Resource feature: Behind the headlines

A good resource, well worth a look – the excellent ‘Behind the Headlines’ facility which is part of the larger, more well known NHS Choices website.  

BTHcategoriesBehind the headlines (BTH) looks at stories in the media to expand and explain how the headline came about.  If you read the article below, you will see how BTH traces the evidence back to the original research and provides an unbiased conclusion.

Hip replacement deaths drop by a half since 2003 

“Death rates following hip replacement surgery fell by half in England and Wales,” reports the BBC News website.

Its headline is based on a new study in The Lancet which looked at data from the National Joint Registry (NJR) over the course of eight years. The registry is an NHS database recording outcomes in artificial joint operations such as hip and knee replacements.

Read the full article, which includes research, a video and an easy to follow conclusion.

Event: Improving Patient Flow within Urgent and Emergency Care Workshop

Improving Patient Flow within Urgent and Emergency Care Workshop event taking place at the Manchester Conference Centre on the 15 November 2013.

The workshop will look at the linkages between emergency care, frail older people, and the concerns about safety, patient experience, and mortality that have emerged from the Francis and Keogh Reports.

To register please go to and sign in.

Reading for reward in October!

As Autumn approaches it’s often a good time to visit the library and make sure you have a good selection of books to help you through the darker evenings.

With this in mind, staff in the Library are inviting everyone who borrows a book during the month of October, to take part in a free prize draw – the prize will be a £10 book token.

This also ties in nicely with our growing collection of popular fiction by well known authors such as: Bill Bryson, David Baldacci, Lynda La Plante, Frank McCourt, Alan Titchmarsh, RW Hughes, Stephanie Meyer, Dean Koontz and Michael Connelly.   As well as novels, there are cookery and travel titles too.  Come along and see what you can find.

Don’t forget if you would like to donate some of your unwanted paperbacks, we’d be very pleased to give them a new home (provided they are in good clean condition). COMING SOON: Libraries are good for you. 18 November 2013

Lutfi Sulaiman*, Robert J. MacFarlane and Mohammad Waseem; The Open Orthopaedics Journal, 2013

Current Concepts in Anaesthesia for Shoulder Surgery
Lutfi Sulaiman*, Robert J. MacFarlane and Mohammad Waseem

The Open Orthopaedics Journal, 2013, 7, (Suppl 3: M5) 323-328)
East Cheshire NHS Trust, Victoria Rd, Macclesfield, SK10 3BL, UK

Abstract: There has been an exponential growth in the volume of shoulder surgery in the last 2 decades and a very wide variety of anaesthetic techniques have emerged to provide anaesthesia and post-operative analgesia. In this article we examine current opinion, risks, benefits and practicalities of anaesthetic practice and the provision of post-operative analgesia for shoulder surgery.


BMJ Best Practice: MRSA

Extract from BMJ Best Practice

“This month’s topic is MRSA, one of BMJ BP’s most recently updated topics and an important cause of infection in both healthy people in the community and in people in healthcare facilities.

The prevalence of MRSA infection is increasing globally. MRSA is an important cause of infection in both healthy people in the community and in healthcare institutions, but the two presentations and therapies differ.

Children and younger adults are more commonly afflicted with community-acquired MRSA, while hospital-acquired MRSA is more common in older age groups. It is also important to distinguish MRSA colonisation from infection.

Read the brief summary of MRSA below and click the links to refresh your knowledge of its prevention, diagnosis, and treatment.

You can also review the available evidence on MRSA and find further reading here.


Ahsan Akhtar*, Robert J. MacFarlane and Mohammad Waseem; The Open Orthopaedics Journal, 2013

Pre-Operative Assessment and Post-Operative Care in Elective Shoulder
The Open Orthopaedics Journal, 2013, 7, (Suppl 3: M4) 316-322
East Cheshire NHS Trust, Victoria Rd, Macclesfield, SK10 3BL, UK

Abstract: Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately.

This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common postoperative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and postoperative analgesia following shoulder surgery.


Important: Insulin Safety online training

Insulin safety training is a requirement for all those who prescribe, prepare, handle or administer insulin. To ensure compliance with NPSA safe prescribing of insulin requirements, please can any prescriber, nurse or pharmacist who has not already completed the training now do so. Please note the website address to access this learning has changed and can be found at:

*Please note – of the 5 e-learning packages listed on this website, it is the Safe Use of Insulin module you are required to complete.

Each module allows users to log on, complete the course, take an on-line test and print a certificate if passed. There is an assessment at the end with a pass rate of 75% to gain a certificate. Please give a copy of your certificate to your line manager.

Extract from internal Staff Briefing

Nausheen S.; BJOG; Conference abstract

An unusual cause of postmenopausal bleeding-a case report of extrauterine leiomyoma.

Citation: BJOG: An International Journal of Obstetrics and Gynaecology, June 2013, vol./is. 120/(575-576), 1470-0328 (June 2013)

Author(s): Nausheen S.

Abstract: Postmenopausal bleeding (PMB) in women can be due to various benign and malignant causes. Uterine leiomyomas can cause PMB in association with endometrial hyperplasia, cancer or rarely sarcomatous transformation. Here is an unusual case of extrauterine leiomyoma which caused the PMB. Case An anxious 79-year-old Caucasian lady presented with unprovoked postmenopausal bleeding of 3 weeks duration with a lump per vaginum which pops out of the vagina and requiring her to push it back. She underwent an abdominal hysterectomy for fibroids in her 40 s. She had no problems with bowel or bladder. She had not been on HRT. On examination she had a normal vulva with a polypoidal swelling 2.5 x 3 cm in size in the lower third of vagina on the right side. The mucosa was vascular with smooth surface and the mass was firm in consistency, non-tender and was not fixed to deeper structures. She had a normal vault. There were no other pelvic or vaginal masses. She had an emergency attendance with another episode of heavy PMB. She had MRI which showed an oval well defined mass representing a benign leiomyoma arising in the lower vagina of size 2.6 9 2.2 cm, showed homogenous low signal on the T2 images with no evidence of infiltration into adjacent structures and no abnormality seen within the remainder of the vagina. Due to her symptoms, excision was done and histology confirmed it as a benign leiomyoma.

Discussion Extrauterine leiomyoma seen in our patient is a rare, benign tumor which may arise from smooth muscle cells, is reported in the vulva, ovaries, broad ligament, urethra and urinary bladder. In addition, unusual growth patterns may be seen, including benign metastasising leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. However, some extrauterine leiomyomas may mimic malignancies causing serious diagnostic dilemma. The most useful modalities for detecting extrauterine leiomyomas are ultrasonography, computed tomography, and magnetic resonance (MR) imaging. Our patient presented with vaginal leiomyoma which caused her recurrent symptoms of PMB due to its growth and surface vasculature, though she had not been on the HRT. However as she had unusual bleeding, MRI excluded any other pathology; hence this case emphasises the clinicians to be aware of this rare tumor.

Publication Type: Journal: Conference Abstract
Source: EMBASE

Anjum G.A.; Jaberansari S.; Habeeb K. BMJ Case Reports

Caecal volvulus: A consequence of acute cholecystitis.

Citation: BMJ Case Reports, June 2013, 1757-790X (06 Jun 2013)
Author(s): Anjum G.A.; Jaberansari S.; Habeeb K.

Abstract: Caecal volvulus is an uncommon cause of closed loop intestinal obstruction which can lead to caecal gangrene and high mortality. Delay in diagnosis is one of the causes of this high mortality. Caecal volvulus is reported to be associated with previous abdominal surgery in most cases. We present the first reported case of caecal volvulus following/associated with acute cholecystitis.

Copyright 2013 BMJ Publishing Group. Allrights reserved.

Publication Type:  Journal: Article  EMBASE

Informed consent for patients with learning disabilities

This article, Informed consent for blood tests in people with a learning disability was recently published in Journal of Advanced Nursing, Sep 2013, vol. 69, no. 9, p. 1966-1976, 0309-2402

Author(s): Goldsmith, Lesley; Woodward, Val; Jackson, Leigh; Skirton, Heather

Abstract: This article is a report of a study of informed consent in people with a learning disability. The aims of the study were to explore the information needs of people with mild-to-moderate learning disabilities with respect to consent for blood tests and to identify ways of facilitating informed consent.

Background. The recent political agenda for social change in the UK has emphasized the right of people with a learning disability to have more autonomy and make their own decisions. As in other countries, there has also been a shift towards shared decision-making in healthcare practice.

Design.  Qualitative study using an ethnographic approach.

Methods. An ethnographic approach was used for this qualitative study. Phase 1 involved observation of six participants with a learning disability having a routine blood test in general practice, followed by semi-structured interviews with 14 participants with a learning disability in Phase 2. Data were collected between February 2009-February 2010.

Findings. The data showed that consent procedures were often inadequate and provision of information to patients prior to a blood test was variable. People with a learning disability expressed clearly their information requirements when having a routine blood test; this included not wanting any information in some cases.

Conclusions. Healthcare practitioners and people with a learning disability need to be familiar with current consent law in their own country to facilitate valid consent in the healthcare context. This study demonstrated the value of qualitative research in exploring the knowledge and attitudes of people with learning disability.

Source: BNI

Nagy M.T.; Hla S.M.; Keys G.W. BMJ Case Reports

Late Streptococcus bovis infection of total knee replacement complicated by infective endocarditis and associated with colonic ulcers.

Citation: BMJ Case Reports, June 2013, 1757-790X (05 Jun 2013)
Author(s): Nagy M.T.; Hla S.M.; Keys G.W.

Abstract: Streptococcus bovis is rare cause of late infections after total knee replacement (TKR). This report presents a case of confirmed late septic arthritis following TKR caused by S bovis that was further complicated with infective endocarditis resulting in aortic valve insufficiency in an immune-competent patient. As an association between S bovis and gastrointestinal malignancies is suggested, a workup for such malignancies was performed that revealed non-malignant ulcers in patient’s ascending colon. The patient is currently recovering from his aortic valve replacement surgery and is scheduled to have annual colonoscopies. His knee joint has improved; however, he developed constant pain because of underlying chronic infection in the affected joint and has
difficulties mobilising. Therefore, a revision TKR is considered but postponed until he fully recovers from his heart valve surgery.

Copyright 2013 BMJ Publishing Group.

Publication Type: Journal: Article
Source: EMBASE

Perspectives on Medical Education: Sept 2013

September 2013,

Open Access This content is freely available online to anyone, anywhere at any time.

An integrated model for developing research skills in an undergraduate medical curriculum: appraisal of an approach using student selected components


Student selected components (SSCs), at that time termed special study modules, were arguably the most innovative element in Tomorrow’s Doctors (1993), the document from the General Medical Council that initiated the modernization of medical curricula in the UK. SSCs were proposed to make up one-third of the medical curriculum and provide students with choice, whilst allowing individual schools autonomy in how SSCs were utilized. In response, at the University of Edinburgh the undergraduate medical curriculum provides an integrated and sequential development and assessment of research skill learning outcomes, for all students in the SSC programme. The curriculum contains SSCs which provide choice to students in all 5 years. There are four substantial timetabled SSCs where students develop research skills in a topic and speciality of their choice. These SSCs are fully integrated and mapped with core learning outcomes and assessment, particularly with the ‘Evidence-Based Medicine and Research’ programme theme.

Read the full article

New academy web portal for NHS staff

Extract from The Guardian – Healthcare Professionals Network

A new organisation that aims to improve training for NHS staff is to be launched on Thursday. The employer-led National Skills Academy for Health (NSA Health) will support NHS trusts and organisations in providing training across a wide range of job fields.

One of its key goals will be to tackle the skills gap in the health service. Although not providing education itself, the academy will direct trusts and other employers to education providers in their own areas and offer some opportunities for e-learning.

Candace Miller, its director, said: “We were hearing real concerns from employers about the availability of good training and educational support for healthcare assistants and other groups in their areas. The creation of the NSA Health will attempt to address this gap.”

Britton E.J.; Saravanan R.; Woodhouse T.; Koss K.; Gut – poster


Transient elastography in the risk stratification of patients with abnormal liver function tests.
Citation: Gut, July 2012, vol./is. 61/(A195), 0017-5749 (July 2012)

Author(s): Britton E.J.; Saravanan R.; Woodhouse T.; Koss K.

Abstract: Transient elastography (TE) (Fibroscan) is a well validated method for assessing liver fibrosis in a trial setting. Gastroenterology Department at Macclesfield DGH is one of the first centres in the UK to adopt Fibroscan examination into the diagnostic pathway of patients with abnormal LFT. This is the first publication of our data of unselected patients undergoing liver stiffness measurement (LSM) demonstrating practicalities and limitations of Fibroscan. Methods: Data were collected from 366 patients with abnormal LFT attending Gastroenterology Clinic from July 2010 to December 2011. Fibroscan examination was performed by two gastroentrology consultants and one specialist nurse. The cohorts of Fatty liver disease (FLD) and Alcoholic liver disease (ALD) were further analysed comparing fibrosis score from TE with clinical findings, laboratory blood tests, ultrasound imaging and liver biopsy.

Results: Patients diagnosis were as follows: FLD 35.8% (n=131), ALD 14.8% (n=54),
Chronic hepatitis C 15.6% (n=57), PSC/PBC 7.7% (n=28), chronic hepatitis B 4.6%
(n=17), haemochromatosis 2.2% (n=8), AIH 1.4% (n=5), chronic usage of Methotrexate 1.9% (n=7). Additionally 42 healthy volunteers participated. The mean time duration for each successful scan was 173 (30-1363) seconds with 18% of patients requiring the XL probe due to central obesity. The fibrosis scores recorded for all patients scanned were F0-1 41% (n=150), F2 6.3% (n=23), F3 7.1% (n=26) and F4 26% (n=95). 15% of scans were considered to be failed as LSM/IQR was >33, most prevalent in the FLD group 16.8% (n=22) and wasn’t operator or probe dependent. Significant proportion of patients with liver fibrosis (F3-4) had no clinical signs of chronic liver disease. 80% of patients F3-F4 fibrosis demonstrated portal hypertension on imaging and 32% of patients in that
group had low platelets (3. The sensitivity and specificity of low platelets for significant fibrosis was 32% and 91% and for portal hypertension on imaging was 64% and 89% respectively. There was significant correlation between liver fibrosis scoring on TE and Metvir fibrosis scoring on biopsy in patients without high degree of inflammation. However, coexisting acute inflammation in some cases contributed to false positive results on Fibroscan.

Conclusion: The Fibroscan technology has allowed rapid stratification of patients with chronic liver diseases. Significant proportion of patients (40%) were appropriately reassured without need of undergoing liver biopsy. 20% of patients without stigmata of chronic disease and without conventional laboratory markers of liver fibrosis were diagnosed with liver cirrhosis. Early experience has shown difficulties of performing TE in patients with central obesity and FLD. Fibroscan finds its valuable role in the care pathway of patients with abnormal LFT.

Publication Type: Journal: Conference Abstract – Poster
Source: EMBASE
Full Text: Available from Highwire Press in Gut.  Athens required

This month’s Eyes on Evidence

Surveillance data from Australia suggests a reduced incidence of genital warts following the introduction of vaccination against human papillomavirus for girls and young women.
A meta-analysis shows that, compared with placebo, pramipexole, ropinirole, rotigotine, gabapentin enacarbil and pregabalin improve symptoms in people with long-term moderate to severe primary restless legs syndrome.
A longitudinal study finds that social isolation and loneliness in older people may be associated with increased all-cause mortality.
An observational study suggests that the risk of thromboembolism after in vitro fertilisation is low but persists into the first trimester of pregnancy.
A meta-analysis notes that COX-2 inhibitors and diclofenac are associated with increased incidence of major vascular events.
A randomised controlled trial suggests that acupuncture for seasonal allergic rhinitis may improve disease-specific quality of life and reduce use of antihistamines.
We highlight a new example from the QIPP collection demonstrating how NHS organisations have implemented new local practices that have both cut costs and improved quality.

Noormohamed M.S.; Neophytou C.; Jain Y.; Rawat S.; BMJ Case Reports

A 66-year-old male with lower abdominal lump: an unusual presentation of an uncommon abdominal pathology. 

Citation: BMJ case reports, 2012, vol./is. 2012/, 1757-790X (2012)

Author(s): Noormohamed M.S.; Neophytou C.; Jain Y.; Rawat S.

Abstract: A 66-year-old Caucasian male was admitted following symptoms of intermittent umbilical pain aggravated after meals and associated with vomiting of contents. Physical examination revealed a tender, partially reducible swelling suspicious of complicated umbilical hernia. Abdominal x-ray revealed dilated small bowel loops which appeared consistent with clinical diagnosis. He underwent a laparotomy subsequently which revealed a small defect in the linea alba with viable small bowel and two firm mesenteric masses encroaching the lumen approximately two feet from the ileocaecal junction. The histology of the excised bowel and masses revealed that the tumour composed of bland spindle cells with slender to plump nuclei and eosinophilic cytoplasm.

Mesenteric fibromatosis are the most common primary tumours of the mesentery and constitute about 3.5% of all fibrous tissue tumours. Intra-abdominal desmoids are very rare and benign tumours but are very aggressive and should be considered in the differential diagnosis of acute abdominal pain.

Publication Type: Journal: Article
Source: EMBASE

Latest news from AQuA

Issue: 66 of the AQuA Bulletin is now exclusively available on the AQuA Portal (click here to log on and download).

  • Hunt – NHS must fundamentally change to solve A&E problems
  • NHS England supports winter plans for urgent and emergency services
  • Safer Hospitals, Safer Wards Technology Fund receives extension

  • Safer Care:  UK to Host G8 Dementia Summit
  • Reducing Mortality: Stoptober – Mass 28-day Stop Smoking Challenge
  • Patient Experience: Joint Briefing – The Francis Inquiry
  • Integration: Improving Integration within Mental Healthcare
  • Productivity: CCG Development Framework – A Clear Direction of Travel
  • Safer Care: How Do We Balance Cost-Effectiveness with Safety?
  • Patient Experience: Caldicott Information Governance Review
  • Prevention: Predicting Hospital Admission: An Observational Study
  • Patient Experience: The Shifting Nature of the Health & Social Care Divide
  • Innovation: Shine Innovation Programme Accepting Applications
  • Productivity: £1bn to Help A&Es and NHS Staff Access Medical Records
  • Data & Intelligence: Data round up…

BMJ Editorials: September 2013

What to do about unsafe medicines?         Gillian J Buckley, Jim E Riviere, and Lawrence O Gostin
The word “cancer”: how language can corrupt thought BK Dunn, Sudhir Srivastava, and Barnett S Kramer
Secondary prevention of venous thromboembolism      Sam Schulman and James Douketis

Children’s intensive care deaths at ‘all time low’

Extract from BBC Health News

Death rates in children’s intensive care units are at an all-time low despite increasing admissions, a report has shown.

The Paediatric Intensive Care Audit Network found the death rate was 3.8% in 2012 – despite admissions rising 5% from 18,596 in 2011 to 19,516 in 2012.

But it warned out-of-hours staffing levels were often not being met.

Experts said children should have the best care, whatever time of day or night they were admitted.

Continue reading the main story

Wellbeing Direct news

First published in Staff Matters (9/9/13)

For more information on the following visit your Wellbeing Direct Pages

  • Staff discounts, schemes, theatre and healthcare offers
  • Staff activities & events
  • Wellbeing Newsletters
  • Change support resources

Current Wellbeing Activities

  • Pilates for Staff
  • Drop a dress size for Xmas – Fitness and Nutrition Offer
  • New Mindfulness Programme for October 13
  • Yoga for Staff
  • Blood Pressure Testing Days
  • Complimentary Therapies, MDGH
  • Trust Choir
  • Staff Health Promotion Calendar of Activities
  • Pre-retirement sessions
  • Mid-career financial planning sessions