Oxford University Hospitals NHS Trust Research Articles

Students 4 Best Evidence: the future of evidence based healthcare

Students 4 Best Evidence (S4BE) is a project set up by the Cochrane Centre. It consists of a growing network of students from a variety of disciplines from around the world who are interested in evidence based healthcare (EBH). We interviewed Martin Burton, director of UK Cochrane Centre, and David Carroll, medical student at Queen’s University Belfast, about the project. Martin is also a consultant otolaryngologist at the Oxford University Hospitals NHS Trust, and a senior clinical lecturer at the University of Oxford. David is one of S4BE’s contributors and editors, an avid tweeter, cat fan, and one of the founders of the Open Access Button (www.openaccessbutton.org). Martin Burton: One of the key things about S4BE is that it is designed for students in any healthcare discipline, or potentially for students studying a non-healthcare discipline. So although we started out working with medical students, we’re hoping that nursing students, physiotherapy students, pharmacy students, etcetera will be interested. For example, we’ve recently had a blog from a post-doctoral chemistry student who’s now got an interest in EBH. We …

SEASONAL VARIATION, SUB–TYPE AND PRODROMAL ILLNESSES IN GUILLAIN–BARRE SYNDROME

BackgroundStudies have produced contradictory evidence for seasonal variation in the incidence of Guillain–Barre Syndrome (GBS), possibly due to the potentially confounding factor of the prodromal illness, for example peaks in...

Mindfulness in maternity

© 2 01 3 M A H ea lt hc ar e Lt d Mindfulness in maternity The University of Oxford Mindfulness Centre (OMC) in conjunction with the Oxford University Hospitals NHS Trust (OUH) maternity service have an ongoing collaboration to develop the introduction and evaluation of Mindfulness Based Childbirth and Parenting (MBCP) throughout the UK. This innovative project involves the development of a MBCPfocused training programme and, for the first time, the delivery of MBCP to antenatal groups in the UK.

PARot – assessing platelet-rich plasma plus arthroscopic subacromial decompression in the treatment of rotator cuff tendinopathy: study protocol for a randomized controlled trial

BackgroundPlatelet-rich plasma (PRP) is an autologous platelet concentrate. It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets. In a clinical setting, PRP may be reapplied to the patient to improve and hasten the healing of tissue. The therapeutic effect is based on the presence of growth factors stored in the platelets. Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty. Outcomes include decreased inflammation, reduced blood loss and post-treatment pain relief. Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery (Am J Sports Med36(6):1171–1178, 2008). Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies. The application of PRP may help to revascularize the area and consequently promote tendon healing. Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies.Methods/DesignPARot is a single center, blinded superiority-type randomized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease. Patients will be randomized to one of the following treatment groups: arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP.The study will run for 3 years and aims to randomize 40 patients. Recruitment will be for 24 months with final follow-up at 1 year post surgery. The third year will also involve collation and analysis of the data. This study will be funded through the NIHR Biomedical Research Unit at the Oxford University Hospitals NHS Trust.Trial registrationCurrent Controlled Trials: ISRCTN10464365

Next-Generation Screening Goes National in UK

Abstract The UK National Health Service is paying for next-generation clinical tumor screening at the Oxford University Hospitals NHS Trust, a key step toward making the technology broadly available throughout the country.

Acute upper gastrointestinal bleeding—time for some new triggers?

Transfusion MedicineVolume 23, Issue 3 p. 139-141 EDITORIAL Acute upper gastrointestinal bleeding—time for some new triggers? V. Jairath, Corresponding Author V. Jairath NHS Blood and Transplant and Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UKCorrespondence: Dr Vipul Jairath, BSc, MBChB (Hons), MRCP, PGDip CT, NHS Blood and Transplant and Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK. Tel.: +44 1865 387906; fax: +44 1865 387957; e-mail: [email protected]Search for more papers by this author V. Jairath, Corresponding Author V. Jairath NHS Blood and Transplant and Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UKCorrespondence: Dr Vipul Jairath, BSc, MBChB (Hons), MRCP, PGDip CT, NHS Blood and Transplant and Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK. Tel.: +44 1865 387906; fax: +44 1865 387957; e-mail: [email protected]Search for more papers by this author First published: 21 May 2013 https://doi.org/10.1111/tme.12048Citations: 7Read 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 No abstract is available for this article.Citing Literature Volume23, Issue3June 2013Pages 139-141 RelatedInformation

GRP-030 Audit of Pharmacists’ Interventions When Screening Adult Chemotherapy Prescriptions on an Electronic Prescribing System

BackgroundThe UK Cancer Standards require there to be protocols for chemotherapy treatment. The Thames Valley Cancer Network (TVCN) has developed and maintained network-wide protocols, which are continually updated for each...

CPC-069 Implementation of a Clinical Pharmacy and Medicines Dispensing Service in a Chemotherapy Day Treatment Unit

BackgroundCancer patients at the Oxford University Hospitals NHS Trust receive the majority of their chemotherapy treatments as daycase patients. The clinical pharmacy service provision to patients receiving chemotherapy did not...

A Non-Invasive Method for Estimating Cardiopulmonary Variables Using Breath-by-Breath Injection of Two Tracer Gases.

Conventional methods for estimating cardiopulmonary variables usually require complex gas analyzers and the active co-operation of the patient. Therefore, they are not compatible with the crowded environment of the intensive care unit (ICU) or operating theatre, where patient co-operation is typically impossible. However, it is these patients that would benefit the most from accurate estimation of cardiopulmonary variables, because of their critical condition. This paper describes the results of a collaborative development between an anesthesiologists and biomedical engineers to create a compact and non-invasive system for the measurement of cardiopulmonary variables such as lung volume, airway dead space volume, and pulmonary blood flow. In contrast with conventional methods, the compact apparatus and non-invasive nature of the proposed method allow it to be used in the ICU, as well as in general clinical settings. We propose the use of a non-invasive method, in which tracer gases are injected into the patient's inspired breath, and the concentration of the tracer gases is subsequently measured. A novel breath-by-breath tidal ventilation model is then used to estimate the value of a patient's cardiopulmonary variables. Experimental results from an artificial lung demonstrate minimal error in the estimation of known parameters using the proposed method. Results from analysis of a cohort of 20 healthy volunteers (within the Oxford University Hospitals NHS Trust) show that the values of estimated cardiopulmonary variables from these subjects lies within the expected ranges. Advantages of this method are that it is non-invasive, compact, portable, and can perform analysis in real time with less than 1 min of acquired respiratory data.

Prioritizing echocardiography in Staphylococcus aureus bacteraemia

Infective endocarditis (IE) is a severe complication in Staphylococcus aureus bacteraemia (SAB) and recent guidelines from the BSAC recommend all patients undergo echocardiography. We assessed the use of echocardiography at a major tertiary referral centre and sought to identify those patients most likely to have positive findings. We retrospectively evaluated all cases of SAB at Oxford University Hospitals NHS Trust between September 2006 and August 2011. Three-hundred-and-six out of 668 patients with SAB underwent cardiac imaging on average 9.8 ± 1.3 days from the first culture. Thirty-one patients (10.1%) had echocardiographic evidence of IE. Risk factors for observing evidence of IE on scanning included the presence of prosthetic heart valves (32% versus 4%, P < 0.001) or cardiac rhythm management (CRM) devices (16% versus 3%, P < 0.004). On excluding patients with prosthetic valves or CRM devices from the analysis, no patient with a line-related bacteraemia and only one patient (an intravenous drug user) with no/mild regurgitation on transthoracic echocardiography had echo evidence of IE. We propose that the use of scarce echocardiography resources could be prioritized. Patients with prosthetic heart valves or a CRM device should receive early cardiological input and transoesophageal echocardiography. In patients with a clearly defined line-related bacteraemia who do not have a prosthetic valve or CRM device or clinical features of IE, response to treatment could be closely monitored and imaging deferred. Patients without a line-related infection or prosthetic valve/device could receive a transthoracic echocardiogram as a screening tool.

Prevalence of risk factors for non-communicable diseases in prison populations worldwide: a systematic review

The burden of non-communicable diseases (NCDs) is disproportionately carried by low-income and middle-income countries and disadvantaged sectors of society such as prisoners. No systematic analysis has been done to assess the prevalence of poor diet, inadequate physical activity, and overweight and obesity in prisoners. We aim to synthesise current evidence and to highlight areas for action and further research. We systematically searched online databases for reports published between 1948 and May, 2011. Studies were screened against eligibility criteria; two authors then independently extracted data with previously agreed proformas. The risk of bias was assessed for each study with a domain-based assessment. Data on body-mass index and physical activity were presented in forest plots; no overall estimates were calculated on account of data heterogeneity. Available data from the population subgroup most similar in terms of age and sex were used to calculate age-adjusted and sex-adjusted prevalence ratios, which estimate the likelihood of insufficient activity and obesity prevalence in prisoners compared with the national population. 31 eligible studies were reported in 29 publications, including more than 60,000 prisoners in 884 institutions in 15 countries. Male prisoners were less likely to be obese than males in the general population (prevalence ratios ranged from 0·33 to 0·87) in all but one study (1·02, 0·92-1·07), whereas female prisoners were more likely to be obese than non-imprisoned women in the USA (1·18, 1·08-1·30) and Australia (prevalence ratios ranged from 1·15 to 1·20). Australian prisoners were more likely to achieve sufficient activity levels than the general population compared with prisoners in the UK (prevalence ratio 1·19, 95% CI 1·04-1·37, for women in Australia in 2009 vs 0·32, 0·21-0·47, for women in the UK; prevalence ratios ranged from 1·37 to 1·59 for men in Australia vs 0·71, 0·34-0·78, for men in the UK). Female mean energy intake exceeded recommended levels and sodium intake was about two to three times the recommended intake for all prisoners. Contact with the criminal justice system is a public-health opportunity to promote health in this vulnerable population; the costs to the individual and to society of failing to do so are likely to be substantial. Improved monitoring and further research is essential to inform appropriate targeting of public health interventions. Oxford University Department of Public Health, Oxford University Hospitals NHS Trust.