Staff Publication

Group pre-assessment for patients undergoing chemotherapy: Our experience at The Royal Shrewsbury Hospital (2017)

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Type of publication:
Conference abstract

Author(s):
*Allos B.; *Redgrave R.; *Davies W.; *Chatterjee A.

Citation:
Lung Cancer; Jan 2017; vol. 103, Supplement 1, Page S47

Abstract:
Introduction: Waiting time targets in England and Wales state cancer treatment must commence within 31 days of the treatment plan being agreed. Often, pressures on chemotherapy units, such as low staffing levels and capacity, delays starting chemotherapy. This may impact outcomes. To improve capacity and waiting times we have implemented group pre-assessment (GPAC) for all prospective chemotherapy patients at our trust. Methods: Previously each patient received a 1-hour pre-assessment appointment with a dedicated nurse. For non-urgent patients we have established GPAC clinics since January 2014. These are run three times a week by volunteers in conjunction with one chemotherapy nurse and accommodate 6 patients per session. Patients watch a 25-minute DVD providing general information on chemotherapy in addition to introducing the unit, nurses and general treatment procedures. A unit tour follows this. Each patient receives a diagnosis-specific  tumour pack and the session concludes with a 10-minute one-to-one meeting with a nurse to discuss their personal treatment regime. Results: We pre-assess up to 18 patients a week via GPAC. Since implementation we have reduced nursing hours needed for this service to a maximum of 6 hours per week. From September 2015 to August 2016 a total of 667 patients attended GPAC clinic with 312 nursing hours required. Our unit has consequently saved 355 nursing hours over that time period (Figure 1). Patient satisfaction with the service remains high with 24/25 (96%) of patients surveyed rating the service as good to excellent across five categories. With GPAC initiation, our average chemotherapy waiting time has reduced to 13 days from over 20 days. Conclusion: By initiating GPAC our department has significantly saved nursing hours allowing us to reallocate these to chemotherapy delivery and service development. With increased capacity to treat patients waiting times have been significantly reduced. This has not been to the detriment of patient satisfaction. (Table Presented).

Management and outcomes of patients with nonsmall cell lung cancer (NSCLC) and synchronous brain metastases: A multicentre retrospective review (2017)

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Type of publication:
Conference abstract

Author(s):
Cook M.; *Allos B.; O'Beirn M.; Jegannathen A.; Denley S.; Homer K.; Sabel L.; *Chatterjee A.; Koh P.

Citation:
Lung Cancer; Jan 2017; vol. 103, Supplement 1, Page S12

Abstract:
Introduction: 10-20% of patients presenting with NSCLC have synchronous brain metastases, conferring a 4.8 month median survival. Recently published QUARTZ trial data challenges the use of whole brain radiotherapy (WBRT) in older inoperable patients. We present a multicentre retrospective review of the management and survival outcomes of newly diagnosed NSCLC patients with synchronous brain metastases in the Greater Midlands. Methods: Patients diagnosed with NSCLC and synchronous brain metastases January 2014 to June 2015 were identified from five regional hospital lung multidisciplinary meetings. Data collected included patient demographics, performance status (PS), staging, histology, number/volume of brain metastases, initial management, subsequent therapeutic strategy and outcomes. Results: Of 758 newly presenting metastatic lung cancer patients identified, 51(6.7%) had biopsy-proven NSCLC and brain metastases, with demographic, diagnostic and management information presented below (Table 1). 35/51 (69%) patients presented symptomatically as inpatients. Median overall survival (OS) of all patients was 3.4 (range 0.4-41.6) months. In PS 0/1 patients, those age <60 had OS of 7.4 (1.6-32.2) months compared with 13.4 (0.9-30.5) months in patients age >=60. Of those receiving best supportive care (BSC), OS was 1.7 (0.4-3.0) months. Patients receiving initial WBRT had OS of 3.5 (0.8-32.2) months, with those surviving >12 months also receiving  systemic therapy. Patients receiving surgery then WBRT had OS of 6.8 months. Patients with EGFR/ALK sensitising tumours had notably increased median OS of 16.5 months. 83.3% received tyrosine kinase inhibitors after initial WBRT. (Table presented) Conclusion: NSCLC patients presenting with synchronous brain metastases have overall poor prognoses regardless of treatment strategy, in keeping with previously published data. Selected patients, namely those with low volume intracranial disease and good PS suitable for neurosurgery/systemic therapy, or those with sensitising mutations had improved outcomes regardless of age. Our data reiterates that careful and timely patient selection is imperative prior to consideration of aggressive  local and systemic therapy or WBRT as opposed to BSC.

Reduction-fixation of the fractured mandible: Which factors associate with a poor surgical outcome? (2017)

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Type of publication:
Conference abstract

Author(s):
*Mustafa E.; Hanu-Cernat L.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2015; vol. 53 (no. 10)

Abstract:
Introduction: Revision rates following open reduction-fixation of mandibular fractures are not widely reported. This study aims to identify fracture and occlusal patterns asso-ciated with operative difficulties and suboptimal outcomes requiring further surgical correction. Method: All patients who required revision reduction and fixation of mandible fractures at the University Hospital Coventry between November 2008 and December 2013 were identified from the theatre database. Patients treated beyond five weeks, requiring plate removal secondary to infection or those that underwent staged fixation of complex facial trauma were excluded. Radiographs, theatre entries and patient records were examinedtoidentify patient demographics, fracture patterns, operative technique and the grade of the operating surgeon. Results: The return to theatre rate in our series was 2.3% (12 cases out of 524). The need for re-intervention was primarily established on clinical grounds. Revisions were required in: 1. Patients non-compliant with diet modification advice. 2. Pre-existent class III malocclusion. 3. Condylar fractures failing conservative management. 4. Wisdom teeth or a dominant occluding molar left in the line of the fracture. 5. Dentoalveolar injury. 6. Inadequate reduction/fixation on first intervention. No correlation was noted with the timing of treatment or occlusal control. Conclusion: Cases that needed revision surgery were fairly stereotype in our series. Poor outcomes were associated with significant occlusal interferences (pre-existing malocclusions, dentoalveolar fractures or teeth retainedinthe line of fracture) and unstable fracture patterns. Awareness of these risk factors may help with the anticipation of operative difficulties and lead to improved treatment outcomes.

Normal acutely performed CT scan of the brain may give a false sense of safety prior to use of antiplatelets in transient focal (2017)

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Type of publication:
Conference abstract

Author(s):
*McNeela N.; *Srinivasan M.

Citation:
Cerebrovascular Diseases; Jul 2017; vol. 43 ; p. 116

Abstract:
Transient focal neurological episodes (TFNE) are frequently assumed to be transient ischaemic attacks (TIAs) in older patients who are then started on antiplatelets for stroke prevention. Imaging with a CT scan of the brain reported as normal or not suggesting haemorrhage can give a false sense of security with regard to therapeutic decision making. Current UK stroke guidelines do not emphasise the need for imaging (either CT or MRI) in transient ischaemic attacks with NICE guidance recommending treat with aspirin immediately and then refer to stroke services for further management. Imaging is then only recommended for patients where the vascular territory or pathology is uncertain with diffusion weighted MRI scans. In cases where MRI is contraindicated second line imaging is a CT head. We present two cases of patients who presented with symptoms of TFNEs treated as TIAs who then subsequently developed haemorrhagic strokes. The first case is of an 80 year old lady with new onset atrial fibrillation who presented with transient face and arm paraesthesia and dysarthria. Following a normal CT head she was started on anticoagulation and discharged home. She subsequently represented with a further two episodes and each time underwent a repeat imaging which again showed no abnormalities until she eventually succumbed to a massive right cortical intracranial haemorrhage. The second case involves a 68 year old gentleman with no significant past medical history other than a recent headache who presented with recurrent symptoms of left face and arm paraesthesia and dysarthria. A CT scan of the brain was normal and so he was treated with antiplatelets for a presumed TIA and discharged. However within six hours he deteriorated with dense left hemiplegia and reduced consciousness. A repeat CT showed a large right frontoparietal bleed with midline shift requiring referral to neurosurgeons. These cases highlight how a CT head in an acute presentation with transient symptoms can be misleading. One option would be consideration of blood sensing MRI scans in investigation of TFNE verses TIA diagnoses. As TFNEs often to present as descending paresthesia, we would recommend all patients with this presentation to undergo urgent inpatient MRI scans before being commenced on treatment.

Breathlessness at end of life: what community nurses should know (2017)

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Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Oct 2017; vol. 31 (no. 5); p. 74-77

Abstract:
The provision of end of life care is important core work for community nursing teams. Once end of life has been recognised, a focus on palliation of symptoms and an emphasis upon assisting people to 'live well until they die' becomes paramount. Breathlessness is a common distressing symptom for patients, significantly affecting their quality of life and is sometimes the cause of unnecessary admissions to hospital. This article explores the pathophysiology of breathing and breathlessness and offers some thoughts on history-taking and physical assessment, skills that nurses in advancing practice roles are now undertaking in the community setting to enhance the care they deliver to patients. This article aims to support community nurses to gain knowledge to inform the provision of effective evidence-based care and assist patients and their families to manage breathlessness at end of life.

Interleukin-17-positive mast cells influence outcomes from BCG for patients with CIS: Data from a comprehensive characterisation of the immune microenvironment of urothelial bladder cancer (2017)

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Type of publication:
Journal article

Author(s):
Dowell A.C.; Taylor G.S.; *Cobby E.; Wen K.; During V.; Anderson J.; James N.D.; Devall A.J.; Cheng K.K.; Zeegers M.P.; Bryan R.T.

Citation:
PloS one; 2017; vol. 12 (no. 9)

Abstract:

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Blowing bubbles helps intubation (2017)

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Type of publication:
Journal article

Author(s):
*Howe, D.

Citation:
Indian Journal of Critical Care Medicine; Oct 2017; vol. 21 (no. 10); p. 710-711

Abstract:
Rocuronium is commonly used in preference to suxamethonium for rapid sequence induction in the Intensive Care Unit (ICU). We describe a patient who suffered significant neck trauma following a suicide attempt. On initial presentation to accident and emergency, he was an easy intubation with a Grade 1 view obtained at laryngoscopy. After surgery to repair his neck laceration, he was extubated and discharged from ICU. He later developed a severe aspiration pneumonia and required reintubation. After induction and paralysis with suxamethonium, the best view at laryngoscopy was a Grade 3 despite the use of different laryngoscopes. As the muscle paralysis wore off the patient began breathing. This produced bubbles in the back of the patient's pharynx which directed the clinician to the laryngeal inlet to allow successful intubation. In this case, the short duration of action of suxamethonium significantly aided intubation due to the return of spontaneous breathing by the patient.

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The role of the myosure hysteroscopic tissue removal system in the office setting at detecting abnormal pathology in women with post-menopausal bleeding, who have had blind endometrial sampling reported as inadequate, inactive or benign endometrium (2017)

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Type of publication:
Conference abstract

Author(s):
*Underwood M. ; *Chadha R.; *Hudda A.; *Green J.; *Fry M.; *Barker V.

Citation:
Journal of Minimally Invasive Gynecology; 2017; vol. 24 (no. 7)

Abstract:
Study Objective: Identify any histological discrepancy between blind endometrial sampling (ES) reported as inadequate, inactive or benign endometrium and office based hysteroscopy with the MyoSure tissue removal system in women with post-menopausal bleeding (PMB). Design: retrospective review of cases from our PMB clinic. Setting:Women attending the PMB clinic who's ES is reported as benign, inactive or inadequate. MyoSure Lite or Classic devices were used for the removal of these lesions. Patients:Women with PMB having an endometrial polypectomy using the MyoSure tissue removal system. Intervention: The MyoSure Lite & Classic tissue removal systems were used to remove endometrial polyps in women with PMB who's ES was inactive, inadequate or benign. Histological comparison between the ES and MyoSure histology was made. Measurements and Main Results: 616 women underwent hysteroscopic evaluation for abnormal uterine 2017; 399 were post-menopausal of which 186 women (46.6%) had inactive endometrium, 82 women (20.6%) had inadequate, 109 (27.3%) had benign/polyp and 22 (5.5%) had simple hyperplasia or higher grade disease detected on the blind endometrial sampling prior to polypectomy. The MyoSure polypectomy of those women with "Proliferative/benign endometrium" demonstrated that 19.3% had higher grade disease (Simple, complex, complex with atypia or cancer) than the ES, for the "inactive group 10.8% had high grade disease and those with an inadequate ES 13.4% had higher grade disease. (Table presented) Endometrial thickness in the PMB group ranged from 1.5-45 mm with a mean of 10.6 mm. There were no reported complications in all 616 cases. Conclusion: This retrospective review of patients with inadequate, inactive or benign ES has demonstrated the significant benefit to patient of having the polyp removed simply without complication in the office setting using the MyoSure tissue removal system. Between 10.8-19.3% will have higher grade disease detected using the MyoSure device, which would have an impact on their medical management.

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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