Falls prevention in hospitals and mental health units: an extended evaluation of the FallSafe quality improvement project.

Background: inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20-30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle.

Shortness of breath, fever and abdominal pain in a 21-year-old student.

A 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle.

The impact of thunderstorm asthma on emergency department attendances across London during July 2013.

Background: This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma.

Methods: The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis.

Emergency Care Handover (ECHO study) across care boundaries: the need for joint decision making and consideration of psychosocial history.

Background: Inadequate handover in emergency care is a threat to patient safety. Handover across care boundaries poses particular problems due to different professional, organisational and cultural backgrounds. While there have been many suggestions for standardisation of handover content, relatively little is known about the verbal behaviours that shape handover conversations.

Pre-eclampsia is associated with, and preceded by, hypertriglyceridaemia: a meta-analysis.

Background: Elevated triglycerides are a feature of the metabolic syndrome, maternal obesity, maternal vasculitis (i.e. systemic lupus erythematosus) and diabetes mellitus.

Awareness of and attitudes towards skin-cancer prevention: a survey of patients in the UK presenting to their general practice.

Background: The rate of skin cancer in the UK continues to rise.

Aim: To identify the current knowledge and awareness of and attitudes towards the avoidance of skin cancer among a variety of patient groups to aid the design of future UK sun-awareness campaigns.

Methods: Patients aged ≥ 16 years presenting to one of three general practices (two urban, one rural) in the UK during the period 1 June to 31 July 2010 were invited to complete a paper-based questionnaire collecting data on their sun-exposure behaviour, with significance assessed by the Fisher exact test.

A longitudinal study of child sleep in high and low risk families: relationship to early maternal settling strategies and child psychological functioning.

Objectives: To investigate whether sleep disturbances previously found to characterise high risk infants: (a) persist into childhood; (b) are influenced by early maternal settling strategies and (c) predict cognitive and emotional/behavioural functioning.

Methods: Mothers experiencing high and low levels of psychosocial adversity (risk) were recruited antenatally and longitudinally assessed with their children. Mothers completed measures of settling strategies and infant sleep postnatally, and at 12 and 18 months, infant age.

Transanal endoscopic surgery using single access and standard laparoscopic instrumentation.

Transanal endoscopic microsurgery (TEM) or operation (TEO) refer to the concept of performing intraluminal excision of rectal lesions with specialized, high specification equipment that maintains a stable pneumorectum and allows either high definition or binocular optical visualization of the target site along with the capacity for using precise instrumentation (including electocautery) for tissue tensioning, dissection, resection and re-apposition. However, neither technology is widely available and capital set-up costs are high. Furthermore, the rigid, elongated cylindrical configuration of the rectoscope can prove restrictive for non-expert practitioners in that it demands a rarefied and hitherto relatively non-transferrable skill-set only achievable with high volume caseloads.

A curriculum to ensure nursing staff competency.

Nurses and healthcare assistants (HCAs) involved in tissue viability are expected to be competent, but there is little agreement over how to define competence or the expertise required by people filling different roles. Most training in England is provided in house by tissue viability nurses or interested non-specialists; England is lagging behind Scotland and Wales in terms of learning materials and other resources. Staff members at a strategic health authority were surveyed so a consensus could be reached over a basic curriculum for tissue viability and the competence expected of nurses and HCAs at different levels of seniority.

The three-surgeon technique for liver tissue dissection: towards real bloodless hepatectomy.

Purpose: Bleeding during hepatectomy remains a major cause of mortality despite recent developments in surgical and anaesthetic techniques. To date there is no single surgical device that combines speed, efficient haemostasis and safety for the adjacent vital structures during parenchymal division. This article presents the Three Surgeon Technique (3ST), a novel method of parenchymal dissection for major hepatectomies and compare it with our standard radiofrequency ablation (RFA) - assisted technique.

Histopathological assessment of metastasis.

In spite of advances in the fields of immunohistochemistry and molecular biology, in clinical practice much of the assessment of metastases still relies on light microscopy using conventional histological stains. This is not so much a reflection of a reluctance by histopathologists to adopt new techniques, but more an indication that for most malignancies an enormous amount of useful prognostic data can be gained from relatively unsophisticated assessment of tissues, and that many of the strongest studies of prognostic factors in malignancy predate the era of molecular diagnostics. Although it is undoubtedly true that newer techniques have added prognostic information in the assessment of many tumors, and many, such as the measurement of estrogen receptor status in breast cancer, could be considered routine, a skilled assessment of the morphology of the tissues still provides the fundamental basis of assessing prognosis in the vast majority of cases.

What's new in resuscitation strategies for the patient with multiple trauma?

The last decade has seen a sea change in the management of major haemorrhage following traumatic injury. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, haemostatic resuscitation and damage control surgery has been widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy and stabilise the patient as early as possible in a critical care setting.

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis.

Background: Total pancreatectomy and islet autotransplantation (TP/IAT) is a treatment option in a subset of patients with chronic pancreatitis. A systematic review of the literature was performed to evaluate the outcome of this procedure, with an attempt to ascertain when it is indicated.

Methods: MEDLINE (1950 to present), Embase (1980 to present) and the Cochrane Library were searched to identify studies of outcomes in patients undergoing TP/IAT.

Treatment and outcome of Wilms' tumour patients: an analysis of all cases registered in the UKW3 trial.

Background: The randomised findings of the UKW3 trial were that preoperative chemotherapy was associated with a more advantageous stage distribution and reduction in therapy burden versus immediate nephrectomy without compromising outcome in localised Wilms' tumour (WT). We analysed outcome in all WT registered in UKW3.

Patients And Methods: Seven hundred and eighteen WT cases (7% anaplastic) were registered in UKW3.

A tale of two appendices - an unexpected finding.

Anomalies of the appendix are uncommon and are usually discovered incidentally during surgery for appendicitis. We present a rare case of appendiceal duplication, which can have serious consequences if overlooked during an operation. Following an initial admission for right iliac fossa pain which led to an uneventful laparoscopic appendicectomy, a 36 year old male was readmitted for increasing abdominal pain and distension.

Collision tumor of the stomach: an unusual combination of adenocarcinoma and immature "neuroepitheliomatous" teratoma.

A 54-year-old woman was diagnosed with an asymptomatic gastric tumor during routine radiological investigation for staging of breast carcinoma. Subsequent endoscopic biopsy confirmed a poorly differentiated adenocarcinoma. Surgical resection of the stomach showed a tumor with 2 distinct components: a superficial lymphoepithelioma-like adenocarcinoma and a deeper submucosal component consistent with immature teratoma.

The investigation and treatment of secondary anaemia.

Secondary anaemia or the anaemia of chronic disease (ACD) is the commonest form of anaemia in hospitalised patients and the second most prevalent anaemia worldwide after iron deficiency. It is characterised by defective iron incorporation in erythropoiesis, an impaired response to erythropoietin, a decrease in erythropoietin production and cytokine induced shortening of red cell survival. For many patients with ACD the cause is apparent but for many others the underlying disease needs to be determined and such patients are often referred to haematologists for investigation.

Rupture of a left sinus of valsalva aneurysm with coronary compression: a rare cause of ischemic chest pain.

We describe the case of a 52-year-old man presenting with chest pain and ischemic electrocardiogram changes. He was initially prepared to undergo primary percutaneous intervention, but echocardiography revealed pericardial effusion and computed tomography confirmed the diagnosis of rupture of a left sinus of Valsalva aneurysm. Emergency surgery was performed, and the aneurysm was repaired using a composite Dacron-Aortic homograft patch.

Deformity of the tongue in an infant: Riga-Fede disease.

Riga-Fede is the rare condition of benign ulceration caused by repetitive trauma to the lingual tissues by the teeth in children younger than two years of age. The differential diagnosis includes infective and neoplastic conditions. Histological diagnosis is required when the symptoms fail to resolve with standard management.

Repeat testing is essential when estimating chronic kidney disease prevalence and associated cardiovascular risk.

Background: Investigations into chronic kidney disease (CKD) and cardiovascular disease in the CKD population may be misleading as they are often based on a single test of kidney function.

Aim: To determine whether repeat testing at 3 months to confirm a diagnosis of CKD impacts on the estimated prevalence of CKD and the estimated 10-year general cardiovascular risk of the CKD population.

Design And Methods: Blood and urine samples from presumed healthy volunteers were analysed for evidence of CKD on recruitment and again 3 months later.

Meta-analysis of efficacy and safety of intravenous ferric carboxymaltose (Ferinject) from clinical trial reports and published trial data.

Background: Recommendations given for intravenous iron treatment are typically not supported by a high level of evidence. This meta-analysis addressed this by summarising the available date from clinical trials of ferric carboxymaltose using clinical trial reports and published reports.

Methods: Clinical trial reports were supplemented by electronic literature searches comparing ferric carboxymaltose with active comparators or placebo.