Trust reaches for excellence in research

Great news for East Cheshire Trust’s research team as published in this years league tables for NIHR research during 2011/12 by The Guardian – see online at

In the (England) Small Acute Trusts category, East Cheshire NHS Trust came in the top 10, 7th out of 31 for number of studies open and 10th for number of patients recruited – a really good result.  The table shows ECT did better than many of its neighbours coming above Mid Cheshire Trust in both categories and also achieving a higher result than some of the local Medium Acute Trusts (Stockport, Southport and Ormskirk and Bolton).  The number of open studies was up by a total of 8 on last year, which also increased the number of patients recruited.
It is gratifying to know that all the hard work and effort made by the research team, has finally paid off .  Congratulations to all, including the PI’s and investigators, as they continue with ongoing research in these areas: Stroke, Oncology, Dementia, Paediatrics, Rheumatology and Cardiac care?
If you want to know more about the research work undertaken in Macclesfield please contact Seonaid Beddows at The Christie NHS Foundation Trust.

Improving Patient Safety Conference: November 2012

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‘This government has one overriding goal for the NHS – for it to produce outcomes that are among the best in the world. Simple to say – hard to deliver – impossible without an absolute commitment to patient safety.’

– Rt Hon Simon Burns MP, Minister for Patient Safety, Department of Health

In the 12 months leading up to September 2011, the National Patient Safety Agency recorded over 1.3 million patient safety incidents in England and Wales. It is estimated that the cost of patient safety incidents cost over £2bn a year, with a further £1bn being spent on healthcare associated infections (HCAI). With these figures in mind, we are proud to present the Reducing HCAIs and Improving Patient Safety Conference 2012, a forum for key stakeholders and practitioners to come together to discuss best practice in improving clinical outcomes through better, more through, patient care, stronger regulation in secondary care and improved use of new technologies to manage patient care and flow.

A limited number of free places available on first come first served basis.

A key pathway to ensuring that patient safety incidences are kept to a minimum is through the use of new, cutting edge, technologies. Technology in patient safety has proven to reduce errors in operating theatres, increased reporting of incidences on hospital wards and the key enabler to drive efficiency to reduce the £3bn cost associated with patient safety and healthcare associated infections.

Latest AQuA Bulletin #39

Issue: 39 of the AQuA Bulletin is now exclusively available on the AQuA Member Web Portal (click here to log on and download).

The bulletin aims to improve healthcare services across NHS North West.  It provides links to more information and resources, highlighting areas for action and participation.

In this issue you’ll find:

  • Long Term Conditions – COPD commissioning tool-kit
  •  Improving Quality – Reducing 30 day readmissions
  • Safer Care – Safer Surgery Week
  • Patient Experience – Compare local care homes
  • Safer Care – Medication Passports
  • Primary Care – COF measures
  • Avoidable Mortality – Cardiovascular Survey
  • Innovation – Cross sector working
  • Resources – Investment in Mental Health
  • Networks – Strategic clinical networks
  • Commissioning – CCS MD appointments
  • Data & Intelligence – Data round up…

Here is Issue 38 in case you missed it.

Falls Prevention Resource Pack

The King’s Fund Information & Library Service Aug/2012
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This resource pack brings together existing and new falls prevention resources aimed at supporting local initiatives in reducing harm to patients from falls.

Singhal R, Shakeel M, Dheerendra S, Morapundi S, Waseem M: Journal of Bone and Joint Surgery

Comparison between aptus and DVR plate as the preferred method of distal radius fracture fixation.   This article was submitted for publication by Drs’ R SinghalM ShakeelS Dheerendra,  S MorapudiM Waseem of MDGH and P Ralte.

  1. J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXVI 66 

Background Volar locking plates have revolutionised the treatment for distal radius fractures. The DVR (Depuy) plate was one of the earliest locking plates which were used and they provided fixed angle fixation. Recently, newer volar locking plates, such as the Aptus (Medartis), have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. The aim of our study was to compare the outcomes of DVR and Aptus volar locking plates in the treatment of distal radial fractures.

Methods   Details of patients who had undergone open reduction and internal fixation of distal radii from October 2007 to September 2010 were retrieved from theatre records. 60 patients who had undergone stabilisation of distal radius fractures with either DVR (n=30) or Aptus (n=30) plate were included in the study.

Results Mean age of patients undergoing fixation using DVR plate was 56.6 years (n=30) with 22 females and 8 males. Fractures in this group included 20 type 23-C, three type 23-B and seven type 23-A. The patients were followed up for an average of 5.5 months (2-16 months). 3 patients underwent revision of fixation due to malunion (n=1), non-union (n=1) and failure of fixation (n=1). Four patients had reduced movements even after intensive physiotherapy necessitating removal of plate.

Mean age of patients undergoing Aptus volar locking plate fixation was 56.38 years (n=30) with 21 females and 9 males. There were 27 type 23-C, two type 23-B and one type 23-A fractures according to AO classification. The patients were followed up for an average of 4.1 months (2-11 months). 2 patients developed complex regional pain syndrome (CRPS) and 1 patient underwent removal of screws due to late penetration of screws into the joint.

Conclusion Complex and unstable fractures of the distal radius can be optimally managed with volar locking plates. Both systems are user friendly. Aptus plates provide an additional advantage of flexibility in implant positioning and enhanced intra-fragmentary fixation compared to the DVR plate. In our study Aptus plates had lower secondary surgical procedures compared to DVR plates.

Singhal, R, et al: Journal of Bone and Joint Surgery: Septic arthritis vs transient synovitis in children

Septic arthritis vs transient synovitis in children: a tertiary healthcare centre study  by R Singhal of MDGH and D PerryFN KhanD CohenHL StevensonLA JamesJS Sampath and CE Bruce

Background Establishing the diagnosis in a child presenting with an atraumatic limp can be challenging. There is particular difficulty distinguishing septic arthritis (SA) from transient synovitis (TS) and consequently clinical prediction algorithms have been devised to differentiate the conditions using the presence of fever, raised erythrocyte sedimentation rate (ESR), raised white cell count (WCC) and inability to weight bear. Within Europe measurement of the ESR has largely been replaced with assessment of C-reactive protein (CRP) as an acute phase protein. We have evaluated the utility of including CRP in a clinical prediction algorithm to distinguish TS from SA.

Method  All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5 degrees C. The definition of SA was based upon microscopy and culture of the joint fluid collected at arthrotomy.

Results 311 hips were included within the study. Of these 282 were considered to have transient synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. An algorithm that indicated a diagnosis of SA in individuals who could not weight-bear and who had a CRP >20mg/L correctly classified SA in 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis.

Dheerendra SK, Journal of Bone Joint Surgery: Measurement of Skin Capacitance

A novel method of diagnosing autonomic dysfunction in carpal tunnel syndrome by SK DheerendraWS KhanP Smitham and NJ Goddard

This article by SK Dheerendra of the Dept of Trauma and Orthopaedics  and colleagues from other Trusts was published in J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXVI 17


Background & Objectives Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The aim of this study is to demonstrate that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance.

Methods Patients with clinical and electrophysiological signs of idiopathic carpal tunnel syndrome meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The measurements were taken from the palmar aspect of distal phalanx of the index and little finger of the affected hand. Normal healthy patients with no signs and symptoms of carpal tunnel syndrome were recruited as controls and skin capacitance was measured in a similar fashion as the CTS group.

Results The CTS group consisted of 25 patients (18 female & 7 male) and 35 hands with an average age of 59.2 years (33-83 years). The mean symptom severity score was 2.80 (1.27-4.18; SD 0.82) and functional status score was 2.53 (1-4.26; SD 1.08). The mean ratio of skin hydration between the index and little finger was 0.85 (0.6-1.25; SD 0.155). Using the paired t-test to determine paired differences between index and little finger measurements, the mean difference was 12.6 (p<0.001).

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