Southampton University Hospitals NHS Trust Research Articles

Response to Hanna et al.

Clinical OtolaryngologyVolume 37, Issue 1 p. 81-82 CORRESPONDENCE: LETTERS Response to Hanna et al. T.C. Biggs, T.C. Biggs Southampton University Hospitals NHS Trust, Southampton, UK E-mail: tim_biggs@ymail.comSearch for more papers by this author T.C. Biggs, T.C. Biggs Southampton University Hospitals NHS Trust, Southampton, UK E-mail: tim_biggs@ymail.comSearch for more papers by this author First published: 21 March 2012 https://doi.org/10.1111/j.1749-4486.2012.02447.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 No abstract is available for this article. Volume37, Issue1February 2012Pages 81-82 RelatedInformation

Inappropriate C-reactive protein testing in epistaxis patients

Clinical OtolaryngologyVolume 36, Issue 4 p. 405-406 CORRESPONDENCE: LETTERS Inappropriate C-reactive protein testing in epistaxis patients T.C. Biggs, T.C. Biggs Southampton University Hospitals NHS Trust, Southampton, UK.E-mail: tim_biggs@ymail.comSearch for more papers by this authorK. Nightingale, K. Nightingale Southampton University Hospitals NHS Trust, Southampton, UK.E-mail: tim_biggs@ymail.comSearch for more papers by this author T.C. Biggs, T.C. Biggs Southampton University Hospitals NHS Trust, Southampton, UK.E-mail: tim_biggs@ymail.comSearch for more papers by this authorK. Nightingale, K. Nightingale Southampton University Hospitals NHS Trust, Southampton, UK.E-mail: tim_biggs@ymail.comSearch for more papers by this author First published: 18 August 2011 https://doi.org/10.1111/j.1749-4486.2011.02357.xCitations: 2Read 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 No abstract is available for this article.Citing Literature Volume36, Issue4August 2011Pages 405-406 RelatedInformation

Maternal MRSA screening in Southampton University Hospitals NHS Trust

IntroductionIn the maternity population the benefits of MRSA (Methicillin-resistant Staphylococcus aureus) screening remain unproven. The authors report results of recently introduced screening in Southampton.MethodsWomen were screened if booked for elective...

Elective admissions: the journey for the person with diabetes

Elective admissions: the journey for the person with diabetes

Impact of disease activity on resting energy expenditure in children with inflammatory bowel disease

Exclusive enteral nutrition is used as primary therapy in Crohn's disease. Nutrition support is frequently required in children with both Crohn's disease and Ulcerative Colitis when acutely unwell and during periods of recovery. There is considerable controversy about nutritional needs during phases of active and inactive disease. It is, for example, often assumed that in acute illness a child requires increased nutritional support however the precise relationship between illness severity and energy expenditure is uncertain. This study explores the relationship between disease activity and resting energy expenditure (REE) in children with inflammatory bowel disease. Patients were recruited from the regional paediatric gastroenterology unit at Southampton University Hospitals NHS Trust. Disease activity was assessed using standard scoring systems (Paediatric Crohn's Disease Activity Index; Simple Colitis Activity Index) and biochemical markers of inflammation (C-Reactive Protein, CRP). Fat free mass was estimated from skinfold thickness and Bioelectrical Impedance Analysis. Resting energy expenditure was measured by indirect calorimetry. A logarithmic correction and a linear regression model were used for analysis of REE corrected for body size. 55 children were studied; 37 (67%) with Crohn's disease and 18 (33%) with Ulcerative Colitis. Median PCDAI was 10 (range 0-60), 22 (59%) had PCDAI > or =10 (active disease). Median SCAI was 1.5 (range 0-12). Within disease groups there were strong correlations between REE/KgFFM(0.52) and disease activity; PCDAI (r -0.386, p 0.018) in Crohn's disease and SCAI (r -0.456, p 0.057) in Ulcerative Colitis. In the cohort as a whole there was no increase in REE/KgFFM(0.52) with increasing CRP (r 0.129, p 0.361). Using the regression model each mg/l increase in CRP was associated with a reduction in REE of nearly 1.5 kCal/day. We were unable to demonstrate a significant relationship between REE and disease activity in children with inflammatory bowel disease.

P182 LOW PROTEIN INTAKE ON 4TH DAY OF HOSPITAL STAY IS INDICATIVE OF HOSPITAL STAY OF MORE THAN 10 DAYS

their employing organisation and patients’ immediate healthcare teams. The Southampton University Hospitals NHS Trust Nutrition Support Team (NST) currently has 1 pharmacist and 2 nurse non-medical prescribers who, where appropriate, prescribe IVN, on 3 working days of 5, with specialist clinician review of all patients and prescriptions carried out on 2 days of 5. NST ward rounds are carried out in a 1200 bed Teaching Hospital, reviewing average of 288 IVN referrals annually of which 74% are fed IVN for a median of 8 days. Records of all prescribing under these arrangements were used to estimate clinician time saved, taken to be 45 mins for initial assessment (IA) and 15 mins for subsequent reviews (SR) using the equation: Hourssaved = 3/5[(n·IA·0.75)+(n·SR·0.25)], where n = number of annual IAs/SRs. Results: A total of 12,554 days of IVN for 1066 patients from 2004 to 2008 were evaluated. No prescriptions were considered inappropriate during clinician review. Results are in Table 1.

Non-invasive intracranial pressure monitoring in African children with infectious encephalopathies: preliminary results

Address: 1Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya, 2Department of Paediatrics and Child Health, Mulago Hospital/Makerere University Medical School, Kampala, Uganda, 3Department of Paediatrics, Imperial College, London, UK, 4Neurological Physics Group, Department of Medical Physics, Southampton University Hospitals NHS Trust, Southampton, UK, 5Clinical Neurosciences, Southampton University, Southampton, UK and 6Neurosciences Unit, Child Health Institute, University of London, London, UK

Adopting a ‘Whole Trust’ infection prevention approach to reduce MRSA bacteraemia rate

Set against a background of rising methicillin-resistant S. aureus (MRSA) infection rates, poor public image and recent staff reorganisation, the infection control team at Southampton University Hospitals NHS Trust has rallied to facilitate change in the infection prevention perceptions and practices throughout the Trust, adopting a ‘Whole Trust’ approach. By encouraging and facilitating local ownership of infection prevention initiatives and addressing specific infection control issues in key areas, with senior leadership from the Director of Nursing and Trust Board the Trust’s MRSA bacteraemia rate has been successfully reduced.

16 The specific uptake size index as a simple measure of absolute renal function from renography

Southampton University Hospitals NHS Trust, Southampton, UK British Nuclear Medicine Society Oral and Poster Abstracts 2007

Increasing out-of-hospital births: what needs to change?

This is the third of three articles describing the work of the Birth Place Choices (BPC) Project, a Department of Health funded project carried out between May 2003 and May 2005 as a collaboration between Southampton University Hospitals NHS Trust and Portsmouth Hospitals NHS Trust. The BPC Project had three aims: 1. To identify factors which influence women's decisions about where to give birth. 2. To determine whether the introduction of specially designed information and educational initiatives increase women's knowledge of choices for place of birth. 3. To determine whether implementation of these initiatives was associated with an increase in the number of women choosing to give birth outside main consultant-led maternity units. This article describes the evaluation process carried out during phase two of the BPC Project, as well as the key successes of the BPC Project and the barriers which limited its effectiveness.

The use of the weber tuning fork test and ‘scratch test’ in postoperative tympanomastoid surgery

Objective. To compare the use of the Weber tuning fork test and ‘Scratch test’ in postoperative patients following tympanomastoid surgery.Method. Prospective cohort study with control group. Southampton University Hospitals NHS Trust. Secondary care. 19 patients undergoing routine tympanomastoid surgery for middle ear disease and 18 patients undergoing translabyrinthine surgery for lateral skull base lesions.Main Outcome Measures. Localisation of Weber tuning fork. Positive or negative Scratch test: clinician applies a gentle scratch using index finger to the bandage over the operated ear. Postoperative pure tone audiometry.Results. In the context of diagnosing a hearing or non‐hearing ear, the Weber test had a specificity of 78% and sensitivity of 100%. The scratch test had a specificity of 100% and sensitivity of 100%. The Weber was 93% specific and 93% sensitive for diagnosing a unilateral conductive hearing loss.Conclusions. As a means of diagnosing an acute postoperative dead ear the Scratch test is an accurate alternative to the Weber test.References 1 Miltenburg D.M. (1994) The validity of tuning fork tests in diagnosing hearing loss. J Otolaryngol. 23, 254–2592 Behn A., Laszlo C.A., Black D., et al. (2005) Which is mightier, the tuning fork or the bone oscillator? J Otolarygol. 34, 135–139

The Birth Place Choices Project: phase two initiative

The Birth Place Choices (BPC) Project was carried out between May 2003 and May 2005 as a collaboration between Southampton University Hospitals NHS Trust and Portsmouth Hospitals NHS Trust. The BPC Project had three aims: 1. To identify factors that influence women's decisions about where to give birth. 2. To determine whether the introduction of specially designed information and educational initiatives increase women's knowledge of choices for place of birth. 3. To determine whether implementation of these initiatives was associated with an increase in the number of women choosing to give birth outside main consultant-led maternity units. This article describes the educational, marketing and change management initiatives that were carried out as part of phase two of the BPC Project. These included a marketing campaign for local Midwifery-Led Units, the provision of a maternity service user leaflet on local birthplace choices, and the development of a multi-professional guideline on place of birth. Midwife practice educators were employed to help disseminate the leaflet and guideline as well as implement educational initiatives for local midwives on and around informed choice and place of birth.

The Birth Place Choices Project: Phase one

The Birth Place Choices (BPC) Project was carried out between May 2003 and May 2005 as a collaboration between Southampton University Hospitals NHS Trust and Portsmouth Hospitals NHS Trust. The BPC Project had three aims: 1. To identify factors that influence women's decisions about where to give birth 2. To determine whether the introduction of specially designed information and educational initiatives increase women's knowledge of choices for place of birth 3. To determine whether implementation of these initiatives was associated with an increase in the number of women choosing to give birth outside main consultant-led maternity units. Phase one of the BPC Project, described here, addressed the first aim. This is the first of three articles describing the work of the BPC Project. Following a literature review and an analysis of locally collected routine statistics relating to birthplace, a cross-sectional survey of local women and focus groups involving local women and midwives were carried out. The findings revealed that, compared to other health professionals, midwives had the greatest influence on maternity service users with regard to their birth place choices, yet were perhaps not using their influence effectively to ensure local women were aware of all their birthplace options, including midwifery-led units and home birth.

A58 The 3-D fractal dimension of DaTSCAN images

Southampton University Hospitals NHS Trust, UK Abstracts of the 34th Annual Meeting of the British Nuclear Medicine Society Manchester International Conference Centre, UK, 27–29 March 2006

Transitional cell carcinoma of the bladder mimicking lobular carcinoma of the breast: a discohesive variant of urothelial carcinoma

To describe a series of 10 cases of transitional cell carcinoma which show morphological features which mimic lobular carcinoma of the breast and diffuse carcinoma of the stomach. Ten cases were identified from the files at Southampton University Hospitals NHS Trust and from the authors' consultation files. Immunostains were performed and clinical information was obtained. Eight of the patients were male and two female. Ages ranged from 52 to 77 years at presentation. All of the tumours showed areas where the tumour was composed of uniform cells with a discohesive single-cell, diffusely invasive growth pattern. In areas the tumour cells were arranged in linear single-cell files and in separate areas solid sheets of discohesive cells. In all of the cases some tumour cells showed prominent intracytoplasmic vacuoles. In addition to this pattern, four cases showed typical transitional cell carcinoma or carcinoma in situ. The majority of the tumours expressed cytokeratin 20 but not oestrogen receptors. This study highlights a pattern of diffusely invasive transitional cell carcinoma not previously described and one which is important to recognize in order to avoid misdiagnosis of metastatic lobular carcinoma of the breast, especially in small biopsies.

A7 How critical is the transaxial reconstruction angle in Datscan??? to image processing?

Southampton University hospitals NHS Trust, UK Autumn Meeting of the British Nuclear Medicine Society: abstracts York, UK, 4–5 October 2004 *Corresponding author

Critical faculties.

NURSE CHRIS SMITH made a unique move this year when he became critical care lead for the Southampton University Hospitals NHS Trust.

Prostasomes: a role in prostatic disease?

BJU InternationalVolume 94, Issue 7 p. 985-989 Prostasomes: a role in prostatic disease? Alistair B. Stewart, Corresponding Author Alistair B. Stewart Department of Urology, Southampton University Hospitals NHS Trust,Alistair B. Stewart, Urology Research Office, E-Level, West wing, Mail Point 67, Southampton General Hospital, Tremona Road, Southampton, S016 6YD, UK. e-mail: alistairstewart@doctors.org.ukSearch for more papers by this authorWilliam Anderson, William Anderson St Mary's Hospital, Portsmouth, andSearch for more papers by this authorGeorge Delves, George Delves St Mary's Hospital, Portsmouth, andSearch for more papers by this authorBashir A. Lwaleed, Bashir A. Lwaleed Department of Urology, Southampton University Hospitals NHS Trust,Search for more papers by this authorBrian Birch, Brian Birch Department of Urology, Southampton University Hospitals NHS Trust,Search for more papers by this authorAlan Cooper, Alan Cooper Portsmouth University, Portsmouth, UKSearch for more papers by this author Alistair B. Stewart, Corresponding Author Alistair B. Stewart Department of Urology, Southampton University Hospitals NHS Trust,Alistair B. Stewart, Urology Research Office, E-Level, West wing, Mail Point 67, Southampton General Hospital, Tremona Road, Southampton, S016 6YD, UK. e-mail: alistairstewart@doctors.org.ukSearch for more papers by this authorWilliam Anderson, William Anderson St Mary's Hospital, Portsmouth, andSearch for more papers by this authorGeorge Delves, George Delves St Mary's Hospital, Portsmouth, andSearch for more papers by this authorBashir A. Lwaleed, Bashir A. Lwaleed Department of Urology, Southampton University Hospitals NHS Trust,Search for more papers by this authorBrian Birch, Brian Birch Department of Urology, Southampton University Hospitals NHS Trust,Search for more papers by this authorAlan Cooper, Alan Cooper Portsmouth University, Portsmouth, UKSearch for more papers by this author First published: 10 November 2004 https://doi.org/10.1111/j.1464-410X.2004.05091.xCitations: 14Read 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 Citing Literature Volume94, Issue7November 2004Pages 985-989 RelatedInformation

Addressing increasing patient acuity and nursing workload.

IN 2002, Southampton University Hospitals NHS Trust (SUHT) participated in the Audit Commission’s national augmented care period (ACP) dataset audit. The ‘snap-shot’ data collected over three days identified a shortfall of 83 level 2 beds and a further 120 patients in the wards who required higher levels of care than they were receiving. As services continued to develop in line with trust service strategies, clinicians testified to increasing complexity of patient condition and levels of activity, but decreasing overall length of stay. They also testified that patient acuity had increased beyond that which current resources could manage appropriately, a picture no doubt reflecting that of many large UK teaching trusts. In recognising this problem, SUHT chose to adopt ‘addressing increasing patient acuity’ as a key modernisation and investment project. An important component of this work was measuring the ‘gap’ between patient care requirements and available resources to enable investment to be channelled to the areas of greatest need and benefit. To achieve this, a single measurement tool that reflected both patient acuity and dependence on nursing resources and could be implemented across all clinical areas was required.

A pilot double blind randomized placebo controlled trial of the use of recombinant factor VIIa (rfVIIa) in high transfusion risk cardiac surgery

Departments of Anaesthesia and Haematology, Southampton University Hospitals NHS Trust, Southampton, Hampshire, UK