RSS 1.0Medicine
The Medicine Directorate encompasses a range of medical specialties as well as a number of associated services (including Anti Coagulation, Blood Transfusion, Chronic Fatigue, Coronary Care, Dementia, Ambulatory Care, Stroke, and Transfusion services) and wards (including Dorothea, Elizabeth, Bob Jakin, Adam Bede, Felix Holt Ward, Mary Garth, Melly, Victoria, and Romola wards). This sub-community displays the research undertaken by staff within those areas.
Collections in this community
Recent Submissions
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Adding faster-acting insulin aspart to basal insulin significantly improved glycaemic control in adults with Type 2 diabetes : the onset 3 trialPoster abstract P111 in section 'Basic and clinical science posters: new insulins, technology, therapies and treatment' from the Diabetes UK Professional Conference 2017, Manchester Central, Manchester, 8–10 March 2017.
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Faster-acting insulin aspart vs insulin aspart as part of basal–bolus therapy improves postprandial glycaemic control in uncontrolled Type 2 diabetes in the double-blinded onset 2 trialPoster abstract A46 (P110) in the section Science in clinical practice 1 from the Diabetes UK Professional Conference 2017, Manchester Central, Manchester, 8–10 March 2017.
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Glucagon-like peptide 1 agonists and death from any cause in primary care settingPoster abstract P417 from the section Clinical care and other categories posters: new technology, therapies and treatment, Diabetes UK Professional Conference 2017, Manchester Central, Manchester, 8–10 March 2017.
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Diabetes care Tree of Knowledge: the IMPACT (Integrated Multi-source resource for Patient And Clinician Teaching) educational tool for enhancing self-management of diabetesPoster abstract P278 from the Diabetes UK Professional Conference 2017, Manchester, 8–10 March 2017.
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Life matters… so does death. Show the world that dying mattersPoster presentation P-29 from the Transforming Palliative Care Hospice UK 2018 National Conference, Telford, United Kingdom, 27 - 28 November 2018.
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The clinical effectiveness of the nutrition support team – an acute district general hospital experienceConference abstract PTU-089 from the British Society of Gastroenterology Annual General Meeting BSG 2018. Liverpool United Kingdom. 4 - 7 June 2018.
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A rare cause of haematemesis – 'downhill varices'Case report of a 57-year-old male, post-renal transplant, with significant haematemesis.
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Unusual presentation of hyperhomocysteinaemiaCase report describing a rare association of hyperhomocysteinaemia with isolated portomesentric thrombosis.
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Improving the uptake of postpartum glucose screening following a gestational diabetes pregnancyPoster abstract 652 from the 56th EASD Annual Meeting of the European Association for the Study of Diabetes : 21-25 September 2020.
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Gestational diabetes : opportunities for improving maternal and child healthGestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.
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A district general hospital real-world experience of the use of semaglutide in patients with type 2 diabetesPoster abstract P351 from the Diabetes UK Professional Conference 2020. Although the conference was cancelled due to COVID-19, accepted abstracts were published as a service to abstract authors.
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Alphabet strategy for diabetes care : a checklist approach in the time of COVID-19 and beyondChronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus. The responsibility for this lies with both the patient and health care professionals. Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care. The Alphabet strategy (AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and under-resourced settings. Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan, Preconception Care, Prevention and Remission of Diabetes. The Strategy and Care Plan has facilitated evidence-based, cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure, cholesterol levels and glycated haemoglobin. Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study. This is despite working in a relatively under-resourced service within the United Kingdom National Health Service. The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional. During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively. The AS has the potential to help with this aspiration.
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What do people hospitalised with COVID-19 think about their care? Results of a satisfaction survey during the first wave of COVID-19 in LiverpoolDespite huge advances in vaccines, testing and treatments for COVID-19, there is negligible evidence on the perceptions of people hospitalised with COVID-19 about the care they received. To address this, we developed a satisfaction survey for people with COVID-19 admitted to our hospital during the first COVID-19 wave in Liverpool. Of those invited, 98/160 (61%) responded, of whom 94/98 (96%) completed the survey. Respondents rated overall care highly (mean 4.7/5) and 89/94 (95%) reported that they would recommend the hospital to friends and/or family. Most respondents felt safe on the ward (94%), with privacy maintained (93%) and pain well managed (90%). Fewer than two-thirds (63%) of respondents considered themselves adequately consulted regarding medications and side effects. Sleep and food/drink quality were also highlighted as areas for improvement. To overcome the issues raised, we generated a 'COVID-19 practice pointers' poster within an integrated educational bundle on COVID-19 wards. The impact of the bundle on perceptions of people hospitalised with COVID-19 will be evaluated in people hospitalised with COVID-19 in Liverpool in 2021. Whether hospitalised for COVID-19 or other conditions, our survey results are a timely reminder of the importance of involving patients in shaping the care that they receive.
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Liquid nitrogen cryotherapy of common warts: cryo-spray vs. cotton wool budBackground: Viral warts represent a large workload for dermatology departments. Cryotherapy with liquid nitrogen is the most widely used method of treatment by dermatologists and is increasingly used by general practitioners in the U.K. Existing data relating to the response to cryotherapy are virtually all derived from the use of a cotton wool bud as the applicator. There is an increasing trend to use the cryo-spray to freeze warts and it has been assumed that this is equally effective. In view of the workload involved it is important to test this assumption. Objectives: This prospective study was undertaken to compare these two methods of liquid nitrogen cryotherapy with regards to cure rate after 3 months of treatment. Methods: Patients referred to two hospital dermatology departments with hand or foot warts were allocated to have liquid nitrogen applied with either a cryo-spray or with a cotton wool bud. Using either technique, liquid nitrogen was applied until ice-ball formation had spread from the centre to include a margin of 2 mm around each wart. Treatment was done fortnightly for up to 3 months. Plantar warts were pared and treated with a double freeze-thaw cycle. The endpoint of the study was complete clearance of all warts. Results: Three hundred and sixty-three patients were enrolled, mean age 21 years (range 3-75), 188 male and 175 female. The mean duration of the warts was 98 weeks (median 78, range 2-936). The number of warts on the hands and feet varied from one to 80 (mean 5). The treatment groups were comparable with regards to baseline demographics. Two hundred and seven patients were evaluable. Cure rates at 3 months were 47% in the cotton wool bud group and 44% in the cryo-spray group (P = 0.8). Warts that had been present for 6 months or less (n = 31) had a greater chance of clearance (84%) compared with warts that had been present for more than 6 months (39%, n = 176) (P < 0.0005). Conclusions: Cryotherapy with liquid nitrogen for hand and foot warts in our study was equally effective when applied with a cotton wool bud or by means of a spray.
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Myeloproliferative neoplasia masquerading as idiopathic intracranial hypertension: a case reportAbstract P113 of the European Neuro-Ophthalmological Society (EUNOS) 15th Meeting, Birmingham, 20-23 June 2022.
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Review on interferon beta: from cells to clinical usageIntroduction: Interferon (IFN) was first introduced by Isaacs and Linddeman in 1957. It referred to a factor that could cause inhibition in the growth of the live influenza virus. Interferons are intracellular proteins that are involved in many cellular processes such as growth, proliferation, differentiation, metabolism of the extracellular matrix, apoptosis, and regulating immune responses. There are different intereferones. Amog them, interferons-beta (IFN-β) is a natural cytokine produced by immune cells in response to biological and chemical stimuli. Signal transduction of IFN-β is initiated throughout a heterodimeric receptor complex that is composed of IFNAR1 and IFNAR2 which leads to expression of various proteins via the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway as well as other pathways. In addition to antiviral effects of IFN-β, it has been shown to have therapeutic effects in some autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and lupus. It has recently been shown that the use of IFN-β in combination with other antiviral compounds may be effective in treatment of Covid-19. In this review the various topics about IFN-β are investigated such as signalling pathways, biological functions, therapeutic effects, and side effects of IFN-β therapy.
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Machine learning prediction of early postpartum prediabetes in women with gestational diabetes mellitusBackground Early onset of type 2 diabetes and cardiovascular disease are common complications for women diagnosed with gestational diabetes. About half of the women with gestational diabetes develop postpartum prediabetes within 10 years of the index pregnancy. These women also have double the risk of developing cardiovascular disease than women without a history of gestational diabetes. Currently, there is no accurate way of knowing which women with gestational diabetes are likely to develop postpartum prediabetes. This study aims to predict the risk of postpartum prediabetes in women diagnosed with gestational diabetes. Methods We build a sparse logistic regression-based machine learning model to learn key variables significant for the prediction of postpartum prediabetes, from antenatal data with maternal anthropometric and biochemical variables as well as neonatal characteristics of 607 UK women diagnosed with gestational diabetes. We evaluate the performance of the proposed model in addition to other more advanced machine learning methods using established metrics such as the area under the receiver operating characteristic curve and specificity for pre-determined values of sensitivity. We use K-L divergence and information graphs to evaluate and compare different thresholds of classification for targeted screening options in resource-constrained settings. We also perform a decision curve analysis to study the net standardized benefit of our model compared to the universal screening approach. Results Strikingly, our sparse logistic regression approach selects only two variables as relevant but gives an area under the receiver operating characteristic curve of 0.72, outperforming all other methods. It can identify postpartum prediabetes in women with gestational diabetes using the Rule-in test with 92% specificity at an optimal probability threshold of 0.381 and using the Rule-out test with 92% sensitivity at an optimal probability threshold of 0.140. Conclusion We propose a simple logistic regression model, which needs only the antenatal fasting glucose at OGTT and HbA1c soon after the diagnosis of GDM, to predict, with remarkable accuracy, the probability of postpartum prediabetes in women with gestational diabetes. We envision this to be a practical solution, which coupled with a targeted follow-up of high-risk women, could yield better cardiometabolic outcomes in women with a history of GDM.
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Unexpected DiagnosisA 74-year-old man presented to the ER with an eight-month history of shortness of breath, cough, anorexia, and weight loss. He had emigrated from sub-Saharan African to the USA, where he was diagnosed and treated for coronary artery disease, heart failure, and stroke; was hospitalized several times; and underwent hernia surgery. Despite the complex care that he received in the USA for many years, the diagnosis of AIDS was continually missed for years, and the patient was eventually diagnosed at the age of 74.
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Cerebellar cavernomaIntroduction A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They're sometimes known as cavernous angiomas, cavernous haemangiomas or cerebral cavernous malformation. A case report of a young male with cavernomas is reported. Methods A 37-year-old man was referred to the ambulatory care unit from the accident and emergency department with a 2-day history of visual disturbance and dizziness. Clinical examinations of all systems were normal including neurologic examination which did not reveal any focal neurological signs. Routine haematology and biochemistry blood tests were all normal. Initially, a computed tomography of the brain was requested which showed no definite acute abnormality, but a small focus of high attenuation present within the left middle cerebellar peduncle may represent a small cavernoma. Further assessment with magnetic resonance imaging was suggested. The patient was then admitted to the acute medical unit for further investigations and workup. Results and discussion An MRI of the brain was performed and revealed multifocal cerebral microhaemorrhages of variable sizes spread randomly throughout the supra- and infra-tentorial compartments of the brain with no predilection for the deep structures (basal ganglia/thalami) to suggest chronic hypertensive encephalopathy. Cavernoma are less common in males at this age, which makes our case more unique. Conclusion A detailed history (personal and family) are key to detect such malformations in young patients, which also helps physicians be aware of its related complexities and further management. Conflict of interest statement None declared.
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Implementing a smoke-free hospital site policyTurning an entire hospital site into a smoke-free environment sounds like a daunting project but good communication and careful preparation can lead to success.