Linda de Cossart | University of Chester (original) (raw)

Papers by Linda de Cossart

BMJ, May 12, 1990

increased intraepithelial lymphocytes. Enteropathy due to cows' milk sensitivity has been associa... more increased intraepithelial lymphocytes. Enteropathy due to cows' milk sensitivity has been associated with post-enteritis syndrome-that is, chronic diarrhoea after infection. Most cases in our study resolved spontaneously despite the children continuing with a normal diet, and three children given a milk free diet showed no obvious benefit. Thus in immunocompetent children crvptosporidium seems to be an important cause of chronic, as well as acute, diarrhoea. It is associated with enteropathy of the small intestine and with severe failure to thrive, which add to the urgent need for effective treatment.

Current Opinion in Critical Care, Dec 1, 2012

This review explores in detail the practice of reflection and its importance for doctors. It offe... more This review explores in detail the practice of reflection and its importance for doctors. It offers a definition of and a framework for both oral and written Clinical Reflection. It presents a thorough and detailed explanation of Clinical Reflection, its meaning, purpose, and processes and provides an illustrative case example from critical care. Detailed reflection about clinical practice is now demanded by all postgraduate medical curricula and is beginning to be a requirement for annual appraisal. Doctors have been slow to develop reflective practice for themselves, tending to adopt methods from other healthcare professionals, because there is little in print to guide this process in relation to medical practice. Clinical Reflection offers doctors a powerful way of supporting their professional development and providing evidence of their practical wisdom as expressed by Aristotle. It is time that an appropriate understanding of what reflection can offer doctors is explored more generally among the profession.

Annals of The Royal College of Surgeons of England, Sep 1, 1997

British Journal of Surgery, Feb 1, 1999

Background: A large number of scoring systems for assessing a patient's risk of complications or ... more Background: A large number of scoring systems for assessing a patient's risk of complications or death has been developed over recent years. This is a review of those that are of relevance to general surgeons. Methods: A Medline literature search was performed to identify all articles concerning`severity of illness',`morbidity',`mortality' and`postoperative complications' in the ®eld of surgery from 1966 to 1997. Further searches were performed to ®nd papers about speci®c identi®ed scoring systems, and relevant articles from the reference lists of these were also sought. Results and conclusion: The advantages of an accurate assessment of a patient's risk include, on an individual level, the opportunity to give a more accurate prognosis and choose the most appropriate treatment. If the risk of an adverse outcome is known for a group of patients, the actual outcome can be compared with the predicted outcome, and comparison can be made between groups in different surgical units for the purposes of audit or research. The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is the most appropriate of the currently available scores for general surgical practice.

Annals of The Royal College of Surgeons of England, Sep 1, 2009

Journal of the Royal Society of Medicine, Feb 1, 2017

Annals of The Royal College of Surgeons of England, Sep 1, 2005

British Journal of Surgery, 2009

Objective: ESCT and NASCET established the role of CEA in appropriate patients but reported a 5–7... more Objective: ESCT and NASCET established the role of CEA in appropriate patients but reported a 5–7% 30-day stroke/death risk. Strategies reducing this would be important. The GALA Trial was conceived following analysis of non-randomised and randomised studies suggesting a 50% risk reduction for LA CEA. Method: A total of 3526 patients (symptomatic or asymptomatic disease) were randomised to GA or LA (95 centres, 24 countries). Primary outcome events were stroke, myocardial infarction or death (randomisation −30 days post-surgery). The data were analysed by intention-to-treat analysis. Results: Events occurred (99·9% follow-up) in 84/1752 (4·8%) GA and 80/1771 (4·5%) LA patients (not significant: three events prevented per 1000 LA patients [95% CI −11, +17]; risk ratio 0·94 [95% CI 0·70, 1·27]). There were no differences for individual outcome events: stroke 70 (4·0%) GA versus 66 (3·7%) LA (three prevented per 1000 LA patients [95% CI −10 to +16]); death 26 (1·5%) GA versus 19 (1·1%) LA (four prevented per 1000 [95% CI −3 to +12]); myocardial infarction LA 9 (0·5%) versus GA 4 (0·2%) (three more per 1000 LA patients [95% CI −2 to +8]). In patients with contralateral carotid occlusion (pre-defined sub-group), outcome events occurred in 15/150 (10%) GA versus 8/160 (5%) LA, p = 0·098. Further 1-year survival data indicate fewer subsequent events (stroke, death, MI) in LA patients (p = 0·094). Conclusion: These data show that CEA outcomes have improved by up to a third since earlier trials and that both LA and GA are safe. For patients with contralateral carotid occlusion, LA might offer a benefit and trends suggesting improved 1-year survival following LA surgery require further analysis.

British Journal of Surgery, Oct 1, 1996

Springer eBooks, 1986

At the Ist International Conference on “Polymers in Medicine” we described a compliant microfibro... more At the Ist International Conference on “Polymers in Medicine” we described a compliant microfibrous polyetherurethane arterial graft of small luminal cross-sectional area, the wall of which was composed of fibres between 1.0 m and 2.0µm in diameter. At that time we reported our results of the implantation into animals of artery grafts of this construction having luminal diameters of 6mm and larger. We also reported the commencement of a study in which we implanted grafts of similar construction having an internal diameter of 3.7mm. In this present publication we follow the performance of these grafts during the last two years.

British Journal of Surgery, Apr 4, 2012

Phlebology, Dec 1, 2001

Objective: To examine the associated features in pregnant women with superficial venous reflux, c... more Objective: To examine the associated features in pregnant women with superficial venous reflux, compared with those without reflux. Methods: Pregnant women were recruited at booking and underwent colour flow duplex ultrasound scanning of the lower limbs to ascertain the presence or absence of reflux in the superficial veins. Body mass index and CEAP scores were calculated. A questionnaire regarding parity, smoking habit and family history of varicose veins was administered. Statistical analysis was carried out using ARCUS. Results: Three hundred and twenty-nine women were recruited, of whom 83 were identified as having reflux (25%). No relationship was observed between reflux and obesity, smoking or family history. Multiparity was significantly correlated with varicose veins (p<0.03). CEAP scores were higher in multiparous women with varicose veins. An increase in symptoms was associated with a positive family history (especially maternal). Smoking was associated with fewer symptoms in those with reflux, as was obesity. Conclusion: Increased parity increased the likelihood of varicose veins, but obesity and family history appeared to make no difference. Symptoms were greater in multiparous women, but less inobese women. An association was made between smoking and fewer symptoms.

Annals of The Royal College of Surgeons of England, Sep 1, 1992

The purpose of basic surgical training is to provide an educational opportunity to develop the yo... more The purpose of basic surgical training is to provide an educational opportunity to develop the young surgeon in the early years of their professional life. The College's Manual of Basic Surgical Training is the current guide for senior house officers (SHOs) and their trainers. The minimum time a trainee might spend in the SHO grade is two years and if they pass the MRCS/AFRCS they are eligible for higher surgical training. However, on average, most spend up to five years in this grade. Fundamental to the development of the SHO in surgery is the acquisition of operative techniques used in a range of operations.

PubMed, Dec 1, 1998

The high dependency unit (HDU) is a facility that is an essential component of any surgical unit.... more The high dependency unit (HDU) is a facility that is an essential component of any surgical unit. This paper reviews the development of a general surgical HDU managed by surgeons over a decade, with analysis of activity from 1991 to 1996. The general surgical workload has increased during the 10-year period, and the case-mix has become richer by an increase in vascular surgery. The HDU provides essential post-operative care to major surgical patients and minimizes the cancellation of aortic operations without placing an extra burden on the intensive care services. The HDU centralises sick patients, facilitating their care, and provides a learning environment for trainee surgeons.

Journal of Clinical Pathology, Sep 1, 1982

A simple method for the quantitative assay of tissue plasminogen activator is described. Human ve... more A simple method for the quantitative assay of tissue plasminogen activator is described. Human veins and uterus obtained at operation are disintegrated in a membrane disintegrator at-70°C and a known weight of the powder, suspended in buffered saline and thoroughly mixed. Assay of the dilutions of this homogenate on isotope-labelled fibrin clots gives straight line plots of log weight against log activity of the dilution and the sample activity is calculated from this. The method has been compared with the conventional histochemical technique. A highly significant correlation between the results of the two methods has been obtained (r = 0-79; p < 0-001).

European Journal of Vascular and Endovascular Surgery, Sep 1, 2008

Objectives: To evaluate an unsupervised home-based exercise programme for physiological, function... more Objectives: To evaluate an unsupervised home-based exercise programme for physiological, functional, and quality of life impact in patients with symptomatic peripheral arterial disease. Design: Prospective cohort with exercise intervention. Materials: Human performance laboratory with non-invasive haemodynamic assessment facilities. Methods: Forty-seven patients with symptomatic peripheral arterial disease (mean age 67.6 AE 7 years, 33 males) participated in an unsupervised home-based exercise programme. Heart rate (HR), ankle brachial blood pressure index (ABPI), leg blood flow (BF), and blood lactate were measured before and after a graded treadmill walk at baseline and after the 12-week exercise programme. Maximum walking distance (MWD) during the treadmill walk was measured at baseline and 12 weeks. Exercise compliance, functional parameters, and quality of life (VascuQoL) were assessed by questionnaire. Results: MWD, leg BF, and VascuQoL scores increased significantly, while resting HR, exercise HR, and end of walk rate-pressure-product (RPP) decreased significantly after 12 weeks. Exercise compliance was significantly correlated with increase in MWD (r Z 0.89, p < 0.001) and QOL score improvement (r Z 0.61, p < 0.001). Conclusions: This supported but unsupervised exercise programme generated improvements in walking distance and leg blood flow without detectable increases in cardiorespiratory work. Exercise compliance is related to MWD and VascuQoL score in a dose-response manner.

European Journal of Vascular and Endovascular Surgery, Nov 1, 1997

Objectives and Design: A prospective study of 709 patients undergoing carotid surgery in the U.K.... more Objectives and Design: A prospective study of 709 patients undergoing carotid surgery in the U.K. and Ireland was performed to evaluate the performance of vascular surgeons. Materials and Methods: Fifty-nine surgeons (range 2-39 cases each) were sampled and all patients undergoing surgery over a 6-month period (1 March 1994-31 August 1994) were included in the study. Indications for surgery were TIA (35.9%), AF (23.3%), CVA (21.4%) and "others" (19.6%). Results: Mean ipsilateral stenosis was 82% (30%-99%). Thirty-one percent of patients had preoperative neurological consults. Shunts were used in 67.6%, tacking sutures in 40.1%, drains in 71.9% and patches in 54.4% of cases. At 30 days there were nine (1.3%) deaths (four cardiac, three neurological). There were 15 ipsilateraI postoperative CVAs (2.1%); 19% of patients had one or more complication, usually minor. Statistical analysis showed no independent risk factor for CVA other than seniority of the surgeon. Conclusions: A combined stroke~death rate of 3% for the series was obtained at 30 days for all cases. This large, validated study suggests that members of the Vascular Society of G.B. and Ireland currently have a very low morbidity~mortality rate for performing carotid surgery. Continued audit is required to ensure that this quality of service does not deteriorate.

Advancing Surgical Education

The intentions of this chapter are to refresh and clarify how we might construe and facilitate th... more The intentions of this chapter are to refresh and clarify how we might construe and facilitate the continuing development of professionalism in surgical practitioners in the twenty-first century. Firstly, we consider the current concept of professionalism in surgery and then attend to two aspects of supporting the development of professionalism in practitioners who are members of a profession that serves vulnerable fellow human beings. Secondly, we share our experience of facilitating one way of beginning those deep but very sensitive considerations about the person the professional brings to their work. We conclude that all this requires members of the profession of surgery to be willing and able to articulate what it means to them to be a member of a profession and that surgical teachers take time to become well developed educators in the moral mode of educational practice.