277/720). Just over 50% of appropriate microbiology samples were sent (422/726). For 42% of cases (311/730), colleagues were advised to stop or reduce antibiotic duration. In 30% of cases (220/730), narrowing of antibiotic spectrum was advised. Thirty percent (219/730) were advised on IV to oral switch. There was a modest reduction in antimicrobial consumption in some specialties comparing the year prior to the introduction of the service 2019–20 to 2020–21; 17.4% reduction respiratory (7810/9137), 0.2% increase in medicine (272698/267351) and 2.1% surgery (68722/67309). In 81 patients reviewed to look at outcomes over 6 weeks, 88% of Consult/AMS team advice was actioned by the lead specialties involved in the patients’ care.Conclusions(i) There is a substantial need for an AMS service within the hospital. (ii) Outcome data shows the ward teams engage with the service and most follow advice. (iii) The service contributed to limiting inappropriate prescribing during the COVID-19 pandemic. There was a modest rise in hospital-wide consumption. (iv) The AMS service needs to be available to provide patient equity across Manchester Foundation Trust, fostering a city-wide AMS strategy that encompasses education, guidelines, audit and quality improvement.

MANAGEMENT OF A RECURRENT MANDIBULAR UNICYSTIC AMELOBLASTOMA

<h3>Background</h3> Ameloblastomas are benign, slow-growing odontogenic tumors with numerous subtypes based on clinical and histologic assessment. They account for approximately 1% of all oral tumors and are slow-growing, expansile lesions that can cause symptoms if they are sufficiently large or affect nearby structures. <h3>Case Report</h3> A 55-year-old female patient was referred to the Department of Oral and Maxillofacial Surgery (OMFS) at North Manchester General Hospital, United Kingdom, by her general dentist in 2009 regarding an extensive mandibular cyst associated with carious teeth. The cyst was enucleated under general anesthesia, and histopathology confirmed the diagnosis of a unicystic ameloblastoma. The patient was uneventfully followed up every six months for 7 years, which indicated continual healing and no signs of recurrence, after which the patient did not return for further review. In 2020, the patient was referred back to the OMFS department for a large swelling around the body of the mandible. An urgent biopsy was performed, which showed features consistent with recurrence of the ameloblastoma. Cross-sectional imaging was undertaken, and the patient's case was discussed at the head and neck multidisciplinary team meeting. Subsequently, the patient has been scheduled for segmental resection and reconstruction with a 3-dimensional chimeric scapula free flap. <h3>Discussion</h3> Eighty percent of all ameloblastomas occur in the mandible. The unicystic ameloblastoma is a variant of the intraosseous ameloblastoma and has the potential for recurrence after 10 years or more. <h3>Conclusions</h3> This case exemplifies the importance of careful and long-term follow-up of ameloblastomas, patient education, and the importance of histologic assessment for diagnosis.

A mother’s hope in the midst of existential immobility from state and stigma

The article is situated ethnographically in households on the main social housing estate in Harpurhey, North Manchester, England. It explores the affective dynamics of motherhood and imaginations of the future with a backdrop of prolonged government disinvestment. We follow the experiences of a mother and her son as they deal with moments of uncertainty and attempt to imagine and prepare for his future free from dependence on state welfare. Considering that parenting marks time in the most intimate of ways and it confronts parents with the passing of time in terms of biological “growth” that sequences time for us, this article addresses how and at what points dependence on the state, over time, reconfigures the affective dynamics of motherhood and imaginations of familial dependencies into the future.

Educating the scientific housewife: the conceptualisation of housework in English girls’ day schools, 1870–1914

ABSTRACT As educational opportunities for women and girls expanded in the Victorian and Edwardian periods, science and domestic subjects were increasingly linked. This article draws upon research from the history of education and women’s history to examine how schools contributed to contemporary constructions of housework. It takes two case studies: the North London Collegiate School and Manchester High School for Girls. Both were new day schools for the daughters of the professional middle classes and faced the challenge of designing an appropriate course of study for future ladies. This article argues that these schools drew on the perceived relationship between science and domestic subjects to form their own conceptualisation of housework as an intellectual activity. Practical work in science and domestic subjects was central to this representation, as the schools acknowledged the realities of running a middle-class household. This conceptualisation of practical, intellectual housework aligned with the interests of female students and staff.

A tribute to some of the doctors who died from COVID-19

A tribute to some of the doctors who died from COVID-19

Hidden from history? A brief modern history of the psychiatric “treatment” of lesbian and bisexual women in England

It is well documented that homosexuality was classified as a mental illness in the DSM until 1973, when it was replaced with the diagnosis of “sexual orientation disturbance”. While it is widely known that homosexual men were criminalised and risked a spell in prison or aversion therapy in a psychiatric hospital (Dickenson, 2013), the class dimension is probably less well known. According to the Queer historian, Chris Waters (2017), it was the more privileged middle class men who were offered aversion therapy, as a “softer” option than jail (Alan Turing being the most prominent example). In contrast, the majority of mostly working class men who were discovered engaging in same-sex relations were more likely to end up in prison, without the offer of “treatment” as an alternative. However, there are aspects of this history we know even less about. Because it is well documented, gay men’s experiences of psychiatric treatment for same-sex attraction have become a dominant historical discourse. But what happened to same-sex attracted women in England (1950–70s) who were not subject to direct court referral routes into psychiatric treatment like their male counterparts? Although female homosexuality was not criminalised in England, it was still, like male homosexuality, officially classified as a mental disorder (“sexual deviation”). As part of a cohort of studies around the theme of sexualities and health funded by the Wellcome Trust, we conducted a bottom-up archival study of women’s and lesbian, gay, bisexual, and transgender (LGB&T) archives in England to investigate this question. Documentation proved to be sparse and fragmented, and what little material we found presented us with numerous challenges to interpretation. A small number of psychiatrists and psychologists had various, often competing, theories about homosexuality and published papers promoting examples of experimental or purportedly successful “treatments”, which they often used to test out their theories. However, it is not clear how much these theories actually influenced practice (Oram and Turnbull, 2001).

Developing a class format to improve the management of total knee replacement (TKR) patients in an out-patient physiotherapy setting

Purpose: Historically patients at North Manchester General Hospital received traditional 1:1 Physiotherapy treatments post TKR. Literature suggests a class environment can be more cost effective and yield improved results. Therefore a TKR class was set up in 2015. This poster highlights the findings from the first year demonstrating clinical outcomes, patient satisfaction and cost-effectiveness.

The Incidence of Inflammatory Bowel Disease in 7 Ethnically Diverse Urban Populations in England: Results From the U.K. INception CohorT Epidemiological Study (UNITE)

Introduction: Previous studies have shown the incidence of UC in South Asians (SA) is higher than the Caucasian population. These studies were done over 20 years ago. The current epidemiology of IBD in the multiethnic UK is unknown. Methods: To describe the UK incidence of IBD and distribution within ethnic groups. Census data (2011) was used for background population size, ethnic groups and to identify areas with high SA populations where Indian and Pakistani were the predominant groups. The incidence was calculated by using the number of subjects in each ethnic group in the background population as the denominator. Adult patients (>16 years) with newly diagnosed IBD (fulfilling Copenhagen diagnostic criteria) were prospective recruited over one year in 7 catchment areas with high SA population. Data including demographics ethnic codes and disease phenotype (Montreal classification) was collected onto the validated Epicom database. Results: Over 1 year IBD was diagnosed in 351 cases; 219 ulcerative colitis (UC), 107 Crohn's disease (CD) and 26 Inflammatory bowel disease unclassified. (IBDU) (Table 1). Overall incidence of UC was higher than CD (9.69/100,000 vs 4.80/100,000), for all populations except Pennine (3.31/100,000 for CD and 2.76/100,000 UC). Crude IBD incidence rates varied between populations: lowest was 6.81/100,000 in Pennine, North Manchester and highest 26.11/100,000 in Leicester. The majority of ethnic groups were Caucasian, Indian or Pakistani (298/351). IBD, UC and CD incidence was similar between Pakistani and Caucasian groups. CD incidence was similar across all ethnic groups. UC incidence was significantly higher in the Indian population compared to Caucasians and Pakistanis (p < 0.001). There was no significant difference in disease extent of UC between ethnic groupsTable: Table. Incidence rates per 100 000 for inflammatory bowel disease, Crohn's disease, ulcerative colitis and inflammatory bowel disease unclassified in England for patients aged 16 years or older in 2016/17Conclusion: This is the first prospective study to report the incidence of IBD in seven ethnically diverse UK populations with the highest IBD incidence in Leicester. We observed wide variation in IBD incidence between regions within the same country, differences in UC incidence within the SA population (Indian vs Pakistani origin) and similar CD incidence rates across all groups. The Indian population seems particularly susceptible to UC suggesting an inherent predisposition beyond environmental factors. Finding an explanation for this observation will be critical to a better understanding to what triggers the disease.

'Our 24-hour palliative care hub offers a single point of access'.

The need for coordinated, seven-day end of life care in north Manchester was evident from the statistics. Deaths in hospital were higher than the national and regional average. In 40% of cases, there was no medical need for the patient to be in hospital in the first place, and research showed 73% of patients would prefer to die at home. Furthermore, 70% of patients felt they were not getting enough support, often resulting in a hospital admission.