Staff Publication

Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party. (2018)

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Type of publication:
Journal article

Author(s):
Hawkey, Peter M; *Warren, Roderic E; Livermore, David M; McNulty, Cliodna A M; Enoch, David A; Otter, Jonathan A; Wilson, A Peter R

Citation:
Journal of Antimicrobial Chemotherapy; Mar 2018; vol. 73 ; p. iii2

Abstract:
The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed. The treatment options available in hospitals using intravenous antibiotics and in primary care using oral agents have been reviewed, ending with a consideration of antibiotic stewardship and recommendations. The guidance has been derived from current peer-reviewed publications and expert opinion with open consultation. Methods for systematic review were NICE compliant and in accordance with the SIGN 50 Handbook; critical appraisal was applied using AGREE II. Published guidelines were used as part of the evidence base and to support expert consensus. The guidance includes recommendations for stakeholders (including prescribers) and antibiotic-specific recommendations. The clinical efficacy of different agents is critically reviewed. We found there are very few good-quality comparative randomized clinical trials to support treatment regimens, particularly for licensed older agents. Susceptibility testing of MDR GNB causing infection to guide treatment needs critical enhancements. Meropenem- or imipenem-resistant Enterobacteriaceae should have their carbapenem MICs tested urgently, and any carbapenemase class should be identified: mandatory reporting of these isolates from all anatomical sites and specimens would improve risk assessments. Broth microdilution methods should be adopted for colistin susceptibility testing. Antimicrobial stewardship programmes should be instituted in all care settings, based on resistance rates and audit of compliance with guidelines, but should be augmented by improved surveillance of outcome in Gram-negative bacteraemia, and feedback to prescribers. Local and national surveillance of antibiotic use, resistance and outcomes should be supported and antibiotic prescribing guidelines should be informed by these data. The diagnosis and treatment of both presumptive and confirmed cases of infection by GNB should be improved. This guidance, with infection control to arrest increases in MDR, should be used to improve the outcome of infections with such strains. Anticipated users include medical, scientific, nursing, antimicrobial pharmacy and paramedical staff where they can be adapted for local use.

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A rare presentation of haematuria: hip prosthesis in the bladder (2018)

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Type of publication:
Journal article

Author(s):
*Phan, Yih Chyn; *Eli, Nnaemeka; *Pillai, Praveen; *O'Dair, Jonathan

Citation:
BMJ case reports; Mar 2018; vol. 2018

Abstract:
An 80-year-old woman presented to our department with visible haematuria and stage II acute kidney injury (AKI). She had stage IIB cervical cancer, for which she received chemotherapy and external beam radiotherapy in 2003. Four years later, she had a left dynamic hip screw for an extracapsular neck of femur fracture following a fall. In 2010, she underwent a right total hip replacement owing to osteoarthritis, and it was subsequently revised in 2012 owing to a right acetabular component failure. In this admission, her AKI improved with intravenous fluid administration and her haematuria settled following catheterisation with a three-way catheter and bladder irrigation with saline. She underwent a flexible cystoscopy which revealed that a part of her right hip prosthesis was in the bladder, having eroded through the right bony pelvis. However, she declined any surgical interventions.

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Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair (2018)

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Type of publication:
Journal article

Author(s):
Braunstein, Mareen; Baumbach, Sebastian F; Boecker, Wolfgang; *Carmont, Mike R; Polzer, Hans

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA; Mar 2018; vol. 26 (no. 3); p. 846-853

Abstract:
PURPOSE Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair. METHODS A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included. RESULTS One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. CONCLUSION Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician. LEVEL OF EVIDENCE II.

The paediatrician and the management of common gynaecological conditions (2018)

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Type of publication:
Journal article

Author(s):
*Ritchie, Joanne K; Latthe, Pallavi; Jyothish, Deepthi; Blair, Joanne C

Citation:
Archives of disease in childhood; Jul 2018, 103(7), p. 703-706

Abstract:
Paediatric gynaecology is an emerging discipline. Since 2000, there has been an advanced training programme in paediatric gynaecology available for obstetric and gynaecology trainees; additionally, a set of clinical standards1 for the care of paediatric and adolescent patients has been developed by The British Society of Paediatric and Adolescent Gynaecology (BritSPAG). BritSPAG is a multidisciplinary group of professionals including gynaecologists, paediatricians, paediatric urologists and endocrinologists.Girls with gynaecological conditions are often seen in general paediatric services; it is important that those assessing them are confident in identifying patients who require more specialist care. Despite this, gynaecology does not appear in the Royal College of Paediatrics and Child Health curriculum. This article aims to increase the knowledge base and confidence of paediatricians in dealing with common paediatric and adolescent gynaecological conditions.

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Psychosexual outcomes in women of reproductive age at more than two-years from excisional cervical treatment - a cross-sectional study (2019)

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Type of publication:
Journal article

Author(s):
Sparić, Radmila; *Papoutsis, Dimitrios; Kadija, Saša; Stefanović, Radomir; *Antonakou, Angeliki; Nejković, Lazar; Kesić, Vesna

Citation:
Journal of Psychosomatic Obstetrics and Gynaecology; Apr 2019; vol. 40 (no. 2); p. 128-137

Abstract:
PURPOSE To investigate the long-term psychosexual outcomes in women following excisional cervical treatment. MATERIALS AND METHODS Women with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) treatment were interviewed after a follow-up colposcopy visit. Their demographics, treatment and psychosexual characteristics were recorded. RESULTS One hundred and forty six women with a mean age of 35.2 ± 5.4 years underwent either LLETZ (68.5%) or CKC (31.5%) treatment within 4.7 ± 2.7 years (range: 2-15) before the interview. 27.4% of women were less interested in sexual intercourse following treatment in comparison with their interest before. Those women with less interest in sexual intercourse after treatment had higher anxiety and depression scores and were more worried about disease progression. Women with post-treatment complications were at risk of less interest in sexual intercourse and of greater anxiety and depression. Women with abnormal smears at follow-up were at risk of greater anxiety. The type of treatment and grade of dysplasia did not affect their interest in sexual intercourse or the anxiety and depression scores. CONCLUSIONS Approximately, one-third of women at more than two years posttreatment may suffer from less interest in sexual intercourse, have relatively greater anxiety and depression, and might still be concerned about the possibility of disease progression.

Adult asthma: what community nurses should know (2018)

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Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Feb 2018; vol. 32 (no. 1); p. 48-53

Abstract:
Asthma is a common lung condition affecting many patients in the community. Nurses are pivotal in the diagnosis and management of people with both stable disease and during I acute flare-ups. Asthma reviews offer opportunities to build therapeutic relationships and optimise treatment, helping patients to recognise and plan management of an asthma attack. On average, three people die of asthma every day in the UK — a stark statistic which should encourage nurses to be forever watchful of opportunities to regularly review the evidence base and provide patient-centred care. This article focuses on the management of chronic adult asthma, at diagnosis, management, and briefly touches on assessment of the acute exacerbation. The key differences between the asthma guidelines of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGKr < 2016) and the National Institute for Health and Care Excellence (NICE, 2017) guidelines, which are currently in use in the UK, are presented for reader consideration.

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What’s in a name: friend or foe? Coping strategies used by stoma patients (2018)

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Type of publication:
Journal article

Author(s):
*Powell, Julie

Citation:
British Journal of Nursing; Mar 2018; vol. 27 (no. 5) S22

Abstract:
The article examines how stoma patients chose to name their stoma and discusses how this can inform medical professionals' understanding of patient experiences. It provides examples of patients who named stoma after common first names or after television characters and explores the success of such coping strategies.

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Optimising patient experience within the ACHD outreach network: A questionnaire based study (2018)

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Type of publication:
Conference abstract

Author(s):
Ooues G.; Clift P.; Bowater S.; Arif S.; Hawkesford S.; Pope N.; Anthony J.; Gaffey T.; Thorne S.; Hudsmith L.; Epstein A.; Prasad N.; Adamson D.; Cummings M.; Spencer C.; Woodmansey P.; *Ingram T.; Morley-Davies A.; Roberts W.; Qureshi N.

Citation:
Heart; Feb 2018; vol. 104, Suppl 2, A12

Abstract:
Purpose The NHS England Congenital Heart Disease standards review is based on a network model to deliver high quality, safe and effective services as locally as possible. We developed a Patient Questionnaire across our Adult Congenital Heart Disease (ACHD) West Midlands network to measure patient experience, satisfaction and to improve services across the network. Methods Patient questionnaires were distributed to patients in all 8 Outreach and the Level 1 ACHD Centre (University Hospital Birmingham). Data was analysed including patients' replies on travel to outpatient clinic, satisfaction on location and timing of their appointment, review by ACHD Specialist Nurse and tests performed, information on their condition and leaflets provided and patients' demographics. Results 130 questionnaires were returned. The majority of patients (67%, n=87) travelled to their appointment with their own car, either alone (36%, n=46) or with a member of their family (44%, n=56). Most patients (93%, n=120) travelled less than one hour to hospital and less than 20 miles (86%, n=99). Patients attending Level 1 Centre appointments travelled a longer distance (mean 29.6+/-44 miles) compared to the Outreach Centres (mean 9.9+/-2.8 miles). Almost all patients found the appointment time and location convenient for them (91%, n=117% and 95%, n=121), and were given enough information regarding their condition (85%, n=98). Conclusion With the development of ACHD Network Outreach clinics to facilitate services and appointments closer to patients' homes, travel times are reduced and high patient satisfaction is maintained.

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Feasibility of performing MRI prostate before prostate biopsy in a district general hospital in the UK (2017)

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Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Loh A.; *Anandakumar A.; *Umranikar S.; *Lynn N.

Citation:
Journal of Endourology; Sep 2017; vol. 31, S2

Abstract:
Introduction & Objective: Men with abnormal digital rectal examination or raised PSA usually undergo
transrectal ultrasound (TRUS) prostate biopsies. NICE guidelines do not recommend routine MRI prostate before prostate biopsy unless they have a previous negative prostate biopsy. However, all men with positive prostate biopsies will have MRI prostates. The recent publication of PROMIS (Prostate MR Imaging Study) trial suggests that MRI prostate can reduce unnecessary biopsies by a quarter and can improve detection of clinically significant cancer. In light of this, we would like to determine if performing MRI prostate before biopsy is likely to increase workload in our radiology department in a district general hospital in the UK. Materials and Methods: Patients who underwent TRUS prostate biopsy between 3 Dec 2015 to 28 April 2016 were identified. Their data were analysed retrospectively. 1 year follow-up was chosen to see how many patients would have had MRIs. Results: 173 patients were listed for prostate biopsies but only 158 patients had biopsies with an average age of 69.8 years old (range: 49-88 years old) and an average PSA of 48.1ug/l (range: 0.5-3283.1ug/l). 57 patients had a negative prostate biopsy during this period. 30/57 patients did not have a MRI at all; 12/57 patients had a MRI after biopsy; 1/57 patient had a MRI as an acute setting after biopsy to look for abscesses; and 14/57 patients had a MRI before biopsy. Conclusions: In our study, 30/158 (19.0%) did not have any MRI prostate in 1 year after their first prostate biopsy. However, it is possible that this group of patients will have a MRI prostate in the second year or later. If we were to perform a MRI prostate before TRUS prostate biopsy for all patients, it would increase 19.0% workload for our radiology department.