Felton S.; Felton M.; Kingston T.Journal of the American Academy of Dermatology; May 2014

Bilateral superficial granulomatous pyoderma of the auricular and periauricular skin
Journal of the American Academy of Dermatology, May 2014, vol./is. 70/5 SUPPL. 1(AB202), 0190-9622 (May 2014)
Author(s): Felton S.; Felton M.; Kingston T.


A 36-year-old presented with a 3-month history of a nonhealing 5-mm diameter ulcer in the left conchal bowl. Swabs revealed no bacterial growth, and blood tests, including eosinophil count, were normal and antineutrophil cytoplasmic antibody negative. Histology from excisional biopsy, performed because of suspected malignancy, described extremely acanthotic squamous epithelium with ulcerated areas lined by palisading histiocytes. The dermis had a neutrophilic and in some areas eosinophilic infiltrate, again with palisading histiocytes. The cartilage was degenerate but not inflamed. There was no dysplasia. The key diagnosis proposed was superficial granulomatous pyoderma. The other histologic differentials, infection and systemic vasculitis, were excluded clinically.

Unfortunately, he subsequently developed marked ulceration across the ipsilateral periauricular skin and within the contralateral conchal bowl. Some areas have healed with cribriform scarring. Treatment with high-dose oral prednisolone and azathioprine did not provide sustained improvement. Minocycline and dapsone had limited success, whilst more recently he has commenced anti-tumor necrosis factor therapy with infliximab after
excluding underlying malignancy.

Publication Type: Journal: Conference Abstract
Source: EMBASE

Iyer S.; Collum J.; Babores M; Ear Nose and Throat; March 2014

Descending necrotizing mediastinitis: A conservative approach
Citation: Ear, Nose and Throat Journal, March 2014, vol./is. 93/3(E11), 0145-5613 (March 2014)
Author(s): Iyer S.; Collum J.; Babores M.


Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous
pleural drainage may be initially appropriate for the stable patient.

Publication Type: Journal: Article

Source: EMBASE

Full Text: Available from ProQuest in Ear, Nose and Throat Journal
Available from EBSCOhost in ENT: Ear, Nose & Throat Journal

Lakhanpal A.; Watters C.; Hughes C.; Iyer S.; Babores M. Thorax; Dec 2013

Outpatient management of pulmonary embolism-patient characteristics and outcomes. 

Citation: Thorax, December 2013, vol./is. 68/(A145), 0040-6376 (December 2013)
Author(s): Lakhanpal A.; Watters C.; Hughes C.; Iyer S.; Babores M.


Management of Pulmonary Embolism (PE) has been until recently largely in-patient based and markedly affects length of stay in these patients. Recent evidence suggests that suspected or confirmed cases of PE can be managed out of hospital. We present our experience of outpatient management of PE in a small district general hospital.


We identified 35 patients investigated/treated for PE as outpatient
between March 2012 and June 2013. Demographic and clinical data was collected from case notes. Statistical analysis was performed on Medcalc based on normality.

Continue reading

SG Anderson, NS Malipatil, H Roberts, G Dunn; Primary Care Diabetes 2014

Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes

Volume 8, Issue 1, April 2014, Pages 65–69

George Dunn of East Cheshire Trust Podiatry Service co-authored this article published in Primary Care Diabetes.

Introduction: Painful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation.

Methods: The Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain.

Results: Treatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8 kg/m2p < 0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group.

Continue reading

News from Health Technology Assessments

NHS patients will benefit from £20 million investment into surgical research

Patients will benefit from £20 million funding into research on new cutting-edge surgical techniques, the President of the Royal College of Surgeons (RCS) has said. Ten of these projects have been funded by the NIHR HTA Programme. These include a project looking at total ankle replacement versus ankle arthrodesis and bypass versus angioplasty in severe ischaemia of the leg. [more…]

Intraoperative Radiation for Breast Cancer Study in The Lancet

The five year results of an NIHR HTA-funded study, on targeted intraoperative radiotherapy (TARGIT) for patients with breast cancer, have been published in The Lancet. [more…]

NIHR launches “Focus on Stroke” as ground-breaking stroke trial opens in the UK

EuroHYP-1, the largest worldwide clinical trial of a new revolutionary stroke treatment called Therapeutic Hypothermia, is due to open in the UK. The study is just one of those featured on “Focus on Stroke”, a new online resource from the NIHR aimed at raising public awareness of the exciting developments happening in stroke research. [more…]

BMJ Learning latest modules

Scenario from BMJ Learning – what would you do?

A 6 week old baby is examined at his baby check. His legs appear to be the same length but he has asymmetrical leg creases. You perform Ortolani’s test and feel a clunk. What is likely to be going on? If you are not sure, then this module should help. Click on the link to complete it today:

How to do the infant physical examination at 6-8 weeks (baby check)

And here are our most popular modules in emergency medicine for you to complete:

Chest pain of recent origin – assessment and diagnosis: in association with NICE

Early management of adults with an uncomplicated first generalised seizure

Epilepsy – in association with NICE

15 Minute Massage in the Library

Week beginning 12 May is ‘Mental Health Awareness Week’ and the library is supporting this by providing therapies to support staff wellbeing. These will include head/foot massage, reflexology and others. These free taster sessions with qualified therapists will take place in the library on Monday 12 May, from 10am-2pm. Everyone welcome to come along to the library and be de-stressed!  Refreshments also available along with quick guides to help you cope with anxiety, depression and related issues.

Please contact the Staff Library for further details on Ext: 1362 (01625 661362).

Caring Together – initial engagement ends soon

Extract from Staff Matters

The initial engagement process for Caring Together finishes on Wednesday (April 30th).  It is vital that you have your say, both as a trust employee and as a user of local healthcare.

Caring Together is an alliance of all of the area’s health and social care providers. It is working to create a joined-up service across the whole of Eastern Cheshire, with the aim of improving everyone’s wellbeing.

But before any changes are proposed or made, people’s views and aspirations for health and social care are being sought. More information can be found:

Grand Round 30 April 2014

The next Grand Round will take place on Wednesday, 30th April 2014, with a presentation by Dr J Hunter, entitled ‘Fluid Therapy’.

The lecture takes place at 1:00pm in the lecture theatre, 1st Floor, Macclesfield District General Hospital. It will be preceded by a hot buffet from 12:15pm, this meeting is sponsored by Ashfield Healthcare. Due to only having one sponsor, the food will be limited.

The following Grand Round will take place on Wednesday, 7th May 2014 with a presentation by the Medicine (Resp/Cardio/Gastro/COE) team.

Publishing success

We are grateful to Terry McLoughlin, CT2 Emergency Medicine Trainee, currently on rotation at East Cheshire for taking the time to visit the Staff Library recently with this update.

Originally from Liverpool, Terry has previously worked in inner city locations but since February 2014 has been gaining experience in a rural setting, treating adult and paediatric patients in Macclesfield’s A&E department.

Formerly a professional rugby player, Terry has swapped tackling his opponents for tackling the publishing world and has seen one of his articles published in the Journal of Clinical Monitoring and Computing. The article looks at new capnography equipment used in anaesthesia.

Terry acknowledged the help and support of colleagues in A&E and the literature search assistance provided by library staff which had been so useful. As a regular night shift worker, Terry thought the Staff Library’s 24/7 service was an excellent feature and one his colleagues would appreciate.

Next on Terry’s agenda is a trip to Canada in June, where he will be presenting research at the ISPOR 19th Annual International Meeting (Montreal) entitled ‘Low incidence of venous thromboembolism in mobile populations’.  This builds on experience gained while working at the Royal London Hospital in 2012 during the London Olympics.  At that time the Royal London was the main tertiary hospital for the Olympic village.

We would like to take this opportunity to wish Terry every success when he returns to familiar pastures in his next placement at Liverpool’s Alder Hey Children’s Hospital.

Article:              Disposable D-Lite Sensors; T F McLoughlinC S Hopkins
International Journal of Clinical Monitoring and Computing 03/2014; DOI:10.1007/s10877-014-9568-http://link.springer.com/article/10.1007/s10877-014-9568-4

Presentation:     ISPOR 19th Annual International Meeting; Montreal, Canada; June 2014
‘Low incidence of venous thromboembolism in mobile populations’.
Presenters: Emmanuel, Mullish and McLoughlin

Easter staffing

The Staff Library will be OPEN but unstaffed on Good Friday 18 April and Easter Monday 21 April.  Everyone with 24hr access will be able to access the paper journals and computers as usual.  Books may also be checked out using the Self Service system.

Normal opening hours will resume on Tuesday 22 April:

Mon-Thurs   8:30-5:00pm
Friday            8:30-4:30pm

Eyes on Evidence: April edition

This month in Eyes on Evidence

E-cigarette awareness and use to quit smoking
A survey suggests that awareness and use of e-cigarettes has increased over the past few years, but a randomised controlled trial indicates that the products are only modestly effective at helping people to quit smoking.

Beta-2 agonists and exercise-induced asthma
A Cochrane review has assessed the effects of short and long-acting beta-2 agonists for the prevention of exercise-induced asthma in adults and children; the majority of included studies assessed the effect of a single dose of a beta-2 agonist. The Medicines and Healthcare Products Regulatory Agency has previously issued advice recommending that long-acting beta-2 agonists should not be prescribed for the relief of exercise-induced asthma symptoms in the absence of regular inhaled corticosteroids.

Blood pressure control with home telemonitoring and pharmacist management
A US-based cluster randomised trial indicates that home telemonitoring with pharmacist medication management provides better blood pressure control than usual primary care, even once telemonitoring has finished.

Risk factors for congenital abnormalities
A prospective study of a UK multi-ethnic birth cohort suggests that consanguinity is a major risk factor for congenital abnormalities, in particular in children of parents of Pakistani origin.

Antidepressant use late in pregnancy and risk of postpartum haemorrhage
A cohort study of women with low income in the USA suggests that use of antidepressants near delivery is associated with an increased risk of postpartum haemorrhage.

CT scans in childhood or adolescence and risk of cancer
A population-based cohort study in Australia suggests that people who undergo CT scans in childhood or adolescence are at increased risk of developing solid, lymphoid and haematopoietic cancers.

Evidence Updates
NICE has recently published an Evidence Update on:
Alcohol-use disorders: preventing harmful drinking

BMJ Clinical Evidence: 2 new reviews

BMJ Clinical Evidence covers a wide range of conditions.  You can view the latest 2 online by following the link above. Make sure you have your Athens account details available.

Fungal toenails and Dystonia.

Updated topic: Dystonia

Dystonia is often a lifelong condition, with persistent pain and disability. A large spectrum of drug, surgical and physical treatments are available for the treatment of dystonia but use of these in practice can be inconsistent. The latest BMJ Clinical Evidence systematic review highlights the evidence base for the treatment of dystonia and where further research is required. 

To sign in or register to ‘My BMJ Clinical Evidence’, click here.

AQuA Bulletin: Issue 80

Issue: 80 of the AQuA Bulletin is exclusively available on the AQuA Portal (click here to log on and download).aqua-logo_

AQuA aims to bring a mixture of tools and publications aimed at improving healthcare services, providing links to more information and resources, highlighting areas for action and participation.

In the current issue:

Top Stories

  • Reducing harm to patients
  • Updated Asthma IOP launched
  • BMJ Quality & Safety: a collection of key articles
  • Horizon Scanning  A new settlement for health and social care
  • Safer Care – New drive to end deliberate face-down restraint
  • Patient Experience – Right to ‘ask’ for personal health budgets begins
  • Innovation – Mental health teams in police stations and courts scheme goes live
  • Patient Experience -Hospital stays improving, finds CQC
  • Innovation -Guidance for unplanned admissions enhanced services
  • Horizon Scanning – Clinical commissioning groups one year on.
  • Safer Care – Professionals divided over hip fracture care
  • Public Health – CMO annual report published on state of the public’s
  • Prevention – NICE recommends tests to help diagnose and manage asthma
  • Horizon Scanning – Update on rising scarlet fever numbers across England
  • Data & Intelligence – Data round up…

Update on Wellbeing

Extract from Staff Matters

Wellbeing Direct

For more information on the following, visit your Wellbeing Direct Pages

  • Staff discounts, schemes, theatre and healthcare offers
  • Staff activities and events
  • Internal staff wellbeing support services
  • Wellbeing newsletters
  • Change support resources

Current Wellbeing Activities

  • NEW   Yin Yoga – Macclesfield
  • Pilates – Macclesfield and Congleton
  • Monthly complementary therapies, MDGH
  • Trust choir
  • Pre-retirement sessions
  • Mid-career financial planning sessions

Click here to view April’s calendar of staff wellbeing activities (Trust staff only over Intranet)

Join the Library in the Staff Restaurant

To make it even easier to join your staff library and find out what services we offer, library staff will be in the staff restaurant between 12.30-1.30 on the following dates:

  • Tuesday 8 April
  • Thursday 1 May
  • Tuesday 13 May
  • Tuesday 10 June

So why not come along and join the library and see how we can help you.

Jean King, Information Governance Manager, will also be available to help you get started with your IG training.

Change to Library charges

Some of our charges will be  increasing from 1 MAY 2014 to bring us more in line with our suppliers such as the British Library and other regional libraries.  Copying and printing charges remain unchanged.

Books – late returns                                          10p per day

Talking Books for loan                                     1.00 for 4 weeks

Inter-library loans book/photocopy       1.00 per item

British Library loans                                        POA

A4 laminating                                                     25p per sheet

Binding    (irrespective of thickness)         2.00

Books lost from stock                                      5.00 + cost of replacement

Books lost from British Library                   152.70