Ali F.R.; Shackleton D.B.; Kingston T.P.; Williams J.D.L: British Journal of Dermatology; July 2014

Occupational exposure to propranolol: An unusual cause of allergic contact dermatitis
Citation: British Journal of Dermatology, July 2014, vol./is. 171/(131), 0007-0963 (July 2014)
Author(s): Ali F.R.; Shackleton D.B.; Kingston T.P.; Williams J.D.L.

Abstract: A 48-year-old man with no personal or family history of atopy presented with a 6-month history of facial and hand dermatitis. For 3 years, the patient had been working in a pharmaceutical factory in which he was exposed to a variety of medicaments including propranolol, ethylcellulose, hypromellose and microcrystalline cellulose. The history was consistent with occupational exposure to an allergen, with improvement of symptoms seen during absences from work. He was patch tested to the hospital standard battery, face series, relevant parts of the textile series, and breakdown products of fragrance mixes 1 and 2, together with the medicaments and items of uniform he was exposed to at work and a variety of his own products appropriately applied. Positive reactions were elicited by propranolol hydrochloride in 1% white soft paraffin and colophony. Colophony was believed to be of old relevance, with a previous history of reactions to plasters reported. In retrospect, the operator had been involved in the manufacture of coated propranolol spheroids.

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Anjum G.A.; Skouras T.; Longley C.; Liu L.S.; Rathe S.; Khan U.A; International Journal of Surgery, 2013,

Day case laparoscopic cholecystectomy: A DGH experience, can a national average target be achieved?
International Journal of Surgery, 2013, vol./is. 11/8(648-649), 1743-9191
Author(s): Anjum G.A.; Skouras T.; Longley C.; Liu L.S.; Rathe S.; Khan U.A.
Language: English

Aim: To evaluate our current practice of Cholecystectomy in terms of number of Day Case Cholecystectomies (DCLC) and re-admissions as compared to National Average, to improve the outcome.

Methods: A retrospective audit from 01/09/2010 to 31/08/2011. All patients who underwent cholecystectomy at DGH Macclesfield, were included in the study. Data was extracted from case notes and electronic discharge summaries, entered to a Performa and was analysed using Microsoft Excel. No exclusion criteria.

Results:  Out of 194, 90.7% were operated laparoscopically, 36% as day case, 43% as 23 hour stay (total 79%)and 21% as inpatient. Average length of stay for all laparoscopic cholecystectomies was 1.21 days. Number of DCLCs varied from 14% to 55% among surgical teams. 10.3% of patients readmitted to the hospital within 29 days of index surgery with intra-abdominal collection, wound infection, pancreatitis and cholangitis in descending order. Conclusion: The high performing team (in number) had highest number of DCLCs (55%). Our readmission rates were comparable to the National Average.

National Average targets for DCLC can be achieved at relatively smaller organizations like DG Hospitals provided that Cholecystectomy is considered as a Day Case procedure by default and clear criteria for patient selection are established and implemented.

Publication Type: Journal: Conference Abstract
Source: EMBASE

Alsaffar H.; Whitby T.; Chandrasekaran S. Hormone Research in Paediatrics, October 2013

The effect of automated bolus calculators on HbA1c in children with type 1 diabetes in Macclesfield

Hormone Research in Paediatrics, October 2013, vol./is. 80/(413), 1663-2818

diabetesBackground: Previous studies have shown that using Automated bolus calculators (ABC) in type1 diabetic children showed noticeable reduction in HbA1C(1). Furthermore, it showed reduction in post prandial blood glucose level(2) and glucose variability(3) for those children treated with insulin pumps. Data from adults has already shown improvement in HbA1C following usage of ABC(4).

Objective: To confirm the effect of ABC on HbA1C in children with type1 diabetes who are on multiple daily insulin injection regimes in our unit.

Methods: This is a cross-sectional study. We have collected the data via Accu-check software and by reviewing the case notes. HbA1C was measured
before and after ABC use. Some of the patients were started immediately on ABC following their diagnosis with diabetes and others were started later after they showed poor glycaemic control.

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Abstract included in BMJ ‘Gut’

Abstract PTU-028 

SYMPTOM ASSESSMENT OF PATIENTS IN THE CHESHIRE BOWEL CANCER SCREENING PROGRAMME WITH A FINDING OF CANCER
doi:10.1136/gutjnl-2013-304907.120

1,*A Bond, 2J Everall, 2I London, K Koss. Gastroenterology, East Cheshire NHS Trust, Macclesfield; 2Gastroenterology/BCSP, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK

Introduction:
When attending the bowel cancer screening (BSC) programme patients undergo pre-colonoscopy assessment of their symptoms. This is conducted by the specialist screening practitioner for the BCS programme. Following a diagnosis of bowel cancer at colonoscopy the questions were asked again, after a 3–6 month period. Comparison could then be made to assess the validity of the pre-assessment questionnaire. It would also allow us to look at whether patients reported all symptoms during pre-assessment.

Murthy, Creech, Burgoyne, Stead, Babores; American Journal of Respiratory and Critical Care Medicine: May 2011

Journal: Conference Abstract

Follow-on patient satisfaction survey of Rapid Access Lung Cancer Clinic (RALC) 5 years after initiation

Authors: (Naveed) Royal Liverpool University Hospital, Liverpool, United Kingdom;  (Murthy, Creech, Burgoyne, Stead, Babores) Macclesfield General Hospital, Macclesfield, United Kingdom

Language: English

Abstract: Introduction: A one stop RALC was set up in our hospital in 2003. We surveyed patients’ satisfaction six months following initiation of the clinic (2004) showing a very good response. We have, now, re-surveyed patients’ satisfaction five years later (2009) using the same questionnaire to assess whether we have maintained similarly high patients’ satisfaction. Method: A questionnaire was posted to 38 randomly selected patients between January ’09 to March ’09 and the responses were sent back to us anonymously. Analysis was performed on parameters such as satisfaction with the information provided, understanding of diagnosis, time to ask questions, things which could be improved by doctors/nurse, things which could be improved in the clinic as a whole, seeing a McMillan nurse in the clinic and finding that helpful. These results were then compared to those in 2004. Results: The response rate was 30/38 (80%). Most patients continued to be happy with the level of information they were given (29/30 (97%)). All patients felt satisfied with their understanding of the diagnosis and the time available to ask questions. 24/30 (80%) patients saw a Macmillan lung cancer nurse on the day of the clinic in 2009.  All of them found it helpful and felt that was the right time to see a Macmillan nurse.
Majority of patients felt that nothing could have been improved upon by the doctor or nurse in the clinic (28/30 (93%)). As regards improvement in the clinic as a whole, only 5/30 (17 %) felt that there were things that could be improved upon. Most of these
comments related to waiting times from being seen in clinic to having CT scans and bronchoscopy later on that day. Below is a comparison of the above parameters between 2004 and 2009 (Graph 1). (Graph presented) Conclusion: This survey demonstrates that patients continue to remain highly satisfied with the level of service provided by this one stop clinic five years from its conception. A ‘one-stop’ RALC clinic significantly reduces time from first appointment to referral to a tertiary centre without reducing patient care and satisfaction.
NHS Evidence | library.nhs.uk
Page 7  Conference Information: American Thoracic Society International Conference, ATS 2011 Denver, CO United States. Conference Start: 20110513 Conference End: 20110518
Publisher: American Thoracic Society
Publication Type: Journal: Conference Abstract

Smith I.E.; Johnson L.; Dowsett M.; R. Robertson J.F.; Robison L.E.; Kokan J.S. et al; Journal of Clinical Oncology

Trial of perioperative endocrine therapy: Individualizing care (POETIC) – conference abstract

Citation: Journal of Clinical Oncology, May 2011, vol./is. 29/15 SUPPL. 1, 0732-183X (20 May 2011)

Author(s): Smith I.E.; Johnson L.; Dowsett M.; R. Robertson J.F.; Robison L.E.; Kokan J.S. et al
Language: English

Abstract: Background: The neoadjuvant IMPACT trial suggested Ki67 levels after 2 weeks endocrine therapy predicts long-term outcome. Major changes in gene expression have also been seen in ER+ breast cancer after aromatase inhibitor (AI) treatment. POETIC evaluates whether changes in Ki67 level after 2 weeks treatment predicts for relapse-free survival (RFS) more effectively than the baseline value. It also tests whether gene expression profile at this timepoint provides more accurate prognostic and predictive information than the pre-treatment profile. Experimental evidence suggests peri-operative endocrine therapy may improve disease outcome. This hypothesis is also addressed in POETIC. (ISRCTN63882543 ) With a sample size of 4000, an improvement in 5 year relapse from 10% to 7% could be detected with 91% power (two sided alpha of 5%), as would a 1.3 fold difference in the ability of Ki67 to predict RFS (90% power, two sided 5% significance level). Target recruitment is 4000 patients from 100 UK hospitals over 3-4 years.

Methods: Patients are randomised in the ratio of 2:1 to perioperative AI (letrozole 2.5mg or anastrozole 1mg daily) starting 2 weeks before planned surgery until 2 weeks after surgery. FFPE and RNA-later samples are taken prior to trial entry (baseline) and at surgery. Eligible patients are postmenopausal with ER+ invasive breast cancer. Consent to take additional research tissue is sought from patients undergoing diagnostic biopsy. Consenting patients donate tumour tissue in RNA-later and/or a FFPE research sample and enter POETIC following diagnosis of ER+ breast cancer. Matching tumour tissue is taken at surgery. Where an RNA-later sample at baseline is unavailable, consenting patients may undergo a further biopsy for research tissue immediately before study entry. Where consent procedures at diagnosis present logistical challenges, sites may provide FFPE tissue left over from diagnosis only. The 1st patient was entered in September 2008, and by January 2011 102 UK hospitals open and 1200 patients were entered. 182 optional RNA-later samples at both time points are available. Current success is due to a flexible approach to tissue sample collection and overcoming local and national logistical challenges.

Conference Information: ASCO Annual Meeting 2011 Chicago, IL United States.

Conference Start: 20110603 Conference End: 20110607

Publisher: American Society of Clinical Oncology

Publication Type: Journal: Conference Abstract

Lung Cancer; Conference Abstract; Creech L.; Clayton K.

The comprehensive lung cancer nursing service
Citation: Lung Cancer, January 2012, vol./is. 75/(S37), 0169-5002 (January 2012) Author(s): Institution: (Creech, Clayton) East Cheshire NHS Trust, Macclesfield District General Hospital,

Abstract: 
The Macmillan Lung Cancer Nursing (MLCN) service at East Cheshire supports patients throughout their journey from pre-diagnosis to specialist palliative care.

The MLCNs are clinical nurse specialists with advanced nursing practice, they provide advice and assessment on all aspects of care, through all treatment modalities.

Method:
The MLCN are present at the breaking of significant news and oncology clinic. They run two nurse led clinics per week for the follow up of patients with a confirmed diagnosis of lung cancer. There is also a Lung Cancer support group for patients to engage in peer support.

Results:
The MCLN support the primary and secondary care colleagues in all aspect of symptom management and patient support Conclusions: The MLCN service is underpinned by a patient centred approach. Ensuring all aspects of Living with Lung Cancer are covered for the patient and ensuring excellent quality end of life care, whether at home, hospital or hospice. Close links and excellent communication ensures the patient is well supported and informed at any stage in their journey.

Conference Information:
10th Annual British Thoracic Oncology Group Conference, BTOG 2012
Dublin Ireland.

Publisher: Elsevier Ireland Ltd
Publication Type: Journal: Conference Abstract