Tolvaptan for Heart Failure, Systematic Review and Meta-Analysis of Trials.

The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure. However, there is paucity of evidence guiding its use, and lack of evidence of its long-term efficacy. Our objectives are to perform a systematic review of studies examining the effects of TLV in patients with heart failure; and a quantitative meta-analysis comparing primary and secondary outcomes between TLV and placebo.

Early Detection of Epidemic GII-4 Norovirus Strains in UK and Malawi: Role of Surveillance of Sporadic Acute Gastroenteritis in Anticipating Global Epidemics.

Noroviruses are endemic in the human population, and are recognised as a leading cause of acute gastroenteritis worldwide. Although they are a highly diverse group of viruses, genogroup-II genotype-4 (GII-4) noroviruses are the most frequently identified strains worldwide. The predominance of GII-4 norovirus strains is driven by the periodic emergence of antigenic variants capable of evading herd protection.

A lateral tarsorrhaphy with forehead hitch to pre-empt and treat burns ectropion with a contextual review of burns ectropion management.

Introduction: Facial burns around the eyes and eyelid ectropion can lead to corneal exposure, irritation, dryness, epiphora, infection or visual loss. We undertook a review of the published articles describing management of eyelid burns as well as methods to treat or prevent ectropion. We describe early experience of a surgical technique that we have found to mitigate ectropion in facial burns with peri-ocular involvement.

Validation of a classification system for causes of death in critical care: an assessment of inter-rater reliability.

Objective: Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients.

Design, Setting And Participants: One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system.

Advanced Level Practice Education: UK Critical Care Pharmacists' Opinions in 2015.

National UK standards for critical care highlight the need for clinical pharmacists to practice at an advanced level and above. The aim of this research paper was to describe the views of UK critical care pharmacists on the current provision of Advanced Level Practice (ALP) education and accreditation. It sought to identify whether there is a need for a national or regional training programme.

Shoulder dystocia and associated manoeuvres as risk factors for perineal trauma.

Introduction And Hypothesis: Shoulder dystocia (SD) is an obstetric emergency that can be associated with serious neonatal morbidity and mortality. The aim of this study was to identify the incidence and risk factors for obstetric anal sphincter injuries (OASIS) in women who sustained SD at birth.

Methods: This was a retrospective observational study over a 5-year period whereby 403 cases of SD were identified.

Primary cutaneous myxoid spindle cell squamous cell carcinoma: a rare skin cancer.

A 72-year-old woman presented to the plastic surgery outpatient department with a nodular lesion to her shin. This nodule had increased in size, but was slow growing. The patient had a history of sun-damaged skin.

The ADMIN-ICU survey: a survey on antimicrobial dosing and monitoring in ICUs.

Objectives: There is little evidence and few guidelines to inform the most appropriate dosing and monitoring for antimicrobials in the ICU. We aimed to survey current practices around the world.

Methods: An online structured questionnaire was developed and sent by e-mail to obtain information on local antimicrobial prescribing practices for glycopeptides, piperacillin/tazobactam, carbapenems, aminoglycosides and colistin.

Socioeconomic deprivation and inpatient complication rates following mastectomy and breast reconstruction surgery.

Background: Socioeconomic deprivation is known to influence the presentation of patients with breast cancer and their subsequent treatments, but its relationship with surgical outcomes has not been investigated. A national prospective cohort study was undertaken to examine the effect of deprivation on the outcomes of mastectomy with or without immediate breast reconstruction.

Methods: Data were collected on patient case mix, operative procedures and inpatient complications following mastectomy with or without immediate breast reconstruction in the English National Health Service between 1 January 2008 and 31 March 2009.

Serum urate and obstructive sleep apnoea in severe obesity.

Obstructive sleep apnoea (OSA) may increase the risk of hyperuricaemia and predispose to gout. The evidence for the effects of OSA on serum urate in severe obesity is limited. This study investigated whether OSA was associated with serum urate in severe obesity and whether continuous positive airway pressure (CPAP) treatment was associated with a fall in urate.

Critical care in the emergency department: acute kidney injury.

Acute kidney injury (AKI) is common among emergency department patients admitted to hospital. There is evidence of inadequate management of the condition leading to adverse outcomes. We present an illustrative case of AKI complicating a gastrointestinal disorder in an older adult.

Pharmacokinetic considerations and dosing strategies of antibiotics in the critically ill patient.

The treatment of sepsis remains a significant challenge and is the cause of high mortality and morbidity. The pathophysiological alterations that are associated with sepsis can complicate drug dosing. Critical care patients often have capillary leak, increased cardiac output and altered protein levels which can have profound effects on the volume of distribution (Vd) and clearance (Cl) of antibacterial agents, both of which may affect the pharmacokinetics (PK) / pharmacodynamics (PD) of the drug.

Reconstructive outcomes of Mohs surgery compared with conventional excision: A 13-month prospective study.

Established in 2012, the Mersey Regional Centre for Mohs Surgery is the first UK Mohs service to be led by a Mohs trained Plastic & Reconstructive surgeon. We evaluate the resection requirements and reconstructive techniques of our patient group and compare their surgical outcome to that which would have been gained with conventional excision (CE) and reconstruction for the same lesions. 157 patients were analysed over 13 months.

Pressure-ulcer reduction using low-friction fabric bootees.

At St Helens and Knowsley Teaching Hospitals NHS Trust, implementation of pressure management measures has reduced the incidence of hospital-acquired pressure ulcers. There is now a focus on those pressure ulcers still occurring despite these measures, particularly grade 2 ulcers on the heel, which are often attributed to friction and shear. During 2012 and 2013 low friction fabric bootees (Parafricta®) were used on at-risk patients (where possible) to attempt to address this issue.

A novel cadaveric simulation program in urology.

Objective: To evaluate the urology human cadaver training program developed by the British Association of Urological Surgeons.

Design: This prospective, observational comparative study recruited urology residents, with different levels of experience, in 2 sessions of a 3-day modular cadaveric operative urology training. Participants performed various procedures on fresh-frozen cadaveric specimens, as per module, supervised by certified urological surgeons.

The Introduction of Standard Operating Procedures to Improve Burn Care in the United Kingdom.

United Kingdom (UK) burn units face substantial new obstacles in delivering high quality care because of the advent of full-shift working patterns, cross-specialty cover arrangements, and increased trainee turnover. Junior trainees rely heavily on senior colleagues, who may not be readily accessible. The authors therefore proposed the introduction of standard operating procedures (SOPs), detailed written instructions used to achieve uniformity in performance and to improve outcomes.

Prevalence and perinatal mortality associated with preterm births in a tertiary medical center in South East Nigeria.

Background: Preterm birth is a high risk condition associated with significant mortality and morbidity in the perinatal, neonatal, and childhood periods, and even in adulthood. Knowledge of the epidemiology of preterm births is necessary for planning appropriate maternal and fetal care.

Objective: The objective of this study was to determine the prevalence, pattern, and perinatal mortality associated with preterm births at the University of Nigeria Teaching Hospital, Enugu, South East Nigeria.

Obstructive sleep apnea is associated with increased arterial stiffness in severe obesity.

Obstructive sleep apnea is associated with obesity and metabolic syndrome, leading to greater cardiovascular risk. Severely obese patients with obstructive sleep apnea may still be at risk of adverse health outcomes, even without previous cardiovascular disease. Pulse wave analysis non-invasively measures peripheral pulse waveforms and derives measures of haemodynamic status, including arterial stiffness, augmentation pressure and subendocardial viability ratio.

The plastic & reconstructive Mohs surgery service.

Mohs Micrographic Surgery (MMS) is the current 'gold-standard' for excision of a number of cutaneous lesions and provides a valuable addition to a skin cancer service. The Mersey Regional Centre for Mohs Surgery is the first MMS service in the UK to be led by an MMS trained Plastic and Reconstructive surgeon, and this article describes an overview of the processes involved in establishing such a service.

A cyamella causing popliteal tendonitis.

A 64-year-old man presented with intermittent but progressive lateral-sided knee pain. Symptoms mimicked those of a lateral meniscal tear. Magnetic resonance imaging revealed a cyamella associated with popliteal tendonitis and an intact lateral meniscus.

Mortality and treatment cost estimates for 1075 consecutive patients treated by a regional adult burn service over a five year period: the Liverpool experience.

Objective: To assess the clinical outcomes and treatment costs of a regional adult burn service in northwest England.

Methods: We retrospectively reviewed data on a five year cohort of 1075 patients treated by the Mersey Regional Burn Service between 2006 and 2010 to obtain age-stratified mortality estimates based on the lethal area 50 (LA50) measure. Treatment cost estimates were made for a one year cohort of 262 patients treated between April 2011 and April 2012.