Author: Jason Curtis

UK Renal Registry 19th Annual Report: Chapter 8 Biochemical Variables amongst UK Adult Dialysis Patients in 2015: National and Centre-specific Analyses (2017)

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Type of publication:
Journal article

Author(s):
Methven S.; Perisanidou L.I.; *Nicholas J. ; Dawnay A.

Citation:
Nephron; Sep 2017; vol. 137 (no. 1); p. 189-234

Abstract:
64.1% of haemodialysis (HD) patients and 60.5% of peritoneal dialysis (PD) patients achieved the Renal Association (RA) audit measure for phosphate (<1.7 mmol/L). . 35.9% of HD and 39.5% of PD patients had a serum phosphate above the RA audit standard (>=1.7 mmol/L). Simultaneous control of all three parameters (calcium, phosphate and parathyroid hormone (PTH)) within current target ranges was achieved by 27.6% of HD and 33.1% of PD patients. 79.3% of HD and 77.8% of PD patients had adjusted calcium in the recommended target range of 2.2-2.5 mmol/L. 57.1% of HD and 61.3% of PD patients had phosphate between 1.1-1.7 mmol/L. 56.8% of HD and 63.6% of PD patients had a serum PTH between 16-72 pmol/L. 18.8% of HD and 13.9% of PD patients had a serum PTH >72 pmol/L. 64.3% of HD and 80.4% of PD patients achieved the audit measure for bicarbonate 18-24 mmol/L for HD patients and 22-30 mmol/L for PD patients).

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UK Renal Registry 19th Annual Report: Chapter 10 Epidemiology of Reported Infections in Patients Receiving Dialysis in England between January 2015 and December 2015: A Joint Report from Public Health England and the UK Renal Registry (2017)

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Type of publication:
Journal article

Author(s):
*Crowley L.; MacNeill S.; Caskey F.J.; Methven S.; Nsonwu O.; Davies J.; Fluck R.; Byrne C.

Citation:
Nephron; Sep 2017; vol. 137 (no. 1); p. 251-257

Abstract:
Between January 2015 and December 2015 there were a total of 31 episodes of Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia in patients receiving dialysis for end stage renal disease. The rate of MRSA episodes per 100 dialysis patient years was 0.13 compared to 0.15 the previous year. Rates of Methicillin Sensitive Staphyloccoccus aureus (MSSA) continued their gradual increase with a rate of 2.35 per 100 patient years compared with 2.26 the year before. This was a result of 560 episodes of bloodstream infection between January and December. Rates of Clostridium difficile infection (CDI) were stable with 245 recorded episodes giving a rate of 1.03 per 100 patient years. Escherichia coli (E.coli) infections occurred at a rate of 1.7 per 100 dialysis patient years, an increase on the previous year's rate of 1.49. As found in previous years, a tunnelled catheter was associated with a higher number of infection episodes than other forms of access in those patients with a staphylococcal bacteraemia.

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The impact of age on the art of mammography and how to adapt accordingly (2017)

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Type of publication:
Journal article

Author(s):
*Lake B.; *Cielecki L. ; *Williams S.; *Worrall C.; *Metelko M.

Citation:
Radiography; Nov 2017; vol. 23 (no. 4)

Abstract:
Introduction Breast cancer is increasingly a disease of the elderly, and combined with the NHS Breast Screening Extension means that more elderly patients are having mammography. Increasing age can make mammography more technically difficult. This is a technical note detailing the results of a local audit which may be of interest due to potential service implications. Method A retrospective audit of the first year of screening extension of The Shropshire Breast Screening Programme. Aims to collect data on patient demographics and describe the technical adaptations developed in Shropshire. Results Breast screening extension has increased by 2.5 times the number of women aged 70-74 screened, and doubled the overall numbers of women over 70 screened. Significantly more older patients are being screened to present technical challenges to a screening programme.  Data was obtained from a month of screening showed that 29% of patients over 70 needed extra time for positioning. Reasons included 22% difficulty in obtaining adequate positioning and 15% needed a relative to aid with consent. Discussion In the Shropshire screening programme different technical adaptations have been developed and are key to ensuring adequate images. These include double appointments, two radiographers, thorough assessment, steeper angles, seated examinations, from-below imaging and pre-planning for  subsequent screen. Conclusion Significantly more older women are having breast screening due to the increasing incidence of breast cancer and the Breast Screening Programme extension. Increasing age can significantly increase time taken for adequate imaging and present technical challenges. Development of technical adaptations to art of mammography is key to achieve adequate images.

Review of trans anal microscopic surgery in a UK district general hospital- a safe practice with excellent patient outcomes (2017)

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Type of publication:
Conference abstract

Author(s):
*V. Vidyaankar, *A. Chakrabarty, *J. McCloud & *R. Clarke

Citation:
Colorectal Disease; Sep 2017; vol. 19 ; Supplement S2 ; p. 123

Abstract:
Aim: Randomised controlled trials have demonstrated advantages of Trans Anal endoscopic microsurgery (TEMS) for the resection of benign and malignant rectal lesions. We assess the safety and outcome of TEMS at a U.K district general hospital. Method: Between July 2011 to January 2017, 122 patients, 54 men and 68 women, Mean age 72 years, underwent TEMS. Patients with Level 4 polyps, large sessile polyps, polyps with invasive features or unsuitable for colonoscopic removal, were selected. Benign follow up with flexible sigmoidoscopy. Cancer follow up with Colonoscopy, MRI, CT, according to protocol. Results: 95 Benign and 27 Cancer lesions. Mean lesion Diameter 46 mm, mean operative time 60 min. Average hospital stay was 1.5 days. Three patients (2.4%) had bleeding, Four (3.2%) perforations, identified and repaired immediately. One (0.8%) surgical emphysema. Four (3.2%) developed pyrexia, two (1.6%) developed minor stricture. One (0.8%) rectovaginal fistula. No recurrence in benign cases. For Early Rectal cancers R0 resection was achieved in 81% and  R1 resection in 19% of cases. One (0.8%) developed local cancer recurrence. No mortality. Conclusion: Our study demonstrates that TEMS can be safely performed at a district general hospital by appropriately trained surgeons, with outcomes comparable with international data.

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Patient and public involvement for a surgical trial in rectal prolapse (2017)

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Type of publication:
Conference abstract

Author(s):
Lee M.; Blackwell S.; Brown S.; Sayers A.; Heywood N.; Fearnhead N.; *Lacy-Colson J.; Cornish J.

Citation:
Colorectal Disease; Sep 2017; vol. 19 ; Supplement S2 ; p. 39

Abstract:
Aim: An integral part of trial design is Patient and Public Involvement (PPI) to incorporate patient views and preferences. The aim of this study is to describe the conduct and findings of early PP for a trial in surgical treatment of rectal prolapse. Method: Participants were invited directly by research collaborators and through social media. Only women were invited due to nature of trial. A modified deliberate engagement process was followed. Patients provided expertise on patient experience of the condition, potential recruitment strategies, and outcome measures. Results: 13 patients attended the PPI meeting. Most were recruited by clinicians. Broad representation of age and demographic origin was achieved. Patients agreed with equipoise, and were willing tobe randomised to posterior or ventral rectopexy. Several qualities of life tools were discussed when selecting appropriate outcomes. With respect to sexual function, older patients preferred FSFI and younger patients preferred PISQ-IR. Final consensus was that PISQ-IR was the best compromise for all. Conclusion: Patients with rectal prolapse are willing to engage in PPI for researchers and discuss intimate details on how treatments have affected their personal lives. The PPI exercise confirmed equipoise and modified the outcome measure of sexual function.

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Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem? (2018)

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Type of publication:
Journal article

Author(s):
*Lumsden, Gordon; *Lucas-Garner, Kerry; *Sutherland, Sarah; *Dodenhoff, Ron

Citation:
Musculoskeletal care; Mar 2018; vol. 16 (no. 1); p. 209-213

Abstract:
AIMSPhysiotherapists are beginning to utilize diagnostic ultrasound imaging in upper limb/shoulder clinics. The aim of the present study was to receive feedback on the views of the patients concerning the usefulness of the information obtained immediately from the scan in the management of their problem.METHODS A questionnaire was offered to all patients attending a physiotherapist-led upper limb/shoulder clinic who underwent ultrasound imaging as part of a shoulder assessment over a 6-month period. A total of 103 patients completed a questionnaire for analysis.RESULTSPatients rated the ultrasound scan to be of benefit in all aspects. Regarding the ability to understand their shoulder problem better and in feeling reassured about their problem, 97% of patients either strongly agreed or agreed that this was the case. Concerning the capability of managing their problem, 89% of patients strongly agreed or agreed that they felt more able to do this. In total, 96% of patients evaluated the ultrasound scan to be of very high/high value to them.CONCLUSION Patients highly rate the information gained from ultrasound imaging in a physiotherapy-led upper limb/shoulder clinic and felt that it assisted them in the understanding, reassurance and management of their problem.

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Functional outcomes of achilles tendon minimally invasive repair using 4- and 6-strand nonabsorbable suture: A cohort comparison study (2017)

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Type of publication:
Journal article

Author(s):
*Carmont M.R.; Brorsson A.; Olsson N.; Nilsson-Helander K.; Karlsson J.; Zellers J.A.; Silbernagel K.G.

Citation:
Orthopaedic Journal of Sports Medicine; Jan 2017; vol. 5 (no. 8)

Abstract:
Background: The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications. Purpose: To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2013 and August 2015, a total of 70 patients (58males, 12 females) with amean age of 42 +/- 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks. Results: There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was -13.1degree (6.6degree) (dorsiflexion) following injury; this was reduced to 7.6degree (4.8degree) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6degree (7.4degree) (neutral) and -7.0degree (5.3degree) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively). Conclusion: Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3months after surgery correlated with heel-rise height at 12 months.

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Partial breast radiotherapy after breast conservation: 5 year outcomes from the IMPORT LOW (CRUK/06/003) phase III trial (2017)

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Type of publication:
Conference abstract

Author(s):
Coles C.; Griffin C.; Bhattacharya I.; Emson M.; Haviland J.; Hopwood P.; Kaggwa R.; Bliss J.; Kirby A.; Donovan E.; *Agrawal R.; Alhasso A.; Brunt A.M.; Ciurlionis L.; Chan H.; Harnett A.; Sawyer E.; Sybdikus I.; Tsang Y.; Wheatley D.; Wilcox M.; Yarnold J.; Jefford M.

Citation:
Radiotherapy and Oncology; May 2017; vol. 123

Abstract:
Background: Local cancer relapse rates after breast conservation surgery followed by radiotherapy have fallen sharply in many countries with risk influenced by patient age and clinico-pathological factors. In women at lower than average risk of local relapse, partial breast radiotherapy restricted to the vicinity of the original tumour is hypothesised to improve the balance of beneficial versus adverse effects compared with whole breast radiotherapy. Methods: The IMPORT LOW trial (ISRCTN12852634) recruited women aged >=50 years after breast conserving surgery for invasive ductal adenocarcinoma pT<=3cm, pN0- 3, G1-3 and >=2mm resection margins. Using 15 daily treatments, patients were randomly allocated (1:1:1) to 40 Gy whole breast radiotherapy (control), 36 Gy whole breast plus 40 Gy to partial breast (reduced dose) or 40 Gy partial breast only (partial breast). Primary endpoint was ipsilateral local relapse rate (80% power to exclude a +2.5% noninferiority margin at 5 years for each test group). Findings: Between May 2007 and October 2010, 2018 women were recruited (control n=675, reduced dose: n=674, partial breast: n=669). With a 72.2 month median followup (IQR 61.7-83.2), 5-year local relapse rates were 1.1% (95%CI 0.5-2.3), 0.2% (0.02-1.2) and 0.5% (0.2-1.4) in control, reduced dose and partial breast groups. Absolute differences in local relapse rate compared with the control group were -0.73% (-0.99, 0.22) for the reduced dose and -0.38% (-0.84, 0.90) for the partial breast groups, demonstrating non-inferiority for both test groups. Photographs, patients and clinicians reported similar or lower levels of adverse effects after reduced dose or partial breast radiotherapy compared with whole breast radiotherapy (see Table 1). (Table presented) Interpretation: At 5 years, partial breast and reduced
dose radiotherapy showed local relapse rates non-inferior to that observed following whole breast radiotherapy and produced equivalent or milder late normal tissue side effects. This simple radiotherapy technique is implementable in radiotherapy centres worldwide.

Surgery for constipation: systematic review and practice recommendations: Results II: Hitching procedures for the rectum (2017)

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Type of publication:
Systematic Review

Author(s):
Grossi U.; Knowles C.H.; Mason J.; *Lacy-Colson J.; Brown S.R.; Campbell K.; Chapman M.; Clarke A.; Cruickshank

Citation:
Colorectal Disease; Sep 2017; vol. 19 ; p. 37-48

Abstract:
Aim: To assess the outcomes of rectal suspension procedures (forms of rectopexy) in adults with chronic constipation. Method: Standardised methods and reporting of benefits and harms were used for all Capacity reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level. Results: Eighteen articles were identified, providing data on outcomes in 1238 patients. All studies reported only on laparoscopic approaches. Length of procedures ranged between 1.5 to 3.5 h, and length of stay between 4 to 5 days. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 5-15%, with mesh complications accounting for 0.5% of patients overall. No mortality was reported after any procedures in a total of 1044 patients. Although inconsistently reported, good or satisfactory outcome occurred in 83% (74-91%) of patients; 86% (20-97%) of patients reported improvements in constipation after laparoscopic ventral mesh rectopexy (LVMR). About 2-7% of patients developed anatomical recurrence. Patient selection was inconsistently documented. As most common indication, high grade rectal intussusception was corrected in 80-100% of cases after robotic or LVMR. Healing of prolapse-associated solitary rectal ulcer syndrome occurred in around 80% of patients after LVMR.
Conclusion: Evidence supporting rectal suspension procedures is currently derived from poor quality studies. Methodologically robust trials are needed to inform future clinical decision making.

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study (2017)

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Type of publication:
Journal article

Author(s):
*Macano C.A.W.; *Lake B.; *Clarke R.; Kirby G.C.; Nyasavajjala S.M.

Citation:
Annals of Medicine and Surgery; Nov 2017; vol. 23 ; p. 28-31

Abstract:
Background There is increasing pressure on emergency services within the NHS requiring efficient, rapid assessment and management of patients. A subsequent reduction in hospital admissions reduces overall costs with an aim to improve quality of care. At the Royal Shrewsbury Hospital we run a one stop emergency surgical clinic. With strict criteria for admission to this clinic we have established a care pathway for those patients requiring urgent surgical review but not necessarily hospital admission. Materials and methods We reviewed our initial referral pathway to the emergency surgical assessment clinic. New guidelines were distributed to the local Care Coordination Centre (CCC) through which GP referrals to the clinic were made. A re-audit carried out 6 weeks later assessed change in clinical practice. Results With the introduction of guidelines for referral we significantly increased the percentage of appropriate referrals to the one stop emergency surgical clinic (42.9%-79.4%, p = 0.000017). The majority (75.8%) of appropriate referrals can be successfully managed on an urgent outpatient basis. Appropriate referrals unsuitable for discharge from clinic had genuine reasons for admission such as abnormal results on assessment, or a need for surgery. 97.8% of referrals not deemed appropriate for the clinic were admitted for inpatient management. Conclusion By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

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