Author: Jason Curtis

Pre-transplant Nurse Led Education Clinic (2019)

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Type of publication:
Poster presentation

Author(s):
*Dean S, *Rogers C, *Chand S

Citation:
Joint British Transplant Society and NHS Blood and Transplant Annual Congress 6th – 8th March 2019, Harrogate Convention Centre

Abstract:
Introduction: Locally, there is a 40% pre-emptive renal transplant listing rate, between 2013-2016; and 22% for living donor pre-emptive 2014-2017. Thus we needed to revise our processes. After returning from the tertiary transplant centre, patient feedback including their shock of what was required and their follow-up arrangements, and they felt under-prepared from their local education.
Methods: By creating a separate renal pre-transplant education clinic, we aim to improve the education and experience of potential recipients and donors in order to improve or transplantation rates. This clinic was started in August 2016. It was also important to rationalise the time of the single transplant nurse more effectively.
Results: The nurse was able to stop time wasted travelling between individual consultant clinics, catching patients in an adhoc manner, and time wasted travelling between hospital sites. There was an increase of 20% over a 18 months period of patients transplant listed. Patients feedback has been qualitatively positive after their tertiary centre assessments, with noone reporting feeling under-prepared or shocked from the information and requirements if transplanted. Discussion: The nurse led clinic has been successful and we would like to share this model with other units. Other surprising benefits have included patients being better prepared for their transplantation clinic assessment at the tertiary assessment. Potential living donor assessments and any initial investigations have been identified and performed in a more timely manner. The clinic has also allowed to unmask and address unmet psychological and social needs prior to being assessed for transplantation and thus reducing the psychological burden post-transplantation.

Genetic Deletion of the Lipid Raft Protein Caveolin-1 Leads to Worsening Renal Fibrosis (2018)

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Type of publication:
Journal article

Author(s):
*Chand S , Hazeldine J, Smith S, Borrows R.

Citation:
Journal of Clinical Nephrology and Renal Care 2018 Jun;4(1):037

Abstract:
Background
Renal disease is a major global public health issue. Renal interstitial fibrosis is the characteristic histopathological finding in all progressive renal disease. Caveolin-1 is the essential structural protein for lipid rafts called caveolae that are ubiquitously distributed among fibroblasts, endothelial and epithelial cells. Caveolin-1 acts as an intracellular signalling pathway chaperone in fibrotic disease. Presently, caveolin-1 expression is associated with more severe renal disease in human and previous murine studies. In non-renal fibrosis, caveolin-1 protects against fibrosis. The purpose of this study was to investigate if caveolin-1 knockout led to an increased fibrotic phenotype using the unilateral ureteric obstruction model of renal fibrosis.
Methods
Using 2 time-points of the unilateral ureteric obstruction model, wild-type and caveolin-1 knockout mouse kidneys were analysed for caveolin-1 expression and markers of fibrosis using histology, Gomori staining, real-time quantified polymerase chain reaction, Western blotting and confocal microscopy.
Results
Confocal microscopy shows caveolin-1 staining mainly in glomerulus, lining of tubules as well as the vasculature. There was increased caveolin-1 expression the longer the unilateral obstruction occurred as well as in the contralateral compensating non-obstructed kidney. Caveolin-1 knockout had less fibrosis at day 3 histologically but more at day 14 as compared to wild-type. There were significantly more F4/80 positive staining cells at day 3 and day 14 in the wild-type injured kidney as compared to the caveolin-1 knockout mouse.
Conclusion
Caveolin-1 knockout leads to a worse fibrosis upon unilateral ureteric obstruction. Caveolin-1 expression manipulation timing remains to be elucidated in reducing renal fibrosis.

Link to full-text [no password required]

Strategies for investigating the genetics of chronic kidney disease (2018)

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Type of publication:
Journal article

Author(s):
*Chand S.

Citation:
Scientific Journal of Genetics and Gene Therapy. 2018 July 4(1): 004-006.

Abstract:
This short review describes the strategies employed for investigating genetic variation in chronic kidney disease as well as highlighting potential shortfalls that should be overcome in future studies.

Link to full-text [no password required]

Caveolin-1 in renal disease (2018)

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Type of publication:
Journal article

Author(s):
*Chand S.

Citation:
Scientific Journal of Genetics and Gene Therapy. 2018 July: 007-014.

Abstract:
Caveolin-1 is the essential structural formation for lipid raft formation. It has been ascribed to several
disease processes in humans due to its ubiquitous distribution. Patients with chronic kidney disease suffer
great morbidity and mortality where manipulation of caveolin-1 could lead to new potential therapeutic
targets in this patient group. This review highlights caveolin-1 structure, signalling and provides examples
of studies of caveolin-1 single nucleotide polymorphism in chronic kidney disease.

Link to full-text [no password required]

Risk Prediction for Acute Kidney Injury in Acute Medical Admissions in the UK (2019)

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Type of publication:
Journal article

Author(s):
The RISK investigators [including *Chand, S ]

Citation:
QJM: An International Journal of Medicine, Volume 112, Issue 3, March 2019, Pages 197–205

Abstract:
Background
Acute Kidney Injury (AKI) is associated with adverse outcomes; therefore identifying patients who are at risk of developing AKI in hospital may lead to targeted prevention.

Aim
We undertook a UK-wide study in acute medical units (AMUs) to define those who develop hospital-acquired AKI (hAKI); to determine risk factors associated with hAKI and to assess the feasibility of developing a risk prediction score.

Design
Prospective multi-centre cohort study across 72 AMUs in the UK.

Methods
Data collected from all patients who presented over a 24-h period. Chronic dialysis, community-acquired AKI (cAKI) and those with fewer than two creatinine measurements were excluded. Primary outcome was the development of h-AKI.

Results
Two thousand four hundred and fourty-six individuals were admitted to the seventy-two participating centres. Three hundred and eighty-four patients (16%) sustained AKI of whom two hundred and eighty-seven (75%) were cAKI and ninety-seven (25%) were hAKI. After exclusions, chronic kidney disease [Odds Ratio (OR) 3.08, 95% Confidence Interval (CI) 1.96–4.83], diuretic prescription (OR 2.33, 95% CI 1.5–3.65), a lower haemoglobin concentration and elevated serum bilirubin were independently associated with development of hAKI. Multi-variable model discrimination was only moderate (c-statistic 0.75).

Conclusions
AKI in AMUs is common and associated with worse outcomes, with the majority of cases community acquired. Only a small proportion of patients develop hAKI. Prognostic risk factor modelling demonstrated only moderate discrimination implying that widespread adoption of such an AKI clinical risk score across all AMU admissions is not currently justified. More targeted risk assessment or automated methods of calculating individual risk may be more appropriate alternatives.

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Risk-Based Maintenance of Medical Devices for use with Humans (2018)

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Type of publication:
Dissertation

Author(s):
*Nigel Watkinson

Citation:
University of Derby

Abstract:
Medical devices continue to increase in quantity and complexity, and as they have a direct correlation with human health and safety their correct use and operation is paramount. This includes effective maintenance to retain serviceability and extend service life. Hospital Clinical Engineering departments are responsible for developing and operating Equipment Management Programs to ensure the safety and reliability of devices whilst optimising lifecycle costs for the organisation. Maintenance of engineering assets traditionally involves following manufacturers predetermined servicing activity at fixed intervals; however, alternative approaches have been employed in many engineering industries to optimise maintenance management resources with reduced risk. Risk-based maintenance (RBM) strategies being the most recent development are evaluated in this paper to consider their appropriateness with medical devices in UK hospitals. A mixed methods approach is used for the research study with a literature review of RBM in engineering industries, analysis of a survey of 74 UK medical engineering professionals and equipment service data
from local organisation. The current and future position of RBM is discussed including development of RBM methodology to be employed with medical devices in UK hospitals.

The study identifies strong endorsement of RBM principles by medical engineering professionals, including widespread employment of RBM, yet with no standardisation. Opposition to RBM is also encountered in favour of traditional approaches with variations in attitude to risk. Recommendations include collaboration of UK professionals for further research and development of medical device specific RBM with standardisation of methodology and approach with engagement of healthcare regulatory authorities.

A comparison of follow-up rates of women with gestational diabetes before and after the updated National Institute for Health and Care Excellence guidance advocating routine follow-up, and the association with neighbourhood deprivation (2019)

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Type of publication:
Journal article

Author(s):
Sebastian Walsh, Mahmoud Mahmoud, Htwe Htun, *Sheena Hodgett, *David Barton

Citation:
British Journal of Diabetes 2019;19:[epub ahead of publication]

Abstract:
Background: Gestational diabetes mellitus (GDM) occurs in one in every 23 UK pregnancies. GDM identifies the mother as high-risk for development of type 2 diabetes. The National Institute for Health and Care Excellence (NICE) published updated guidance in February 2015 recommending routine follow-up of women with GDM.

Aims: This cohort study compared follow-up rates of women with GDM before and after the updated guidance. We also investigated for an association between follow-up rates and deprivation.

Methods: Participants were identified from the database of the GDM service of two English hospitals and were organised into two cohorts: ‘pre-guidance’ (2012–2015) and ‘post-guidance’ (2015–2016). Using the recommendations of the NICE guidance as the follow-up standard, we used the hospitals’ computer system to compare follow-up rates of the two cohorts. The English Indices of Deprivation split the country into 32,844 small areas and rank them in order of deprivation such that 1 is the most deprived area and 32,844 is the least deprived. We compared the patients’ postcodes against the English Indices of Deprivation to investigate the relative levels of neighbourhood deprivation of those followed up compared with those not followed up. The Z statistic was used to test for statistical significance.

Results: 535 participants were included (pre-guidance n=306, post-guidance n=229). Baseline average age (pre-guidance 32.2 years, post-guidance 32.5 years), body mass index (30.7 kg/m2, 30.9 kg/m2) and fasting glucose (4.9 mmol/L, 4.8 mmol/L) were all comparable between cohorts. The follow-up rate improved from 60.5% in the pre-guidance group to 69.9% in the post-guidance group. The median deprivation rank of those followed up was 14,565 compared with 13,393 in those not followed up. This difference was not found to be significant.

Conclusion: A higher proportion of women with GDM were followed up with screening for type 2 diabetes after the updated NICE guidance in 2015 recommended routine follow-up. Across the study, over a third of women were not followed up. There was no statistically significant difference in the deprivation levels of those women followed up compared with those not followed up.

TPS-calculated vs. measured dose around a prosthetic hip implant (2018)

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Type of publication:
Poster presentation

Author(s):
*Maryke Fox, *Mike Alexander

Citation:
IPEM Medical Physics & Engineering Conference & Biennial Radiotherapy Meeting Proceedings, York, UK. September 2018

Abstract:
An increasing number of patients presenting for prostate radiotherapy have prosthetic hips. It is well known
that modern treatment planning systems are unable to accurately model dose in the vicinity of high density
prostheses. This work sought to characterise how dose is modelled by the Eclipse TPS around a hip prosthesis in a water phantom by comparing the modelled dose with dose measured by a Farmer chamber and find estimate dose due to scatter. Transmission, lateral scatter and back scatter were measured at a range of distances from the prosthesis and compared to the Eclipse modelled dose. It was found that dose distal to the prosthesis was underestimated by over 20%, backscatter was not modelled at all by Eclipse but lateral scatter was adequately modelled. The dose due to backscatter and lateral scatter from the prosthesis were not significant contributors to dose. These results indicate that planners should avoid treating through prosthetic hips, and that dose due to scatter was unlikely to cause ill effects.

Link to poster [PDF]

Cleavage stage or blastocyst transfer- Which is better? (2019)

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Type of publication:
Book chapter

Author(s):
*Jason Kasraie

Citation:
Kasraie, J. (2019). Cleavage Stage or Blastocyst Transfer: Which Is Better? In G. Kovacs & L. Salamonsen (Eds.), How to Prepare the Endometrium to Maximize Implantation Rates and IVF Success (pp. 91-103). Cambridge: Cambridge University Press.

Abstract:
Embryo transfer is the last step in the IVF treatment cycle, yet the one with the highest failure rate. This book provides a practical review of all aspects of endometrial receptivity, including histological, hormonal, biochemical and immunological, to enable specialists to make evidence-based decisions that influence success rates.

Link to more details