Type of publication:
Service improvement case study
Author(s):
*Jane Carter and *Rachel McKenzie
Citation:
SaTH Improvement Hub, September 2024
Abstract:
To improve staff competence and confidence with completing home/access visits in line with personal competencies and self evaluation by December 2024 as evidenced by self perceived competence rating
Type of publication:
Service improvement case study
Author(s):
*Jules Lewis, Lead Nurse for Staff Bereavement Support and *Penny Watson Admin Support for Staff Bereavement Support
Citation:
SaTH Improvement Hub, January 2025
Abstract:
To develop an OWEN Room for staff bereavement support sessions; a calm, inviting, comfortable and safe space that allows staff to share how they are feeling, be heard and supported
Type of publication:
Journal article
Author(s):
Issa, Mohamed Talaat; *Sultana, Emiko; Hamid, Mohammed; Mohamedahmed, Ali Yasen; Albendary, Mohamed; Zaman, Shafquat; Bhandari, Santosh; *Ball, William; Narayanasamy, Sangara; Thomas, Pradeep; Husain, Najam; Peravali, Rajeev; Sarma, Diwakar.
Citation:
International Journal of Colorectal Disease. 40(1):68, 2025 Mar 15.
Abstract:
INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.
METHODS: We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient
demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.
RESULTS: A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated
with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.
CONCLUSION: The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant
lesions.
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Type of publication:
Systematic Review
Author(s):
*Patel, Ravi; Khan, Muhammad Murtaza; Gibson, William; Banerjee, Robin; Pardiwala, Asif.
Citation:
Chinese Journal of Traumatology. 2025 Feb 19. [epub ahead of print]
Abstract:
PURPOSE: Surgical management of the lateral end of clavicle fractures hasbeen a challenge for orthopedic surgeons considering the high rate ofnon-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate vs. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications.
METHODS: A search of the literature was made with the keyword "clavicle" in PubMed/Ovid Medline/Embase and University of Edinburgh online library "discover Ed". A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors.
RESULTS: A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studies. The most commonly reported incidence of complication was acromial osteolysis. The quality of studies was assessed using modified Coleman score. Other than 2 studies that were considered for the study that met the "fair" standard all of them were considered "poor" based on the modified Coleman score.
CONCLUSION: Both hook plate and locking plate provide acceptable operative treatment options for the lateral end of clavicle fracture. However, a consideration of surgeons' experience, the likelihood of a second operation, and the size of the lateral fragment should be considered when choosing between the 2 types of implants.
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Type of publication:
Conference abstract
Author(s):
Raj S.; Ellanna G.; Vicky S.; Jo H.; Matthew J.; Louise H.; Manreet T.; Apurna J.; Qamar G.; *Anirban C.; Charles P.; Jane R.; Bleddyn J.; Janet D.
Citation:
Lung Cancer. Conference: 23rd Annual British Thoracic Oncology Group Conference 2025. Belfast Ireland. 200(Supplement 1) (no pagination), 2025. Article Number: 108368. Date of Publication: 01 Feb 2025.
Abstract:
Introduction Significant advances in systemic therapy have improved survival for patients with advanced-stage non-small cell lung cancer (NSCLC). However, current treatment strategies and dose-fractionation for high-dose palliative radiotherapy (RT) are based on trials from the 1990s, when RT planning was simple, typically parallel-pair or 3-dimensional conformal, with less precise delivery. Contemporary lung RT uses 4D-CT, volumetric modulated arc radiotherapy (VMAT), aided by online cone beam CT verification, which enable greater accuracy, better target volume coverage, whilst reducing doses to normal organs at risk. Methods and Results: The SHiP-Rt study aims to evaluate the safety and efficacy of reducing the number of RT fractions and RT duration, using contemporary planning, verification, and delivery techniques. This single-arm, multi-centre, phase-II study will evaluate the shortened hypofractionated accelerated palliative RT regimen of 30 Gy in 6 alternate-day fractions, with strict normal tissue dose constraints. We aim to recruit 37 patients, across 4 sites within the West Midlands. The RTTQA will support quality assurance for the RT. Patients with locally-advanced or metastatic NSCLC, who are candidates for high-dose palliative RT, before or after first-line systemic therapy are eligible for recruitment. The primary objective of this study is to assess the safety of the proposed dose-fractionation. Secondary objectives include evaluating toxicity profiles, patient-reported outcome measures (PROMS), Time to Progression (TTP), feasibility and the NHS cost-saving. Developed in collaboration with the Warwick CTU, this study was favourably reviewed by NCRI CTRad, NCRI lung CSG, and the RTTQA. Funding was awarded by the UHCW Charity and Coventry Hospitals Charity. Conclusion This study is open to recruitment. The potential advantages from this regimen include RT given in fewer fractions and hospital visits, resulting in cost-savings for the NHS and opportunity benefits for other patients. If successful, this study will support a phase-III randomised controlled trial to assess efficacy.
Type of publication:
Journal article
Author(s):
Brothwell, Shona Lc; Fitzsimons, Patricia E; Gerrard, Adam; Schwahn, Bernd C; Stockdale, Christopher; Bowron, Ann; Anderson, Mark; Hart, Claire E; Hannah, Romanie; Ritchie, Francesca; *Deshpande, Sanjeev A; Sreekantam, Srividya; Watts, Gemma; Yap, Sufin; Mundy, Helen; Veiraiah, Aravindan; Collins, Abigail; Cozens, Alison; Morris, Andrew A; Crushell, Ellen.
Citation:
Archives of Disease in Childhood. 2025 Mar 11. [epub ahead of print]
Abstract:
INTRODUCTION: Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.
OBJECTIVE: To describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).
METHODS: A retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.
RESULTS: Almost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years – 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.
CONCLUSION: Consumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children,
especially those under 8 years of age, should avoid slush ice drinks containing glycerol.
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
Abarca, Yozahandy A; Scott-Emuakpor, Renee; Tirth, Jhanavi; Moroz, Oksana; Thomas, George Pandarakalam; *Yateem, Dana; Golbari, Rebecca; Aphia, Ninigail; Lysak, Yuliya; Narasimhan, Niketa; Siddiqui, Humza F.
Citation:
Cureus. 17(1):e78298, 2025 Jan.
Abstract:
Alopecia areata (AA) is an autoimmune condition that presents with non-scarring hair loss affecting multiple patients worldwide during their lifetime. It ranges from well-defined patchy to diffuse total hair loss, impacting all hair-bearing areas of the body. AA most commonly predominantly manifests on the scalp. The pathophysiology of AA is complex and multi-faceted. The findings of our review article were consistent with the recent literature, delineating autoimmunity, genetic susceptibility, and environmental aspects to be the contributing factors. One of the main causes of AA is believed to be the disruption in the immune privilege of the hair follicles. Multiple genetic loci involved in hair follicle maturation and immune process have been linked to the development of AA as evidenced by several studies. It has been postulated that psychological stressors, smoking, alcohol consumption, sleep disturbances, gut microbiota, and drugs play a role in the pathogenesis of AA by exacerbating the immune response against the hair follicles. AA is a clinically diagnosed disorder. Topical, intra-lesional, and oral corticosteroids, topical and oral minoxidil, cyclosporine, and other immune therapy drugs are widely accepted first-line treatment options, although incomplete remission and relapses are common. Recently JAK-2 inhibitors and mesenchymal stem cell exosomes have shown promising results, potentially treating severe and refractory hair loss. AA has a bidirectional relationship with psychological symptoms as it can lead to social anxiety and depression, which in turn can aggravate hair loss. Hence, it is crucial to implement a holistic approach to managing AA including topical and systemic therapies, psychological counseling, and lifestyle modifications. It is imperative to fully declinate the pathophysiological mechanisms of the disease and formulate therapies in future research to help clinicians and dermatologists devise definitive guidelines to treat the condition for long-term remission.
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
Iyen, B; Qureshi, N; Kai, J; *Capps, N; Durrington, P N; Cegla, J; Soran, H; Schofield, J; Neil, H A W; Humphries, S E.
Citation:
Atherosclerosis. 403:119142, 2025 Feb 18.
Abstract:
BACKGROUND: Social deprivation is associated with higher cardiovascular disease (CVD) morbidity and mortality. We examined whether this is also observed in people with Familial Hypercholesterolaemia (FH).
METHODS: Subjects with FH and linked secondary care records in Hospital Episode Statistics (HES) were identified from UK Clinical Practice Research Datalink (CPRD) and the Simon Broome (SB) adult FH register. Cox proportional hazards regression estimated hazard ratios (HR) for composite CVD outcomes (first HES outcome of coronary heart disease, myocardial infarction, angina, stroke, transient ischaemic attack, peripheral vascular disease, heart failure, coronary revascularisation interventions (PCI and CABG)) in Index of Multiple Deprivation (IMD) quintiles.
RESULTS: We identified 4309 patients with FH in CPRD (1988-2020) and 2956 in the SB register. Both cohorts had considerably fewer subjects in the most deprived compared to the least deprived quintile (60 % lower in CPRD and 52 % lower in SB). In CPRD, the most deprived individuals had higher unadjusted HRs for composite CVD (HR 1.71 [CI 1.22-2.40]), coronary heart disease (HR 1.63 [1.11-2.40]) and mortality (HR 1.58 [1.02-2.47]) compared to the least deprived but these became insignificant after adjusting for age, sex, smoking and alcohol consumption. In the SB register, hazard ratios for composite CVD increased with increasing deprivation quintiles and remained significant after adjustment for age, sex, smoking and
alcohol consumption (adjusted HR in quintile 5 vs quintile 1 = 1.83 [1.54-2.17]).
CONCLUSIONS: Strikingly fewer individuals with FH are identified from lower socioeconomic groups, though the most deprived FH patients have the highest risk of CVD and mortality. In CPRD, this risk was largely explained by smoking and alcohol consumption, but not in the SB register. More effective strategies to detect FH and optimise risk factor management, are needed in lower socioeconomic groups.
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
Little S.; Tawn J.; Khalil G.; Hardasani R.; Radford S.; Das D.; Peerally M.F.;
Citation:
Frontline Gastroenterology. (no pagination), 2025. Article Number: flgastro-2024-102952. Date of Publication: 2025 [epub ahead of print]
Abstract:
Link to full-text [NHS OpenAthens account required]
Type of publication:
Conference abstract
Author(s):
Kumar A.; Baxter J.; Rimmer P.; Noble B.; Makki M.; Chikhlia A.; Cheesbrough J.; Disney B.; *Muir J.; Karova M.; *Butterworth J.; Bower J.; Sagar N.; Al-Talib I.; Nahal J.; Hatta A.; Ali N.; Sagar V.; Varyani F.; Smith S.; Bourne S.; Hsu Y.K.; Eltahir A.; De silva S.; Harvey P.;
Citation:
Journal of Crohn's and Colitis. Conference: 20th Congress of ECCO. Berlin Germany. 19(Supplement 1) (pp i2143), 2025. Date of Publication: 01 Jan 2025.
Abstract:
Background: Tofacitinib, filgotinib and upadacitinib are JAK inhibitors (JAKi) that are licensed for treatment in moderate to severe ulcerative colitis (UC). Whilst these drugs have demonstrated efficacy against placebo, there is no head-to-head data. This study aims to compare the clinical efficacy between these drugs.
Method(s): This is a multi-centred, retrospective cohort study with data collected from January 2018 to June 2024. Patients with UC were recruited on their first JAKi, irrespective of previous advanced therapies. Clinical remission (faecal calprotectin (FCP) <250, Mayo 1, UCEIS 1, pMayo 2, SCCAI 2) and response (50% reduction in FCP from baseline, reduction in partial Mayo or UCEIS by 3 or more, or sustained <3) was measured at 3- and 6-months. If a patient stopped taking JAKi, they were considered to have failed both response and remission. Data was non-parametric and outcome measures were compared using Chi-squared tests.
Result(s): There was a total of 266 patients included in the final analysis. 70 (26%) were on upadacitinib, 47 (18%) on filgotinib and 149 (56%) on tofacitinib (Table 1). At least 87% (129/149) on tofacitinib had exposure to a previous biologic compared to 80% (56/70) for upadacitinib and 66% (31/47) for filgotinib. At 3-months, clinical response in upadacitinib, filgotinib and tofacitinib was demonstrated in 83%, 74% and 75% patients, respectively and clinical remission was seen in 69%, 64% and 52%, respectively. At 6-months, clinical response was demonstrated in 79%, 65% and 63%, respectively and remission was seen in 75%, 61% and 51%, respectively. Upadacitinib demonstrated significantly higher 3-months remission rate (p=0.019) and 6-months response (p=0.010) and remission rates (p= 0.001) compared to tofacitinib. In the bio-exposed cohorts, upadacitinib demonstrated greater 6-months remission rates (71%) compared to 64% on filgotinib (p=NS) and 52% tofacitinib (p= 0.022). In bio-naive cohorts (n=50), upadacitinib demonstrated greater 6-months remission rates (93%) compared to 56% on filgotinib (p=0.024) and 50% tofacitinib (p= 0.009). Combining the JAKi, 90% of patients were not on steroids at 3-months and 94% were not on steroids at 6-months. A total of 26 patients had a colectomy at the time of their JAKi, 17 on tofacitinib, 5 on filgotinib and 4 on upadacitinib.
Conclusion(s): This study demonstrates that upadacitinib is more likely to achieve 3- and 6-month remission compared to tofacitinib. In a small subgroup of bio-naive patients Upadacitinib was more likely to achieve 6-month remission compared to filgotinib and tofacitinib. JAKi were associated with minimal adverse events and importantly, the efficacy of JAKi does not appear diminished by prior biologic use.
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Shrewsbury and Telford Hospital NHS Trust has an active Research and Innovation Department.
Find out more by visiting either the R&I Intranet pages (only available on a Trust PC) or the R&I pages on the SaTH website.
Shrewsbury and Telford Hospital NHS Trust has an active Improvement Hub.
Find out more by visiting either the Improvement Hub Intranet pages (only available on a Trust PC) or the Improvement Hub page on the SaTH website.