Staff Publication

The impact of the introduction of a palliative Macmillan consultant radiographer at one UK cancer centre (2016)

Posted on by

Type of publication:
Journal article

Author(s):
Goldfinch R., Allerton R., *Khanduri S., *Pettit L.

Citation:
British Journal of Radiology, 2016, vol./is. 89/1065(no pagination)

Abstract:
Objective: The UK radiotherapy (RT) workforce needs novel strategies to manage increasing demand. The appointment of a palliative RT (PRT) consultant radiographer (CR) offers a potential solution to enhance patient pathways providing timely RT. This article examined the impact of one such appointment. Methods: Two prospective audits were completed 1 year apart. All patients receiving PRT for bone metastases between 01/01/2014-31/03/2014 (Audit 1) and 01/01/2015-31/01/2015 (Audit 2) were included. Data collected included demographics, treatment site, dose, fractionation, treatment indication and professionals who planned the PRT. The patient pathway from decision to treat (DTT) to commencement of PRT was scrutinized. Results: 97 patients were identified for Audit 1 and 87 patients for Audit 2. Demographics were similar. Figures relate to Audit 1 and in brackets Audit 2. Indications for treatment: pain 55% (61%), metastatic spinal cord compression 41% (38%) and other neurological symptoms 4% (1%). The CR independently planned 13% (60%), being supervised for 36% (3%). Consultant clinical oncologists planned 43% (31%), with 7% (6%) planned by specialist registrars (SpRs). The pathway was enhanced in Audit 2, with 85% of patients treated within 14 days compared with 73% of patients treated in Audit 1. Conclusion: A CR has the potential to impact on the patient pathway, enabling quicker times from DTT to treatment. Continued audit of the role is required to ensure that it complements SpR training. Advances in knowledge: Increasing longevity and improved systemic therapies have led to greater numbers of patients living longer with metastatic disease. The appointment of a CR offers a potential solution to the capacity difficulties faced by UK RT services.

The spectrum of renal allograft failure (2016)

Posted on by

Type of publication:
Journal article

Author(s):
*Chand S. , Atkinson D., Collins C., Briggs D., Ball S., Sharif A., Skordilis K., Vydianath B., Neil D., Borrows R.

Citation:
PLoS ONE, September 2016, vol./is. 11/9(no pagination)

Abstract:
Background: Causes of "true" late kidney allograft failure remain unclear as study selection bias and limited follow-up risk incomplete representation of the spectrum. Methods: We evaluated all unselected graft failures from 2008-2014 (n = 171; 0-36 years post-transplantation) by contemporaryclassification of indication biopsies "proximate" to failure, DSA assessment, clinical and biochemical data. Results: The spectrum of graft failure changed markedly depending on the timing of allograft failure. Failures within the first year were most commonly attributed to technical failure, acute rejection (with T-cell mediated rejection [TCMR] dominating antibody-mediated rejection [ABMR]). Failures beyond a year were increasingly dominated by ABMR and 'interstitial fibrosis with tubular atrophy' without rejection, infection or recurrent disease ("IFTA"). Cases of IFTA associated with inflammationin non-scarred areas (compared with no inflammation or inflammation solely within scarred regions) were more commonly associated with episodes of prior rejection, late rejection and nonadherence, pointing to an alloimmune aetiology. Nonadherence and late rejection were common in ABMR and TCMR, particularly Acute Active ABMR. Acute Active ABMR and nonadherence were associated with younger age, faster functional decline, and less hyalinosis on biopsy. Chronic and Chronic Active ABMR were more commonly associated with Class II DSA. C1q-binding DSA, detected in 33% of ABMR episodes, were associated with shortertime to graft failure. Most non-biopsied patients were DSA-negative (16/21; 76.1%). Finally, twelve losses to recurrent disease were seen (16%). Conclusion: This data from an unselected population identifies IFTA alongside ABMR as a very important cause of true late graft failure, with nonadherence-associated TCMR as a phenomenon in some patients. It highlights clinical and immunological characteristics of ABMR subgroups, and should inform clinical practice and individualised patient care.

Link to more details or full-text: http://search.proquest.com/docview/1821784851/F5FCCBF39FE8431CPQ/4?accountid=49082

Preoperative risk factors for conversion from laparoscopic to opencholecystectomy: a validated risk score derived from a prospective U.K.database of 8820 patients (2016)

Posted on by

Type of publication:
Journal article

Author(s):
Sutcliffe R.P., Hollyman M., Hodson J., Bonney G., Vohra R.S., Griffiths E.A., Fenwick S., Elmasry M., Nunes Q., Kennedy D., Khan R.B., Khan M.A.S., Magee C.J., Jones S.M., Mason D., Parappally C.P., Mathur P., Saunders M., Jamel S., Haque S.U.L., Zafar S., Shiwani M.H., Samuel N., Dar F., Jackson A., Lovett B., Dindyal S., Winter H., Rahman S., Wheatley K., Nieto T., Ayaani S., Youssef H., Nijjar R.S., Watkin H., Naumann D., Emeshi S., Sarmah P.B., Lee K., Joji N., Heath J., Teasdale R.L., Weerasinghe C., Needham P.J., Welbourn H., Forster L., Finch D., Blazeby J.M., Robb W., McNair A.G.K., Hrycaiczuk A., Charalabopoulos A., Kadirkamanathan S., Tang C.-B., Jayanthi N.V.G., Noor N., Dobbins B., Cockbain A.J., Nilsen-Nunn A., de Siqueira J., Pellen M., Cowley J.B., Ho W.-M., Miu V., White T.J., Hodgkins K.A., Kinghorn A., Tutton M.G., Al-Abed Y.A., Menzies D., Ahmad A., Reed J., Monk D., Vitone L.J., Murtaza G., Joel A., Brennan S., Shier D., Zhang C., Yoganathan T., Robinson S.J., McCallum I.J.D., Jones M.J., Elsayed M., Tuck L., Wayman J., Aroori S., Kimble A., Bunting D.M., Hosie K.B., Fawole A.S., Basheer M., Dave R.V., Sarveswaran J., Jones E., Kendal C., Tilston M.P., Gough M., Wallace T., Singh S., Downing J., Mockford K.A., Issa E., Shah N., Chauhan N., Wilson T.R., Forouzanfar A., Wild J.R.L., Nofal E., Bunnell C., Madbak K., Rao S.T.V., Devoto L., Siddiqi N., Khawaja Z., Hewes J.C., Rodriguez D.U., Sen G., Carney K., Bartlett F., Rae D.M., Stevenson T.E.J., Sarvananthan K., Dwerryhouse S.J., Higgs S.M., Old O.J., Hardy T.J., Shah R., Hornby S.T., Keogh K., Frank L., Al-Akash M., Upchurch E.A., Frame R.J., Hughes M., Jelley C., Weaver S., Roy S., Sillo T.O., Galanopoulos G., Cuming T., Cunha P., Tayeh S., Kaptanis S., Heshaishi M., Eisawi A., Abayomi M., Ngu W.S., Fleming K., Bajwa D.S., Chitre V., Aryal K., Ferris P., Silva M., Lammy S., Mohamed S., Khawaja A., Ghazanfar M.A., Bellini M.I., Ebdewi H., Elshaer M., Gravante G., Drake B., Ogedegbe A., Mukherjee D., Arhi C., Giwa L., Iqbal N., Watson N.F., Aggarwal S.K., Orchard P., Villatoro E., Willson P.D., Mok K.W.J., Woodman T., Deguara J., Garcea G., Babu B.I., Dennison A.R., Malde D., Lloyd D., Slavin J.P., Jones R.P., Ballance L., Gerakopoulos S., Jambulingam P., Mansour S., Sakai N., Acharya V., Sadat M.M., Karim L., Larkin D., Amin K., Khan A., Law J., Jamdar S., Sampat K., O'shea K.M., Manu M., Asprou F.M., Malik N.S., Chang J., Johnstone M., Lewis M., Roberts G.P., Karavadra B., Photi E., Hewes J., Gould L., Rodriguez D., O'Reilly D.A., Rate A.J., Sekhar H., Henderson L.T., Starmer B.Z., Coe P.O., Tolofari S., Barrie J., Bashir G., Sloane J., Madanipour S., Halkias C., Trevatt A.E.J., Borowski D.W., Hornsby J., Courtney M.J., Virupaksha S., Seymour K., Robinson S., Hawkins H., Bawa S., Gallagher P.V., Reid A., Wood P., Finch J.G., Parmar J., Stirland E., Gardner-Thorpe J., Al-Muhktar A., Peterson M., Majeed A., Bajwa F.M., Martin J., Choy A., Tsang A., Pore N., Andrew D.R., Al-Khyatt W., Santosh Bhandari C.T., Chambers A., Subramanium D., Toh S.K.C., Carter N.C., Mercer S.J., Knight B., Vijay V., Alagaratnam S., Sinha S., Khan S., El-Hasani S.S., Hussain A.A., Bhattacharya V., Kansal N., Fasih T., Jackson C., Siddiqui M.N., Chishti I.A., Fordham I.J., Siddiqui Z., Bausbacher H., Geogloma I., Gurung K., Tsavellas G., Basynat P., Shrestha A.K., Basu S., Chhabra A., Harilingam M., Rabie M., Akhtar M., Kumar P., Jafferbhoy S.F., Hussain N., Raza S., Haque M., Alam I., Aseem R., Patel S., Asad M., Booth M.I., Ball W.R., Wood C.P.J., Pinho-Gomes A.C., Kausar A., Obeidallah M., Varghase J., Lodhia J., Bradley D., Rengifo C., Lindsay D., Gopalswamy S., Finlay I., Wardle S., Bullen N., Iftikhar S.Y., Awan A., Leeder P., Fusai G., Bond-Smith G., Psica A., Puri Y., Hou D., Noble F., Szentpali K., Broadhurst J., Date R., Hossack M.R., Goh Y.L., Turner P., Shetty V., *Riera M., *Macano C.A.W., *Sukha A., Preston S.R., Hoban J.R., Puntis D.J., Williams S.V., Krysztopik R., Kynaston J., Batt J., Doe M., Goscimski A., Jones G.H., Smith S.R., Hall C., Carty N., Ahmed J., Panteleimonitis S., Gunasekera R.T., Sheel A.R.G., Lennon H., Hindley C., Reddy M., Kenny R., Elkheir N., McGlone E.R., Rajaganeshan R., Hancorn K., Hargreaves A., Prasad R., Longbotham D.A., Vijayanand D., Wijetunga I., Ziprin P., Nicolay C.R., Yeldham G., Read E., Gossage J.A., Rolph R.C., Ebied H., Phull M., Khan M.A., Popplewell M., Kyriakidis D., Hussain A., Henley N., Packer J.R., Derbyshire L., Porter J., Appleton S., Farouk M., Basra M., Jennings N.A., Ali S., Kanakala V., Ali H., Lane R., Dickson-Lowe R., Zarsadias P., Mirza D., Puig S., Al Amari K., Vijayan D., Sutcliffe R., Marudanayagam R., Hamady Z., Prasad A.R., Patel A., Durkin D., Kaur P., Bowen L., Byrne J.P., Pearson K.L., Delisle T.G., Davies J., Tomlinson M.A., Johnpulle M.A., Slawinski C., Macdonald A., Nicholson J., Newton K., Mbuvi J., Farooq A., Mothe B.S., Zafrani Z., Brett D., Francombe J., Spreadborough P., Barnes J., Cheung M., Al-Bahrani A.Z., Preziosi G., Urbonas T., Alberts J., Mallik M., Patel K., Segaran A., Doulias T., Sufi P.A., Yao C., Pollock S., Manzelli A., Wajed S., Kourkulos M., Pezzuto R., Wadley M., Hamilton E., Jaunoo S., Padwick R., Sayegh M., Newton R.C., Farag S.F., Hebbar M., Spearman J., Hamdan M.F., D'Costa C., Blane C., Giles M., Peter M.B., Hirst N.A., Hossain T., Pannu A., El-Dhuwaib Y., Morrison T.E.M., Taylor G.W., Thompson R.L.E., McCune K., Loughlin P., Lawther R., Byrnes C.K., Simpson D.J., Mawhinney A., Warren C., McKay D., McIlmunn C., Martin S., MacArtney M., Diamond T., Davey P., Jones C., Clements J.M., Digney R., Chan W.M., McCain S., Gull S., Janeczko A., Dorrian E., Harris A., Dawson S., Johnston D., McAree B., Ghareeb E., Thomas G., Connelly M., McKenzie S., Cieplucha K., Spence G., Campbell W., Hooks G., Bradley N., Cassidy J.T., Boland M., Burke P., Nally D.M., Hill A.D.K., Khogali E., Shabo W., Iskandar E., McEntee G.P., O'Neill M.A., Peirce C., Lyons E.M., O'Sullivan A.W., Thakkar R., Carroll P., Ivanovski I., Balfe P., Lee M., Winter D.C., Kelly M.E., Hoti E., Maguire D., Karunakaran P., Geoghegan J.G., Martin S.T., Cross K.S., Cooke F., Zeeshan S., Murphy J.O., Mealy K., Mohan H.M., Nedujchelyn Y., Ullah M.F., Ahmed I., Giovinazzo F., Milburn J., Prince S., Brooke E., Buchan J., Khalil A.M., Vaughan E.M., Ramage M.I., Aldridge R.C., Gibson S., Nicholson G.A., Vass D.G., Grant A.J., Holroyd D.J., Jones A., Sutton C.M.L.R., O'Dwyer P., Nilsson F., Weber B., Williamson T.K., Lalla K., Bryant A., Carter R., Forrest C.R., Hunter D.I., Nassar A.H., Orizu M.N., Knight K., Qandeel H., Suttie S., Belding R., McClarey A., Boyd A.T., Guthrie G.J.K., Lim P.J., Luhmann A., Watson A.J.M., Richards C.H., Nicol L., Madurska M., Harrison E., Boyce K.M., Roebuck A., Ferguson G., Pati P., Wilson M.S.J., Dalgaty F., Fothergill L., Driscoll P.J., Mozolowski K.L., Banwell V., Bennett S.P., Rogers P.N., Skelly B.L., Rutherford C.L., Mirza A.K., Lazim T., Lim H.C.C., Duke D., Ahmed T., Beasley W.D., Wilkinson M.D., Maharaj G., Malcolm C., Brown T.H., Shingler G.M., Mowbray N., Radwan R., Morcous P., Wood S., Kadhim A., Stewart D.J., Baker A.L., Tanner N., Shenoy H.

Citation:
HPB, November 2016, vol./is. 18/11(922-928)

Abstract:
Background Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.

Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000 (2016)

Posted on by

Type of publication:
Journal article

Author(s):
Ness A.R., Waylen A., Hurley K., Jeffreys M., Penfold C., Pring M., Leary S.D., Allmark C., Toms S., Ring S., Peters T.J., Hollingworth W., Worthington H., Fisher S., Rogers S.N., Thomas S.J., Rogers S., Thiruchelvam J.K., Abdelkader M., Anari S., Dykerand K., McCaul J., Benson R., Stewart S., Lester J., Hamidand A., Lamont A., Fresco L., Mehanna H., Lester S., Cogill G., Roy A., Bisase B., Balfour A., Evans A., Gollins S., Conway D., Hall C., Gunasekaran S.P., Lees L., Lowe R., England J., Scrase C., Wight R., Sen M., Doyle M., Moule R., Rowell N., Beaumont-Jewell D., Loo H.W., Goodchild K., Jankowska P., Paleri V., Casasola R., Roques T., Tierney P., Dyson P., Andrade G., Tatla T., Christian J., Winter S., Baldwin A., Davies J., King E., Barnes D., Repanos C., Kim D., Richards S., Dallas N., McAlister K., Hwang D., Berry S., Cole N., Moss L., Palaniappan N., Homer J., Nutting C., Siva M., *Hari C. , Wood K., Simcock R., Waldron J., Hyde N., P Gunasekaran S., Hamid A., Foran B., Ahmed I., Gahir D., O'Hara J., Carr R., Forster M., Sheehan T., Thomas S., Evans M., Wagstaff L., Mano J., Brammer C., Tyler J., Coatesworth A.

Citation:
Clinical Otolaryngology, December 2016, vol./is. 41/6(804-809)

HEART UK statement on the management of homozygous familialhypercholesterolaemia in the United Kingdom (2016)

Posted on by

Type of publication:
Journal article

Author(s):
France M., Rees A., Datta D., Thompson G., *Capps N., Ferns G., Ramaswami U., Seed M., Neely D., Cramb R., Shoulders C., Barbir M., Pottle A., Eatough R., Martin S., Bayly G., Simpson B., Halcox J., Edwards R., Main L., Payne J., Soran H.

Citation:
Atherosclerosis, December 2016, vol./is. 255/(128-139)

Abstract:
This consensus statement addresses the current three main modalities of treatment of homozygous familial hypercholesterolaemia (HoFH): pharmacotherapy, lipoprotein (Lp) apheresis and liver transplantation. HoFH may cause very premature atheromatous arterial disease and death, despite treatment with Lp apheresis combined with statin, ezetimibe and bile acid sequestrants. Two new classes of drug, effective in lowering cholesterol in HoFH, are now licensed in the United Kingdom. Lomitapide is restricted to use in HoFH but, may cause fatty liver and is very expensive. PCSK9 inhibitors are quite effective in receptor defective HoFH, are safe and are less expensive. Lower treatment targets for lipid lowering in HoFH, in line with those for the general FH population, have been proposed to improve cardiovascular outcomes. HEART UK presents a strategy combining Lp apheresis with pharmacological treatment to achieve these targets in the United Kingdom (UK). Improved provision of Lp apheresis by use of existing infrastructure for extracorporeal treatments such as renal dialysis is promoted. The clinical management of adults and children with HoFH including advice on pregnancy and contraception are addressed. A premise of the HEART UK strategy is that the risk of early use of drug treatments beyond their licensed age restriction may be balanced against risks of liver transplantation or ineffective treatment in severely affected patients. This may be of interest beyond the UK.

Are local, speciality specific career days beneficial for medical students and foundation doctors? (2016)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Barker V., *Godden M., *Jones C., *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, December 2016, vol./is. 123/(6-7)

Abstract:
The Health Education Midlands holds an annual career day for all specialities to attend, allowing all medical students and foundation doctors to explore different specialities within the local area. The Royal College of Obstetricians and Gynaecologists also provide a careers day, for anyone to attend. Both of these are useful resources however do have some limitations due to number of delegates attending and also number of specialities in attendance. Our local obstetrics and gynaecology school held a pilot, local, careers days to allow any medical student from 4th year and above and any foundation doctor within the region, the opportunity to attend. The day consisted of a variety informal presentations about the 'day in a life' and was given by a variety of trainees across the school. The deputy head of school also came and provided more specific information on training pathways. The day also included several workshops covering resilience, CV building, and practical skills. The informal nature meant that the delegates could feel free to ask any of us any questions they wish to do so during the process. The delegates were asked to provide feedback at the end of the day. We had a total of 42 delegates, of which the majority found the day useful, we did not receive any negative feedback. We hope that the delegates can use this experience when deciding on future careers. We are intending on repeating the careers day again.

Link to full-text: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14447/epdf