Barefoot Science Insoles Promotion and Shop

10th July, MDGH Library, 10am until 2pm

barefoot_scienceThe Barefoot Science team will be presenting their products on Thursday, 10 July on the 2nd floor of New Alderley House.

This is an internationally patented product showcasing “the only insoles in the World that have the ability to rebuild weak foot muscles and as a consequence, eliminate / reduce your physical aches and pains.”

Discount available for East Cheshire NHS Staff 

More information available at


Peter Mekhail, Simon Ward; et al; European Journal of Trauma and Emergency Surgery; May 2014

A recent publication from Mensa Study Group including Peter Mekhail, Simon Ward of East Cheshire Trust.

Risk stratification, management and outcomes in emergency general surgical patients in the UK


The Royal College of Surgeons of England (RCS) published guidance in 2011 setting standards for the management of emergency surgical patients with the aim of reducing surgical mortality. These suggested the presence of a consultant surgeon and anaesthetist, and transfer to a higher level of care postoperatively for all patients deemed high risk.


This prospective multi-institutional study sought to evaluate whether adherence to these standards was associated with reduced mortality.

Download the full-text using the title link at the top of this post.

Nausheen S.; Roberts A.J.; Wakefield N.; et al; BJOG; April 2014

Mode of delivery and perineal injury following primary obstetric anal sphincter injury
Citation: BJOG: An International Journal of Obstetrics and Gynaecology, April 2014, vol./is.
121/(228), 1470-0328 (April 2014)
Author(s): Nausheen S.; Roberts A.J.; Wakefield N.; Canavan L.; Dinardo L.

Abstract: Introduction Obstetric anal sphincter injury (OASI) complicates 1% of vaginal deliveries. It is believed that 60-80% of women are asymptomatic following OASI repair at 12 months but studies have shown that 17-24% developed worsening of faecal symptoms after a second vaginal delivery. The risk of recurrent OASI is believed to be 5-7 fold higher in women with a previous OASI, however the true recurrence is not exactly known due to various confounding factors. Methods We conducted a retrospective review of deliveries in two maternity units in the Mersey Deanery (UK), between 2007 and 2012 (29 706 deliveries). We identified 176 women who had sustained an OASI in a previous pregnancy who went on to have a subsequent delivery, (188 subsequent deliveries).The primary outcomes studied were mode of delivery and perineal injury sustained in the subsequent delivery.

Continue reading

Noorullah O.; Lekharaju V.P.; Din I.U.; Klcova J.; Cross T.; Evans J.; Sturgess R.; Palmer D.; Kumar P.; O’Grady E.; Stern N.; Journal of Hepatology, April 2014,

An external validation of the hepatoma arterial-embolisation prognosis (HAP) score: The Liverpool experience 

Citation: Journal of Hepatology, April 2014, vol./is. 60/1 SUPPL. 1(S401-S402), 0168-8278 (April 2014)

Author(s): Noorullah O.; Lekharaju V.P.; Din I.U.; Klcova J.; Cross T.; Evans J.; Sturgess R.; Palmer D.; Kumar P.; O’Grady E.; Stern N.

Abstract: Background and Aims: Most hepatocellular carcinomas (HCCs) have palliative treatment. Trans-arterial embolisation (TAE) or chemoembolisation (TACE) are used with variable results. The HAP score was recently described to determine patients likely to benefit from
TAE or TACE. We report our experience with TAE and TACE to assess whether the HAP score was valid for our cohort of patients. Methods: Retrospective review of cases given TAE or TACE in Liverpool, UK (2006-2013). HAP score [1 point each for albumin <36 g/dl, AFP >400 ng/ml, bilirubin >17 mumol/l, tumour diameter >7cm. HAP A = 0 points,
B = 1, C = 2, D> 2].

Source: EMBASE

Nausheen S.; Clare A.; BJOG: An International Journal of Obstetrics and Gynaecology, April 2014

Case series: Uterine rupture, a district general hospital experience in the UK

BJOG: An International Journal of Obstetrics and Gynaecology, April 2014, vol./is. 121/(141-142), 1470-0328 (April 2014)

Author(s): Nausheen S.; Clare A.

Abstract: Background Uterine rupture is a rare obstetric emergency associated with significant adverse fetal and maternal outcomes. In high-income countries, the incidence is very low in women with an unscarred uterus at <2 in 10 000. However, the risk is increased in women who have had a previous caesarean section. They must be counselled during pregnancy about their options for mode of delivery, either elective repeat caesarean section or vaginal birth (VBAC). The RCOG advises that women should be informed of the risk of uterine rupture as 22-74/10 000 deliveries, and the ACOG quote a rate of 0.5-0.9%. This risk is increased by induction of labour or other uterine scars, such as inverted T or classical segment scars. Cases This series presents seven patients with uterine rupture seen at a UK district general hospital over a 3-year period between 2010-2013. During this period, we had 6049 deliveries, 732 of whom will have had a previous caesarean section. Less than half of these women opted for elective repeat caesarean section and so 417 women chose a VBAC. This gives a local rate of term scar rupture of 1.1% in women. In these patients the rupture was not always associated with excessive pain or CTG abnormalities. The diagnoses were made prior to the onset of labour as well as in labour and postnatally. One woman who did not realise she was pregnant and presented to accident and emergency in a state of shock. An ultrasound revealed a fetus in abdomen. During labour, rupture occurred with and without syntocinon augmentation and one case presented postnatally when she had a retained placenta.

Full Text: Available from Wiley in BJOG: An International Journal of Obstetrics and Gynaecology


Continue reading

Staff Library ‘Updates’ Service

bulletins circleTwice a year, the Staff Library Service issues a series of  Updates that list the details of recent research reports in various specialties. Many of the articles have a link to the full text which you can access via an Athens password. Details on how to do this are explained clearly in each Update.

The Update series includes:

  • Audiology
  • Cardiac Care
  • Chaplaincy and Counselling
  • Dermatology
  • Dietetics
  • Mental Health
  • Occupational Therapy
  • Ophthalmology
  • Physiotherapy
  • Speech and Language Therapy

If you would like to receive an electronic copy of any of the  ‘Updates‘ by email, then please contact us on 01625 661362.

Parsons, S, Symmons, DPM; Medicine April 2014

The burden of musculoskeletal conditions

Abstract:  Musculoskeletal conditions (MsC) are a major burden to the individual, society and the health service; 15–20% of all GP consultations involve patients with MsC. Incident cases of osteoarthritis are ten times more common than rheumatoid arthritis (RA). The prevalence of MsC is higher in women, rises with age and is likely to continue to rise as life expectancy increases. The costs of MsC include those to healthcare services, to society and indirect costs. MsC are among the most commonly reported causes of work-related ill health. Rheumatoid arthritis alone costs the UK economy between £3.8 and 4.8 billion a year. The average cost of a major hip procedure is £7800 and of a major knee procedure £6000. Risk factors for MsC include age and gender. The prevalence of certain MsC varies depending on ethnicity, lifestyle factors and genetic predisposition. The main consequences of MsC are chronic pain and disability. The burden of MsC is high and the impact of these conditions on the health service and society will continue to rise alongside increasing life expectancy.


Davies R.; Symmons D.P.M.; Hyrich K.L; Medicine; May 2014

Biologics registers in rheumatoid arthritis

Abstract: The introduction of biological therapies has resulted in improved outcomes in patients with rheumatoid arthritis (RA), although there are concerns about the long-term safety of these drugs specifically relating to lymphoma and serious infection. Biologics registers have been established worldwide to investigate long-term safety as well as effectiveness of biologic drugs in inflammatory conditions such as RA.

To date, publications from biologics registers have focused mainly on anti-tumour necrosis factor therapy (anti-TNF agents). The reports show that anti-TNF agents are effective in the treatment of RA. However, they are also associated with higher rates of serious infection. Lymphoma risk does not appear to increase, although findings are limited by mean follow-up periods of less than 5 years.

Moving forward, biologics registers will continue to capture long-term follow-up of anti-TNF drugs in RA, as well as incorporating new classes of biologics and other musculoskeletal diseases. This will further extend our knowledge of the long-term safety and effectiveness of biologic drugs, when used in ‘real life’ situations, and across conditions.

Source: Embase
Elsevier in Medicine

Full text article available to order through our inter-library loan scheme.

EC Trust links with ENER-G to shrink carbon footprint

Being green – East Cheshire Trust has begun work with the Salford-based company ENER-G to substantially reduce its energy costs.  Both Congleton War Memorial and Macclesfield District General hospitals will take part in this scheme which they hope will achieve major energy efficiency improvements. Some of the proposed changes involve the replacement of some 3,250 light fittings with high efficiency LED lighting, together with boiler efficiency improvements.

Read the full article





Blogging as therapy

FREE ACCESSsocmedia_icons

An interesting article in last week’s Health Services Journal on Blogging: patient led therapy in a digital world – it appears that blogging can be good for you!


Read some inspiring stories by clicking the link above.

“Blogging as a therapy can be life changing. Reading these stories is an education, an emotional experience, a journey. There are some very practical insights, some philosophical points and some clear messages for developing a great and relevant future healthcare system.” Roz Davies


Manager’s Bulletins

MH900422236[1]Whether you manage several teams or just a couple of individuals, did you know that NHS Employers regularly produce the NHS Managers Bulletins which provide tools, information and advice on people management. Everything from sickness/absence to making the appraisal process more satisfying.

Here are some links to the latest ones:

Updates from NICE: Eyes on Evidence

This month in Eyes on Evidence

Acid-suppressive drugs and oesophageal adenocarcinoma in Barrett’s oesophagus
A systematic review and meta-analysis indicates that proton pump inhibitors reduce the risk of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett’s oesophagus.

Prescriptions for anxiolytics and hypnotics and risk of death
A population-based cohort study in UK primary care suggests that people who are prescribed anxiolytic and hypnotic drugs have a significantly increased risk of death from any cause over a 7-year period.

Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.

Bedtime schedules and children’s cognition and behaviour
Two analyses of 7-year-olds in the UK Millennium Cohort Study suggest that not having a regular bedtime is associated with impaired cognition in girls and behavioural difficulties in both girls and boys.

Trained glycaemia alert dogs for people with type 1 diabetes

A small UK intervention study suggests that trained glycaemia alert dogs may be able to notify people with type 1 diabetes during blood glucose variations.

NICE opens consultation on the NICE Accreditation Process Manual Update
NICE is inviting comments on its proposals to update the NICE Accreditation Process Manual.

Evidence Updates

NICE has recently published Evidence Updates on:

  • Physical activity and the environment
  • Autism in adults
  • Opioids in palliative care

NHS Employers: Calculating new mileage rates – poster




New mileage rates from 1 July 2014
How is mileage allowance calculated? Following the latest changes to the mileage allowance rates we have produced a poster that clearly presents the breakdown in costs and charges and compares 2013 to 2014 mileage rates. The new rates will apply to journeys made by NHS employees on and after 1 July 2014. The changes are also outlined in pay circular AfC 2/2014, and the terms and conditions handbook will be updated and republished shortly. You can access the poster, new pay circular, as well as a summary and FAQs on the changes, from our latest news page.
Extract from NHS Employers website

eTOC pilot service

A new service from The Staff Libraryjama

From 16 June we will be piloting our electronic table of contents service (eTOC) which uses emails to update the recipient of the latest content of their favourite journals.  Initially we are focussing on just two of the hundreds of online publications – New England Journal of Medicine (NEJM) and the Journal of American Medical Association (JAMA). However, if there is sufficient interest we hope to extend this to include requests and other quality journals.

Sample content would look like this – following the links would bring up the article abstract. If we do not have a subscription to the journal, we would order the article for you as part of our inter-library loan service.

nejmNew England Journal of Medicine (24 new articles):

Tattoos and Sarcoidosis
Spot Diagnosis
Pharmacology and the Treatment of Complicated Skin and Skin-Structure Infections
Management of Skin Abscesses
Pregnancy and Infection
Adverse Health Effects of Marijuana Use

If you are interested in taking part or would like to know more, please contact Jan Read or email the Staff Library on 66 1362. Thank you.

CQC: Review of children’s transition to adult health services

Care Quality Commission (CQC)

From the pond into the sea: children’s transition to adult health services

This review found that young people with complex health needs do not always receive the necessary care and support when they move on to adult care services. The transition process can be a vulnerable time for young people and their families. During this period, they stop receiving health services that they may have had since a young age and move on to equivalent adult services which can be structured and funded differently. The review found that there are many committed professionals providing high-quality care but that system-wide change is needed in order to make the transition between services smoother for patients and families.


Click for report

“This report describes a health and social care system that
is not working, that is letting down many desperately ill
youngsters at a critical time in their lives. We have put the
interests of a system that is no longer fit for purpose above
the interests of the people it is supposed to serve.”

BMJ Learning: Pain – June 10 2014

You see a 28 year old tennis player who has pain in his right knee. This started during a match four days ago. He twisted to hit a ball but his foot remained in the same position. What is most likely to be going on? And what tests would you do? If you are not sure then this module will help. Click on the link to complete it today:

Knee examination

And here are our most popular modules on pain:

TRIP: Recently published Cardiology articles

The following systematic reviews have been recently published relating to cardiology:

Selected Nursing/Management articles

Identifying goals with the NHS Healthcare Leadership Model

P Ellis, J Abbott – Journal of Renal Nursing, 2014

In this paper, two previous papers (Ellis and Abbott, 2014a; 2014b) and one subsequent article in this series, the authors are exploring the content and nature of the new NHS Healthcare Leadership Model (NHS Leadership Academy, 2013).

… e-learning resources: As nursing students become consumers of education, Karen McCutcheon makes the case for adapting the NHS leadership framework to online …

K McCutcheon – Nursing Management, 2014

This is acknowledged by Glen (2005) and more recently Johnson et al (2013), who observe that much of the existing electronic learning content is just a transformation of traditional content into a digital representation. Figure 1 NHS leadership framework

‘Being a nurse leader is a tough role’ In these challenging times, staff need to be re-energised to increase team confidence, says Jane Valle

J Valle – Nursing Management, 2014

The King’s Fund (2013) has said that a transformation of systems, leadership and organisational culture is needed throughout the NHS if the lessons of the Francis inquiry are to be acted on. In fact, transformation is required beyond the NHS, across all healthcare settings.

Safeguarding vulnerable adults

V Betts, D Marks-Maran, T Morris-Thompson – Nursing Standard, 2014

the independent inquiries into care at Winterbourne View hospital and Mid Staffordshire NHS Foundation Trust the provision of information to service providers on how to improve service quality
and take He also addressed the need for leadership training as well as training in

Quality of life and neck pain in nurses

LE Joslin, CR Davis, P Dolan, EM Clark – International Journal of Occupational …, 2014

Received: October 22, 2013. Such an approach may ultimately offer financial savings for the NHS, improve the quality of life of nurses, and increase We would like to thank Professor Gordon Bannister for his gen- erous advice, expert knowledge and selfless leadership with this


Diabetes Week: 8-14 June 2014

Diabetes Week is Diabetes UK’s annual awareness and fundraising week.  Taking place from Sunday 8 to Saturday 14 June, thetheme is ‘I Can’.


Here are some useful website links to reputable sites:


Recent search articles from NHS Evidence:

Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?

Author(s) Balfe, Myles, Brugha, Ruairi, Smith, Diarmuid, Sreenan, Seamus, Doyle, Frank, Conroy, Ronan
Citation: Health & Place, 01 March 2014, vol./is. 26/(180-187), 13538292
Publication Date: 01 March 2014
Source: CINAHL
Patients with diabetes in cardiac rehabilitation:attendance and exercise capacity.

Author(s) Armstrong MJ, Martin BJ, Arena R, Hauer TL, Aggarwal S, Sigal RJ
Citation: Medicine & Science in Sports & Exercise, May 2014, vol./is. 46/5(845-50), 0195-9131;1530-0315 (2014 May)
Publication Date: May 2014
Source: Medline
Hormone replacement therapy for women with type 1 diabetes mellitus (The Cochrane Library)

Liz Mackay , Lynn Kilbride ,et al.  Online Publication Date: June 2013


eTOC Service in development

BMJ_sample_etocWe are currently developing a new strand to our current awareness service.  As well as offering a monthly bulletin service covering Breast Surgery, Critical Care and Falls Awareness; subscription service to a wide variety of healthcare newsfeeds eg: Child Health, Dementia, Diabetes and Orthopaedics to name just a few, you may also sign up to receive an electronic table of content (eTOC) from some of the leading journals.

The first of these is now available from the British Medical Journal.

What would I receive?  You would receive one email per month listing all the key content – news, letters, editorial, research, clinical reviews etc, and each with direct links to the content you are interested in.

How do I proceed?  If you or a number of colleagues in your department would like to receive the BMJ eTOC, please contact  or, quoting your name and email address.  Simples!


Health Matters: 3 June

This week’s Health Matters public lecture will look at an innovative pilot project in East Cheshire which will see doctors ‘Skype’ with patients in local nursing homes.

The talk, entitled Telehealth in East Cheshire – the future of care?, will be delivered by consultant gastroenterologist Dr Ramasamy Saravanan.  It will take place at Macclesfield District General Hospital’s Lecture Theatre on Tuesday, June 3rd, from 7pm to 8pm.

This week’s Grand Round

The next Grand Round will take place on Wednesday, 4th June 2014, with a presentation by Dr Marinaki & Dr Leese entitled ‘Rape and Sexual Assault:  Patient or crime scene?’  

The lecture takes place at 1pm 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 GSK and Astra Zeneca.