Royal Bournemouth Hospital Research Articles

Effect of methanol stem bark extract of Ochna schweinfurthiana (Ezeata) on liver enzymes in Wistar rats

1 Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka. Anambra State. Nigeria. 2 Department of Physiology, Faculty of Basic Medical Sciences, Chukwuemeka Odumegwu Ojukwu University, Uli campus. Anambra State. Nigeria. 3 Department of General Medicine, Faculty of Clinical Medicine, Royal Bournemouth Hospital (University Hospital Dorset NHS Foundation Trust) Bournemouth, England, BH7 7DW United Kingdom. 4 Department of Gastroenterology, Faculty of Clinical Medicine, Royal Bournemouth Hospital (University Hospital Dorset NHS Foundation Trust) Bournemouth, England, BH7 7DW United Kingdom. 5 Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, Abia StateUniversity Teaching Hospital, Aba. Abia State. Nigeria.

The Accuracy of Digital Preoperative Templating in Primary Total Hip Replacements.

Background​ Digital templating is an essential part of preoperative planning in elective total hip replacement (THR) surgery. The goals of templating are to predict femoral and acetabular implant sizes, to assess leg length, offset, and implant positioning. Templating markers such as the KingMark device (Brainlab, Munich, Germany) have been developed to improve the accuracy. Although templating is commonly used in many centres, there are challenges related to the accuracy of the process, such as true magnification ideal positioning of the pelvis and hips/body habit (obesity). Objectives The aim of this study was to assess the accuracy of preoperative templating in THR patients, and to assess the difference between templating performed with and without the KingMark device. Methods​ Our retrospective study included 642 consecutive patients who had primary THR at the Royal Bournemouth Hospital in the UK. Four hundred fifty-three (71%) of patients had the KingMark device on their templated radiographs. Patients who had hybrid total hip replacements using an uncemented acetabular component and cemented femoral component were included in the study. Digital templating was done using TraumaCad software (Brainlab). Analysis of the accuracy of predicting component size has been evaluated by comparing preoperative planned sizes with implanted sizes as documented by the surgeons and labels attached to the operative note. ​ ​Results​ The templated size corresponded to the actual femoral implant used in approximately 65.2% of cases. When femoral prostheses within one size above or below the templated size were included,​the accuracy of preoperative templating rose to 97.2%. Regarding the uncemented acetabular component, the templated size corresponded to the actual acetabular implant used in 46.3% of cases. When acetabular cup within one size above or below the templated size were included, the accuracy of preoperative templating rose to 87.5%. Similarly, there was minimal difference between the predicted templated sizes using the KingMark device compared to templating performed without it. ​Conclusions​ Preoperative templating is an essential part in optimizing the outcome of THRs. Templating allows the surgeon to estimate the size of the components to be used. It also provides a starting point, from which the surgeon can proceed from, and saves valuable intraoperative time by assessing the level of the femoral neck osteotomy and the degree of lateral rasping. Multiple factors affect the accuracy of preoperative templating including the patient BMI, external rotation of the hip and surgeon's experience. Although there are different methods of templating, digital templating with 2D radiographs is likely the most cost-effective and efficient process available at this time.

Patient satisfaction and attitudes towards immediate sequential bilateral cataract surgery.

To investigate patients' first-hand experience, satisfaction and attitudes towards immediate sequential bilateral cataract surgery (ISBCS). Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, UK. Retrospective study using semi-structured phone interviews and qualitative content analysis. Semi-structured telephone interviews were conducted by an independent interviewer, to explore patients' experiences of ISBCS, at least four weeks postoperatively. The open-ended responses were analysed using qualitative content analysis. Categories and meaning units were tabulated, with the number and percentage of patients contributing to each category provided. 25 patients were included. All patients rated their overall satisfaction of ISBCS as 'very satisfied' and would opt again to have both eyes operated on the same day. 22 patients (88%) reported a 'very good/comfortable' surgery experience. After surgery, 24 patients (96%) felt completely safe going home, with most organizing for family or friends to drive them home. None of the patients experienced any complications in the postoperative period. 24 patients (96%) experienced only minimal reduction in accomplishing daily living activities after surgery and 24 patients (96%) said they would recommend ISBCS to family and friends. The results support wider implementation of ISBCS from the patient's perspective and experience. Providing written information addressing common themes and concerns is recommended to increase patient acceptance and uptake of ISBCS preoperatively.

Combined clerking – streamlining emergency admissions

Conventional clerking by the emergency department (ED) followed by specialty clerking involves duplication of information. Having multiple documentation lengthens clerking time, slows patient flow and takes longer to review during the admission. The Royal Bournemouth Hospital is a district general hospital on the south coast. The trust sought to improve the efficiency by reducing duplication as part of a quality improvement (QI) team focusing on the first 24 hours of the patient journey. Our group was formed by open invitation. The QI team organised weekly open meetings and included consultant representatives from the ED, surgery, acute medicine, elderly care, stroke and cardiology. It also consisted of a …

Who's who? Championing the '#TheatreCapChallenge'.

Our Developing Perioperative Practice service improvement project, sponsored by the Royal Bournemouth Hospital, addressed whether the remarkably simple idea of putting names and roles on hats in theatre would improve communication and patient care. We were inspired by our own experiences as a group of student Operating Department Practitioners: unfamiliarity with members of the team, wanting to feel included in the work but not out of our depth, and by social media campaigns such as the '#TheatreCapChallenge' and '#hellomynameis', aiming to humanise care and increase patient safety. Researching, clinically trialling and presenting this project gave us a systematic approach to improving the quality of care within the theatre environment.

An audit of residual cancer burden reproducibility in a UK context.

The residual cancer burden score (RCB) is currently the preferred quantification tool for assessing residual disease following neoadjuvant chemotherapy (NACT) in breast cancer clinical trials. This has been shown to be highly reproducible at the MD Anderson Cancer Centre, where it was developed originally. We wanted to evaluate RCB in a UK context, where macroscopic handling of tissue may differ between sites. The pathology slides from 90 post-NACT patients from Guy's and St Thomas' NHS Foundation Trust and the Royal Bournemouth Hospital were reviewed independently by two specialist breast histopathologists who recalculated the RCB for each case. Data were collated and analysed statistically for interobserver reproducibility, for both numerical and categorical RCB. Overall, agreement between pathologists was 'good' [kappa = 0.775; 95% confidence interval (CI) = 0.668-0.882]. The overall concordance for continuous RCB score and for categorical RCB group was statistically significant (Spearman's correlation coefficient = 0.9497; 95% CI = 0.9235-0.9671; P < 0.0001 and Spearman's correlation coefficient = 0.9145; 95% CI = 0.8712-0.9437; P < 0.0001, respectively). Discordance could not be attributed to any one component of the RCB calculation. These data suggest that the RCB score is reproducible in a UK context. Further data comparing it to other quantification systems is required, however, before any superiority can be established.

Accuracy of sample timing with short Synacthen tests at Royal Bournemouth Hospital

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Easing diabetes’ psychological burden

Easing diabetes’ psychological burden

Long term patient-reported benefit from ptosis surgery.

To assess the long term impact of ptosis surgery on health-related quality-of-life using the Glasgow Benefit Inventory (GBI) patient-reported outcome measure. A retrospective case note review was carried out on all patients who had undergone ptosis surgery (6 November 2008 to 5 December 2010) by one surgeon at Royal Bournemouth Hospital. Patient demographics, surgical technique, and complications were recorded. The GBI questionnaire data was obtained by telephone interview. A total of 62 ptosis operations (33 right, 29 left, of which 18 were bilateral) on 44 patients; 20 male, 24 female were included. Median age 77 years (range: 17-95 years). One wound dehiscence occurred, but no redo ptosis procedures were required. GBI data was obtained on 32 patients (45 ptosis procedures) at a mean follow-up period of 42.8 months postoperatively (range 31-67 months). The mean total GBI score for ptosis surgery was +21.36 (range 0-58.33; 95% confidence interval: 17.28-25.43, P<0.05). Patients derived a highly significant benefit to their health-related quality-of-life from ptosis surgery measured by the GBI that was maintained for up to 5 years.

Intrathoracic extramedullary haemopoiesis in a patient with hereditary spherocytosis

A 63-year-old Thai man with hereditary spherocytosis presented with pruritus of his legs and subsequently found to have a raised serum ferritin of 1638 µg/L. He had previously not required...

76 * Implantable cardiac device extraction in a non-surgical centre is safe and effective

Background: Current guidance on transvenous lead extraction suggests that a cardiothoracic surgeon should be immediately available during all such procedures. Survey data confirm that the vast majority of centres regularly performing transvenous lead extractions have on-site surgical cover. Our centre has provided a tertiary device extraction service, utilising a full range of lead extraction techniques, with surgical cover provided by non cardiothoracic surgeons on-site and off-site cardiothoracic specialist back up. We present a retrospective description of 8 years of outcome data following extraction of cardiac devices in this single centre. Methods: All consecutive transvenous lead removal procedures meeting the 2009 Heart Rhythm Society (HRS) definition for lead extraction performed at the Royal Bournemouth Hospital between September 2005 and September 2013 (8 years) were identified. The procedure reports, lead data and hospital records for each case were retrospectively reviewed, the findings were then cross referenced with hospital coding and date of death records. Patient demographics, procedural technique details and outcome data for all leads were identified and are presented. Normally distributed continuous variables are reported as mean±SD. Results: Over the 8 year period from September 2005 and September 2013, 385 leads were extracted during 226 separate procedures at the Royal Bournemouth Hospital. There were no peri-procedural deaths or requirement for emergency cardiac surgery. Procedural success was achieved in 98% procedures, with failure in the remaining 2%. Complete procedural success was achieved in 94% of cases. Conclusions: These data suggest that contrary to current international guidance, for the great majority of patients with all forms of cardiac implantable devices, extraction can be performed safely and effectively in a centre with appropriate experience without the need for formal on-site cardiothoracic surgical cover. | Patient and Lead Demographics and Outcomes | |:------------------------------------------------------------------------------------:| ----------------------------- | | Age range for patients undergoing extraction procedure | 20 to 95 years (Mean 69.5±14) | | Proportion of patients with one or more major co-morbidity | 66% | | Proportion of leads undergoing extraction for infection | 59.5% | | Proportion of cases utilising specialist extraction equipment | 46% | | Mean duration of implant prior to extraction | 67.3±53.9 months | | Number of leads extracted at less than 12 months from implant | 9 | | Number of right atrial leads extracted | 130 | | Number of right ventricular pacing leads extracted | 143 | | Number of right ventricular pacing leads extracted | 63 | | Number of coronary sinus (left ventricular) leads extracted | 49 | | Total procedural mortality or emergency transfer to a Cardiothoracic surgical centre | 0 Cases | | 30 day, all cause mortality | 7 Cases |

PTH-025 Dietitian-led Virtual Coeliac Disease Clinic Results In Cost Savings And Increased Patient Satisfaction

IntroductionWe identified that demand for follow up of adult patients diagnosed with coeliac disease exceeded the capacity of our dietitian-led coeliac annual review clinic. A dietitian-led virtual coeliac clinic was...

Cutting a mediolateral episiotomy at the correct angle: evaluation of a new device, the Episcissors-60

BackgroundAnal incontinence is nine times more prevalent in women than in men due to obstetric anal sphincter injury (OASI). OASI is linked to midline episiotomies and mediolateral episiotomies with post-delivery angles of <30 and >60 degrees. Studies show that doctors and midwives are unable to correctly “eyeball” the safe angle required due to perineal stretching by the fetal head at crowning. A new scissor instrument (Episcissors-60) was devised to allow cutting a mediolateral episiotomy at a fixed angle of 60 degrees from the perineal midline.MethodsScissors with a marker guide limb pointing towards the anus were devised, ensuring an angle of 60 degrees between the scissor blades and the guide limb. This device was initially tested in models. Post-delivery angles were recorded on transparencies and analyzed by an author blinded to clinical details. Accoucheurs were asked to rate the ease of use on a 5-point scale.ResultsOf the 17 women, 14 delivered with ventouse, two with forceps, and one with sequential ventouse–forceps. Indications for instrumental delivery were suboptimal cardiotocogram and/or prolonged second stage of labor. Mean birth weight was 3.41 (2.92–4.12) kg. A mean post-delivery angle of 42.4±7 (range 30–60, median 43) degrees (95% confidence interval 38.8–46) was achieved with the Episcissors-60 instrument. Eighty-eight percent of clinicians agreed or strongly agreed that the scissors were easy to use.ConclusionThe Episcissors-60 delivered a consistent post-delivery angle of 43 degrees. They could replace “eyeballing” when performing mediolateral episiotomies and form part of a preventative strategy to reduce OASI.

Hospital-Acquired Anaemia Secondary to Phlebotomy in Elderly Patients

Introduction: Anaemia contributes to increased morbidity and mortality in hospitalised patients, yet unnecessary blood tests from inpatients may actually induce a “hospital acquired anaemia” (HAA). This study examines the incidence of phlebotomy-induced anaemia during a hospital admission. Methods: Patients admitted to the Royal Bournemouth Hospital between 2009 and 2011 for a period of more than two weeks were identified. Those with normal haemoglobins on admission (Hb > 130 g/dL in men; Hb > 120 g/dL in women) were selected to be included in the study. One hundred and sixty two patients were randomly selected from this group and their admission and discharge haemoglobin was recorded, and the change in Hb was calculated. The number of blood tests taken during admission was calculated from each patient from which volume of blood lost was determined. Age, sex and co-morbidities, bleeding complications and blood transfusions were noted. T-test for unequal variance was used for analysis. Results: Of the 162 patients, 69 (42.5%) developed a HAA (defined as haemoglobin drop from normal to i.e. 132 mls in the anaemia group vs. only 80.2 mls in no-anaemia group. Further analysis of the anaemia group revealed that 40 patients developed a “mild anaemia” (defined as drop in Hb from normal to

Knee replacement: lessons from the airline industry

In the current global financial situation, the NHS is under pressure to cut costs and increase productivity without affecting patient outcomes. One area that has been targeted is the procurement of joint replacement hardware. In this article, the authors describe the process for change of total knee replacement at the Royal Bournemouth Hospital, and the early clinical consequences. They attempt to learn lessons from the aviation industry as to how this could be improved in the future.

International Ophthalmic Nurses Association event takes a global view

International Journal of Ophthalmic PracticeVol. 4, No. 4 PerspectiveInternational Ophthalmic Nurses Association event takes a global viewHelen GibbonsHelen GibbonsSearch for more papers by this authorHelen GibbonsPublished Online:28 Sep 2013https://doi.org/10.12968/ijop.2013.4.4.169AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 August 2013Volume 4Issue 4ISSN (print): 2044-5504ISSN (online): 2052-2851 Metrics History Published online 28 September 2013 Published in print 1 August 2013 Information© MA Healthcare LimitedPDF download

Sight threatening pets? The tarantula tale

The objective of this article is to highlight potential injury to the eye from handling or keeping tarantulas and stress the importance of taking a good history and thorough eye examination. Recently two cases of ocular problems caused by tarantula hairs being lodged in the eye were seen at the Royal Bournemouth Hospital. Most tarantulas of the New World species are able to flick a mist of microscopic barbed urticating hairs from their abdomen into the face of potential predators to ward them off. These hairs can lodge in the cornea and migrate into the eye causing intraocular inflammation. This study examines the effects on the eye, highlights key information about tarantulas and looks at other published cases of injury to the eye from tarantula hairs. Injury from tarantula hairs in the eye can range from mild to fairly extensive inflammation resulting in vitreo-retinal surgery. Health professionals dealing with eye injuries need to be aware of the potential damage so that a careful history is taken and a full slit lamp examination performed. Tarantulas are becoming popular as pets kept in captivity. Customers should be warned about the risks of handling tarantulas and advised to wear eye protection if handling is essential.

Non-compliant children undergoing occlusion therapy: a route to good practice

Amblyopia is a prevalent condition that causes a diminution of the visual acuity of the affected eye. The condition is usually diagnosed in early life but if it is not treated by the age of between 6 and 8 years, it can lead to permanently reduced vision in the affected eye. Treatments are limited. Occlusion when complied with, is generally regarded as the treatment of choice, ‘forcing’_ the use and visual experience of the amblyopic eye. For that reason, amblyopia is an avoidable form of visual impairment. Compliance is central to the success of the treatment. However, it has been documented for many decades that non compliance is widespread and is extremely difficult for some families, and professionals to manage. This article explores the deeper reasons that underpin non compliance and describes an innovative programme of care – ‘An Intensive Occlusion Therapy Programme’ – devised and developed by the author, with the support of colleagues, on the Eye Unit at The Royal Bournemouth Hospital. For the past 10 years, using techniques including positive parenting and distraction, the Programme has been motivating and educating children and parents to successfully implement occlusion treatment at home. It has achieved some excellent visual outcomes, children at ease with ‘patching’ and confident parents who are in control of the occlusion regimen. The Programme has also proved highly cost effective by reducing consultant, orthoptic and clinic time, removing the need for admitting children for several days for supervized occlusion and created a coordinated, structured clinical pathway for the multi-disciplinary team to follow, thus providing seamless, family-centred care. As many testimonies demonstrate, parents thoroughly recommend and advocate this Programme to other parents facing similar problems with compliance.

Developing a ‘buddy scheme’ for foundation doctors

Changes in working practices have resulted in disruption of the traditional team structure and work patterns. The need for support for juniors during the transition from medical school led to a buddying programme for foundation trainees at the Royal Bournemouth Hospital (RBH). In phase 1, a programme was evaluated using a questionnaire consisting of 12 questions, some of which took the format of a five-point Likert scale. Areas for improvement were identified and implemented in phase 2. Outcomes were re-evaluated using the same questionnaire format. Compared with phase 1, more foundation year-1 doctors (FY1s) felt that they benefited from an FY2 buddy (68 versus 17%; p = 0.0025), and that the buddy had helped to smooth the transition from student to doctor (39 versus 17%; p = 0.20), in phase 2. First contact was initiated by the FY2 (90 versus 43%, p = 0.02), and occurred as a face-to-face meeting (68 versus 29%, p = 0.09). FY1s felt that buddies were more accessible (89 versus 24%, p = 0.0001), developed a better rapport (84 versus 31%, p = 0.002) and felt more likely to get involved in buddying in the future (55 versus 22%, p = 0.05). Our buddy scheme improved on previous models, and was effective and well received. The committee responsible for organising and overseeing the scheme is thought to have contributed to this improvement. In order for any such scheme to be successful it is important to constantly evaluate and adapt the scheme.

The Reintroduction of Antiplatelet Agents Post Gastrointestinal Haemorrhage: A Retrospective Cross-Sectional Study and Proposed Management Algorithm

To review current practice at The Royal Bournemouth Hospital, UK with regard to reintroduction of antiplatelet agents following gastrointestinal (GI) haemorrhage in patients with coronary stents; To attempt to clarify whether a pattern or co-ordinated strategy was in place at our institution.