Staff Publication

Comparing quality of life outcomes between Laparoscopic Sleeve Gastrectomy and Laparoscopic RouxY Gastric Bypass using the RAND36 questionnaire (2017)

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Type of publication:
Journal article

Author(s):
*Macano C.A.W.; *Brookes A.; *Lafaurie G.; *Riera M.; Nyasavajjala S.M.

Citation:
International Journal of Surgery; Jun 2017; vol. 42 ; p. 138-142

Abstract:
Background Obesity surgery is an effective treatment to improve the health of patients. There is a lack of data regarding weight loss surgery outcomes and effects on Quality of Life (QoL). This study aims to compare changes in QoL following either Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). Methods SF36 questionnaires were mailed to all LSG and LRYGB patients who underwent surgery in 2013. Demographic data was obtained from hospital records. Statistical analysis was undertaken using Stats direct. Results 158 patients were sent postal questionnaires. 60 were returned (38%). 41 were women, 16 LSG, 44 LRYGB, mean age 52 years, mean BMI pre-surgery 41.0. Both procedures yielded similar weight loss over 2 year follow up (p = 0.01), and similar improvements in obesity related co-morbidities. These procedures yielded significant improvements in all QoL scales and domains other than the emotional role limitations scale following sleeve gastrectomy. Conclusion Bariatric surgery has been shown to improve a patient's QoL. More research is needed to explain the reasons why there was a difference between Sleeve and Bypass procedures in emotional changes to patients.

Congenital talipes equinovarus and congenital vertical talus secondary to sacral agenesis (2017)

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Type of publication:
Journal article

Author(s):
Bray J.J.H.; Brown R.; *Crosswell S.

Citation:
BMJ Case Reports; 2017

Abstract:
Sacral agenesis is a rare congenital defect which is associated with foot deformities such as congenital talipes equinovarus (CTEV) and less commonly congenital vertical talus (CVT). We report a 3-year-old Caucasian girl who was born with right CTEV and left CVT secondary to sacral agenesis. Her right foot was managed with a Ponseti casting method at 2 weeks, followed by an Achilles tenotomy at 4 months. The left foot was initially managed with a nocturnal dorsi-flexion splint. Both feet remained resistant and received open foot surgery at 10 months producing plantigrade feet with neutral hindfeet. At 19 months, she failed to achieve developmental milestones and examinations revealed abnormal lower limb reflexes. A full body MRI was performed which identified the sacral agenesis. We advocate early MRI of the spine to screen for spinal defects when presented with resistant foot deformities, especially when bilateral.

Link to more details or full-text: http://casereports.bmj.com/content/2017/bcr-2017-219786.abstract [NHS OpenAthens account required]

Can trainees design and deliver a national audit of epistaxis management? A pilot of a secure web-based audit tool and research trainee collaboratives (2017)

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Type of publication:
Journal article

Author(s):
Mehta N.; Williams R.J.; Smith M.E.; Hall A.; Hardman J.C.; Cheung L.; Ellis M.P.; *Fussey J.M.; Lakhani R.; Hopkins C.; McLaren O.; Nankivell P.C.; Sharma N.; Yeung W.; Carrie S.

Citation:
Journal of Laryngology and Otology; Jun 2017; vol. 131 (no. 6); p. 518-522

Abstract:
Objective: To investigate the feasibility of a national audit of epistaxis management led and delivered by a multiregion trainee collaborative using a web-based interface to capture patient data. Methods: Six trainee collaboratives across England nominated one site each and worked together to carry out this pilot. An encrypted data capture tool was adapted and installed within the infrastructure of a university secure server. Site-lead feedback was assessed through questionnaires. Results: Sixty-three patients with epistaxis were admitted over a two-week period. Site leads reported an average of 5 minutes to complete questionnaires and described the tool as easy to use. Data quality was high, with little missing data. Site-lead feedback showed high satisfaction ratings for the project (mean, 4.83 out of 5). Conclusion: This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.

Quality improvement project for emergency oxygen delivery on a respiratory ward (2016)

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Type of publication:
Conference abstract

Author(s):
*Hutchinson K.E.; *Craik S.; *Srinivasan K.; *Moudgil H.; *Ahmad N.

Citation:
Thorax; Dec 2016; vol. 71, Supplement 3

Abstract:
Background British Thoracic Society (BTS) guidelines state that oxygen should be used to treat hypoxaemia and prescribed to a target saturation range.1 Patients at risk of type 2 respiratory failure should target 88-92%, with the rest 94-98%. In the BTS national audit in 2013, out of 6214 patients, 55% had oxygen prescribed and 52% were prescribed and delivered to within a target saturation range.2 Methods We ran a Quality Improvement Project (QIP) involving three PDSA cycles to improve the delivery of oxygen to patients on the Respiratory Ward at the Princess Royal Hospital, Telford. We set our standards as: 1. 90% of patients receiving oxygen have it prescribed on a drug chart 2. 100% of patients prescribed oxygen have a documented target saturation range 3. 100% of patients have oxygen delivered appropriately to target The QIP process
commenced in Autumn 2015. After the first cycle we used bedside prompt cards and delivered teaching sessions with doctors, nurses and healthcare assistants (HCAs). After the second cycle we appointed a nurse, HCA and two FY1 doctors as 'O2 Ninjas'. Data were collected at three points after each cycle from drug charts and VitalPaC. Results See Table (Table Presented) Conclusions Our QIP shows that education and empowerment of 'grass root' healthcare workers can improve oxygen prescription on a Respiratory ward. We suggest this QIP is replicated in other trusts and specialties to improve safe oxygen delivery.

Adding Celecoxib With or Without Zoledronic Acid for Hormone-Naïve Prostate Cancer: Long-Term Survival Results From an Adaptive, Multiarm, Multistage, Platform, Randomized Controlled Trial (2017)

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Type of publication:
Randomised controlled trial

Author(s):
Mason, Malcolm D; Clarke, Noel W; James, Nicholas D; Dearnaley, David P; Spears, Melissa R; Ritchie, Alastair W S; Attard, Gerhardt; Cross, William; Jones, Rob J; Parker, Christopher C; Russell, J Martin; Thalmann, George N; Schiavone, Francesca; Cassoly, Estelle; Matheson, David; Millman, Robin; Rentsch, Cyrill A; Barber, Jim; Gilson, Clare; Ibrahim, Azman; Logue, John; Lydon, Anna; Nikapota, Ashok D; O'Sullivan, Joe M; Porfiri, Emilio; Protheroe, Andrew; *Srihari, Narayanan Nair; Tsang, David; Wagstaff, John; Wallace, Jan; Walmsley, Catherine; Parmar, Mahesh K B; Sydes, Matthew R; STAMPEDE Investigators

Citation:
Journal of clinical oncology : official journal of the American Society of Clinical Oncology; 35, no. 14 (May 2017) p. 1530-1541.

Abstract:
Purpose Systemic Therapy for Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy is a randomized controlled trial using a multiarm, multistage, platform design. It recruits men with high-risk, locally advanced or metastatic prostate cancer who were initiating long-term hormone therapy. We report survival data for two celecoxib (Cel)-containing comparisons, which stopped accrual early at interim analysis on the basis of failure-free survival. Patients and Methods Standard of care (SOC) was hormone therapy continuously (metastatic) or for ≥ 2 years (nonmetastatic); prostate (± pelvic node) radiotherapy was encouraged for men without metastases. Cel 400 mg was administered twice a day for 1 year. Zoledronic acid (ZA) 4 mg was administered for six 3-weekly cycles, then 4-weekly for 2 years. Stratified random assignment allocated patients 2:1:1 to SOC (control), SOC + Cel, or SOC + ZA + Cel. The primary outcome measure was all-cause mortality. Results were analyzed with Cox proportional hazards and flexible parametric models adjusted for stratification factors. Results A total of 1,245 men were randomly assigned (Oct 2005 to April 2011). Groups were balanced: median age, 65 years; 61% metastatic, 14% N+/X M0, 25% N0M0; 94% newly diagnosed; median prostate-specific antigen, 66 ng/mL. Median follow-up was 69 months. Grade 3 to 5 adverse events were seen in 36% SOC-only, 33% SOC + Cel, and 32% SOC + ZA + Cel patients. There were 303 control arm deaths (83% prostate cancer), and median survival was 66 months. Compared with SOC, the adjusted hazard ratio was 0.98 (95% CI, 0.80 to 1.20; P = .847; median survival, 70 months) for SOC + Cel and 0.86 (95% CI, 0.70 to 1.05; P =.130; median survival, 76 months) for SOC + ZA + Cel. Preplanned subgroup analyses in men with metastatic disease showed a hazard ratio of 0.78 (95% CI, 0.62 to 0.98; P = .033) for SOC + ZA + Cel. Conclusion These data show no overall evidence of improved survival with Cel. Preplanned subgroup analyses provide hypotheses for future studies.

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Anatomical siting of the splenic flexure using computed tomography (2017)

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Type of publication:
Journal article

Author(s):
*Meecham, L; *Brookes, A; *Macano, Caw; *Stone, T; *Cheetham, M

Citation:
Annals of the Royal College of Surgeons of England; Mar 2017; vol. 99 (no. 3); p. 207-209

Abstract:
INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

An unusual cause of tonsillar asymmetry (2017)

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Type of publication:
Journal article

Author(s):
*Karamchandani, D; *El-Shunnar, S K; *Fussey, J M; *Ahsan, S F; *Bhatia, S

Citation:
Annals of the Royal College of Surgeons of England; Mar 2017; vol. 99 (no. 3); p. e112

Abstract:
We present the first reported case of tonsillar asymmetry secondary to a mandibular osteoma. Computed tomography rather than tonsillectomy for histology prevented the distress and risk of unnecessary surgery, and the patient was managed conservatively.

The incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS: a hospital-based cohort study (2017)

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Type of publication:
Journal article

Author(s):
*Antonakou, Angeliki; *Papoutsis, Dimitrios; *Henderson, Karen; *Qadri, Zahid; *Tapp, Andrew

Citation:
Archives of gynecology and obstetrics. Vol 295(5):1201-1209

Abstract:
PURPOSETo identify the incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in women who sustained an OASIS in their first vaginal delivery and have a subsequent vaginal birth.METHODS Data were collected retrospectively for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Women with breech deliveries, stillbirths, foetal congenital abnormalities and multiple pregnancies were excluded.RESULTSOver the study period, we identified 11,191 women who had a first vaginal birth, of which 603 (5.4%) sustained a first episode of OASIS. Of these women, 243 (40.2%) had a subsequent pregnancy with 190 (78.1%) having a second vaginal birth, 13 (5.4%) an emergency caesarean section (CS) delivery while in labour and 40 (16.5%) an elective CS delivery. In those who delivered vaginally, 16 (8.4%) women had a repeat OASIS. After adjusting for several confounding factors, it was found that the risk of a repeat OASIS was associated with the use of epidural analgesia (OR = 3.66; 95% CI:1.14-11.71) and an episiotomy in the first delivery (OR = 3.93; 95% CI:1. 03-15.02) and a short labour (<2.8 h) in the second delivery (OR = 14.55; 95% CI: 1.83-115.75). The time interval between the two vaginal births was not associated with any increased risk of a repeat OASIS.CONCLUSION We found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

Human factors: role of cognitive and social skills in clinical practice (2017)

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Type of publication:
Journal article

Author(s):
*Thomas Wood

Citation:
Emergency Nurse; Mar 2017; vol. 24 (no. 10); p. 18-19

Abstract:
Last September, a team from our trust was chosen by the Resuscitation Council UK (RCUK) to represent the UK in a simulation-based cardiopulmonary resuscitation (CPR) competition at the annual European Resuscitation Congress, in Iceland.