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Publication Experimental modelling of internal surface laryngeal fracturing observed in fatal applied neck pressure(Elsevier, 2025-04) Johnson, Frederick; Veneziale, Liliana; Biggs, Mike; Johnson, Christopher; South Warwickshire University NHS Foundation Trust; University of Leicester; Leicester Royal Infirmary; Royal Liverpool University Hospital; Geriatric Medicine; Medical and Dental; Johnson, FrederickPathological findings can be subtle or limited, in some cases of fatal neck compression. Decalcification and en-bloc transverse histological processing using mega block cassettes, revealed a number of internal unicortical fractures to the thyroid lamina (anteriorly at the midline and posteriorly) and bilaterally in the cricoid cartilage, not visible on external inspection, which proved to be medico-legally important, in a case with very few other pathological findings, and where the application of a neck/head lock was suspected. In order to explore the nature and mechanism of these poorly recognised "buckling" type fractures, simple experiments were undertaken using 3D data printed pliable models of the thyroid and cricoid cartilages, exposed to various types of compression. The models were coated internally with hardened/cooled isomalt (a sugar baking product), to allow the pattern of surface material stress cracking to be documented as compression was applied. Compression (including isolated anterior pressure and bilateral "squeezing") was confirmed to cause internal surface material cracking to both the thyroid and cricoid cartilage models, including in the locations found in the post mortem histology casework described above. Some surface material patterns of cracking were more commonly/typically associated with particular forms of compression. Over 90% of all the surface material cracking was obliquely or vertically orientated on the models, supporting transverse (rather than longitudinal) sectioning of the decalcified larynx as the best means for capturing these fractures within the plane of histological section, in appropriate casework. Keywords: 3D-printing; Experimental; Fracture; Internal; Larynx; Strangulation.Publication Exploring the epidemiology of atrial fibrillation in Nigeria : a focus on atrial fibrillation in heart failure patients and its association with stroke(Springer, 2024-02-29) Otabor, Emmanuel Olushola; Alaka, Abiola; Onwuzo, Chidera N.; Olukorode, John; Fagbenro, Adeniyi; Ajiboye, Adetayo; South Warwickshire University NHS Foundation Trust; University of Michigan, USA; Benjamin S. Carson College of Health and Medical Sciences, Ilishan-Remo, Nigeria; Bowen University College of Health Sciences, Iwo, Nigeria; Central and Northwest London NHS Foundation Trust; Internal Medicine; Medical and Dental; Otabor, Emmanuel O.Atrial fibrillation (AF) represents a significant global public health concern, particularly due to its association with adverse health outcomes such as stroke and heart failure. In Nigeria, where the burden of cardiovascular diseases is rising, understanding the prevalence and impact of AF is crucial for effective healthcare planning and intervention strategies. This review examines the epidemiology of AF in Nigeria, comparing it with global and African data. It explores demographic and regional variations, comorbidity factors, and the impact of AF on the healthcare system, mortality, and quality of life. Notably, the prevalence of AF in Nigeria generally falls just under 5%, but this figure rises to approximately 9% in stroke patients and 11-20% among those with heart failure (HF). Rheumatic heart disease (RHD) is identified as a significant AF risk factor within Africa, affecting around 20% of AF patients - a stark contrast to the 2% in North America. AF's association with higher mortality rates and functional deterioration highlights the urgent need for improved diagnostic and therapeutic approaches, alongside broader public health measures. In conclusion, the review emphasises the significant public health concern AF represents in Nigeria, especially among HF and stroke patients, and stresses the importance of tailored healthcare policies and interventions to mitigate AF's impact and improve patient outcomes. Keywords: atrial fibrillation; cardiovascular disease; epidemiology of atrial fibrillation; heart failure; quality of life; stroke.Publication Intravenous therapy(RCN Publishing (RCNi), 2015-02-17) Morrow-Barnes, Abby; South Warwickshire University NHS Foundation Trust; Nursing and Midwifery Registered; Morrow-Barnes, AbbyA CPD article boosted Abby Morrow-Barnes’s knowledge of the insertion and use of cannulae in older patients.Publication Management of patients with low-risk febrile neutropenia(RCN Publishing (RCNi), 2015-06-10) Fowler, Matthew; South Warwickshire University NHS Foundation Trust; Oncology; Nursing and Midwifery Registered; Fowler, MattThe National Institute for Health and Care Excellence in the UK advocates that patients with neutropenia who are at low risk of developing septic complications should be considered for management in the community rather than in hospital. The Multinational Association of Supportive Care in Cancer (MASCC) risk index is widely used to identify patients who are deemed to be at low risk of developing septic complications as a result of febrile neutropenia (FN), but it has limitations. A newer tool, the Clinical Index of Stable Febrile Neutropenia (CISNE), further stratifies patients who may be suitable for management in the community. This article uses a case study to explore the management of a patient who presented with suspected FN. It examines the use of the MASCC risk index and the CISNE to make recommendations for the future management of patients with low-risk FN in the community. Keywords : Chemotherapy - low-risk febrile neutropenia - management - risk - treatment complicationsPublication Longstanding insulin dependent diabetics may not require insulin after the introduction of GLP-1 analogues(SAGE Publications, 2015-03-12) Raja, Umar Y.; Eastaugh, Alison E.; Younas, Mohammed S.; Hanif, Wasim; South Warwickshire University NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Diabetes and Endocrinology; Medical and Dental; Raja, Umar Y.Glucagon like peptide (GLP-1) analogues are a relatively novel medication developed primarily for the treatment of type 2 diabetes since 2005. Although GLP-1 analogues have been shown to be more effective in the first few years of diagnosis in type 2 diabetes, we report a case of a patient with longstanding insulin-dependent diabetes started on a GLP-1 analogue, liraglutide, who now has controlled blood sugars without the need of insulin. Keywords: GLP-1; GLP-1 analogues; Obesity; insulin-dependent diabetes; type 2 diabetes.Publication Pulmonary oedema(RCN Publishing (RCNi), 2016-06-01) Morrow-Barnes, Abby; South Warwickshire University NHS Foundation Trust; Nursing and Midwifery Registered; Morrow-Barnes, AbbyA CPD article refreshed Abby Morrow-Barnes’s knowledge of acute pulmonary oedema and prompted her to reflect on her practice.Publication ADVICE for a healthier life : Adult Vaccination Campaign in Europe(Elsevier, 2016-05-12) Ozisik, Lale; Tanriover, Mine Durusu; Rigby, Shirley; Unal, Serhat; European Federation of Internal Medicine ADVICE Working Group; Hacettepe University, Ankara, Turkey; South Warwickshire University NHS Foundation Trust; Internal Medicine; Medical and Dental; Rigby, ShirleyImmunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe. Keywords: Adult immunization; European Federation of Internal Medicine; Guideline; Primary prevention; Vaccines.Publication Are we up to date with the NEWS?(Elsevier, 2017-06-02) Blair, John; Morgan, James; Cassell, Josephine; Waite, Anna; Velho, Chiron; South Warwickshire University NHS Foundation Trust; Elderly Care; Medical and Dental; Blair, John; Morgan, James; Cassell, Josephine; Waite, Anna; Velho, ChironNo abstract available.Publication Managing encephalitis(RCN Publishing (RCNi), 2017-03-22) Morrow-Barnes, Abby; South Warwickshire University NHS Foundation Trust; Nursing and Midwifery Registered; Morrow-Barnes, AbbyA CPD article improved Abby Morrow-Barnes’s knowledge of the nursing care and treatment of patients with encephalitis.Publication Daily aspirin 300mg : how much do patients take? Drug accountability for the first 5 years of the AspECT study(BMJ Publishing Group, 2017-06-17) Jankowski, J.; Love, S.; Reilly, G.; De Caestecker, J.; Attwood, S.; Watson, P.; Barr, H.; Ang, Y.; Wise, A.; Bhandari, P.; Sanders, S.; Harrison, R.; Penman, I.; Rodgers, C.; Edwards, C.; Gibbons, M.; Church, N.; Vaidya, K.; Neale, J.; Ragunath, K.; Morris, D.; Johnston, D.; Moayyedi, P.; University Hospitals Coventry and Warwickshire NHS Trust; University of Oxford; University Hospital Leicester; Durham University; Queens University Belfast; Gloucester Royal Hospital; Wrightington, Wigan and Leigh NHS Foundation Trust; Spire Portsmouth Hospital; South Warwickshire University NHS Foundation Trust; Western General Hospital, Edinburgh; Northern Trust, Antrim; Torbay Hospital; Craigavon Area Hospital; NHS Fife; Queens Medical Centre, Nottingham; Queen Elizabeth II Hospital, Welwyn Garden City; Ninewells Hospital, Dundee; McMaster University, Toronto, Canada; Pathology; Medical and Dental; Sanders, S.Conference abstract PWE-124 of the British Society of Gastroenterology Annual Meeting, 19 Jun - 22 Jun 2017, Manchester, UK.Publication Using simulation to prepare for clinical practice(Wiley, 2017-03-30) Morgan, James; Green, Victoria; Blair, John; South Warwickshire University NHS Foundation Trust; University of Warwick; Medical Education; Medical and Dental; Morgan, James; Green, Victoria; Blair, JohnBackground: A significant proportion of medical students feel underprepared for clinical practice, especially in skills such as decision making, prioritisation and prescribing. Changes to medical curricula, including assistantships and shadowing, provide supervised practise, but students remain unable to fully take responsibility for patient care. Simulation may assist in addressing this deficit. A simulation course entitled 'Simulated ward round and professional skills' (SWAPS) was developed to improve student preparation for clinical practice. Methods: Preliminary work surveyed 22 foundation doctors to identify perceived areas of weakness and to guide the learning outcomes of the course. Following the design and development of the course, 133 final-year medical students were observed completing a 60-minute simulation scenario aimed at providing experiential learning in a ward environment, reflecting professional practice. Students received structured feedback and completed pre- and post-course questionnaires to evaluate changes in confidence over the learning domains. Qualitative feedback was also collected. A significant proportion of medical students feel underprepared for clinical practice RESULTS: The p values were significant in all assessed domains, indicating a perceived improvement in confidence following the SWAPS course. Qualitative feedback highlighted the perceived utility of the course in exposing students to clinical ward-based scenarios infrequently encountered in their medical curriculum. Students praised the personal feedback received and realism of the simulation. Discussion: This paper contributes to the growing body of literature supporting the use of simulation to replicate a ward round and the daily roles of a junior doctor. The SWAPS course seems to empower students to take responsibility for clinical decision making and experience some of the realities of foundation training in a simulated setting.Publication The outcome of dapagliflozin use in a real-life clinical setting in multi-district general hospitals(Wiley, 2015-03-11) Bellan Kannan, R.; Othonos, N.; Dimitriadis, G.; Barber, T.; Murthy, N.; Young, J.; Saravanan, P.; Mahto, R.; Raja, U.; South Warwickshire University NHS Foundation Trust; George Eliot Hospital NHS Trust, Nuneaton; University Hospitals Coventry and Warwickshire NHS Trust; Worcestershire Acute Hospitals NHS Trust; Diabetes and Endocrinology; Medical and Dental; Othonos, N.; Saravanan, P.Poster abstract P470 in the section 'Clinical care and other categories posters' of the Diabetes UK Professional Conference 2015, ExCeL London, 11–13 March 2015.Publication Filling the Gap - Improving Awareness and Practice in Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in the Older Patient: A European Consensus View(Thieme, 2016-10-04) Wehling, M.; Ashton, C.; Ekpo, E.; Gwynn, S.; Laville, M.; Olsson, K.; Spring, M.; Center for Geriatric Pharmacology in Mannheim; South Warwickshire University NHS Foundation Trust; Lewisham and Greenwich NHS Trust; SG Market Access Ltd, Chichester; Lyon Sud University Hospital, Pierre Benite, France; Lund University, Sweden; Kingston and Richmond NHS Foundation Trust; Medical and Dental; Ashton, C.Introduction: Causes of hyponatraemia in older patients are multivariate and in the case of SIADH may often be drug induced. Diagnostic and treatment algorithms are unclear for this important age group. Methods: The author group identified 6 broad themes for consensus and formulated 42 separate consensus statements within these 6 themes. Statements were then circulated to geriatricians, general practitioners and other doctors to test agreement at the European level. Results: 64 responses were evaluated from around Europe. Agreement was achieved in 86% of the statements following amendment and redistribution of 6 of the statements. The survey and its feedback prompted the development of 13 recommendations related to the diagnosis and treatment of hyponatraemia including SIADH. Conclusion: The series of 13 recommendations developed here is intended to increase clarity for clinicians managing older patients with hyponatraemia and SIADH. Surprisingly, despite the lack of clear guidelines or recommendations for this age group consensus levels for the author-based statements were high among the respondents.Publication Gamification of dermatology : Stud2yBuddy, a novel game to facilitate dermatology revision for final-year medical students(Oxford University Press, 2019-07) Pardoe, Cleone; Ventre, Rachel; Cripps, David; Hough, Josephine; Singhal, Shabnam; South Warwickshire University NHS Foundation Trust; Medical Education; Medical and Dental; Pardoe, C.; Ventre, R.; Cripps, D.; Hough, J.; Singhal, S.This abstract from the British Association of Dermatologists 99th Annual Meeting introduces a card-based board game to facilitate dermatology revision for final-year medical students.Publication Gamification of dermatology: Stud2yBuddy, a novel game to facilitate dermatology revision for final-year medical students(Royal College of Physicians, 2019-06) Ventre, Rachel; Pardoe, Cleone; Singhal, Shabnam; Cripps, David; Hough, Josephine; South Warwickshire University NHS Foundation Trust; Medical Education; Medical and Dental; Ventre, Rachel; Pardoe, Cleone; Singhal, Shabnam; Cripps, David; Hough, JosephineBrief report on a card-based board game used as a dermatology revision tool with the aim of increasing the confidence of final year medical students.Publication Reflect and rehydrate: improving junior doctor wellbeing and promotion of coping skills through peer-led education and support(Royal College of Physicians, 2019-06) Shields, Alexandra; Zaheen, Inayah; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Medical Education; Medical and Dental; Zaheen, InayahA brief report on a trial of formal reflection circles named ‘Reflect and rehydrate’ (R&R) sessions as a model for improving junior doctor wellbeing.Publication Reducing readmission rates through a discharge follow-up service(Royal College of Physicians, 2019-06) Vernon, Duncan; Brown, James E.; Griffiths, Eliza; Nevill, Alan M.; Pinkney, Martha; Solihull Metropolitan Borough Council; Aston University, Birmingham; South Warwickshire University NHS Foundation Trust; University of Wolverhampton; Solihull Hospital; Frailty; Medical and Dental; Griffiths, ElizaApproximately 15% of elderly patients are readmitted within 28 days of discharge. This costs the NHS and patients. Previous studies show telephone contact with patients -post-discharge can reduce readmission rates. This service -evaluation used a cohort design and compared 30-day emergency readmission rate in patients identified to receive a community nurse follow-up with patients where no attempt was made. 756 patients across seven hospital wards were -identified; 303 were identified for the intervention and 453 in a -comparison group. Hospital admission and readmission data was extracted over 6 months. Where an attempt to contact a patient was made post-discharge, the readmission rate was 9.24% compared to 15.67% where no attempt to -contact was made (p=0.011). After adjustment for -confounding using logistic regression, there was evidence of reduced readmissions in the 'attempt to contact' group odds ratio = 1.93 (95% c-onfidence interval = 1.06-3.52, p=0.033). Of the patients who community nurses attempted to contact, 288 were contacted, and 202 received a home visit with general practitioner -referral and medications advice being the most common -interventions initiated. This service evaluation shows that a simple intervention where community nurses attempt to contact and visit geriatric patients after discharge causes a significant reduction in 30-day hospital readmissions. Keywords: Discharge; geriatrics; readmission; telephone contract.Publication Perceptions of foundation year doctors: barriers to delivering teaching and accessing teaching training(Royal College of Physicians, 2019-03) Parry, Helen; Lau, Carmen; Vigneswaran, Natali; Yadegarfar, Motahare; Zhu, Julia; South Warwickshire University NHS Foundation Trust; Medical Education; Medical and Dental; Parry, Helen; Lau, Carmen; Vigneswaran, Natali; Yadegarfar, Motahare; Zhu, JuliaA brief report on the results of a questionnaire examining potential barriers which exist for foundation year doctors in teaching or accessing teaching training.Publication Interactive teaching workshop for foundation year doctors at a district general hospital(Royal College of Physicians, 2019-03) Lau, Carmen; Parry, Helen; Zhu, Julia; Yadegarfar, Motahare; Vigneswaran, Natali; South Warwickshire University NHS Foundation Trust; Medical Education; Medical and Dental; Lau, Carmen; Parry, Helen; Zhu, Julia; Yadegarfar, Motahare; Vigneswaran, NataliReport on an interactive teaching workshop for foundation year doctors at a district general hospital to assess whether teaching skills training for foundation-year doctors improves confidence in teaching.Publication A survey of frailty services in acute NHS hospitals in the West Midlands(Royal College of Physicians, 2019-09) Jacques, Holly; Gaywood, James; Singh, Kanwaljit; South Warwickshire University NHS Foundation Trust; Good Hope Hospital, Sutton Coldfield; Geriatrics; Healthcare for Older People; Medical and Dental; Jacques, Holly; Singh, KanwaljitA short article reporting a survey of frailty services in acute NHS hospitals in the West Midlands.