Royal Devon Research Articles

The diagnosis, prevention and management of elderly feet

Practice NursingVol. 23, No. 11 DermatologyThe diagnosis, prevention and management of elderly feetJean WatkinsJean WatkinsSearch for more papers by this authorJean WatkinsPublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2012.23.11.554AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferences Adams I, Whiting MF, Savin JA, Branford WA (1989) Skin and subcutaneous tissues. In: Neal DAdams IM, eds. Common Foot Disorders. Churchill Livingstone, Edinburgh: 91–6 Google Scholar Cleveland Clinic (2011) Diseases and conditions: Lower extremity (leg and foot) ulcers. http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx (accessed 11 October 2012) Google Scholar Diabetes UK (2011) Reports and statistics: Diabetes prevalence 2011 (Oct 2011). http://www.diabetes.org.uk/Professionals/Publications-reports-and-resources/Reports-statistics-and-case-studies/Reports/Diabetes-prevalence-2011-Oct-2011/ (accessed 18 September 2012) Google Scholar Ferry R (2011) Diabetic foot care. http://www.emedicinehealth.com/diabetic_foot_care/article_em.html (accessed 11 October 2012) Google Scholar Ngan V (2011) Bedsores. http://dermnetnz.org/reactions/bedsore.html (accessed 11 October 2012) Google Scholar Ngan V (2011) Diabetic foot ulcers. http://dermnetnz.org/systemic/diabetic-foot.html (accessed 11 October 2012) Google Scholar NHS Choices (2012) Gangrene. http://www.nhs.uk/conditions/Gangrene/Pages/Introduction.aspx (accessed 11 October 2012) Google Scholar Office for National Statistics (2010) Ageing. http://www.statistics.gov.uk/cci/nugget.asp?id-949 (accessed 11 October 2012) Google Scholar Peterborough Chiropody and Podiatry (2006) Chiropody services. http://www.peterborough-chiropody.co.uk/chiropody_services_Peterborough.html#corns (accessed 11 October 2012) Google Scholar Royal Devon and Exeter NHS Foundation Trust (2008) Management of diabetic foot ulcer. http://www.rdehospital.nhs.uk/docs/patients/diabetes/Anti%20biotic%20protocol%20diabetic%20foot12.09.07.pdf (accessed 11 October 2012) Google Scholar Sci-Info-Pages (2011) Skin and pressure sore care, treatment and prevention after spinal cord injury. http://www.sci-info-pages.com/skin_pres2.html (accessed 11 October 2012) Google Scholar The Whitley Clinic (2012) Treatment of corns. http://corn-treatment.co.uk/treatment-of-corns.htm (accessed 11 October 2012) Google Scholar Vowden P, Vowden K (2001) Doppler assessment and ABPI: Interpretation in the management of leg ulceration. http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html (accessed 11 October 2012) Google Scholar FiguresReferencesRelatedDetails 1 November 2012Volume 23Issue 11ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Received 5 July 2012 Accepted 30 July 2012 Published online 29 September 2013 Published in print 1 November 2012 Information© MA Healthcare LimitedKeywordsFeetelderlycalluscornsulcerspressure soresmanagementPDF download

638 - Watchful Waiting is Safe Following Long Course Chemoradiation for Locally Advanced Rectal Cancer in Patients who have a Complete Clinical Response

ABSTRACT Introduction Pre-operative long course chemoradiation (LCRT) has been shown to improve rates of clear surgical resection margins in the treatment of locally advanced rectal cancer. The aim of our study was to compare patient and tumour demographics and outcome in patients who had a complete response (Group A) to pre-operative long course chemoradiation (LCRT) to those that did not have a complete response (Group B) in MRI-staged locally advanced rectal cancer treated at the Royal Devon and Exeter Hospital. Methods Retrospective review of patients treated with LCRT for locally advanced MRI-staged rectal cancer from 2004-2009. Results Fifty-nine patients were reviewed. 13 (22%) Group A and 46 (78%) Group B. Group A had a median age 64 (range 50-77) and Group B 65 (range 38-78). Of 13 complete responders 6 underwent surgery and 7 were kept under close observation. 2 of these 7 subsequently had surgery at 24 and 41 weeks respectively. 5/13 (38.5%) have avoided local surgery to date. All 13 patients are alive with median follow up of 46 months (range 35-88). One developed metastatic disease with both liver and lung metastasis, which have been resected and patient is currently disease-free. 45 of the 46 incomplete responders have been followed up; 22 (48%) have died. 17 (37%) died with cancer, 14 (30%) developed distant recurrence, 5 (11%) local recurrence, 1 (2%) distant and local recurrence and 2 (4%) were inoperable post-LCRT. Discussion Watchful Waiting is a safe and effective option for patients following LCRT for locally advanced rectal cancer who have a complete clinical response to treatment and this avoids surgical morbidity. In terms of patient and tumour demographics both groups were comparable. We suggest that biological tumour factors play the determining role in a patient's response to LCRT and this area requires further investigation to determine who may undergo a complete response. Group A (%) Group B (%) T stage T2 0 3 (6.7) T3 10 (77) 36 (80) T4 3 (23) 6 (13.3) N stage N0 4 (31) 7 (15) N1 4 (31) 12 (27) N2 5 (38) 26 (58) Sex Male 11 (85) 36 (78) Female 2 (15) 10 (22) Tumour height Low 11 (85) 30 (65) Mid 2 (15) 12 (26) Upper 0 4 (9) Disclosure All authors have declared no conflicts of interest.

An Audit of the Time Interval to Radiotherapy after Breast Conserving Surgery for Early Breast Cancer

Introduction: Breast conserving surgery (BCS) with adjuvant radiotherapy is an effective treatment for most women with early breast cancer. There is evidence to suggest locoregional recurrence is more likely if radiotherapy is delayed more than 8 weeks. The 2009 NICE guidelines state that adjuvant radiotherapy should be started ‘as soon as possible within 31 days of completion of surgery’. This audit will determine whether this guideline is met at the Royal Devon and Exeter NHS Foundation Trust (RDEFT).

Insertion of a second nasal pack as a prognostic indicator of emergency theatre requirement in epistaxis patients

s / International Journal of Surgery 10 (2012) S1–S52 S36 ABSTRACTS Conclusions: In our study, thyroplasty as a method for vocal cord medialisation led to improved voice quality post-operatively and to good patient satisfaction. 0363: INSERTION OF A SECOND NASAL PACK AS A PROGNOSTIC INDICATOR OF EMERGENCY THEATRE REQUIREMENT IN EPISTAXIS PATIENTS Edward Ridyard , Vinay Varadarajan , Indu Mitra . University of Manchester, Manchester, UK; North West Higher Surgical Training Scheme, North West, UK; Manchester Royal Infirmary, Manchester, UK Aim: To quantify the significance of second nasal pack insertion in epistaxis patients, as a measure of requirement for theatre. Method: A one year retrospective analysis of 100 patient notes was undertaken. After application of exclusion criteria (patients treated as outpatients, inappropriate documentation and patients transferred from peripheral hospitals) a total of n1⁄434 patients were included. Of the many variables measured, specific credence was given to requirement of second packing and requirement for definitive management in theatre. Results: Of all patients, 88.5% required packing. A further 25% (7/28) of this group had a second pack for cessation of recalcitrant haemorrhage. Of the second pack group, 85.7% (6/7) ultimately required definitive management in theatre. One sample t-test showed a statistically significant correlation between patients with a second nasal pack and requirement for theatre (p 0.05). Conclusion: Rhinoplasty is a common operation in both England and Wales. The current economic constraint combined with differences in funding and corporate ethos between the two sister NHS organisations has led to a statistical reduction in numbers undergoing rhinoplasty in England but not in Wales. 0427: PATIENTS' PREFERENCES FOR HOW PRE-OPERATIVE PATIENT INFORMATION SHOULD BE DELIVERED Jonathan Bird, Venkat Reddy, Warren Bennett, Stuart Burrows. Royal Devon and Exeter Hospital, Exeter, Devon, UK Aim: To establish patients' preferences for preoperative patient information and their thoughts on the role of the internet. Method: Adult patients undergoing elective ENT surgery were invited to take part in this survey day of surgery. Participants completed a questionnaire recording patient demographics, operation type, quality of the information leaflet they had received, access to the internet and whether they would be satisfied accessing pre-operative information online. Results: Respondents consisted of 52 males and 48 females. 16% were satisfied to receive the information online only, 24% wanted a hard copy only and 60% wanted both. Younger patients aremore likely towant online information in stark contrast to elderly patients who preferred a hard copy. Patients aged 50-80 years would be most satisfied with paper and internet information as they were able to pass on the web link to friends and family who wanted to know more. 37% of people were using the internet to further research information on their condition/operation. However, these people wanted information on reliable online sources to use. Conclusions: ENT surgeons should be alert to the appetite for online information and identify links that are reliable to share with patients. 0510: ENHANCING COMMUNICATION BETWEEN DOCTORS USING DIGITAL PHOTOGRAPHY. A PILOT STUDY AND SYSTEMATIC REVIEW Hemanshoo Thakkar, Vikram Dhar, Tony Jacob. Lewisham Hospital NHS

Treatment for primary hypothyroidism: current approaches and future possibilities

Primary hypothyroidism is the most common endocrine disease. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people with hypothyroidism who are biochemically euthyroid on levothyroxine replacement there is a significant proportion who report poorer quality of life. This review explores the historical and current treatment options for hypothyroidism, reasons for and potential solutions to suboptimal treatment, and future possibilities in the treatment of hypothyroidism.

Feedback fatigue

The Clinical TeacherVolume 8, Issue 4 p. 288-288 Letter to the editor Feedback fatigue Thomas Fysh, Thomas Fysh Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UKSearch for more papers by this author Thomas Fysh, Thomas Fysh Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UKSearch for more papers by this author First published: 16 November 2011 https://doi.org/10.1111/j.1743-498X.2011.00474.xCitations: 3 Corresponding author’s contact details: Mr Thomas Fysh, Department of Surgery, c/o Miss Dun, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Wonford, Exeter Devon, EX2 4DW, UK. E-mail: tomfysh@doctors.net.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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume8, Issue4December 2011Pages 288-288 RelatedInformation

George Harry Hall

After training at University College Hospital, London, George Harry Hall (“Harry”) worked in London and Bristol, plus a spell of national service in the Royal Air Force. A year in...

Development of a condition‐specific measure to assess quality of life in patients with hypodontia

To develop a measure to assess quality of life in patients with hypodontia. Royal Devon and Exeter NHS Foundation Trust. The study was divided into two parts. The first phase involved developing a patient-specific questionnaire using 22 patients with hypodontia in five focus groups. The transcripts from these groups were analysed thematically, and emerging themes used to direct the remaining focus groups. When no new themes were identified, it was assumed that data saturation was reached and no further focus groups were organised. In the second phase of the study, a health-related quality of life questionnaire was developed. Analysis of transcripts revealed four themes: treatment, effect on daily activities, appearance and other peoples' reactions. These themes were incorporated into a questionnaire. The readability, ease of administration, face and content validity of the questionnaire were tested. A new measure for assessment of quality of life in patients with hypodontia is presented.

Chaplin v Royal Devon and Exeter Hospital NHS Foundation Trust

Chaplin v Royal Devon and Exeter Hospital NHS Foundation Trust

Hepatocellular carcinoma in exeter, 10 year experience

IntroductionHepatocellular carcinoma (HCC) is a well-recognised complication of cirrhosis. The British Society of Gastroenterology (BSG) recommends surveillance with abdominal ultrasound and α-feto protein measurement every 6 months.1 Surveillance is believed...

Aseptic meningitis in a patient receiving treatment with anti-tumour necrosis factor alpha

We read with interest the review by Antonio Tristano [1] regarding neurological adverse events associated with antitumour necrosis factor alpha (anti-TNF-a) treatment. We believe that aseptic meningitis is also a potential complication of anti-TNF-a treatment and we report the following case. A 53-year-old plumber presented with 3 weeks of night sweats, fevers and generalised headache. There was no weight loss, recent foreign travel, occupational exposure to sewage or chemicals. He had a single female sexual partner and a recent negative human immunodeficiency virus (HIV) test. He had a pet dog and no further contact with animals or insect bites. His past history included IgA nephropathy (currently quiescent), hypothyroidism and an undifferentiated seronegative inflammatory arthritis. This had involved generalised joint pains but had particularly involved his right ankle and a biopsy had shown synovitis. He was HLA B27 negative. He had been treated with sulphasalazine, which was not tolerated. Despite methotrexate and oral steroids he had continuing right subtalar joint inflammation and adalimumab was added. At presentation his disease was inactive. His medications were levothyroxine, Humira (adalimumab) 40 mg/week since 2008 and oral methotrexate 20 mg/week since 2007 and his arthritis symptoms were well controlled. He was not taking non-steroidal antiinflammatory medication, and took paracetamol (acetaminophen) only for his headache. On admission, examination revealed a pyrexia, \5 splinter haemorrhages, normal heart sounds, chest, abdomen, neurological examination and no meningism, lymphadenopathy or oro-genital ulceration. Investigations showed white cell count 12.7 9 10/L (reference range 3.8–10.6 9 10/L), neutrophil count 9.16 9 10/L (reference range 1.8–6.5 9 10/L), monocyte count 1.12 9 10/L (reference range 0.2–0.8 9 10/L) with C-reactive protein, lactate dehydrogenase and blood film normal. IgA was mildly elevated at 4.11 g/L (reference range 0.8–4.0 g/L). Liver, renal, and thyroid function, plasma viscosity, creatinine kinase, chest X-ray and unenhanced MRI brain/ enhanced MRI spine were normal. Three sets of blood cultures were negative. Urinalysis including Bence-Jones protein and a myeloma screen were negative. Two urine specimens and a sputum specimen were also negative for auramine-phenol stain and tuberculosis (TB) culture after 6 weeks. Complement, extractible nuclear antigens, lupus anticoagulant, anticardiolipin antibody, double stranded DNA and antinuclear antibody were negative. Classical anti neutrophil cytoplasmic antibody (cANCA) was positive (titre 1:320), MPO and PR-3 negative. Cerebrospinal fluid (CSF) was measured serially (see Table 1). Oligoclonal bands were negative. A cytospin with immunophenotyping showed evidence of lymphocyte infiltration, the lymphocyte population consisting of both B and T cells. Cytology revealed reactive lymphocytes. Auramine-phenol stain for TB and TB culture was negative. Cryptococcal antigen and fungal cultures were negative after extended incubation. Herpes simplex virus DNA, enterovirus RNA and CMV (via PCR) were not detected. A CT scan of the thorax/abdomen/pelvis and trans-thoracic echocardiography were normal. HIV and hepatitis A. J. Hamilton (&) N. J. Gutowski Department of Neurology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK e-mail: alexander.hamilton@nhs.net

A comparative study of nursing attitudes towards young male survivors of brain injury: A questionnaire survey

Background The attitudes members of the nursing profession hold towards survivors of brain injury may impact on the level of help, and degree of involvement they are willing to have. Given that the manner in which an individual receives their brain injury has been shown to impact on public prejudices, the importance of exploring nursing attitudes to this vulnerable group, and the subsequent impact this may have on the caring role, requires investigation. Objective To investigate the attitudes held by members of the nursing profession towards young male survivors of brain injury whose behaviour either contributed, or did not contribute, to their injury. Design Independent groups design. Setting and participants Ninety trainee and sixty-nine qualified nurses respectively drawn from a university in the south west of England and the emergency, orthopaedic and paediatric Departments of the Royal Devon and Exeter Hospital, UK. Methods Participants were randomly assigned to one of four fictional brain injury scenarios. A young male character was portrayed as sustaining a brain injury as a result of either an aneurysm, or through drug taking, with their behaviour being either a contributory or non-contributory factor. On reading these, participants were asked to complete the prejudicial evaluation scale, the social interaction scale and the helping behaviour scale. Results Analysis of variance showed that qualified nurses held more prejudicial attitudes than student nurses towards survivors of brain injury. Mean scores indicated that individuals seen as contributing towards their injury were likely to experience more prejudice (blame total = 42.35 vs. no blame total = 38.34), less social interaction (blame total = 37.54 vs. no blame total = 41.10), and less helping behaviour (blame total = 21.49 vs. no blame total = 22.34) by both groups. Conclusions Qualified nurses should be mindful of the impact their attitudes and judgements of survivors of brain injury may have on the subsequent care they provide. Greater emphasis on the effects of negative attitudes on patient interactions during training may provide nurses with the understanding to recognise and avoid challenges to their caring role in the future.

An on-line video education programme for couples with twins: a qualitative study

The counselling of women and couples with multiple pregnancies is difficult for both clinician and patient, particularly within the setting of a typical busy antenatal clinic. It requires the imparting...

Identification of First Case of Neonatal Diabetes in Singapore and Successful Conversion from Insulin to Sulphonylurea

Introduction: To date Neonatal Diabetes Mellitus (NDM) has not been reported in Singapore. Neonatal diabetes is a rare (1 in 100,00–300,000 live births) insulin-requiring form of diabetes with well defined subgroups, permanent neonatal diabetes (PND) and transient neonatal diabetes (TND), each accounting for approximately 50% of patients. Genotyping NDM identifies the exact unique molecular aetiology of very early onset insulin requiring diabetes and has the potential to dramatically alter the management of the patient, who would otherwise be insulin dependent for life. Method: We identified a child who presented at 3 and half months of age with diabetic ketoacidosis and determined the phenotypic and genotypic characteristics. Blood samples for molecular genetic analysis were sent to Royal Devon and Exeter Foundation Trust, UK. We determined her Continuous Glucose Monitoring profiles after initiation of sulphonylurea therapy. Results: The patient was diagnosed as a heterozygous for a missense mutation R201H, in the KCNJ11 gene. Results confirmed a diagnosis of permanent neonatal diabetes due to a mutation in the Kir6.2 subunit of the KATP channel. We initiated sulphonylurea therapy and subsequently ceased insulin treatment successfully. Currently 2 years old, this patient is no longer insulin dependent. Conclusion: This is the first case report of neonatal diabetes in Singapore. It describes the importance of correct identification of the case, and successful conversion of therapy from insulin to sulphonylureas with optimal blood glucose control. We emphasise the need for medical practitioners to consider molecular testing for all patients who present with diabetes below 6 months of age as this will facilitate accurate diagnosis and appropriate therapy.

Andrew Knox and Christopher Gardner-Thorpe, The Royal Devon and Exeter Hospital 1741–2006, Exeter, Andrew Knox and Christopher Gardner-Thorpe, 2008, pp. xiii, 222, £16.99 (hardback 978-0-9561700-1-9), £8.99 (paperback 978-0-956170-0-2).

This book has its origins in a series of Devon and Exeter Medical Society lectures in 2006–7. It successfully combines a scholarly approach with a very readable and accessible narrative that covers not just the Royal Devon and Exeter Hospital (RDE) but the delivery of health care in the large area between Plymouth and Bristol. The surprisingly affordable price, with all profits going to the Medical Society for the promotion of medical research, combined with the carefully arranged text and the lovely images on the dust-jacket will ensure its appeal to a wide audience. The authors are both retired RDE consultants and they offer a warm insider view of the development of the institution. Building on past histories of the Hospital, this new work concentrates on the National Health Service era. While many publications marking the sixtieth anniversary of the NHS have grappled with its problems and analysed its organizational structures, financial pressures and persistent inequalities, Andrew Knox and Christopher Gardner-Thorpe provide an optimistic view of the past, present and future of health care at the Royal Devon and Exeter. They argue that after 1948 more doctors and other specialist staff were employed, and they innovatively developed new services, brought in the latest surgical and medical techniques, and treated more patients with better outcomes than ever before. The sense of progress, driven by key personalities and a sense of collective endeavour amongst the local medical community, is highlighted by the way chapters 3 to10 are organized to facilitate description of each of the medical specialities. This structure places the work within the medical history rather than the social history of medicine tradition but the authors locate their analysis within current policy as well as historiographical debates. One of the main themes in the book is the importance all communities place on having a good local hospital. For Knox and Gardner-Thorpe the ability to recruit and retain highly qualified medical and other staff is the key to this. They identify three significant phases in the history of the Hospital and associate them with the delivery of medical education. From the 1740s, the RDE had an enviable reputation as a centre of excellence but lost national prominence after the 1858 Medical Act, before rediscovering something of its former glory within the structures of the NHS, despite concern about an apparent financial bias towards regional rivals in Plymouth and Bristol. Staff at the Hospital helped pioneer new surgical and other treatments, and the authors provide a very interesting explanation about their ability to do so and the attraction a city like Exeter had for leading clinicians and researchers. Despite a clear commitment to objectivity, this celebration of medical achievements at the Royal Devon and Exeter at times lacks a critical edge, and I, personally, would have liked to see a little more attention given to both the role of the other staff, particularly nurses, and the patient experience. This is however a unique record, offering insights not just into the history of one hospital but health care in provincial areas more generally. It is fortunate that the authors were able to capture the memories of so many colleagues who experienced most of the changes after 1948 first hand. It is a sad fact that the first half of the twentieth century already eludes this type of study. There remains something of a question about why doctors in Exeter, a city with conservative views, were so quick and keen to embrace what we would now recognize as the principles of the NHS. Knox and Gardner-Thorpe offer only tentative suggestions, but the wartime blitz and the somewhat problematic involvement of RDE consultants with pre-1948 local authority medical services seem to merit further investigation. In fact the whole project seems designed to encourage and facilitate further work on the history of various aspects of the Royal Devon and Exeter Hospital. Future scholars will owe a considerable debt to this publication.

Investigation of infants born to mothers with thyroid disorders: an ongoing search for consensus

Journal of Evaluation in Clinical PracticeVolume 16, Issue 1 p. 206-208 Investigation of infants born to mothers with thyroid disorders: an ongoing search for consensus Michael O. Ogundele MB BS MSc DTCH MRCPCH, Corresponding Author Michael O. Ogundele MB BS MSc DTCH MRCPCH Paediatric Specialist Registrar, Department of Paediatrics, Royal United Hospital Bath NHS Trust, Combe Park, Bath, UKDr Michael O. Ogundele40 Redruth RoadLiverpool L11 6NAUKE-mail: m.ogundele@nhs.netSearch for more papers by this authorM. W. Quinn MD DCH FRCPCH, M. W. Quinn MD DCH FRCPCH Consultant Paediatrician, Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UKSearch for more papers by this authorM. Salzmann MB BS MSc FRCPath, M. Salzmann MB BS MSc FRCPath Consultant Chemical Pathologist, Department of Clinical Chemistry, Royal Devon and Exeter NHS Foundation Trust, Exeter, UKSearch for more papers by this author Michael O. Ogundele MB BS MSc DTCH MRCPCH, Corresponding Author Michael O. Ogundele MB BS MSc DTCH MRCPCH Paediatric Specialist Registrar, Department of Paediatrics, Royal United Hospital Bath NHS Trust, Combe Park, Bath, UKDr Michael O. Ogundele40 Redruth RoadLiverpool L11 6NAUKE-mail: m.ogundele@nhs.netSearch for more papers by this authorM. W. Quinn MD DCH FRCPCH, M. W. Quinn MD DCH FRCPCH Consultant Paediatrician, Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UKSearch for more papers by this authorM. Salzmann MB BS MSc FRCPath, M. Salzmann MB BS MSc FRCPath Consultant Chemical Pathologist, Department of Clinical Chemistry, Royal Devon and Exeter NHS Foundation Trust, Exeter, UKSearch for more papers by this author First published: 12 February 2010 https://doi.org/10.1111/j.1365-2753.2009.01140.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 Volume16, Issue1February 2010Pages 206-208 RelatedInformation

Prospective assessment of patient directed outpatient communication from a patient and general practitioner perspective

Background:Following the NHS Cancer Plan of 2000, patients should automatically be offered copies of correspondence between NHS clinicians. All patients in this centre increasingly receive a copy of correspondence between...

Referral rates for diagnostic testing support an incidence of permanent neonatal diabetes in three European countries of at least 1 in 260,000 live births

Referral rates for diagnostic testing support an incidence of permanent neonatal diabetes in three European countries of at least 1 in 260,000 live births

Paediatric distal radial fracture manipulation: multicentre analysis of process times

Background:Children with simple radial fractures requiring manipulation are conventionally admitted for manipulation under general anaesthesia. On the assumption that children (and their parents) wish to spend as little time in...

Deletion 3q22.1–q23 with blepharophimosis, ptosis and epicanthus inversus and an Albright hereditary osteodystrophy-like brachydactyly phenotype

Department of Clinical Genetics, Royal Devon & Exeter Hospital, Exeter, United Kingdom Correspondence to Dr Marion S. Croft, Clinical Genetics Department, Royal Devon & Exeter Hospital, Gladstone Road, Exeter, EX1 2ED, UK Tel: +44 1392 405725; fax: +44 1392 405739; e-mail: [email protected] Received 26 September 2007 Accepted 20 November 2007