Evaluation of the Head and Neck Cancer Patient Concerns Inventory in routine multidisciplinary Speech and Language Therapy/Dietetics follow up clinics (2021)

Type of publication:
Poster presentation

Author(s):
*Zuydam AC , *Lowe D, *Rogers SN, *McLaughlin K, *Glaister C, *Burch L

Citation:
Preseted at BAHNO 2021 Annual Scientific Meeting Friday 14th May 2021

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Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab (2021)

Type of publication:
Journal article

Author(s):
Kennedy N.A.; Goodhand J.R.; Chee D.; Lin S.; Chanchlani N.; Ahmad T.; Bewshea C.; Nice R.; McDonald T.J.; *Butterworth J.; Cooney R.; Croft N.M.; Kok K.B.; Hart A.L.; Irving P.M.; Lamb C.A.; Limdi J.K.; Macdonald J.; McGovern D.P.; Mehta S.J.; Murray C.D.; Patel K.V.; Pollok R.C.; Raine T.; Russell R.K.; Selinger C.P.; Smith P.J.; Bowden J.; Lees C.W.; Sebastian S.; Powell N.

Collaborators at Shrewsbury and Telford Hospital NHS Trust: *Jeff Butterworth, *Colene Adams, *Elizabeth Buckingham, *Danielle Childs, *Alison Magness, *Jo Stickley.

Citation:
Gut; May 2021; vol. 70 (no. 5); p. 865-875

Abstract:
OBJECTIVE: Antitumour necrosis factor (anti-TNF) drugs impair protective immunity following pneumococcal, influenza and viral hepatitis vaccination and increase the risk of serious respiratory infections. We sought to determine whether infliximab-treated patients with IBD have attenuated serological responses to SARS-CoV-2 infections. DESIGN: Antibody responses in participants treated with infliximab were compared with a reference cohort treated with vedolizumab, a gut-selective anti-integrin alpha4beta7 monoclonal antibody that is not associated with impaired vaccine responses or increased susceptibility to systemic infections. 6935 patients were recruited from 92 UK hospitals between 22 September and 23 December 2020. RESULT(S): Rates of symptomatic and proven SARS-CoV-2 infection were similar between groups. Seroprevalence was lower in infliximab-treated than vedolizumab-treated patients (3.4% (161/4685) vs 6.0% (134/2250), p<0.0001). Multivariable logistic regression analyses confirmed that infliximab (vs vedolizumab; OR 0.66 (95% CI 0.51 to 0.87), p=0.0027) and immunomodulator use (OR 0.70 (95% CI 0.53 to 0.92), p=0.012) were independently associated with lower seropositivity. In patients with confirmed SARS-CoV-2 infection, seroconversion was observed in fewer infliximab-treated than vedolizumab-treated patients (48% (39/81) vs 83% (30/36), p=0.00044) and the magnitude of anti-SARS-CoV-2 reactivity was lower (median 0.8 cut-off index (0.2-5.6) vs 37.0 (15.2-76.1), p<0.0001). CONCLUSION(S): Infliximab is associated with attenuated serological responses to SARS-CoV-2 that were further blunted by immunomodulators used as concomitant therapy. Impaired serological responses to SARS-CoV-2 infection might have important implications for global public health policy and individual anti-TNF-treated patients. Serological testing and virus surveillance should be considered to detect suboptimal vaccine responses, persistent infection and viral evolution to inform public health policy. TRIAL REGISTRATION NUMBER: ISRCTN45176516.

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Service redesign: how a tissue viability specialist lead nurse developed and improved acute wound care through real-world evidence and partnership working (2021)

Type of publication:
Journal article

Author(s):
*Clare Checketts, Jacqui Hughes, Helen Horton, Tim Styche

Citation:
British Journal of Healthcare Management, May 2021,

Abstract:
The importance of leadership in service redesign should not be underestimated. Increasing demand for services and cost-effective approaches makes the drive and dedication of a leader towards quality improvement crucial. The lead tissue viability nurse at the Shrewsbury and Telford Hospital NHS Trust worked in partnership with the wound care industry to redesign the trust’s acute wound care service. An audit was carried out and an opportunity to reduce variations in care was identified. To achieve this, the service reduced the number of foam dressings on the formulary, listing only the ALLEVYN (Smith+Nephew, UK) family of wound dressings. As a result, the volume of dressings used reduced by 4.8%, meaning that the service produced less waste and saw a cost reduction of approximately £14066 over a 6-month period. This article highlights the positive outcomes that can be achieved through streamlining formularies, reducing variations in care and delivering robust care pathways. It also describes the collaborative working approach taken by this service, spearheaded by the lead tissue viability nurse, as an example of innovative practice for other NHS trusts.

Description of a novel technique for creation of a custom-made prosthesis to aid vocalisation following laryngectomy (2021)

Type of publication:
Journal article

Author(s):
*Halliday, E; *Beswick, H; *Bunn, S; *Ahsan, S F

Citation:
European Annals of Otorhinolaryngology, Head and Neck Diseases; Mar 2021 [epub ahead of print]

Abstract:
There are various options to restore phonation after laryngectomy; one option involves using tracheo-oesophageal voice by placing a speaking valve through the tracheo-oesophageal wall. Some patients struggle to obtain good fixation of an adhesive base plate to the skin; this can result in air leakage and poor voice. We describe a technique using a custom-made prosthesis to provide a better base plate for fixation of the heat and moisture exchange cassette. This technique involves making an impression of the anterior neck around the laryngectomy stoma to create an anatomically fitted prosthesis, which accurately fills the void around the stoma. The custom-made prosthesis provides a more individualised fit compared to a standard base plate, helping improve vocalisation and communication.

GLP-1 receptor agonists in type 2 diabetes: An underused asset? Updated January 2021 (2021)

Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Jan 2021; vol. 25 (no. 1); p. 1-13

Abstract:
As our understanding of the incretin hormones has increased, a number of drugs targeting this system have been developed. The realisation of this potential has developed rapidly, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now a standard feature in management guidelines for type 2 diabetes. This article reviews the operation of the incretin system and the mechanism by which GLP-1 RAs act to provide benefit in type 2 diabetes. The availability and indications for use of the GLP-1 RAs, and their clinical benefits and disadvantages, are summarised. The position of GLP-1 RAs in the management of type 2 diabetes is discussed pragmatically, with reference to various key guidelines. This article has been updated in January 2021 to incorporate recent guideline changes and the launch in the UK of an oral formulation of semaglutide.

BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab (2021)

Type of publication:
Journal article

Author(s):
Dobson R.; Ghosh A.K.; Manisty C.; Ky B.; Marwick T.; Stout M.; Pearce K.; Harkness A.; Steeds R.; Robinson S.; Oxborough D.; Adlam D.; Stanway S.; Rana B.; *Ingram T.; Ring L.; Rosen S.; Lyon A.R.; Plummer C.; Harbinson M.; Sharma V.; Augustine D.X.

Citation:
JACC: CardioOncology; Mar 2021; vol. 3 (no. 1); p. 1-16

Abstract:
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor receptor (HER) 2-positive targeted treatment (e.g., trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.

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Digital mammographic interpretation by UK radiographer mammographers: A JAFROC analysis of observer performance (2021)

Type of publication:
Journal article

Author(s):
*Williams S.; *Aksoy U.; *Cielecki L.; Reed W.; Woznitza N.

Citation:
Radiography; March 2021 [epub ahead of print]

Abstract:
Introduction: Radiologists utilise mammography test sets to bench mark their performance against recognised standards. Using a validated test set, this study compares the performance of radiographer readers against previous test results for radiologists. Method(s): Under similar test conditions radiographer readers were given an established test set of 60 mammograms and tasked to identify breast cancer, they were measured against their ability to identify, locate and give a confidence level for cancer being present on a standard set of mammographic images. The results were then compared to previously published results for radiologists for similar or the same test sets. Result(s): The 10 radiographer readers demonstrated similar results to radiologists and for lesion sensitivity were the highest scoring group. The study group score a sensitivity of 83; a specificity of 69.3 and lesion sensitivity of 74.8 with ROC and JAFROC scores of 0.86 and 0.74 respectively. Conclusion(s): Under test conditions radiographers are able to identify and accurately locate breast cancer in a range of complex mammographic backgrounds. Implications for practice: The study was performed under experimental conditions with results comparable to breast radiologists under similar conditions, translation of these findings into clinical practice will help address access and capacity issues in the timely identification and diagnosis of breast cancer.

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Can existing routine clinical data be used to predict hypoxaemia for mnd patients undertaking commercial flight? (2021)

Type of publication:
Conference abstract

Author(s):
Cliff I.J.; Mustfa N.; Stone H.; Hurst C.; *Crawford E.

Citation:
Thorax; Feb 2021; vol. 76

Abstract:
Introduction: Pre-COVID-19, the total number of passengers traveling by commercial airlines rose to 4.3 billion, with Europe amounting to a 7.2% increase. The risks of respiratory compromised patients developing hypoxaemia during flight is well documented. Assessment of these patients is time consuming and often requires specialised equipment. Furthermore, the majority of evidence is based on research into patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this study is to investigate potential predictive biomarkers relating to the development of hypoxaemia during flight in patients with Motor Neurone Disease (MND). Method(s): 118 MND patients referred into a fitness to fly service (n=118) completed baseline lung function and a Hypoxic Challenge Test (HCT) as part of a risk stratification for (Table presented) planned air travel (77 male). Data from patients requiring inflight oxygen was compared to patients who did not, in accordance with the British Thoracic Society recommendations 2011: Managing passengers with stable respiratory disease planning air travel. Statistical analysis was performed using one-way ANOVA, Kruskal-Wallis, and Chi-Squared tests, as appropriate. Result(s): There was no significant difference between the pass (n=94) and fail (n=24) groups for age, gender, smoking history or BMI. There was a significant difference for all spirometry data (FEV1, FVC and FEV1/FVC ratio – absolute, percent predicted and standardised residuals). Moreover, the resting blood gases (FiO221%) data showed significant difference for all parameters with the exception of pH (<0.001). The Regression analysis showed limited predictive value of spirometry and/or resting blood gas data with the exception of PaCO2 and base excess (BE). Conclusion(s): The predictive value of spirometic paraments and resting blood gases are limited in assessing hypoxaemia during commercial flight in MND patients, with the exception of parameters relating to respiratory failure. Despite the significant difference between the two groups, routine physiological data was limited in the predictive regression equations. We recommend that the safest approach in managing this group of patients is to perform an HCT in all patients intending to use air travel until more evidence-based data is available.

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