The 'three-legged stool': a system for spinal informed consent.

Many hospitals do not have a structured process of consent, the attainment of which can often be rather 'last-minute' and somewhat chaotic. This is a surprising state of affairs as spinal surgery is a high-risk surgical specialty with potential for expensive litigation claims. More recently, the Montgomery ruling by the United Kingdom Supreme Court has placed the subject of informed consent into the spotlight.

Intranasal sodium citrate solution improves olfaction in post-viral hyposmia.

Background: Calcium plays an integral role in olfactory signal transduction, including feedback inhibition. Sodium citrate acts as a calcium sequestrant and when applied intranasally, reduces free calcium available for feedback inhibition, which should theoretically improve olfaction. We aimed to investigate the utility of intranasal sodium citrate in improving the olfactory function of hyposmic patients, by performing this prospective placebo controlled, single-blind trial.

New paradigms for BRCA1/BRCA2 testing in women with ovarian cancer: results of the Genetic Testing in Epithelial Ovarian Cancer (GTEOC) study.

Background: Over recent years genetic testing for germline mutations in BRCA1/BRCA2 has become more readily available because of technological advances and reducing costs.

Objective: To explore the feasibility and acceptability of offering genetic testing to all women recently diagnosed with epithelial ovarian cancer (EOC).

Methods: Between 1 July 2013 and 30 June 2015 women newly diagnosed with EOC were recruited through six sites in East Anglia, UK into the Genetic Testing in Epithelial Ovarian Cancer (GTEOC) study.

Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study.

Objective: To explore the impact of risk-adjustment on surgical complication rates (CRs) for benchmarking gynaecological oncology centres.

Design: Prospective cohort study.

Setting: Ten UK accredited gynaecological oncology centres.

The Use of Temporoparietal Fascial Flap to Eliminate Wound Breakdown in Subtotal Petrosectomy for Chronic Discharging Ears.

Objective: To find out if the use of the vascularized temporo-parietal fascial flap (TPFF) reduces postoperative infection or wound breakdown in subtotal petrosectomy for chronic discharging ears.

Patients: A retrospective review on 26 subtotal petrosectomies with blind pit closures on chronic discharging ears performed by a single surgeon between 2000 and 2015 was performed. All patients had a minimum follow-up period of 6 months.

Glycemic control in inpatients with diabetes following august changeover of trainee doctors in England.

The first Wednesday of August is the day of changeover of trainee doctors in England. It is widely perceived that inexperience and nonfamiliarity with the new hospital systems and policies in these first few weeks lead to increased medical errors, mismanagement, and mortality. The aim of this study was to analyze the impact of the August changeover of trainee doctors on inpatient glycemic control in a single English hospital.

The direct cost of intravenous insulin infusions to the NHS in England and Wales.

The cost of intravenous insulin infusion to the NHS is unknown. The aim of this study was to estimate the direct cost of insulin infusions to the NHS in England and Wales in the first 24-hour period of infusion. Data from the National Inpatient Diabetes Audit 2013 in the UK were used to estimate the number of insulin infusions in use across England and Wales.

Assessment of chemotherapy-induced peripheral neuropathy using the LDIFLARE technique: a novel technique to detect neural small fiber dysfunction.

Introduction: The diagnosis and quantification of chemotherapy-induced peripheral neuropathy (CIPN) remains a challenge. Conventional methods including quantitative sensory testing (QST), nerve conduction tests, and biopsy are unable to detect subclinical changes, and do not consistently correlate with severity of patients' symptoms and functional impairment. This study aims to determine the utility of the LDI (laser Doppler imager) FLARE technique in the diagnosis of CIPN and whether it correlates with symptom severity.

Nocardia farcinica complicating Cogan's syndrome.

Nocardiosis is an uncommon bacterial gram-positive infection caused by aerobic actinomycetes in the genus Nocardia. Nocardiosis is typically regarded as an opportunistic infection with approximately two-thirds of infected patients being immunocompromised. In this case report we describe a 45-year-old female who presented with a right thigh abscess.

Impact of the Diabetes Inpatient Care and Education (DICE) project and the DICE Care Pathway on patient outcomes and trainee doctor's knowledge and confidence.

Aim: To evaluate the impact of the Diabetes Inpatient Care and Education project and a comprehensive diabetes care pathway, the Diabetes Inpatient Care and Education Care Pathway, on patient outcomes and on the knowledge and confidence of trainee doctors.

Methods: The effect on patient outcomes was evaluated by comparing the National Diabetes Inpatient Audit data before (2012) and after (2013) implementing the Diabetes Inpatient Care and Education project. The impact on trainee doctors was evaluated using the Modified Kirkpatrick model.

Noninterventional statistical comparison of BTS and CHEST guidelines for size and severity in primary pneumothorax.

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Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources.

Aim: To triangulate three data sources and report the characteristics and long-term outcomes of patients with diabetes requiring emergency department (ED) care for hypoglycaemia.

Method: Three data sources were used-ambulance electronic records, hospital episode statistics and patient administration system. Hypoglycaemia (capillary blood glucose <4.

Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications).

Background: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.

Methods: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres.

Physiotherapy for functional motor disorders: a consensus recommendation.

Background: Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment.

Assessment of diabetic neuropathy using a point-of-care nerve conduction device shows significant associations with the LDIFLARE method and clinical neuropathy scoring.

Accurate assessment of diabetes polyneuropathy (DPN) is important in the prevention of foot ulcerations and amputations. Simple screening methods including the 10 g monofilament and the 128-Hz tuning fork are not sensitive enough nor intended for detection of early neuropathy, while more confirmatory tests such as nerve conduction studies are not universally available. We evaluated a rapid, low-cost, point-of-care nerve conduction device (POCD; NC-stat®|DPNCheck™) for the assessment of DPN and compared it with the LDIFLARE technique-an established method for early detection of small fibre dysfunction.

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes.

Objectives: To determine whether temporal patterns of hypoglycaemia exist in inpatients with diabetes 'at risk' of hypoglycaemia (those on insulin and/or sulfonylureas), and if so whether patterns differ between hospitals and between these treatments.

Setting: Retrospective multicentre audit of inpatients with diabetes involving 11 acute UK National Health Service (NHS) trusts.

Participants: Capillary blood glucose readings of 3.

Serious harm from inpatient hypoglycaemia: a survey of hospitals in the UK.

Aim: To estimate the incidence of serious harm to inpatients with diabetes from hypoglycaemia.

Method: An anonymised questionnaire was e-mailed to lead organisers at the 142 acute NHS Trusts that contributed to the National Diabetes Inpatient Audit 2012. Each diabetes team was asked collectively to recall and report any serious adverse events from inpatient hypoglycaemia in the previous year.

The Ipswich Touch Test: a simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration.

Aims: The Ipswich Touch Test is a novel method to detect subjects with diabetes with loss of foot sensation and is simple, safe, quick, and easy to perform and teach. This study determines whether it can be used by relatives and/or carers to detect reduced foot sensation in the setting of the patient's home.

Methods: The test involves lightly and briefly (1-2 s) touching the tips of the first, third and fifth toes of both feet with the index finger.

Paediatric supracondylar humeral fractures: epidemiology, mechanisms and incidence during school holidays.

Purpose: The purpose of this study was to investigate the epidemiology of paediatric patients sustaining supracondylar humeral fractures, to identify common mechanisms of injury and to corroborate the anecdotal evidence that fractures occur more frequently during school holidays.

Methods: All paediatric patients who presented to the accident and emergency department with a supracondylar distal humerus fracture over the 3-year period from 1 July 2008 to 30 June 2011 were included in the study. Data were collected from the electronic medical records and radiology picture archiving and communication system (PACS) regarding age at injury, sex, Gartland type, date of injury, mechanism and management.

Late-onset neutropenia in patients with rheumatoid arthritis after treatment with rituximab.

Objective: Late-onset neutropenia (LON) is an adverse effect of rituximab (RTX) in hematological malignancies, a finding that was recently reported in rheumatoid arthritis (RA). The aim of our study was to estimate its incidence in RA.

Methods: We retrospectively reviewed complete blood (cell) count of patients with RA who received RTX between October 2007 and July 2011 to identify neutropenia (≤ 1.

Milwaukee shoulder syndrome.

Milwaukee shoulder syndrome (MSS) is a rare destructive, calcium phosphate crystalline arthropathy. It encompasses an effusion that is noninflammatory with numerous aggregates of calcium hydroxyapatite crystals in the synovial fluid, associated with rotator cuff defects. We describe a patient that presented with recurrent shoulder pain and swelling with characteristic radiographic changes and MSS was confirmed on aspiration of the synovial fluid.

Orlistat, an under-recognised cause of progressive renal impairment.

Obesity is an emerging risk factor for chronic kidney disease (CKD) in the developed world. Orlistat, an intestinal lipase inhibitor, used in the treatment of obesity is available as an over-the-counter medication across the European union and in many countries worldwide. It is associated with acute kidney injury (AKI).

Use of mastoid obliteration techniques in cholesteatoma.

Purpose Of Review: To evaluate the choice of techniques, safety and long-term outcome of mastoid obliteration and assess the place of imaging in the postoperative monitoring of residual cholesteatoma.

Recent Findings: All recent reports on mastoid obliteration for the management of cholesteatoama were favourable. Long-term follow-up reports did not show problems arising from hidden cholesteatoma, even for the paediatric population.

Pasireotide therapy in a rare and unusual case of plurihormonal pituitary macroadenoma.

Unlabelled: We report the use of pasireotide in a rare and unusual case of pituitary macroadenoma co-secreting GH, prolactin and ACTH. A 62-year-old Caucasian man presented with impotence. Clinically, he appeared acromegalic and subsequent investigations confirmed GH excess and hyperprolactinaemia.

Successful two-stage revision of a KineSpring® joint unloading implant: a case study.

Few nonsurgical treatment options are available to the patient with debilitating knee osteoarthritis (OA) that is refractory to conservative care. The KineSpring® System joint unloading implant is a unique device that reduces the load carried by the medial compartment of the knee joint by up to 13 kilograms during the stance phase of gait. We report a case of a male patient who underwent implant with the KineSpring System for symptomatic knee OA but subsequently required revision due to local infection.