Staff Publication

Diagnostic yield of biliary brushing cytology: A single centre study (2016)

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Type of publication:
Conference abstract

Author(s):
*Wasimi M., Azam A.S., Abdullah P., Muzaffar S.

Citation:
Journal of Pathology, March 2016, vol. 238, Supplement 1, p.S19

Abstract:
Introduction: Biliary brushing cytology is a commonly used technique for the diagnosis of extra hepatic biliary and pancreatic malignancy. Despite a high specificity, the sensitivity remains low and variable. British Society of Gastroenterology guidelines recommend cytological analysis of brushing taken from the biliary structure to support diagnosis of malignancy in suspected individuals. We report here a single center experience of diagnostic yield of cytological specimens of biliary brushings. Objectives: (a) To determine the percentage of biliary brushing cytology cases with positive, negative, false positive and false negative results. (b) To determine the positive and negative predictive value of this test in our centre. (c) To see the correlation between cytological, radiological and clinical findings. Methodology: This is a retrospective data analysis of all biliary brushing cytology cases reported over three years from Jan 2012 to Jan 2014. The data was obtained from cytology reports and findings were correlated with the radiological diagnosis, outcome from the MDT meetings and subsequent follow up from the clinic letters. Results: A total of 34 biliary brushing cytology cases were reported between 2012 to 2014. Among them 22 were men and 12 were women. Average age was 69 years (Range 24-92 years). Out of 34, 15 cases (44%) showed presence of malignant cells and all these were true positives with underlying pancreatic and biliary malignancy. Among the remaining 19 cases, 10 cases were true negatives and 9 cases were false negatives. In our cohort, the specificity of biliary brushing cytology was 100% and sensitivity was 63%. The positive predictive value 100% and negative predictive value 53%. Conclusion: Biliary brushing cytology in conjunction with radiological investigation and serology is a useful technique in patients with suspected pancreato-biliary malignancy. Our results are comparable to studies done in other centres. To be re-audited.

Link to more details or full-text: http://onlinelibrary.wiley.com/doi/10.1002/path.4705/epdf

Friedrich Berthold Reinke (1862-1919): brilliant yet troubled anatomist of the vocal fold (2015)

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Type of publication:
Journal article

Author(s):
*Senior A.

Citation:
The Journal of laryngology and otology, November 2015, vol./is. 129/11(1053-1057)

Abstract:
Reinke's space is a critical laryngeal structure, and the eponym remains in current use in both clinical and research settings. However, little is known about the life of the German anatomist Friedrich Berthold Reinke. His name is missing from the otolaryngological histories, despite his work on the structure he described being responsible for a fundamental advance in our understanding of the larynx. Although brilliant, Reinke was described as impetuous and coarse by his colleagues, resulting in his academic career being cut short. Reinke's relative anonymity is thought to derive from the fact that he never defined himself as a laryngologist. Without question, Reinke's observations of the human vocal fold are substantive contributions, without which modern laryngology could not have evolved. This article aimed to summarise this brilliant yet troubled man's life and achievements, allowing appreciation for his singular genius and fundamental contribution to laryngology.

Are we following the guidelines to prevent contrast induced acute kidney injury? a clinical audit on patients with chronic kidney disease(CKD) undergoing coronary angiogram (2016)

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Type of publication:
Conference abstract

Author(s):
*Kanthasamy V., *Gill S.

Citation:
Global Heart, June 2016, vol./is. 11/2 SUPPL. 1(e94)

Abstract:
Introduction: Contrast induced acute kidney injury(CI-AKI) is one of the potential risk involved in high risk patients who undergo Coronary Angiography/interventions. As the procedure involved intra-arterial administration of contrast media, it expose the patient directly to the toxic side effects. It classically occurs within 72 hours of receiving the contrast media and usually recovers over the following five days. Its incidence increases significantly among the patients with risk factors and is greatly associated with short and long term mortality. The risk of CI-AKI is has been reported as high as 25% in patients with combination of CKD and diabetes, Cardiac failure, older age and exposure to nephrotoxic agents. Objectives: A clinical audit performed in order to assess the adherence to the NICE guidelines to prevent contrast induced Acute Kidney Injury among CKD patients undergoing diagnostic Coronary Angiogram and to identify the incidence of AKI following the procedure. Methods: A retrospective clinical audit was conducted to cover 6 months from May to October 2014. Data was collected from the cath lab register and patients with chronic kidney disease with eGFR<60 were included in the audit covering both in-patient and outpatient procedures(n=30). Data collection was based on the NICE guidance to look for the adherence of monitoring for renal function pre/post angiogram and considering hydration as preventive measure. Results: 93 % of the patients had two or more risk factors including CKD. All patients had renal function checked prior to the procedure but only 57 %(n=17) had post procedure renal function checked within 1 week and only 53 % were hydrated. 10 out of 17 patients( 59%) showed a decline in renal function. Among them 4 (23%) patients had AKI as per KDIGO criteria (Kidney Disease: Improving Global Outcomes) and of which 3 (75%) were not hydrated pre/post procedure. Renal function did not return to baseline in one of those 4 patients. Conclusion: In overall it was clearly evident that taking preventive measures against CIAKI in CKD patients were overlooked. Our recommendations were to introduce a checklist pre & post procedure for all patients so that high risk patients can be identified, to instruct the GP(on discharge) to re-check the renal functions in 3 days and to re-audit.

Parent experiences of paediatric allergy pathways in the West Midlands Region of the United Kingdom - A qualitative study (2016)

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Type of publication:
Conference abstract

Author(s):
*Diwakar L., Cummins C., Williams L., Sansom H., Kerrigan C., *Rees M., Hackett S., Lilford R., Roberts T.

Citation:
Allergy: European Journal of Allergy and Clinical Immunology, August 2016, vol./is. 71/(577)

Abstract:
Background: Almost all allergy care in the UK is provided by the publicly funded National Health Service (NHS). Services are deficient in most parts of the country at both primary and secondary level, with few regions having appropriate access to trained allergy clinical teams. The problem is especially acute for paediatric allergy services. Method: We are carrying out a qualitative study using in-depth, semi-structured interviews of parents purposively selected from two separate NHS Paediatric allergy clinics. All interviews are being audio-taped and transcribed anonymously. Analysis is by framework approach facilitated by NVivo software. Themes are being identified and alternate theories for findings will be sought using peer panels and literature searches. Interviews will be carried out until data saturation is achieved. Results: Preliminary analysis of 6 completed interviews has revealed a few emerging themes. Access to Primary Care services was variable with some parents expressing frustration at delays in obtaining appointments. Some of the mothers felt aggrieved that their 'gut reactions' regarding the well being of their child were often disregarded by Primary Care Physicians (PCPs). This was perceived strongly as 0being dismissed0 and made the mothers feel frustrated and often helpless with regards to taking care of their children. "I'd come out sometimes and I'd be so frustrated because I felt like, 'You weren't listening'. They just wouldn't listen to me. It was as if – you know, 'You're just an overreacting mom'." (P6) Even when the PCPs did not provide effective treatments, mothers were quite accepting of the treatment when they felt that their views were respected and 'listened to' " that's not eczema cream, so I thought that's not what I was expecting … but I can't really-you know -fault them for trying the different creams."(P7) Referral practices from Primary to Secondary Care also varied significantly with some parents facing frustrating delays with referral. Most of our interviewees found specialist clinics satisfactory, although some expressed discontentment over the usefulness of the consultation and followup processes. Conclusion: Parents experience considerable variation with regards to access, knowledge and attitude of PCPs in the WM region for children with allergies. Experiences with secondary care were largely favourable. In general, parents greatly valued being listened to and taken seriously by their clinicians.

Improving documentation of communication with parents in neonatal unit. A service development experience (2016)

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Type of publication:
Conference abstract

Author(s):
Kasim Aldaleel O., *Welch R.

Citation:
Archives of Disease in Childhood, April 2016, vol./is. 101/(A71-A72)

Abstract:
Introduction Effective communication with parents/patients is essential according to Domain 3 of the General Medical Council's (GMC) Guide for Good Medical Practice. Documentation of communication is crucial for clinical and medicolegal aspects. A local survey in our unit revealed a room for development, when 35.3% only of communication with parents was documented. Aim To improve documentation of communication with parents in the neonatal unit, in line with GMC Good Medical Practice Guide, aiming at 100% documentation of communications with parents. Method A development team was assigned with clear responsibilities and leadership. As part of PDSA (Plan-Do-Study-Act) cycle for improvement, tools were developed as an Act to improve documentation of communication with parents. The developed tools were; making documentation of communication with parents a handover component, making the documentation in the notes a personal responsibility of the doctor who spoke to parents and recording that, creating posters about documenting communication with parents and distributing them in different areas of the department as reminders and having a weekly updated Statistical Process Control chart (SPC chart) clearly visible in the unit. Results A Test of the Change was carried out after 2 months by a review of the last 6 weeks of the SPC Chart. The overall percentage of documented communication with parents was 72.85% (51/70) over 6 weeks period. The first week did not show significant change when 36% (4/11) of communications were documented. However, there was a steady improvement between the second and the fifth weeks, ranging from 71% to 80%, before reaching 92% in the sixth week. That was a positive test of change which was highlighted and implementation of these tools was agreed. High quality documented communications were selected and presented to trainees for learning benefits. Conclusion Having accurate medical records is medicolegally essential. Developing local tools to improve documentation of communication with parents is important when that documentation is sub-optimal. The SPC chart, posters, and communication documentation handing over are effective tools. However, other tools might be effective depending on each unit's needs.

Prevention and control of multiresistant Gram-negative bacteria: recommendations from a Joint Working Party (2016)

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Type of publication:
Journal article

Author(s):
Wilson, A.P.R., Livermore, D.M., Otter, J.A., *Warren, R.E., Jenks, P., Enoch, D.A., Newsholme, W., Oppenheim, B., Leanord, A., McNulty, C., Tanner, G., Bennett, S., Cann, M., Bostock, J., Collins, E., Peckitt, S., Ritchie, L., Fry, C., Hawkey, P.

Citation:
Journal of Hospital Infection, 2016, vol./is. 92/S1-S44

Link to more details or full-text: http://www.journalofhospitalinfection.com/article/S0195-6701(15)00314-X/pdf

Knowledge gaps in the management of familial hypercholesterolaemia. A UK based survey (2016)

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Type of publication:
Journal article

Author(s):
Jonathan Schofield, See Kwok, Michael France, *Nigel Capps, Ruth Eatough, Rahul Yadav, Kausik Ray, Handrean Soran

Citation:
Atherosclerosis (2016) [article in press]

Abstract:
Background and aims: Untreated individuals with familial hypercholesterolaemia (FH) are at increased
risk of developing premature cardiovascular disease (CVD). Early diagnosis and treatment can result in a
normal life expectancy. A recent survey commissioned by the European Atherosclerosis Society (EAS)
reported a lack of awareness of FH in the general population.We conducted a survey to assess knowledge
among healthcare professionals involved in the assessment and management of cardiovascular risk and
disease in the United Kingdom.
Methods: A survey designed to assess knowledge of diagnostic criteria, risk assessment, the role of
cascade screening, and management options for patients with FH was distributed to 1000 healthcare
professionals (response rate 44.3%). The same survey was redistributed following attendance at an
educational session on FH.
Results: 151 respondents (40.5%) reported having patients under their care who would meet the diagnostic criteria for FH, but just 61.4% recognized that cardiovascular risk estimation tools cannot be
applied in FH, and only 22.3% understood the relative risk of premature CVD compared to the general
population. Similarly, just 65.9% were aware of recommendations regarding cascade screening.
Conclusions: The prevalence and associated risk of FH continue to be underestimated, and knowledge of
diagnostic criteria and treatment options is suboptimal. These results support the recent Consensus
Statement of the EAS and production of quality standards by the National Institute for Health and Care
Excellence. Further work is required to formulate interventions to improve FH awareness and knowledge, and to determine the effect these interventions have on patient outcomes.

Spedali Degli Innocenti, the Foundling Hospital in Florence, Italy (2016)

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Type of publication:
Journal article

Author(s):
*Summers, Bruce

Citation:
Medical humanities, June 2016, vol. 42, no. 2, p. 141-142

Abstract:
The author reflects on a visit to the Ospedale Degli Innocenti, the former Renaissance foundling hospital in Florence, having escaped from an international clinical conference. He considers the symbolism of the architecture and artwork in relation to its function as a sanctuary for abandoned children.

Predicting and measuring fluid responsiveness with echocardiography (2016)

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Type of publication:
Journal article

Author(s):
*Miller, Ashley, Mandeville, Justin

Citation:
Echo research and practice, June 2016, vol. 3, no. 2, p. G1

Abstract:
Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart-lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

Link to full text: http://www.echorespract.com/content/3/2/G1.abstract

Gynaecological laparoscopic injuries: a 10-year retrospective review at a District General Hospital NHS Trust (2016)

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Type of publication:
Journal article

Author(s):
*Moores K.L., *Bentick B.

Citation:
Gynecological Surgery, May 2016, vol./is. 13/2(125-130)

Abstract:
Worldwide, increasingly complex surgery is being performed laparoscopically; thus, laparoscopic complication rates may be increasing. Reported risks from all complications of laparoscopic surgery are between 1 and 12.5/1000 cases and serious complications in 1/1000 cases. Accurate complication rates of surgery are difficult to obtain as most data are from retrospective studies and may be incomplete. This paper is a 10-year retrospective review of gynaecological laparoscopic complications from 1 January 2003 to 31 December 2012. Data sources are SEMAHELIX Hospital Database, Gynaecology Complications Register, Clinical Governance Records, Complaints and Legal Cases. Recorded complications were classified as diagnostic, sterilisations and therapeutic laparoscopies. Further classifications are as follows: major complications and type of injury (bowel, urological, vascular, other), minor complications and failed sterilisations. Twenty-nine complications were identified from 5128 laparoscopies; total complication rate is 5.7/1000 procedures. Major complication rates are as follows: diagnostic, 2.2/1000; sterilisations, 3.3/1000; and therapeutic, 3.1/1000, subcategorised into bowel 1.4/1000, urological 0.2/1000 and vascular 1.2/1000. Our total complication rate lies within published national rates. Compared to published standards of major complications, diagnostic laparoscopy and laparoscopic sterilisation rates were comparable. Conversely, our therapeutic laparoscopy complication rate was much lower. The highest complication rate was in the failed sterilisation group; however, this rate is within published sterilisation failure rates. Bowel and vascular complications were comparable; minor complication rates were low in all groups.