Breast cancer surgery without suction drainage and impact of mastectomy flap fixation in reducing seroma formation (2017)

Type of publication:
Conference abstract

Author(s):
*Zaidi S.; *Hinton C.

Citation:
European Journal of Surgical Oncology; May 2017; vol. 43 (no. 5)

Abstract:
Background: One of the most invalidating complications after breast cancer surgery is seroma formation. The incidence of seroma formation after breast surgery varies from 3% to 85%. Seroma formation and inadequate drainage of seroma may lead to infections, pain, hospitalization and delay in treatment. Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants. Aim: To determine the effect of a ‘no drains’ policy on seroma formation and other complications in women undergoing breast cancer surgery and to evaluate the effect of obliteration of dead space by suture fixation of the mastectomy flaps to the underlying chest wall, on the amount and duration of postoperative fluid drainage and incidence of seroma formation after breast surgery. Materials and methods: A retrospective analysis was performed on a consecutive series of patients that had been treated with mastectomy with or without axillary surgery for breast cancer for the last 1 year. Patients divided into Group 1 the wound was closed in the conventional method at the edges and closed suction drains are used. Group 2; after completing the mastectomy procedure, using absorbable sutures (vicryl), continuous stitches 3 cm apart were taken, in rows, between the subcutaneous tissues of the skin flaps and the underlying muscles. Special attention is taken to the obliteration of the largest potential dead space, the empty axillary apex. Closed suction drains are used. Group 3 similar procedure but no drain used. The patient characteristics collected were: age, type of surgery, side of the affected breast, neoadjuvant chemotherapy, diabetes, body mass index (BMI), smoking, anticoagulants usage and length of hospital stay. Definitions: Postoperative haematoma: clear postoperative haematoma formation in the area of the operation, for which intervention is necessary. Wound infection: clinical signs of infection (pain, swelling, erythema, fever, exudate, delayed wound healing or breakdown), purulent discharge or a positive microbiological culture. Seroma production: palpable fluid collection, with serous consistency, produced subcutaneous in the area of operation or axilla Results: 113 women were included in the study. Women underwent modified radical mastectomy (MRM) and ALND , MRM +/- sentinel lymph node biopsy (SLNB) /axillary node sampling (ANS) and simple Mx. There was no significant difference between the studied groups concerning the age, type of surgery, side of the affected breast, neoadjuvant chemotherapy, diabetes, body mass index (BMI), smoking, anticoagulants usage. There were six patients with evacuation of haematoma postoperatively and belong to group 1 and 2 with drains. The number (and percentage) of women with wound infection was none in the group 1, 8 in gp 2 and 2 among gp 3 patients. Seroma formation was 10 in gp 1, 9 in gp 2 and 4 in gp 3. The length of hospital stays (days) was 2.7 in gp 1, 2.6 in gp 2 and 1.3 days in gp 3 patients with no drains (ND). Conclusion: This study investigated that wound drainage following mastectomy could be avoided by suturing flaps to the underlying chest wall, thereby facilitating early discharge with no associated increase in surgical morbidity. This study suggests that MRM +/- ALND/SLNB/ANS can be performed without the use of suction drains without increasing seroma formation and other complication rates. Adopting a ‘nodrains’ policy may also contribute to earlier hospital discharge.

Link to full-text: http://www.ejso.com/article/S0748-7983(17)30225-1/abstract

Term admissions to neonatal units in England: A role for transitional care? A retrospective cohort study (2017)

Type of publication:
Journal article

Author(s):
Battersby C.; Michaelides S.; Upton M.; Rennie J.M.; Babirecki M.; Harry L.; Rackham O.; Wickham T.; Hamdan S.; Gupta A.; Wigfield R.; Wong L.; Mittal A.; Nycyk J.; Simmons P.; Singh A.; Seal S.; Hassan A.; Schwarz K.; Thomas M.; Foo A.; Shastri A.; Whincup G.; Brearey S.; Chang J.; Gad K.; Hasib A.; Garbash M.; Allwood A.; Adiotomre P.; Ahmed J.S.; Deketelaere A.; Khader K.A.; Shephard R.; Mallik A.; Abuzgia B.; Jain M.; Pirie S.; Zengeya S.; Watts T.; Jampala C.; Seagrave C.; Cruwys M.; Dixon H.; Aladangady N.; Gaili H.; James M.; Lal M.; Ambadkar; Rao P.; Hickey A.; Dave D.; Pai V.; Lama M.; Miall L.; Cusack J.; Kairamkonda V.; Jayachandran; Kollipara; Kefas J.; Yoxall B.; Whitehead G.; Krishnamurthy; Soe A.; Misra I.; Pillay T.; Ali I.; Dyke M.; Selter M.; Panasa N.; Alsford L.; Spencer V.; Gupta S.; Nicholl R.; Wardle S.; McBride T.; Shettihalli N.; Adams E.; Babiker S.; Crawford M.; Gibson D.; Khashu M.; Toh C.; Hall M.; Sleight E.; Groves C.; Godambe S.; Bosman D.; Rewitzky G.; Banjoko O.; Kumar N.; Manzoor A.; Lopez W.; D’Amore A.; Mattara S.; Zipitis C.; De Halpert P.; Settle P.; Munyard P.; McIntyre J.; Bartle D.; Yallop K.; Fedee J.; Maddock N.; Gupta R.; *Deshpande S.; Moore A.; Godden C.; Amess P.; Jones S.; Fenton A.; Mahadevan; Brown N.; Mack K.; Bolton R.; Khan A.; Mannix P.; Huddy C.; Yasin S.; Butterworth S.; Edi-Osagie N.; Cairns P.; Reynolds P.; Brennan N.; Heal C.; Salgia S.; Abu-Harb M.; Birch J.; Knight C.; Clark S.; Van Sommen V.; Murthy V.; Paul S.; Kisat H.; Kendall G.; Blake K.; Kuna J.; Kumar H.; Vemuri G.; Rawlingson C.; Webb D.; Bird; Narayanan S.; Gane J.; Eyre E.; Evans I.; Sanghavi R.; Sullivan C.; Amegavie L.; Leith W.; Vasu V.; Gallagher A.; Vamvakiti K.; Eaton M.; Millman G.

Citation:
BMJ Open; May 2017; vol. 7 (no. 5)

Abstract:
Objective: To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design: Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting: All 163 neonatal units in England 2011-2013. Participants: 133 691 term babies born >=37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes: Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results: Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion: Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

Link to full-text: http://bmjopen.bmj.com/content/7/5/e016050

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Etest versus broth microdilution for ceftaroline MIC determination with Staphylococcus aureus: Results from PREMIUM, a European multicentre study (2017)

Type of publication:
Journal article

Author(s):
Canton R.; Morosini M.I.; Livermore D.M.; Diaz-Reganon J.; Rossolini G.M.; Verhaegen J.; Cartuyvels R.; Claeys G.; De Beenhouwer H.; Delmee M.; Denis O.; Glupczynski Y.; Leven G.; Melin P.; Pierard D.; Pagani L.; Arena F.; Luzzaro F.; Gesu G.P.; Serra R.; D’Argenio A.; Sarti M.; Pecile P.; Mazzariol A.; Biscaro V.; Manso E.; Catania M.R.; Giraldi C.; Stefani S.; Labonia M.; Aschbacher R.; Giammanco A.; Cristino M.; Sancho L.; Diogo J.M.; Ramalheira E.; Ramos H.; Pinheiro D.; Garcia-Castillo M.; Calvo J.; Oliver A.; Gimeno C.; Pascual A.; Quintano F.T.; Bartolome R.; Cisterna R.; Cercenado E.; Merino P.; Marco F.; Bou G.; Sanchez J.E.G.; Cilla G.; Iglesias M.R.; Droz S.; Frei R.; James D.; Mushtaq S.; Howe R.; Paton R.; Gould K.; Eyre A.; Jepson A.; Swann A.; Weston D.; *Harvey G.; Humphrey H.

Citation:
Journal of Antimicrobial Chemotherapy; 2017; vol. 72 (no. 2); p. 431-436

Abstract:
Objectives: To compare the concordance of ceftaroline MIC values by reference broth microdilution (BMD) and Etest (bioMerieux, France) for MSSA and MRSA isolates obtained from PREMIUM (D372SL00001), a European multicentre study. Methods: Ceftaroline MICs were determined by reference BMD and by Etest for 1242 MSSA and MRSA isolates collected between February and May 2012 from adult patients with community-acquired pneumonia or complicated skin and soft tissue infections; tests were performed across six European laboratories. Selected isolates with ceftaroline resistance in broth (MIC >1 mg/L) were retested in three central laboratories to confirm their behaviour. Results: Overall concordance between BMD and Etest was good, with >97% essential agreement and >95% categorical agreement. Nevertheless, 12 of the 26 MRSA isolates found resistant by BMD scored as susceptible by Etest, with MICs <1 mg/L, thus counting as very major errors, whereas only 5 of 380 MRSA isolates found ceftaroline susceptible in BMD were miscategorized as resistant by Etest. Twenty-one of the 26 isolates with MICs of 2 mg/L by BMD were then retested twice by each of three central laboratories: BMD MICs of 2 mg/L were consistently found for 19 of the 21 isolates. Among 147 Etest results for these 21 isolates (original plus six repeats per isolate) 112 were >1 mg/L. Conclusions: BMD and Etest have good overall agreement for ceftaroline against Staphylococcus aureus; nevertheless, reliable Etest based discrimination of the minority of ceftaroline-resistant (MIC 2 mg/L) MRSA is extremely challenging, requiring careful reading of strips, ideally with duplicate testing.

Link to full-text: jac.oxfordjournals.org/content/early/2016/10/19/jac.dkw442.full.pdf

End of Life Care Marriages in a Hospital setting (2017)

Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
Jules Lewis

Abstract:
Shrewsbury and Telford Hospital NHS Trust Staff have been working hard to have a clear process for when an End of Life Care Patient wishes to get married in Hospital.

Flowcharts have been designed for both Ward Staff and the Chaplaincy service to follow to ensure the process is done without confusion and nothing is forgotten at this special and emotional time, this includes required documentation for special licence and contact details of people who will be able to assist in and out of hours.

Both religious and civil services can be offered depending on the couples preference.

The end of life care team have created a wedding bag to assist the ward staff in making this day as special as possible, this includes bunting, a ring box, a wedding card, champagne glasses and fizz, confetti, pen, paper, a keepsake gift and the flow charts on the process.

The Ward staff together with the End of Life Care Team get flowers and cake on the big day.

Ward Staff even managed to get a photographer to capture the special day for the wedding earlier this year with our hospital photographer printing the photos for the couple next working day, the wedding even took place in our swan room which made it extra special.

Thank you to everyone involved in making this happen from the Registrar services, Hospital Chaplaincy Team, End of Life Care Team, Communications Team, Photographer, Ward Staff and to the Director of Corporate Governance.

Together we made it happen because it’s the right thing to do as we have one chance to get it right.

Link to more details

The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis (2016)

Type of publication:
Journal article

Author(s):
Carbone M., Sharp S.J., Flack S., Paximadas D., Spiess K., Adgey C., Griffiths L., Lim R., Trembling P., Williamson K., Wareham N.J., Aldersley M., Bathgate A., Burroughs A.K., Heneghan M.A., Neuberger J.M., Thorburn D., Hirschfield G.M., Cordell H.J., Alexander G.J., Jones D.E.J., Sandford R.N., Mells G.F., Jones D., Kirby J., Hirschfield G., Alexander G., Sandford R., Taylor-Robinson S., Ch’ng C.L., Rahman M., Yapp T., Sturgess R., Healey C., Czajkowski M., Gunasekera A., Gyawali P., Premchand P., Kapur K., Marley R., Foster G., Watson A., Dias A., Subhani J., Harvey R., McCorry R., Ramanaden D., Gasem J., Evans R., Mathialahan T., Shorrock C., Lipscomb G., Southern P., Tibble J., Gorard D., Palegwala A., Dawwas M., Dolwani S., Prince M., Foxton M., Elphick D., Mitchison H., Gooding I., Karmo M., Saksena S., Mendall M., Patel M., Ede R., Austin A., Sayer J., Hankey L., Hovell C., Fisher N., Carter M., Koss K., Piotrowicz A., Grimley C., Neal D., Lim G., Levi S., Ala A., Broad A., Saeed A., Wood G., Brown J., Wilkinson M., Gordon H., Ramage J., Ridpath J., Ngatchu T., Grover B., Shaukat S., Shidrawi R., Abouda G., Ali F., Rees I., Salam I., Narain M., Brown A., Williams S., Grellier L., Banim P., Chilton A., Curtis H., Gess M., Drake I., Davies M., Jones R., McNair A., Srirajaskanthan R., Pitcher M., Sen S., Bird G., Barnardo A., Kitchen P., Yoong K., Chirag O., Sivaramakrishnan N., MacFaul G., Shah A., Evans C., Saha S., Pollock K., Bramley P., Mukhopadhya A., Fraser A., Mills P., Shallcross C., Campbell S., Shepherd A., Dillon J., Rushbrook S., Przemioslo R., Macdonald C., Metcalf J., Shmueli U., Davis A., Naqvi A., Lee T., Ryder S.D., Collier J., Klass H., Ninkovic M., Cramp M., Sharer N., Aspinall R., Goggin P., Ghosh D., Douds A., Hoeroldt B., Booth J., Williams E., Hussaini H., Stableforth W., Ayres R., Marshall E., Mann S., Lombard M., Richardson P., Patanwala I., Maltby J., Brookes M., Mathew R., Vyas S., Singhal S., Gleeson D., Misra S., *Butterworth J., George K., Harding T., Douglass A., Panter S., Shearman J., Bray G., Butcher G., Forton D., Mclindon J., Das D., Cowan M., Whatley G., Mandal A., Gupta H., Sanghi P., Jain S., Pereira S., Prasad G., Watts G., Wright M., Gordon F., Unitt E., Grant A., Delahooke T., Higham A., Brind A., Cox M., Ramakrishnan S., King A., Collins C., Whalley S., Li A., Fraser J., Bell A., Wong V.S., Singhal A., Gee I., Ang Y., Ransford R., Gotto J., Millson C., Bowles J., Harrison M., Galaska R., Kendall J., Whiteman J., Lawlor C., Gray C., Elliott K., Mulvaney-Jones C., Hobson L., Van Duyvenvoorde G., Loftus A., Seward K., Penn R., Maiden J., Damant R., Hails J., Cloudsdale R., Silvestre V., Glenn S., Dungca E., Wheatley N., Doyle H., Kent M., Hamilton C., Braim D., Wooldridge H., Abrahams R., Paton A., Lancaster N., Gibbins A., Hogben K., Desousa P., Muscariu F., Musselwhite J., McKay A., Tan L., Foale C., Brighton J., Flahive K., Nambela E., Townshend P., Ford C., Holder S., Palmer C., Featherstone J., Nasseri M., Sadeghian J., Williams B., Thomas C., Rolls S.-A., Hynes A., Duggan C., Jones S., Crossey M., Stansfield G., MacNicol C., Wilkins J., Wilhelmsen E., Raymode P., Lee H.-J., Durant E., Bishop R., Ncube N., Tripoli S., Casey R., Cowley C., Miller R., Houghton K., Ducker S., Wright F., Bird B., Baxter G., Keggans J., Hughes M., Grieve E., Young K., D. Williams, Ocker K., Hines F., Innes C., Valliani T., Fairlamb H., Thornthwaite S., Eastick A., Tanqueray E., Morrison J., Holbrook B., Browning J., Walker K., Congreave S., Verheyden J., Slininger S., Stafford L., Denise O’Donnell, Ainsworth M., Lord S., Kent L., March L., Dickson C., Simpson D., Longhurst B., Hayes M., Shpuza E., White N., Besley S., Pearson S., Wright A., Jones L., Gunter E., Dewhurst H., Fouracres A., Farrington L., Graves L., Marriott S., Leoni M., Tyrer D., Martin K., Dali-kemmery L., Lambourne V., Green M., Sirdefield D., Amor K., Colley J., Shinder B., Jones J., Mills M., *Carnahan M., Taylor N., Boulton K., Tregonning J., Brown C., Clifford G., Archer E., Hamilton M., Curtis J., Shewan T., Walsh S., Warner K., Netherton K., Mupudzi M., Gunson B., Gitahi J., Gocher D., Batham S., Pateman H., Desmennu S., Conder J., Clement D., Gallagher S., Orpe J., Chan P., Currie L., Lynn O’Donohoe, Oblak M., Morgan L., Quinn M., Amey I., Baird Y., Cotterill D., Cumlat L., Winter L., Greer S., Spurdle K., Allison J., Dyer S., Sweeting H., Kordul J.

Citation:
Hepatology, March 2016, vol./is. 63/3(930-950)

Abstract:
The biochemical response to ursodeoxycholic acid (UDCA)-so-called “treatment response”-strongly predicts long-term outcome in primary biliary cholangitis (PBC). Several long-term prognostic models based solely on the treatment response have been developed that are widely used to risk stratify PBC patients and guide their management. However, they do not take other prognostic variables into account, such as the stage of the liver disease. We sought to improve existing long-term prognostic models of PBC using data from the UK-PBC Research Cohort. We performed Cox’s proportional hazards regression analysis of diverse explanatory variables in a derivation cohort of 1,916 UDCA-treated participants. We used nonautomatic backward selection to derive the best-fitting Cox model, from which we derived a multivariable fractional polynomial model. We combined linear predictors and baseline survivor functions in equations to score the risk of a liver transplant or liver-related death occurring within 5, 10, or 15 years. We validated these risk scores in an independent cohort of 1,249 UDCA-treated participants. The best-fitting model consisted of the baseline albumin and platelet count, as well as the bilirubin, transaminases, and alkaline phosphatase, after 12 months of UDCA. In the validation cohort, the 5-, 10-, and 15-year risk scores were highly accurate (areas under the curve: >0.90). Conclusions: The prognosis of PBC patients can be accurately evaluated using the UK-PBC risk scores. They may be used to identify high-risk patients for closer monitoring and second-line therapies, as well as low-risk patients who could potentially be followed up in primary care.

Link to full-text (access available to eligible users via an NHS OpenAthens account)

Outcomes of two trials of oxygen-saturation targets in preterm infants (2016)

Type of publication:
Journal article

Author(s):
Tarnow-Mordi W., Stenson B., Kirby A., Juszczak E., Donoghoe M., *Deshpande S., Morley C., King A., Doyle L.W., Fleck B.W., Davis P.G., Halliday H.L., Hague W., Cairns P., Darlow B.A., Fielder A.R., Gebski V., Marlow N., Simmer K., Tin W., Ghadge A., Williams C., Keech A., Wardle S.P., Kecskes Z., Kluckow M., Gole G., Evans N., Malcolm G., Luig M., Wright I., Stack J., Tan K., Pritchard M., Gray P.H., Morris S., Headley B., Dargaville P., Simes R.J., Brocklehurst P.

Citation:
New England Journal of Medicine, February 2016, vol./is. 374/8(749-760)

Abstract:
BACKGROUND The safest ranges of oxygen saturation in preterm infants have been the subject of debate. METHODS In two trials, conducted in Australia and the United Kingdom, infants born before 28 weeks’ gestation were randomly assigned to either a lower (85 to 89%) or a higher (91 to 95%) oxygen-saturation range. During enrollment, the oximeters were revised to correct a calibration-algorithm artifact. The primary outcome was death or disability at a corrected gestational age of 2 years; this outcome was evaluated among infants whose oxygen saturation was measured with any study oximeter in the Australian trial and those whose oxygen saturation was measured with a revised oximeter in the U.K. trial. RESULTS After 1135 infants in Australia and 973 infants in the United Kingdom had been enrolled in the trial, an interim analysis showed increased mortality at a corrected gestational age of 36 weeks, and enrollment was stopped. Death or disability in the Australian trial (with all oximeters included) occurred in 247 of 549 infants (45.0%) in the lower-target group versus 217 of 545 infants (39.8%) in the higher-target group (adjusted relative risk, 1.12; 95% confidence interval [CI], 0.98 to 1.27; P = 0.10); death or disability in the U.K. trial (with only revised oximeters included) occurred in 185 of 366 infants (50.5%) in the lower-target group versus 164 of 357 infants (45.9%) in the higher-target group (adjusted relative risk, 1.10; 95% CI, 0.97 to 1.24; P = 0.15). In post hoc combined, unadjusted analyses that included all oximeters, death or disability occurred in 492 of 1022 infants (48.1%) in the lower-target group versus 437 of 1013 infants (43.1%) in the higher-target group (relative risk, 1.11; 95% CI, 1.01 to 1.23; P = 0.02), and death occurred in 222 of 1045 infants (21.2%) in the lower-target group versus 185 of 1045 infants (17.7%) in the higher-target group (relative risk, 1.20; 95% CI, 1.01 to 1.43; P = 0.04). In the group in which revised oximeters were used, death or disability occurred in 287 of 580 infants (49.5%) in the lower-target group versus 248 of 563 infants (44.0%) in the higher-target group (relative risk, 1.12; 95% CI, 0.99 to 1.27; P = 0.07), and death occurred in 144 of 587 infants (24.5%) versus 99 of 586 infants (16.9%) (relative risk, 1.45; 95% CI, 1.16 to 1.82; P = 0.001). CONCLUSIONS Use of an oxygen-saturation target range of 85 to 89% versus 91 to 95% resulted in nonsignificantly higher rates of death or disability at 2 years in each trial but in significantly increased risks of this combined outcome and of death alone in post hoc combined analyses. (Funded by the Australian National Health and Medical Research Council and others; BOOST-II Current Controlled Trials number, ISRCTN00842661, and Australian New Zealand Clinical Trials Registry number, ACTRN12605000055606.).

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00006024-201602250-00011&LSLINK=80&D=ovft

Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: Case report (2014)

Type of publication:
Journal article

Author(s):
*Papoutsis D., *El-Attabi N., *Sizer A.

Citation:
Clinical and Experimental Obstetrics and Gynecology, 2014, vol./is. 41/3(351-353), 0390-6663 (2014)

Abstract:
This is the second case in literature of posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia. A 27-year-old primigravida with dichorionic diamniotic twin pregnancy was admitted at 36 weeks of gestation for induction of labour due to preeclampsia. On the second day postpartum, the patient developed severe hypertension, visual symptoms, confusion, headache, and eclamptic fits. Head computed tomography (CT) showed hypodense basal ganglia lesions. The patient was treated in the intensive treatment unit with hydralazine and labetalol infusions and anticonvulsants. Five days later, there was complete clinical improvement and follow-up magnetic resonance imaging (MRI) was normal. The patient was discharged 11 days post-delivery. Diagnosis of PRES is based on the presence of clinical features of acute neurologic compromise, abnormal neuroimaging findings, and complete reversibility of findings after prompt treatment. Early recognition and proper treatment result in complete reversibility of this condition.

 

Top 15 research priorities for preterm birth with clinicians and service users’ involvement-outcomes from a james lind alliance priority setting partnership (2014)

Type of publication:
Conference abstract

Author(s):
Uhm S., Alderdice F., Chambers B., Gyte G., Gale C., Duley L., James C.P., David A.L., McNeill J., Turner M.A., Shennan A., *Deshpande S., Crowe S., Chivers Z., Brady I., Oliver S.

Citation:
Archives of Disease in Childhood: Fetal and Neonatal Edition, June 2014, vol./is. 99/(A158), 1359-2998 (June 2014)

Abstract:
Background Preterm birth is the single most important determinant of adverse infant outcomes in terms of survival, quality of life, psychosocial and emotional impact on the family, and health care costs. Research agenda in this area has been determined primarily by researchers, and the processes for priority setting in research have often lacked transparency. Objectives To identify 15 most important priorities for future research for practitioners and service users in the area of preterm birth. Methods A priority setting partnership was established by involving clinicians, adults who were born preterm, and parents and families with experience of preterm birth. Research uncertainties were gathered from surveys of service users and clinicians, and analyses of systematic reviews and clinical guidance, and then prioritised in a transparent process, using a methodology advocated by the James Lind Alliance. Results 593 uncertainties were submitted by 386 respondents and 52 were identified from literature reviews. After merging similar questions, a long list of 104 questions were distributed for voting. The 30 most popular items were then prioritised at a workshop. The top 15 research priorities included prevention of preterm birth, management of neonatal infection, necrotising enterocolitis, pain and lung damage, care package at discharge, feeding strategies, pre-eclampsia, emotional and practical support, attachment and bonding, premature rupture of membranes and best time for cord clamping. Conclusions These top research priorities in preterm birth provide guidance for researchers and funding bodies to ensure that future research addresses questions that are important to both clinicians and service users.

Link to more details or full-text: http://fn.bmj.com/content/99/Suppl_1/A158.1.abstract