New books available

The Library & Knowledge Service purchased a large number of new books last month ~ view a selection of the new titles here. All members of East Cheshire NHS Trust staff, students on placement and volunteers are able to borrow books from the Library. Contact the Library for more information: / 01625 66 1362.

Library books 2

Library and Knowledge Service annual survey now open!

Click here for survey

Click here for survey

The annual survey for the Library and Knowledge Service is now open – if you want to take part follow this link and complete as much as you can. It should take no more than ten minutes, and would help to provide us with information that we can use to improve library services.

Remember, we can only do this through your help: your feedback guides our service!

The survey is open until 5pm on the 24th of July.

Clinical Study: Staff Publication in Advances in Orthopaedics

Outcomes of Geriatric Hip Fractures Treated with AFFIXUS Hip Fracture Nail

This clinical study written by Ahmed Mabrouk, Mysore Madhusudan, Mohammed Waseem (East Cheshire NHS Trust), Steven Kershaw, and Jochen Fischer has been published in Advances in Orthopaedics.

Summary: Geriatric hip fractures are one of the commonest fractures worldwide. The purpose of this study was to report the outcomes of a series of unstable geriatric hip fractures treated with AFFIXUS hip fracture nail.  Read the full article here

If you are interested, there is a YouTube clip which covers Hip Fracture Nail but is not in any way associated with the persons mentioned in this post or connected to this article.

Nursing Standard: A well-deserved higher profile: Health visitors are gaining greater recognition thanks to a new fellows programme

The work of Health Visitor Team Leader, Andrea Johns of East Cheshire Trust, is recognised in this recently published article A well-deserved higher profile: Health visitors are gaining greater recognition thanks to a new fellows programme” reported by Petra Kendall-Raynor, Well done Andrea!

Read the full article in the Nursing Times here

Health Technology Assessment: The SNAP Trial

The SNAP trial: A randomised placebo-controlled trial of nicotine replacement therapy in pregnancy – Clinical effectiveness and safety until 2 years after delivery, with economic evaluation 

Citation: Health Technology Assessment, 2014, vol./is. 18/54(1-128), 1366-5278;2046-4924 (2014)

Author(s): Cooper S.; Lewis S.; Thornton J.G.; Marlow N.; Watts K.; Britton J.; Grainge M.J.;
Taggar J.; Essex H.; Parrott S.; Dickinson A.; Whitemore R.; Coleman T;  Coughtrie M.;
Mannion C.; et al

East Cheshire Trust (Macclesfield Hospital) participated as a source of recruitment.

Abstract: Smoking during pregnancy causes many adverse pregnancy and birth outcomes. Nicotine replacement therapy (NRT) is effective for cessation outside pregnancy but efficacy and safety in pregnancy are unknown. We hypothesised that NRT would increase smoking cessation in pregnancy without adversely affecting infants.

Objectives: To compare (1) at delivery, the clinical effectiveness and cost-effectiveness for achieving biochemically validated smoking cessation of NRT patches with placebo patches in pregnancy and (2) in infants at 2 years of age, the effects of maternal NRT patch use with placebo patch use in pregnancy on behaviour, development and disability.

Design: Randomised, placebo-controlled, parallel-group trial and economic evaluation
with follow-up at 4 weeks after randomisation, delivery and until infants were 2 years old.

Read the full article here


Endocrine Abstracts; B Roisin, L Hayley, C Surendran

Epidemiology and risk factors for diabetic retinopathy in CYP with type 1 diabetes mellitus in a DGH

B Roisin, L Hayley, C Surendran – 2014

Endocrine Abstracts (2014) 36 P30 | DOI:10.1530/endoabs.36.P30
Introduction: Nearly all patients with type 1 diabetes mellitus develop diabetic retinopathy (DR) within 20 years of diagnosis. It is the second largest cause of blindness in those of working age in the UK. Several risk factors have been accepted by the Royal College of Ophthalmologists, including gender, duration of diabetes, glycaemic control, blood lipid profile, blood pressure, and renal impairment.

Click the title link to read more.

S. Tiboni, A. Bhangu, N. J. Hall; British Journal of Surgery 2014


  1. S. Tiboni, A. Bhangu, N. J. Hall* and on behalf of the Paediatric Surgery Trainees Research Network and the National Surgical Research Collaborative.   Article first published online: 2 APR 2014

Collaborator: P. Szatmary (East Cheshire NHS Trust)

An Athens account is required to read the full text


Fawcett RJ; BMJ Case Reports, 2013, vol./is. 2013/, 1757-790X (2013)

cyclistCongratulations to Dr RJ Fawcett on the publication of this article:
Morel-Lavallee lesion in a male cyclist.

Citation: BMJ Case Reports, 2013, vol./is. 2013/, 1757-790X (2013)
Author(s): Fawcett RJ
Language: English
Publication Type: Case Reports; Journal Article
Full Text: Available from EBSCOhost in BMJ Case Reports

J Broomfield*, P Ralte, S Morapudi, N Vasireddy and S Kershaw; Journal of Surgical Case Reports

Title: Anterior knee pain: an unusual presentation of renal cell carcinoma

Metastasis of any kind to the patella is rare. Metastasis to the patella causing symptoms representing the first presentation of underlying malignancy is rarer still. We report the case of a previously fit and well 74-year-old male presenting with left anterior knee pain. The initial diagnosis was osteoarthritis but after continued symptoms a diagnosis of solitary patella metastasis from a primary renal cell carcinoma was confirmed.

Read the remainder of this article at:


Gok M.A.; Malik K.I.; Jeff A.; Sadat M.M.; Ward S.J.; Khan U.A; Surgical Endoscopy and Other Interventional Techniques,

Emergency versus elective colorectal resections for malignancy: A single centre experience

Colorectal cancer is the 3rd most common malignancy in men & women in
the UK. Colorectal cancer presents as a surgical emergency in 30% of cases as
obstruction, perforation, abdominal pain, haemorrhage or sepsis. Emergency colorectal
cancer has been associated with high post-operative morbidity & mortality. The aim of
the study is to assess emergency colorectal malignant resections at a District General

This is a retrospective study carried out since January 2007 till September 2013 at Macclesfield District General Hospital.

Collection notes: Academic-License. Please when asked to pick an institution please pick
NHS. Please also note access is from 1997 to date only.



Continue reading

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.

Continue reading

SP Morapudi, R Zhou, K Barnes: Bone and Joint Journal of Orthopaedics: 2014

Another publication from the Orthopaedics Dept, this time in The Bone and Joint Journal of Orthopaedics


SP Morapudi, R Zhou, K Barnes – Bone & Joint Journal Orthopaedic Proceedings …, 2014

Abstract. Summary There is little knowledge in surgeons about the guidelines for prophylactic antibiotics in patients with prosthetic joints when undergoing a dental procedure. read more 

EY Tang, S Knight: Rheumatology; April 2014

This conference abstract on A local audit of pulmonary hypertension screening in systemic sclerosis in the north western region, written by Tang E.Y.; Knight S.

Citation: Rheumatology (United Kingdom), April 2014, vol./is. 53/(i118), 1462-0324 (April 2014)

Abstract: Background: Scleroderma, both limited and diffuse, can be associated with pulmonary hypertension. This can be life threatening. Licensed treatments are now available. In the North Western region, this rare condition is diagnosed and managed in conjunction with the Sheffield Pulmonary Hypertension Unit. This unit has developed national guidelines for screening for pulmonary hypertension in this patient group. This retrospective audit was to assess how well we comply with the guidelines and whether steps need to be taken to improve compliance.

Methods: Patients identified from Medisave programme by searching scleroderma, SSc, CREST. Proforma was designed based on the Sheffield guidelines.

Continue reading

RJ Macfarlan, TD Donnelly, Y Khan, S Morapundi, M Waseem, J Fischer: Biomed Research 2014

Congratulations to the staff of the Dept of Trauma and Orthopaedics for having the following article published.

Clinical Outcome and Wound Healing following Carpal Tunnel Decompression: A Comparison of Two Common Suture Materials

RJ MacFarlane, TD Donnelly, Y Khan, S Morapudi… – BioMed Research …, 2014

Department of Trauma and Orthopaedics, Macclesfield District General Hospital,
East Cheshire NHS Trust, Victoria Road, Macclesfield SK10 3BL, UK.

Published 7 August 2014


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

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.

Felton M.,Felton S.,Kay N; 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
Author(s): Felton M.,Felton S.,Kay N.
Abstract:  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.

Van Der Ploeg, N; Hamer, D; European Journal of Surgical Oncology, May 2014

Breast care clinical nurse specialist led follpw up for patients who have undergone breast cancer surgery and have annual mammography

European Journal of Surgical Oncology, May 2014 vol/iss 40/5/(636), 0748-7983

Source: Embase

Abstract: Patients have annual mammograms for six years post diagnosis of breast cancer, they are seen within one hour of having their mammograms by a clinical nurse specialist, for clinical examination, results of mammography and follow up. The aim of the study was to evaluate whether patients were satisfied with the service or whether the process was more stressful than returning two weeks later for the results at a further appointment and whether they would prefer to see a doctor rather than a nurse. Method: The data was collected via questionnaire completed by the patient after they have attended for the follow up visit. All responses were anonymous. Results: Data was collected for one month in September 2013, 100 questionnaires were completed. This included patients who had undergone wide local excision, mastectomy +/- reconstruction of the breast. 100% of patients were very happy to be seen by a breast care specialist nurse. 100% of patients valued the service and found it less stressful having one visit to the hospital and receiving the results on the same day, 96% felt that any concerns were addressed at the consultation, 4% had no concerns.

Conclusion: Receiving mammogram results within one hour of having the mammogram significantly reduces level of anxiety in patients and seeing a breast care specialist nurse results in a very high level of patient satisfaction.

This article can be ordered through our inter-library loan scheme.


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

Miller C.A.; Naish J.H; Egdell, R; Journal of Cardiovascular Magnetic Resonance, January 2014

Voxel-wise quantification of myocardial blood flow with cardiovascular magnetic resonance: Effect of variations in
methodology and validation with positron emission tomography
Journal of Cardiovascular Magnetic Resonance, January 2014, vol./is. 16/1, 1097-6647;1532-429X (24 Jan 2014)
Author(s): Miller C.A.; Naish J.H.; Ainslie M.P.; Tonge C.; Tout D.; Arumugam P.; Banerji A.; Egdell R.M.; Clark D.; Weale P.; Steadman C.D.; McCann G.P.; Ray S.G.; Parker G.J.; Schmitt M.

Abstract:  Quantitative assessment of myocardial blood flow (MBF) from cardiovascular magnetic resonance (CMR) perfusion images appears to offer advantages over qualitative assessment. Currently however, clinical translation is lacking, at least in part due to considerable disparity in quantification methodology. The aim of this study was to evaluate the effect of common methodological differences in CMR voxel-wise measurement of MBF, using position emission tomography (PET) as external validation.

Methods. Eighteen subjects, including 9 with significant coronary artery disease (CAD) and 9 healthy volunteers prospectively underwent perfusion CMR. Comparison was made between MBF quantified using: 1. Calculated contrast agent concentration curves (to correct for signal saturation) versus raw signal intensity curves; 2. Mid-ventricular versus basal-ventricular short-axis arterial input function (AIF) extraction; 3. Three different deconvolution approaches; Fermi function parameterization, truncated singular value decomposition (TSVD) and first-order Tikhonov regularization with b-splines. CAD patients also prospectively underwent rubidium-82 PET (median interval 7 days).

Results: MBF was significantly higher when calculated using signal intensity compared to contrast agent concentration curves, and when the AIF was extracted from mid- compared to basal-ventricular images. MBF did not differ significantly between Fermi and Tikhonov, or between Fermi and TVSD deconvolution methods although there was a small difference between TSVD and Tikhonov (0.06 mL/min/g). Agreement between all
deconvolution methods was high. MBF derived using each CMR deconvolution method showed a significant linear relationship (p < 0.001) with PET-derived MBF however each method underestimated MBF compared to PET (by 0.19 to 0.35 mL/min/g).

Variations in more complex methodological factors such as deconvolution method have no greater effect on estimated MBF than simple factors such as AIF location and observer variability. Standardization of the quantification process will aid comparison between studies and may help CMR MBF quantification enter clinical use. 2014 Miller et al.; licensee BioMed Central Ltd.
Publication Type: Journal: Article
Source: EMBASE
Full Text: Available from EBSCOhost in Journal of Cardiovascular Magnetic Resonance (BioMed Central)

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.

Continue reading