Salisbury District Hospital Research Articles

Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury

IntroductionIndividuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an...

Donepezil overdose secondary to use of a smart home device for medication reminders.

British Journal of Hospital MedicineVol. 83, No. 1 Case ReportDonepezil overdose secondary to use of a smart home device for medication remindersGautam Sen, Tim WellsGautam SenCorrespondence to: Gautam Sen; E-mail Address: [email protected]Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UKSearch for more papers by this author, Tim WellsDepartment of Cardiology, Salisbury District Hospital, Salisbury, UKSearch for more papers by this authorGautam Sen; Tim WellsPublished Online:26 Jan 2022https://doi.org/10.12968/hmed.2021.0243AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Assiri GA, Shebl NA, Mahmoud MA et al. What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open. 2018;8(5):e019101. https://doi.org/10.1136/bmjopen-2017-019101 Crossref, Medline, Google ScholarAtri A. The Alzheimer's disease clinical spectrum: diagnosis and management. Med Clin North Am. 2019;103(2):263–293. https://doi.org/10.1016/j.mcna.2018.10.009 Crossref, Medline, Google ScholarBirks JS, Harvey RJ. Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev. 2018;6(6):CD001190. https://doi.org/10.1002/14651858.CD001190.pub3 Medline, Google ScholarChoi Y, Demiris G, Thompson H. Feasibility of smart speaker use to support aging in place. Innov Aging. 2018;2(suppl_1):560–560. https://doi.org/10.1093/geroni/igy023.2073 Crossref, Google ScholarHernandez RK, Farwell W, Cantor MD, Lawler EV. Cholinesterase inhibitors and incidence of bradycardia in patients with dementia in the veterans affairs new England healthcare system. J Am Geriatr Soc. 2009;57(11):1997–2003. https://doi.org/10.1111/j.1532-5415.2009.02488.x Crossref, Medline, Google ScholarJoint Formulary Committee. British National Formulary. London: BMJ Group and Pharmaceutical Press; 2018 Google ScholarNational Institute for Health and Care Excellence. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. 2018. https://www.nice.org.uk/guidance/ta217/resources/donepezil-galantamine-rivastigmine-and-memantine-for-the-treatment-of-alzheimers-disease-pdf-82600254699973 (accessed 25 November 2021) Google ScholarO'Brien K, Liggett A, Ramirez-Zohfeld V, Sunkara P, Lindquist LA. Voice-controlled intelligent personal assistants to support aging in place. J Am Geriatr Soc. 2020;68(1):176–179. https://doi.org/10.1111/jgs.16217 Crossref, Medline, Google ScholarShepherd G, Klein-Schwartz W, Edwards R. Donepezil overdose: a tenfold dosing error. Ann Pharmacother. 1999;33(7-8):812–815. https://doi.org/10.1345/aph.18273 Crossref, Medline, Google ScholarSmith E, Sumner P, Hedge C, Powell G. Smart-speaker technology and intellectual disabilities: agency and wellbeing. Disabil Rehabil Assist Technol. 2020;1–11. https://doi.org/10.1080/17483107.2020.1864670 Google Scholar FiguresReferencesRelatedDetailsCited byDonepezil overdose9 April 2022 | Reactions Weekly, Vol. 1901, No. 1 2 January 2022Volume 83Issue 1ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 26 January 2022 Published in print 2 January 2022 Information© MA Healthcare LimitedPDF download

225 The Management of Acute Cholecystitis in a District General setting: An Audit of Practice

Abstract Aim The benefits of laparoscopic cholecystectomy during index admission with acute cholecystitis (AC) are multiple. As such, current NICE guidelines dictate that adults with AC undergo laparoscopic cholecystectomy within 1 week of diagnosis. However, significant variation exists with regards to the management of such patients. Here we present the results of an audit of practice at a UK district general hospital and suggest that this standard can be achieved regardless of hospital. Method Electronic database search at Salisbury District Hospital over a period of 12 months to identify all patients with a coded diagnosis of AC. Electronic Discharge System (EDS) was consulted to assess whether patients underwent laparoscopic cholecystectomy within 7 days of diagnosis. Notes were reviewed for all patients who failed to meet this target to ascertain reasons why. Results Of the 336 patients coded as AC 8 were excluded due to incorrect coding leaving 328. 285 patients (87%) underwent laparoscopic cholecystectomy within 7 days. Of the 43 that did not, 31 (65%) had clinically justified reasons for delay. 285/297 (96%) patients met the NICE standard. Conclusions At Salisbury District Hospital 87% patients presenting with AC underwent laparoscopic cholecystectomy within 7 days. Common reasons for failure included: Awaiting further investigation (i.e., ERCP / MRCP), unfit for operative management, patient choice. Excluding justifiable reasons 96% of patients met NICE standards. Poor documentation was the most common cause for failure. Subsequent education and re-audit showed significant improvement. This audit exemplifies that NICE standards for the management of AC can be achieved in a district general setting.

448 Foundation Doctor Local Peer-Led and Organised Basic Surgical Skills in General Surgery and Plastic Surgery

Abstract Aim Foundation doctors are under pressure early in their careers to attend highly subscribed and expensive surgical courses. We assessed the feasibility of a foundation doctor led and locally organised basic surgical skills introduction. Method The lead foundation doctor organised a basic surgical skills introduction for foundation year doctors at Salisbury District Hospital liaising with the postgraduate centre and local surgical consultants. This training was supervised by local consultants and registrars. This teaching delivered theory and practise in suturing, knot tying and laparoscopy by local and familiar trainers. Feedback was collected using the Likert scale. Results 12 foundation doctors attended. 100% either agreed or strongly agreed the introduction was helpful and well organised. 25% either agreed or strongly agreed feeling confident with suturing and knot tying before the teaching which increased to 92% after teaching. Only 8.3% either agreed or strongly agreed feeling confident with the principles of basic laparoscopy before teaching which increased to 83% after teaching. 100% either agreed or strongly agreed the teaching will improve their clinical practise and enhance their interest in surgery. 92% strongly agreed or agreed that the teaching improved their knowledge in basic surgical skills, and the peer led and organised structure was an effective teaching method. Conclusions Foundation doctor locally peer led teaching organised with supervision by local consultants is an effective method of delivering basic surgical skills with improvement especially marked in basic laparoscopy and help enhance interest in surgical training.

The Mental health impact of COVID-19: Salisbury District Hospital

Data obtained included the total number of ED presentations, and the number presenting with deliberate self-harm, suicidal intent, lacerations, anxiety, depression, psychosis and overdose. Data collected was statistically analyzed using the two-proportion z-test. Data from ICU showed a 15.7% increase in specified mental health presentations from 2019 to 2020, compared to a 0.65% decrease from 2018 to 2019. The MHLT report revealed no statistical difference in the number of referrals made between 2019 and 2020. ED data showed mental health issues made up 2.06% of all presentations in 2020, a statistically significant increase compared to 1.53% in 2019 due to the large sample size. Despite fewer overall admissions to ICU and presentations to ED at Salisbury District Hospital in 2020, the percentage of these due to self-harm, overdose and suicidal attempts have increased compared to the same period in 2019 and 2018. Similar patterns are emerging in studies, both in the UK and internationally, and long-term consequences on the mental health of the population are to be expected.

The Mental Health Impact of COVID-19: Salisbury District Hospital

Background: With 1.5% of hospital presentations in Salisbury district hospital in 2019 being attributed to mental health issues, this paper aims to highlight the indirect impact COVID-19 has had on mental health burden in a district general hospital, in southern England. Methods: A retrospective analysis was carried out on intensive care unit (ICU) records between March 1st and May 31st 2018, 2019 and 2020 relating to total admissions and mental health presentations. Data relating to referrals was analysed from the mental health liaison team (MHLT) for the above monthly periods in 2019 and 2020. Last of all, information relating to emergency department (ED) total and mental health presentations were collected via the trust informatics team for the same period in 2018, 2019 and 2020. Data collected were statistically analysed using the two-proportion z-test. Results: Data from ICU showed a 15.7% increase in specified mental health presentations from 2019 to 2020, compared to a 0.65% decrease from 2018 to 2019. The MHLT report revealed no statistical difference in the number of referrals made between 2019 and 2020. ED data showed mental health issues made up 2.06% of all presentations in 2020, a statistically significant increase compared to 1.53% in 2019. Conclusion: Despite fewer overall admissions to ICU and presentations to ED at Salisbury District Hospital in 2020, the percentage of these due to self-harm, overdose and suicidal attempts have increased compared to the same period in 2019 and 2018. Literature remains limited but the long-term consequences on the mental health of the population are to be expected.

The FRAXA and FRAXE allele repeat size of boys from the Avon Longitudinal Study of Parents and Children (ALSPAC).

The FRAXA and FRAXE alleles of the FMR1 and FMR2 genes located on the X chromosome contain varying numbers of trinucleotide repeats. Large numbers of repeats at FRAXA (full mutations) manifest as Fragile X syndrome, associated with mental impairment that affects males more severely. In this paper, we present the dataset of frequencies of FRAXA and FRAXE repeat size extracted from DNA samples collected from boys enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). DNA data were extracted from samples collected in ALSPAC clinics from several types of samples: cord blood, venepuncture blood taken at 43 months, 61 months, seven years or nine years. The DNA was amplified at FRAXA and FRAXE using fluorescent PCR in the Wessex Regional Genetics Laboratory, Salisbury District Hospital. The mean repeat size for FRAXA is 28.92 (S.D. 5.44), the median 30 and the range 8 to 68. There were particularly high numbers of boys with repeat sizes of 20 (10.67%) and 23 (7.35%). The mean repeat size for FRAXE is 17.41 (S.D. 3.94), with median of 16 and range of 0 to 61. There is a relatively high degree of variation of the FRAXA repeat size particularly and we suggest the extensive data available from the ALSPAC study opens up areas of research into understanding phenotypes associated with relatively unexplored repeat sizes. This could be particularly interesting for the lower repeat sizes occurring with high frequency at FRAXA in this population. As the data can be linked to exposures and phenotypes, it will provide a resource for researchers worldwide.

The FRAXA and FRAXE allele repeat size of boys from the Avon Longitudinal Study of Parents and Children (ALSPAC)

The FRAXA and FRAXE alleles of the FMR1 and FMR2 genes located on the X chromosome contain varying numbers of trinucleotide repeats. Large numbers of repeats at FRAXA (full mutations) manifest as Fragile X syndrome, associated with mental impairment that affects males more severely. In this paper, we present the dataset of frequencies of FRAXA and FRAXE repeat size extracted from DNA samples collected from boys enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). DNA data were extracted from samples collected in ALSPAC clinics from several types of samples: cord blood, venepuncture blood taken at 43 months, 61 months, seven years or nine years. The DNA was amplified at FRAXA and FRAXE using fluorescent PCR in the Wessex Regional Genetics Laboratory, Salisbury District Hospital. The mean repeat size for FRAXA is 28.92 (S.D. 5.44), the median 30 and the range 8 to 68. There were particularly high numbers of boys with repeat sizes of 20 (10.67%) and 23 (7.35%). The mean repeat size for FRAXE is 17.41 (S.D. 3.94), with median of 16 and range of 0 to 61. There is a relatively high degree of variation of the FRAXA repeat size particularly and we suggest the extensive data available from the ALSPAC study opens up areas of research into understanding phenotypes associated with relatively unexplored repeat sizes. This could be particularly interesting for the lower repeat sizes occurring with high frequency at FRAXA in this population. As the data can be linked to exposures and phenotypes, it will provide a resource for researchers worldwide.

Leadership in the spotlight

When I was appointed as Medical Director of Salisbury District Hospital in 2011, I felt fairly confident that I could manage the role. Salisbury was known as a relatively small...

A 5-year follow-up study of 633 cutaneous SCC excisions: Rates of local recurrence and lymph node metastasis

A 5-year follow-up study of 633 cutaneous squamous cell cancer (SCC) excisions was performed by collecting data on rates of local recurrence (LR) and lymph node (LN) metastasis. A retrospective analysis of patients was performed across four regional plastic surgery centres (Stoke Mandeville Hospital, Aylesbury; John Radcliffe Hospital, Oxford; Salisbury District Hospital, Salisbury and Queen Alexandra Hospital, Portsmouth) assessing rates of LR and LN metastasis. We report 5-year outcomes from 598 SCCs (95% follow-up rate). The total recurrence rate (LR and LN metastasis) was 6.7% (n = 40) at 5 years, with 96% of these occurring within 2 years. Median time to LR was 9 months (1-57), with 76.9% (n = 20) undergoing further wide local excision. Median time to LN metastasis was 5.5 months (1-18 months). There were two cases of disease-related death. Only 15% (n = 6) of incomplete excisions recurred. Interestingly, 19.1% (n = 9) of 47 SCCs with perineural invasion on original histopathology recurred versus only 5.6% (n = 31) of the 551 SCCs without perineural invasion (p = 0.005). This study is one of the largest studies to date following up 598 SCC excisions at 5 years with total recurrence rates comparable to those in current published literature. We report perineural invasion as a significant predictor of recurrence and that 96% of total recurrence occurred within 2 years. This is in contrast to current UK guidelines (75% at 2 years, 95% at 5 years), thus suggesting that shorter length of hospital follow-up may be reasonable.

Hospital skin cream may be great, but selling it is a worrying sign

You couldn’t make it up. Salisbury District Hospital is selling moisturising cream to help fund patient care.

One Year on From NAP3

*Department of Anaesthesia and Intensive Care, Royal United Hospital, and †Royal United Hospital, Bath; and ‡Salisbury District Hospital, Salisbury, United Kingdom.

Prospective analysis of waiting times for emergency plastic surgery in four units

Trauma is a significant part of the workload in plastic surgery. There are currently wide variations in the available resource for dealing with these patients. Delays to treatment currently exist and may result in poorer clinical outcomes. Data was collected prospectively in 4 centres (Cork University Hospital, John Radcliffe Hospital, Stoke Mandeville Hospital and Salisbury District Hospital) assessing delays to theatre. We assessed time to theatre, both from injury and from review, cancellation rate, starvation time and patient satisfaction. 424 patients were audited over an 8-week period. The average time from review to theatre was 15.7h and the average injury-to-theatre time was 58.6h. The average starvation time was 10h; the mean cancellation rate was 25%. Patients are satisfied overall with the service provided with 83% rating the service as excellent or good, and 63% feeling that there wait was not too long. Despite an increase in provision of emergency plastic surgery trauma lists, the average wait for emergency plastic surgery is increasing. Despite this patients remain, on the whole, satisfied with the service that they are receiving.

Silicone Sling Allows Adjustable Ptosis Correction in Children and in Adults at Risk of Corneal Exposure

Background/Aim: Brow suspension is the procedure of choice for ptosis correction in patients with poor levator function. A subgroup of these patients, namely the ocular myopathies, is at risk of progressive muscle weakness and subsequent corneal exposure. We aim to demonstrate that silicone rods can be easily adjusted and therefore allows greater control of lid height in these patients.Method: A retrospective review of 42 consecutive silicone sling brow suspensions in 26 patients performed in Salisbury District Hospital between 1998 and 2007. The recurrence rate and ease of adjustment after silicone slings are compared with published results using monofilament prolene, polyfilament nylon, Mersilene mesh and expanded polytetrafluoroethylene.Results: Children: 12 lids of 10 children had primary brow suspension using silicone slings. Median follow up was 42 months. One lid required adjustment 3.75 years after surgery. Adults: 30 lids of 16 patients had silicone sling brow suspensions. Median follow up was 22 months. Seven lids (19.4%) needed adjustment between 2 and 11 months after surgery (median 8 months).Conclusion: Our results were comparable to alternative materials in respect of recurrence and were superior in respect of both granuloma formation and infection. Silicone is superior to all listed materials in respect of ease of adjustment of the sling in cases where the ideal lid position was not achieved after primary surgery.

Impact of a clinical nurse specialist on the treatment of chronic hepatitis C

Hepatitis C virus is a common cause of liver disease and a major health problem worldwide. Modern treatment strategies can be successful in up to 50% of cases, with patients treated in specialist and more general hospital settings. Guidelines issued by the Department of Health and the then National Institute for Health and Clinical Excellence made it obligatory for a clinical nurse specialist (CNS) to be involved with assessing and treating patients with chronic hepatitis C. The aim of this retrospective case study was to assess the impact on referral, assessment and treatment of patients with chronic hepatitis C before and after the introduction of a CNS to Salisbury District Hospital. There was a significant improvement in patient follow-up and intention to treat, with a doubling in treatment rates. This was achieved by improving clinic attendance after the patient's initial outpatient assessment, allowing improved biopsy rates and subsequent selection for antiviral therapy. However, over half the cases with chronic hepatitis C identified in primary care each year were not referred to secondary care for assessment.

A novel method of tracheal suction

Clinical OtolaryngologyVolume 33, Issue 2 p. 192-193 A novel method of tracheal suction M. Ward, M. Ward ENT Department, Salisbury District Hospital, Salisbury, UK.E-mail: [email protected]Search for more papers by this authorV.S. Sunkareneni, V.S. Sunkareneni ENT Department, Salisbury District Hospital, Salisbury, UK.E-mail: [email protected]Search for more papers by this author M. Ward, M. Ward ENT Department, Salisbury District Hospital, Salisbury, UK.E-mail: [email protected]Search for more papers by this authorV.S. Sunkareneni, V.S. Sunkareneni ENT Department, Salisbury District Hospital, Salisbury, UK.E-mail: [email protected]Search for more papers by this author First published: 18 April 2008 https://doi.org/10.1111/j.1749-4486.2008.01640.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 No abstract is available for this article. Volume33, Issue2April 2008Pages 192-193 RelatedInformation

Implant retained prosthetic reconstruction of large rhinectomy defects

Reconstruction of large rhinectomy defects has remained a challenge since ancient times. Surgical reconstruction is often delayed, complex and less than satisfactory and prosthetic rehabilitation in the past has been compromised by poor stability and adverse tissue reactions. Advances in biomaterials and increasing experience with craniofacial implants now offer the opportunity to satisfactorily reconstruct post-rhinectomy defects with an implant-retained prosthesis. We describe our experience of 36 patients treated at Salisbury District Hospital, using implant retained prosthesis to reconstruct large nasal defects, which would make this the largest series reported to date.

Adverse effects reported in epilatory ruby laser treatment

A retrospective study was conducted to investigate the incidence of reported adverse responses after epilatory laser treatment to control the growth of facial hair in patients with polycystic ovary syndrome. Forty-eight patients received a median of 6 (range 2-11) treatments with an Aesculap ruby laser during a 704 day monitoring period at Salisbury District Hospital. Nine adverse skin responses such as blistering, scabbing, sustained localised erythematous reactions or hyperpigmentation were reported. The energy output of the laser was also recorded at the start of every clinical session during this period using an external energy meter. The measured energy output of the laser was plotted alongside incidents of adverse responses, although no statistically significant correlation was found. The question of whether or not some adverse effects in ruby laser treatment can be attributed to laser performance remains open.

RECOVERY AFTER REPAIR OF ACCESSORY NERVE: ADVANCING THE AGE BARRIER

Department of Plastic Surgery, Salisbury District Hospital, Salisbury, United Kingdom Correspondence to Dr. MacKenzie, Department of Plastic Surgery, Salisbury District Hospital, Salisbury SP2 8BJ, United Kingdom, [email protected]

Introducing and developing nurse leadership through a learning set approach

This study is an evaluation of how far the use of co-operative learning has helped six `new' Directorate Senior Nurses (DSNs) at Salisbury District Hospital NHS Trust in the UK to develop their roles, and reflects on their acquisition of leadership skills and capability. The project has two elements: co-operative learning and evaluation research of both learning methods and leadership development. The six DSNs – five nurses and one midwife – agreed to take part in both aspects, with the research aspect consisting of tape-recorded, qualitative interview questions based on the leadership characteristics given by Krause [The Way of the Leader, Nicholas Brealey, London, 1997]. The research showed that co-operative learning was an effective way of learning leadership and role acquisition. The DSNs identified gaps in their knowledge and understanding of leadership. However, they found that, by exploring their life experiences through reflection and developing knowledge from theory as part of co-operative learning, they were able to construct strategies to help them manage their role in new and creative ways.