ItemSinging Exercises Improve Sleepiness and Frequency of Snoring among Snorers—A Randomised Controlled Trial(Scientific Research Publishing, 2013-05-24) Powell, M. P. Hilton; Savage, J. O.; Hunter, B.; McDonald, S.; Repanos, C.; RObjectives: To assess the effectiveness of regular singing exercises in reducing symptoms of snoring and sleep apnoea. Methods: A prospective single blinded randomised controlled trial was conducted in the otolaryngology department of a UK teaching hospital (Exeter). 127 adult patients with a history of simple snoring or sleep apnoea were recruited. 93 patients completed the study. Patients were excluded because of severe sleep apnoea (apnoea index > 40), or morbid obesity (BMI > 40). The study group completed a self-guided treatment programme of singing exercises contained on a 3CD box set, performed for 20 minutes daily. Outcome measures included the Epworth Sleepiness Scale, the SF-36 generic quality of life assessment tool, visual analogue scales (VAS range 0-10) of snoring loudness and frequency, and visual analogue scale of compliance (for intervention group). Results: The Epworth scale improved significantly in the experimental group compared to the control group (difference -2.5 units; 95% CI -3.8 to -1.1; p = 0.000). Frequency of snoring reduced significantly in the experimental group (difference -1.5; 95% CI -2.6 to -0.4; p = 0.01), and loudness of snoring showed a trend to improvement which was non-significant (difference -0.8; 95% CI -1.7 to 0.1; p = 0.08). Compliance with exercises was good; median 6.6 (quartiles = 4.1, 8.3). Conclusions: Improving the tone and strength of pharyngeal muscles with a 3 months programme of daily singing exercises reduces the severity, frequency and loudness of snoring, and improves symptoms of mild to moderate sleep apnoea. ItemIdentifying clinical criteria to predict Type 1 diabetes, as defined by absolute insulin deficiency: a systematic review protocol(BMJ, 2012-12-28) Shields, B. M.; Peters, J. L.; Cooper, C.; Powell, R. J.; Knight, B. A.; Hyde, C.; Hattersley, A. T.INTRODUCTION: Management of a patient's diabetes is entirely dependent upon the type of diabetes they are deemed to have. Patients with Type 1 diabetes are insulin deficient so require multiple daily insulin injections, whereas patients with Type 2 diabetes still have some endogenous insulin production so insulin treatment is only required when diet and tablets do not establish good glycaemic control. Despite the importance of a correct diagnosis, classification of diabetes is based on aetiology and relies on clinical judgement. There are no clinical guidelines on how to determine whether a patient has Type 1 or Type 2 diabetes. We aim to systematically review the literature to derive evidence-based clinical criteria for the classification of the major subtypes of diabetes. METHODS AND ANALYSIS: We will perform a systematic review of diagnostic accuracy studies to establish clinical criteria that predict the subsequent development of absolute insulin deficiency seen in Type 1 diabetes. Insulin deficiency will be determined by reference standard C-peptide concentrations. Synthesis of criteria identified will be undertaken using hierarchical summary receiver operating characteristic curves. ETHICS AND DISSEMINATION: As this is a systematic review, there will be no ethical issues. We will disseminate results by writing up the final systematic review and synthesis for publication in a peer-reviewed journal and will present at national and international diabetes-related meetings. ItemSurgical smoke - a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units(Elsevier, 2012-03-23) Hill, D. S.; O'Neill, J. K.; Powell, R. J.; Oliver, D. W.Surgeons and operating theatre personnel are routinely exposed to the surgical smoke plume generated through thermal tissue destruction. This represents a significant chemical and biological hazard and has been shown to be as mutagenic as cigarette smoke. It has previously been reported that ablation of 1 g of tissue produces a smoke plume with an equivalent mutagenicity to six unfiltered cigarettes. We studied six human and 78 porcine tissue samples to find the mass of tissue ablated during 5 min of monopolar diathermy. The total daily duration of diathermy use in a plastic surgery theatre was electronically recorded over a two-month period. On average the smoke produced daily was equivalent to 27-30 cigarettes. Our survey of smoke extractor use in UK plastic surgery units revealed that only 66% of units had these devices available. The Health and Safety Executive recommend specialist smoke extractor use, however they are not universally utilised. Surgical smoke inhalation is an occupational hazard in the operating department. Our study provides data to quantify this exposure. We hope this evidence can be used together with current legislation to make the use of surgical smoke extractors mandatory to protect all personnel in the operating theatre. ItemRoutine antenatal anti-D prophylaxis--is the protection adequate?(Wiley, 2011-09-09) Davies, J.; Chant, R.; Simpson, S.; Powell, R.BACKGROUND/AIMS: Prophylactic anti-D given during pregnancy can be detected in current indirect antiglobulin tests (IAT). Using this to measure the persistence of prophylactic anti-D, this study set out to determine whether there is an association between anti-D detectable at delivery and the RhD status of the foetus and/or the duration of the pregnancy post the standard 28 week dose of routine antenatal anti-D prophylaxis (RAADP). The study also investigated the detection rates of anti-D at delivery when given in a two dose regime or a one dose regime. METHOD: All IAT screening was undertaken using fully automated Diamed gel technology. The results from 407 women were included in the two dose regime study, and 157 in the one dose regime study. RESULTS: 160/407 (39%) women receiving one dose of prophylactic anti-D had no detectable anti-D at delivery. 123/157 (78%) women on the one dose regime had no detectable anti-D at delivery. No association was found between detectable anti-D at delivery and the RhD status of the infant in either study arm. A strong association was found between detectable anti-D Ig at delivery and the duration of the pregnancy post the 28 week dose in each study arm. CONCLUSION: Our data show that neither the two dose nor the one dose regime appear to provide adequate cover at delivery for a large percentage of pregnant women. This appears to be associated with the duration of the pregnancy past the 28 week dose but not associated with the RhD status of the foetus. ItemBONE MARROW OEDEMA IN ASYMPTOMATIC KNEES OF ATHLETES(British Editorial Society of Bone and Joint Journal, 2012-01-01) V, Mandalia; C, William; K, Brown; P, Schranz; D, Silver; A, Redfern; R, PowellThe aim of this prospective study was to determine the prevalence of bone marrow oedema (BME) in asymptomatic knees of athletes and to investigate the factors associated with appearance of BME in this group.A total of 25 asymptomatic athletes who competed at an international, national or county level during their most recent sport season were recruited in this study and had MRI scan of both knees (n=50). MRI scans were reported independently by two experienced musculoskeletal radiologists. Statistical analysis included Cohen's kappa test to identify inter-observer agreement for MRI diagnosis of bone marrow oedema and multiple logistic regression model to identify the factors associated with BME on MRI scan.There was very good agreement between radiologists for diagnosis of BME (Kappa = 0.896). Seven participants (28%) were found to have BME. Six of the participants had BME in unilateral knees and one participant had BME in bilateral knees. The commonest location of BME was medial femoral condyle (62.5%) The amount of time spent in preseason training (34-38 weeks) was significantly associated with appearance of BME (P=0.048)BME seems to be common in asymptomatic athletes and one should realize that this finding might not be related to the clinical complaints of the patients. The results of the present study show that there is a training effect associated with BME. Knowing what is a ‘normal’ or ‘abnormal’ scan is important for a competitive athlete, as erroneously diagnosing BME as the underlying cause of athletes' symptoms could lead to decreased playing time or inappropriate therapy.