Mahmood A; Fountain J; Vasireddy N; Waseem M; The Open Orthopaedics Journal; 2012;

Wrist MRI Arthrogram v Wrist Arthroscopy: What are we Finding?

Citation: The Open Orthopaedics Journal, 2012, vol./is. 6/(194-8), 1874-3250 (2012)

Author(s): Mahmood A; Fountain J; Vasireddy N; Waseem MS Evidence |

Institution: Macclesfield District General Hospital, Victoria Road, Macclesfield, SK10 3BL, UK.

Abstract: The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at a District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month interval between the two procedures.The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthroscopies performed by two upper limb surgeons. Patients who underwent both procedures were identified. The arthrogram reports and operation notes were examined for correlation.

Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had 90% sensitivity and 75% specificity. The lunotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 91% sensitivity and 88% specificity.Wrist arthrogram and arthroscopy are both invasive techniques.


Greystoke A, Dean E, Saunders MP, Cummings J, Hughes A, Ranson M, Dive C, Renehan AG; British Journal of Cancer;

Multi-level evidence that circulating CK18 is a biomarker of tumour burden in colorectal cancer.

Citation:  British Journal of Cancer, 10 2012, vol./is. 107/9(1518-24), 0007-0920;1532-1827 (2012 Oct 23)
Author(s):  Greystoke A, Dean E, Saunders MP, Cummings J, Hughes A, Ranson M, Dive C, Renehan AG
Abstract:   Circulating total cytokeratin 18 (tCK18) and/or caspase cleaved cytokeratin 18 (cCK18) (measured by M65 and M30 enzyme-linked immunosorbent assays (ELISAs), respectively) are used as pharmacodynamic (PD) biomarkers of epithelial cell death in clinical trials. Having validated these ELISAs, we assessed their utility in colorectal cancer (CRC).METHODS: We applied the assays in several settings: 53 controls; 97 patients undergoing surgery and 74 patients with metastatic CRC undergoing chemotherapy (55 first line; 56 patients with repeated sampling through chemotherapy). Prognostic significance was evaluated using Kaplan-Meier life tables and Cox models; PD utility was assessed by analysis of repeated measures.RESULTS: Median cCK18 and tCK18 levels were elevated in patients with cancer (both P=0.0001), and among cancer patients, there were increasing trends from early to advanced stages (both P(trends)=0.0001). Increasing tCK18 predicted for reduced survival after surgery with curative intent (adjusted hazard ratio (HR) for doubling in concentration 1.77, 95% CI: 1.04, 3.01) and after first-line chemotherapy in metastatic disease (adjusted HR per doubling in concentration=1.78, 95% CI: 1.37, 2.30). In patients with progressive disease during chemotherapy, repeated sampling revealed profiles with high baselines and progressive upwardly increases after cycle 1.CONCLUSION: This study provides evidence for cytokeratin 18 (CK18) as a prognostic and PD biomarker in patients with CRC and supports continued deployment of circulating CK18 in biomarker-enhanced trials.
Publication type:  Journal Article,Research Support, Non-U.S. Gov’t
Source:  Medline

Chandramouli S., Kazmi S.M.H., Graham A., Bayliss J., Babores M.; American Journal of Respiratory and Critical Care Medicine; May 2010

Identification of non compliant patients and their characteristics from home oxygen data
Citation: American Journal of Respiratory and Critical Care Medicine, May 2010, vol./is. 181/1 MeetingAbstracts, 1073-449X (01 May 2010)

Author(s):  Chandramouli S., Kazmi S.M.H., Graham A., Bayliss J., Babores M.

Abstract:   The Home Oxygen Service (HOS) caters to 90,000 people in England and Wales. Since 2008, Air Products plc, principal supplier of oxygen, has been providing information on concordance to Primary Care Trusts and Local Health Boards with a concordance report issued every quarter. This identifies patients whose actual oxygen usage differs significantly from their ordered usage and gives useful information on various aspects of their therapy. Aims: Identify oxygen prescribing patterns of patients non compliant with therapy Methods: We analyzed the quarterly report generated between November 2008 and February 2009 and focused on non compliant patients with a variance in oxygen usage of more than 30%. Patient demographics comprising age, sex and primary diagnoses were collected and prescribers identified. Patients were divided into over and under users and their oxygen usage data was studied in more detail to identify patterns. Results: A total of 240 patients were using oxygen of various modalities in our area. 60 (40%) non compliant patients were identified with a mean (SD) age of 75(12) years. Females=38 (63%) Nearly half had COPD (29/60) while in 19 (32%) a formal diagnosis was not documented. All of these prescriptions were from primary care. Respiratory nurse specialists (RNS) prescribed oxygen in 20(37%) patients and primary care in 30(50%) patients. Ten (16%) prescriptions were unknown. (Table presented) Conclusions: Amongst non compliant patients, a large proportion of oxygen prescriptions continue to emanate from primary care and a third of these patients do not have a formal diagnosis. Nearly all these patients are prescribed LTOT which is not only difficult to discontinue but also imposes considerable burden on healthcare resources. In our cohort, under-users were more likely to be female and SBOT users. SBOT is still being prescribed in both settings despite its lack of evidence although isolated SBOT prescriptions are almost completely confined to primary care. Comparison with patients who are compliant is needed to fully elucidate the difference between these groups. Finally, more attention to non compliant patients identified from this readily available data not only ensures cost savings but also appropriate oxygen therapy.

Publication type:   Journal: Conference Abstract

Radiology; Nov 2012; Advanced solid tumors treated with cediranib: …. 2012

This journal article “Advanced solid tumors treated with cediranib: Comparison of dynamic contrast-enhanced MR imaging and CT as markers of vascular activity” was published in Radiology, November 2012, vol./is. 265/2(426-436), 0033-8419;1527-1315 (November 2012)

Author(s):   Messiou C.,Orton M.,Ang J.E.,Collins D.J.,Morgan V.A.,Mears D.,Castellano I.,Papadatos-Pastos D.,Brunetto A.,Tunariu N.,Mann H.,Tessier J.,Young H.,Ghiorghiu D.,Marley S.,Kaye S.B.,DeBono J.S.,Leach M.O.,DeSouza N.M.
Abstract:  Purpose: To assess baseline reproducibility and compare performance of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging versus DCE computed tomographic (CT) measures of early vascular response in the same patients treated with cediranib (30 or 45 mg daily). Materials and Methods: After institutional review board approval, written informed consent was obtained from 29 patients with advanced solid tumors who had lesions 3 cm or larger and in whom simultaneous imaging of an adjacent artery was possible. Two baseline DCE MR acquisitions and two baseline DCE CT acquisitions 7 days or fewer apart (within 14 days of starting treatment) and two posttreatment acquisitions with each modality at day 7 and 28 (+/-3 days) were obtained. Nonmodeled and modeled parameters were derived (measured arterial input function [AIF] for CT, population-based AIF for MR imaging; temporal sampling rate of 0.5 second for CT, 3-6 seconds for MR imaging). Baseline variability was assessed by using intra- and intersubject analysis of variance and Bland-Altman analysis; a paired t test assessed change from baseline to after treatment. Results: The most reproducible parameters were DCE MR imaging enhancement fraction (baseline intrapatient coefficient of variation [CV] = 8.6%), volume transfer constant (CV = 13.9%), and integrated area under the contrast uptake curve at 60 seconds (CV = 15.5%) and DCE CT positive enhancement integral (CV = 16.0%). Blood plasma volume was highly variable and the only parameter with CV greater than 30%. Average reductions (percentage change) from baseline were consistently observed for all DCE MR imaging and DCE CT parameters at day 7 and 28 for both starting-dose groups (45 and 30 mg), except for DCE CT mean transit time. Percentage change from baseline for parameters reflecting blood flow and permeability were comparable, and reductions from baseline at day 7 were maintained at day 28. Conclusion: DCE MR imaging and DCE CT can depict vascular response to antiangiogenic agents with response evident at day 7. Improved reproducibility with MR imaging favors its use in trials with small patient numbers. RSNA, 2012.

New ‘Be Food Smart’ Change4Life campaign

Government launches new ‘Be Food Smart’ Change4Life campaign

via NeLM – Nutrition and Metabolism on 1/7/13

Source: Department of Health (DH)

The Public Health Minister is launching a new Change4Life campaign – ‘Be Food Smart’ – to promote healthier eating habits. Those who sign up to the campaign will receive a free ‘Food Smart Meal Mixer’ containing a number of quick, easy, healthier recipes, as well as a range of offers from a number of food manufacturers.   A prime time advertising slot is the centrepiece of the campaign, exposing the ‘hidden nasties’ in everyday foods, and helping people to be ‘food smart’.  The campaign also features a smart phone and tablet app featuring a meal mixer and a shopping list function, to help people make healthy choices in the supermarket.   Please see the link below for further details.

More wellbeing activities for 2013

10 week Diet & Fitness Camp
Programmes starting in Crewe, Congleton and Macclesfield – starts end of January 2013

£50 for 10 Weeks.  1 hour session per week
First 30 staff to enrol will received £20 subsidy from the Trust – just £30 to pay!
£50 of free personal training vouchers at the end of the 10 weeks
To express your interest or receive more information contact Jamie on 07917441487

pilatesPilates at Congleton War Memorial and MDGH   

Please email your expression of interest for either or both of the following classes to 
If enough interest is received classes would commence beginning of February charged at £4 per session

Pilates Class –  Tuesday Evenings, Congleton War Memorial, 17.30 until 18.30

Pilates Class – Wednesday Evenings, MDGH, 17.30 until 18.30

New Staff Health Promotion Activity Calendar

Take a look at our new health promotion calendar to find out more about health awareness activities in your workplace from January until April 2013.

Staff Health Promotion Calendar Intranet access only

Tracheostomy Management Study Session

tracheostomyTracheostomy Management Study Session  to be held on 06/02/13 – 13.00-17.00
Education and Training Centre, Macclesfield District General Hospital.

This study session is open to all East Cheshire NHS Trust Acute and Community staff caring for patients with a tracheostomy, covering all aspects of its management.

For further information please contact Kate Heath ENT NP 01625 661285 or email

To book a place please contact L&D support service 01606 54 4948

Care in local communities: a new vision and model for district nursing

Department of Health

Care in local communities: a new vision and model for district nursing
This vision and service model builds on ‘Compassion in practice’, the national vision for nurses, midwives and care staff. It was developed by a strategic partnership of the Department of Health, NHS Commissioning Board Authority, The Queen’s Nursing Institute, alongside district nurse leaders and practitioners. It sets out the foundations of district nursing services, the developments and innovations that ensure services can meet current and future needs, and the district nurse-led team contribution to providing care and support in the community, including peoples’ homes. It aims to be a resource for those designing and providing local community health services, including nurse leaders, health and wellbeing boards, clinical commissioning groups, and others with an interest in developing integrated care for older people.

News from The King’s Fund

The King’s Fund

Developing supportive design for people with dementia
This publication marks the completion of 26 Enhancing the Healing Environment (EHE) schemes in 23 NHS acute, community and mental health hospitals in England to improve the environment of care for people with dementia. It seeks to provide practical, value-for-money examples to encourage and inspire staff and their organisations to provide an environment of care that better supports people with dementia.

Blog watch: The Twitter Journal Club

The Twitter Journal Club is a Twitter-based journal club, who meet fortnightly to discuss & critique a variety of medical papers.  The membership includes doctors, medical students, and anyone else who is interested.  They try to pick papers that are particularly significant and will be relevant to a wide range of people. You can suggest papers at any time here.

Anyone is welcome, including students, with one aim being to provide an chance for medical students to learn by discussing papers with practicing doctors. They also hope it will provide an opportunity for doctors to learn about research in fields outside their own.

How it works

The Twitter Journal Club uses the hashtag ie: #TwitJC but unlike most Twitter users, it does not post any public tweets. To read more about how this works please follow this link which will enable you to discover more.

Sample posts

RECALL of Best Practice app – URGENT

mphoneMessage from BMJ

We have been experiencing a technical fault with the Best Practice app for iPad. 

Please delete the Best Practice app for iPad and for iPhone from your systems and from any shared devices.  We are trying to reach all users but you may have more up to date user data so we would request that you take the necessary steps to inform your users that they should not use the app.

We are confident that this technical fault only applies to the iPad app but we have also temporarily withdrawn the app for iPhone as a precaution until an app update for both iPad and iPhone is available.

We are taking urgent steps to correct the fault and to issue an updated app.  Our customer services team will be in touch as soon as the revised app for iPad and iPhone are available – having previously downloaded the app you will be able to download the updated versions free of charge.

Please note that Best Practice on other platforms such as the online version ( and the mobile browser version ( are not affected by this fault and we therefore recommend that your users access these in the meantime.

We apologise for the inconvenience caused by this fault and ask that you take the actions above without delay.