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Article ; Online: The provision of a trauma bed in theatre recovery and its impact on trauma theatre efficiency: experience from a high-volume trauma unit.

Saleem, J / Brown, O / Mclean, C / Kurzatkowski, K / Radha, S / Mallina, R

Annals of the Royal College of Surgeons of England

2024

Abstract: Introduction: Inefficiencies in the trauma setting are well known and have been further exacerbated by the COVID-19 pandemic among other factors, resulting in national guidance to aid improvements in resource utilisation. This study introduced a novel ... ...

Abstract	Introduction: Inefficiencies in the trauma setting are well known and have been further exacerbated by the COVID-19 pandemic among other factors, resulting in national guidance to aid improvements in resource utilisation. This study introduced a novel surgeon-led intervention, a trauma bed in recovery, with the aim of improving trauma theatre efficiency. Methods: This quality improvement project was conducted using a Plan Do Study Act (PDSA) methodology and comprised multiple cycles to assess theatre performance. A multidisciplinary team (MDT) approach with relevant stakeholder input enabled intervention implementation, aimed at facilitating 'golden patient' arrival in the anaesthetic room as early as possible. The primary outcome was the time at which the first patient entered the anaesthetic room, and the secondary outcome was the number of cases performed each day. Results: The study period was 1 year and encompassed three PDSA cycles. The intervention achieved its primary outcome by PDSA cycle 1 and its secondary outcome by PDSA cycle 2, demonstrating statistically significantly improved results ( Conclusions: A ringfenced trauma bed significantly improved theatre start times and thereby theatre efficiency. This is a simple, pragmatic intervention that benefitted the MDT trauma team while also demonstrating a sustained impact. Given that National Health Service efficiency is at the forefront of national healthcare discourse, we recommend that this intervention is implemented in other trauma units to help provide a solution to this longstanding issue.
Language	English
Publishing date	2024-02-13
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2023.0106
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Article ; Online: "Persistent Post-Operative Pain in Children - An Argument for a Transitional Pain Service in Pediatrics".

Haynes, Natasha / Mclean, Catriona / Collins, John / de Lima, Jonathan

Pain management nursing : official journal of the American Society of Pain Management Nurses

2022 Volume 23, Issue 6, Page(s) 784–790

Abstract: Background: Persistent post-operative pain continues to occur in pediatric patients. Despite the growing amount of literature on causes, there is little discussion on treatment and prevention with a majority of studies focusing on specific surgeries.: ...

Abstract	Background: Persistent post-operative pain continues to occur in pediatric patients. Despite the growing amount of literature on causes, there is little discussion on treatment and prevention with a majority of studies focusing on specific surgeries. Aim: The aim of this retrospective chart study is to identify risk factors and clinical features of persistent post-operative pain after any surgery in a pediatric quaternary complex pain service, describe the pharmacologic and non-pharmacologic management in children, and explore options to improve outcomes, in particular, the introduction of a transitional pain service. Methods: A retrospective chart review recorded demographics, gender, age, pain location and surgery type, treatment, and outcomes of 31 children identified through relevant registers over a 2-year period. Results: A total of 31 children were positively identified as having persistent post-operative pain and were seen in the complex pain clinic. Consistent with the literature, most cases represented neuropathic pain and persistent post-operative pain was most commonly seen after orthopedic surgery. All but four children had resolution of their pain after implementing the pain management plan. Management was characterized by early intervention, emphasis on non-pharmacologic strategies, and conservative use of opioids. Conclusions: Identifying risk factors is useful, however putting strategies into place for prevention is necessary. Early intervention and the implementation of strategies before and immediately after are best provided by a transitional pain service.
Language	English
Publishing date	2022-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2213260-0
ISSN	1532-8635 ; 1524-9042
ISSN (online)	1532-8635
ISSN	1524-9042
DOI	10.1016/j.pmn.2022.06.004
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Zs.MO 514: Show issues

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Article ; Online: The anatomical distribution of lentiginous melanoma (lentigo maligna and lentigo maligna melanoma): Differences according to sex.

Punchihewa, Nisal / Wee, Edmund / Kelly, John W / Mclean, Catriona / Mar, Victoria J / Pan, Yan

The Australasian journal of dermatology

2023 Volume 64, Issue 3, Page(s) e277–e280

MeSH term(s)	Humans ; Hutchinson's Melanotic Freckle ; Melanoma ; Skin Neoplasms
Language	English
Publishing date	2023-04-20
Publishing country	Australia
Document type	Journal Article
ZDB-ID	138052-7
ISSN	1440-0960 ; 0004-8380
ISSN (online)	1440-0960
ISSN	0004-8380
DOI	10.1111/ajd.14058
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Article ; Online: Frontal sinus infection leading to sino-orbital aspergillosis: a case report.

Yvon, Camille / Abdulla, Didar / Watson, Sarah / Bagwan, Izhar / Mclean, Christopher

The Pan African medical journal

2021 Volume 40, Page(s) 95

Abstract: Sino-orbital aspergillosis is an uncommon but aggressive infection. It rarely originates from the frontal sinus due to the complex anatomy of the frontal recess and anteromedial position of its ostium. An 87-year-old man of Nigerian heritage with a ... ...

Abstract	Sino-orbital aspergillosis is an uncommon but aggressive infection. It rarely originates from the frontal sinus due to the complex anatomy of the frontal recess and anteromedial position of its ostium. An 87-year-old man of Nigerian heritage with a history of multiple myeloma, chronic kidney disease and type 2 diabetes, presented to the eye clinic with a right tense swollen eyelid and proptosis. Computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed a right superomedial mass communicating with the frontal sinus and biopsy confirmed an orbital aspergilloma. The patient was successfully treated with debulking surgery and anti-fungal treatment despite developing side effects to the drugs. To improve prognosis, ophthalmologists should be aware of this distinct entity and use a multi-disciplinary approach.
MeSH term(s)	Aged, 80 and over ; Antifungal Agents/therapeutic use ; Aspergillosis/diagnosis ; Aspergillosis/drug therapy ; Diabetes Mellitus, Type 2/drug therapy ; Frontal Sinus/diagnostic imaging ; Frontal Sinusitis ; Humans ; Orbital Diseases/diagnosis ; Orbital Diseases/etiology
Chemical Substances	Antifungal Agents
Language	English
Publishing date	2021-10-13
Publishing country	Uganda
Document type	Case Reports
ZDB-ID	2514347-5
ISSN	1937-8688 ; 1937-8688
ISSN (online)	1937-8688
ISSN	1937-8688
DOI	10.11604/pamj.2021.40.95.28261
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Article ; Online: Caruncular lesions: A 16-year single centre review in the United Kingdom.

Yvon, Camille / Balamurugan, Thiagarajah / Bianchi, Eleonora / Lee, Han Bin / Mclean, Christopher

European journal of ophthalmology

2022 , Page(s) 11206721221137938

Abstract: Background/aims: To review the clinicopathological features of caruncle biopsies carried out at a district general hospital in the United Kingdom (UK), and compare with other centres where data has been published.: Methods: Retrospective, single- ... ...

Abstract	Background/aims: To review the clinicopathological features of caruncle biopsies carried out at a district general hospital in the United Kingdom (UK), and compare with other centres where data has been published. Methods: Retrospective, single-centre, observational case series between 2004-2020. Results: A total of 31 lesions from 31 patients were analysed. 18 of 31 patients were men (58%), and the age ranged from 12 to 91 years. 13 different histopathological types of lesions were identified in our case series, including 9 melanocytic nevi (29%), 7 benign squamous papillomas (23%), 5 skin adnexal lesions (16%), 3 chronic inflammation (10%), 3 epithelial cysts (10%), 1 basal cell carcinoma (3%), 2 malignant melanomas (6%) and l lymphoproliferative disorder (3%). Pre-operative suspected diagnoses were often vague but correct in 12 of 18 cases (67%), where data was available. Conclusion: The uncommon nature and variety of caruncular lesions make the diagnostic process difficult. Our case series is the first reported in the UK, showing a slightly higher proportion of malignant melanomas, in keeping with the population demographics. Excisional biopsies would, therefore, be prudent in the majority of cases to rule out any possible malignancy.
Language	English
Publishing date	2022-11-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1089461-5
ISSN	1724-6016 ; 1120-6721
ISSN (online)	1724-6016
ISSN	1120-6721
DOI	10.1177/11206721221137938
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Article ; Online: Early Melanoma Diagnosis With Sequential Dermoscopic Images.

Yu, Zhen / Nguyen, Jennifer / Nguyen, Toan D / Kelly, John / Mclean, Catriona / Bonnington, Paul / Zhang, Lei / Mar, Victoria / Ge, Zongyuan

IEEE transactions on medical imaging

2022 Volume 41, Issue 3, Page(s) 633–646

Abstract: Dermatologists often diagnose or rule out early melanoma by evaluating the follow-up dermoscopic images of skin lesions. However, existing algorithms for early melanoma diagnosis are developed using single time-point images of lesions. Ignoring the ... ...

Abstract	Dermatologists often diagnose or rule out early melanoma by evaluating the follow-up dermoscopic images of skin lesions. However, existing algorithms for early melanoma diagnosis are developed using single time-point images of lesions. Ignoring the temporal, morphological changes of lesions can lead to misdiagnosis in borderline cases. In this study, we propose a framework for automated early melanoma diagnosis using sequential dermoscopic images. To this end, we construct our method in three steps. First, we align sequential dermoscopic images of skin lesions using estimated Euclidean transformations, extract the lesion growth region by computing image differences among the consecutive images, and then propose a spatio-temporal network to capture the dermoscopic changes from aligned lesion images and the corresponding difference images. Finally, we develop an early diagnosis module to compute probability scores of malignancy for lesion images over time. We collected 179 serial dermoscopic imaging data from 122 patients to verify our method. Extensive experiments show that the proposed model outperforms other commonly used sequence models. We also compared the diagnostic results of our model with those of seven experienced dermatologists and five registrars. Our model achieved higher diagnostic accuracy than clinicians (63.69% vs. 54.33%, respectively) and provided an earlier diagnosis of melanoma (60.7% vs. 32.7% of melanoma correctly diagnosed on the first follow-up images). These results demonstrate that our model can be used to identify melanocytic lesions that are at high-risk of malignant transformation earlier in the disease process and thereby redefine what is possible in the early detection of melanoma.
MeSH term(s)	Dermoscopy/methods ; Diagnostic Imaging ; Early Diagnosis ; Humans ; Melanoma/diagnostic imaging ; Skin Neoplasms/diagnostic imaging
Language	English
Publishing date	2022-03-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	622531-7
ISSN	1558-254X ; 0278-0062
ISSN (online)	1558-254X
ISSN	0278-0062
DOI	10.1109/TMI.2021.3120091
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Article ; Online: Interferon-beta in multiple sclerosis causing thrombotic microangiopathy.

Yam, Charmaine / Fok, Anthony / Mclean, Catriona / Butler, Ernest / Kempster, Peter

Internal medicine journal

2019 Volume 49, Issue 2, Page(s) 274–276

MeSH term(s)	Female ; Humans ; Interferon-beta/adverse effects ; Kidney/pathology ; Kidney Diseases/chemically induced ; Middle Aged ; Multiple Sclerosis/drug therapy ; Thrombotic Microangiopathies/chemically induced
Chemical Substances	Interferon-beta (77238-31-4)
Language	English
Publishing date	2019-02-10
Publishing country	Australia
Document type	Case Reports ; Letter
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.14204
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Zs.A 792: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 424: Show issues

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Article ; Online: The anatomic distribution of cutaneous melanoma: A detailed study of 5141 lesions.

Wee, Edmund / Wolfe, Rory / Mclean, Catriona / Kelly, John W / Pan, Yan

The Australasian journal of dermatology

2019 Volume 61, Issue 2, Page(s) 125–133

Abstract: Background/objectives: There is evidence that cutaneous melanomas at different anatomic sites present with distinctive clinicopathologic features. We examined the anatomic distribution of cutaneous melanoma and its variation by patient characteristics, ... ...

Abstract	Background/objectives: There is evidence that cutaneous melanomas at different anatomic sites present with distinctive clinicopathologic features. We examined the anatomic distribution of cutaneous melanoma and its variation by patient characteristics, subtype and Breslow thickness, using high-resolution anatomic site data. Methods: A cross-sectional study was performed of all primary cutaneous melanoma cases managed at a tertiary referral centre, analysing prospectively collected clinical data across 50 anatomic subsites. Results: The study included 5141 in situ or invasive melanomas; most were invasive (76.2%), and the median Breslow thickness of invasive lesions was 1.0 mm. Superficial spreading (57.2%), lentigo maligna (20.8%) and nodular (12.2%) were the most common histopathological subtypes. Sun-exposed sites such as the female nose and cheek, the male ear, as well as the upper back in both sexes had the highest incidence of melanoma per unit area. When compared to the posterior forearm, the scalp, ear, preauricular, perioral, subungual and plantar sites had thicker invasive melanomas (each P < 0.05). The peri-auricular, ear and cheek had the highest incidence of nodular melanoma per unit area. There were subtype-, age- and sex-specific differences in melanoma anatomic distribution. Conclusion: Melanoma most commonly arises in sun-exposed facial areas, as well as the upper back. Increased thickness is found for melanoma in acral and many head and neck sites. Nodular melanoma is more likely to occur in head and neck sites including the peri-auricular area, ear and cheek. Clinicians should carefully assess these sites during skin examinations.
MeSH term(s)	Cheek/pathology ; Facial Neoplasms/pathology ; Head and Neck Neoplasms/pathology ; Humans ; Melanoma/pathology ; Neoplasm Invasiveness ; Neoplasm Staging ; Scalp/pathology ; Sex Factors ; Skin Neoplasms/pathology ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2019-12-27
Publishing country	Australia
Document type	Journal Article
ZDB-ID	138052-7
ISSN	1440-0960 ; 0004-8380
ISSN (online)	1440-0960
ISSN	0004-8380
DOI	10.1111/ajd.13223
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Article ; Online: Clinically amelanotic or hypomelanotic melanoma: Anatomic distribution, risk factors, and survival.

Wee, Edmund / Wolfe, Rory / Mclean, Catriona / Kelly, John W / Pan, Yan

Journal of the American Academy of Dermatology

2018 Volume 79, Issue 4, Page(s) 645–651.e4

Abstract: Background: The recognition and diagnosis of clinically amelanotic or hypomelanotic melanoma is a challenge.: Objective: This study aimed to examine the anatomic distribution and risk factors associated with clinically amelanotic or hypomelanotic ... ...

Abstract	Background: The recognition and diagnosis of clinically amelanotic or hypomelanotic melanoma is a challenge. Objective: This study aimed to examine the anatomic distribution and risk factors associated with clinically amelanotic or hypomelanotic melanoma and compare the survival of patients with clinically amelanotic or hypomelanotic melanoma with that of patients with pigmented melanoma. Methods: A prospective cohort study of all cases of primary invasive melanoma managed at a tertiary referral center was performed. Results: There were a total of 3913 invasive melanomas, and 384 (9.8%) were clinically amelanotic or hypomelanotic. Skin phototype I; red as well as blonde hair color; actinic keratoses; nodular, desmoplastic, and lentigo maligna subtype; increased Breslow thickness; and mitoses were independently associated with amelanotic or hypomelanotic melanoma (P < .05). After adjustment for subtype and thickness, the face, ears, lateral aspect of the neck, upper portion of the arm, posterior aspect of the forearm, dorsal aspect of the hand, and anterior aspect of the lower portion of the leg were associated with increased odds of amelanotic or hypomelanotic melanoma when compared with the upper portion of the back (P < .05). Mortality risk from melanoma appeared greater for amelanotic or hypomelanotic melanoma than for pigmented melanoma (hazard ratio, 1.5; 95% confidence interval, 1.1-2.1) but was similar once Breslow thickness was taken into account. Limitations: Single tertiary referral center. Conclusion: Although clinically amelanotic or hypomelanotic melanoma can occur on all body sites, it is more common on chronically sun-exposed areas. Clinicians should have an increased index of suspicion in patients with a sun-sensitive skin phenotype, red hair, and associated actinic keratoses.
MeSH term(s)	Adult ; Aged ; Australia/epidemiology ; Body Surface Area ; Cohort Studies ; Disease-Free Survival ; Female ; Humans ; Hypopigmentation/mortality ; Hypopigmentation/pathology ; Hypopigmentation/therapy ; Kaplan-Meier Estimate ; Male ; Melanoma/mortality ; Melanoma/pathology ; Melanoma/therapy ; Melanoma, Amelanotic/mortality ; Melanoma, Amelanotic/pathology ; Melanoma, Amelanotic/therapy ; Middle Aged ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Prevalence ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Skin Neoplasms/mortality ; Skin Neoplasms/pathology ; Skin Neoplasms/therapy ; Survival Analysis ; Tertiary Care Centers ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2018-08-28
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	603641-7
ISSN	1097-6787 ; 0190-9622
ISSN (online)	1097-6787
ISSN	0190-9622
DOI	10.1016/j.jaad.2018.04.045
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Article: Penicillin suppository treatment of vulvovaginitis in children.

MCLEAN, C C

Southern medical journal

2003 Volume 45, Issue 8, Page(s) 741

MeSH term(s)	Child ; Female ; Humans ; Infant ; Penicillins/therapeutic use ; Vaginitis ; Vulvovaginitis
Chemical Substances	Penicillins
Language	English
Publishing date	2003-04-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	185329-6
ISSN	1541-8243 ; 0038-4348
ISSN (online)	1541-8243
ISSN	0038-4348
DOI	10.1097/00007611-195208000-00015
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