Staff Publication

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial (2015)

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Type of publication:
Randomised controlled trial

Author(s):
Laver L, *Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov;23(11):3383-92

Abstract:
PURPOSE:
Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.
METHODS:
Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.
RESULTS:
All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (+/-8.9) and 59.6 (+/-12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.
CONCLUSIONS:
Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain.
LEVEL OF EVIDENCE: II.

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 M, Baumbach SF, Boecker W, *Carmont MR, Polzer H.

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Mar;26(3):846-853

Abstract:
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.

External beam radiotherapy in differentiated thyroid carcinoma: A systematic review. (2016)

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Type of publication:
Systematic Review

Author(s):
*Fussey JM, Crunkhorn R, Tedla M, Weickert MO, Mehanna H.

Citation:
Head Neck. Volume38, IssueS1, April 2016, Pages E2297-E2305

Abstract:
External beam radiotherapy (EBRT) is not a first line treatment in differentiated thyroid carcinoma (DTC), but is recommended as an adjuvant treatment in certain cases. The evidence for EBRT in DTC is limited. A comprehensive literature search was performed. Data on patient demographics, disease stage, treatment characteristics, and outcomes were collected from included articles after quality appraisal. Sixteen articles met the inclusion criteria, with a pooled population of 5114. Only 1 study was prospective and there were no randomized controlled trials. Most of the evidence suggests that EBRT improves locoregional control in patients at high risk of locoregional recurrence. This was corroborated by analysis of pooled patient data. Available evidence suggests an improvement in locoregional control when EBRT is used in patients over the age of 45 at high risk for locoregional recurrence. However, there is a need for long-term prospective multicenter research on the subject.

Investigation of the Role of Semen in Embryo Implantation: a pilot study (2016)

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Type of publication:
Poster presentation

Author(s):
*Cloete H., *Binnersley S., *Henderson A., *Mitchell A., *Kasraie J.

Citation:
Poster presentation at the ACE Annual Conference, 5-6 January 2016.

Abstract:
Aim: To investigate the effect of unprotected intercourse on embryo implantation in patients undergoing fertility treatment. Evidence suggests that seminal plasma elicits an endometrial immune response that promotes tolerance towards an invading conceptus. However, in assisted reproductive techniques (ART), seminal plasma is usually excluded and does not come into contact with the female reproductive tract. In humans, investigators have shown that intra-vaginal and/or intra-cervical application of seminal plasma at the time of fertility treatment may improve pregnancy outcomes.
Method: Women were asked to share information about timing and frequency of intercourse in the week of, and 2 weeks prior to, fresh and frozen embryo transfer (FET). Women who had unprotected intercourse in the 5 days prior to ovulation and up to the day of embryo transfer were assigned to the study group (n = 40). Women who abstained in this period were assigned to the control group (n = 66).
Main study outcomes: Biochemical pregnancy rate, clinical pregnancy rate and implantation rate. Statistical analysis showed no significant difference in main outcomes between groups when results were pooled for all treatment types (in vitro fertilisation (IVF)/intra-cytoplasmic sperm injection (ICSI) and FET cycles). However, a significantly reduced implantation rate was observed in the study group when considering the IVF/ICSI stratum alone (24% versus 44%, p = 0.03).
Conclusion: This pilot study supports intercourse abstinence during fertility treatment, however study limitations such as small sample size and patient recall means further investigation is recommended.

Retrospective study evaluating the Ankyloglossia release procedure within SATH (2015)

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Type of publication:
Journal article

Author(s):
*G. Mihalache, *S. Bhatia, *M. El Muiz, *N. Meixner

Citation:
British Journal of Oral and Maxillofacial Surgery, December 2015 Volume 53, Issue 10, Pages e42–e43

Abstract:
Ankyloglossia also more commonly known as tongue tie is a congenital abnormality, which results in a shorter thick lingual fraenulum which in turn restricts the movement of the tongue. The condition can interfere with breast feeding early on and speech or social functions when older. Ankyloglossia affects approximately 5% of the population. The benefits of breast feeding are well known and health care professionals are becoming more aware of tongue tie as a treatable cause of breast feeding difficulty.

The Successes of our Clinical Research Team Away Day (2015)

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Type of publication:
Poster presentation

Author(s):
Sr Helen Moore Trust Lead Research Nurse

Citation:
Presented at the Celebrating Clinical Research Nursing Conference, London

Abstract:
The Clinical Research Team at Shrewsbury and Telford Hospital NHS Trust continues to expand. It was decided to have a whole Team Away Day to consolidate our experiences to date; to improve our communication; to develop a leaner and more efficient way of working.

After the success of the Away Day, four working groups were initiated to drive forward the successes over the coming year allowing the Away Day to have a legacy.

Link to more details or full-text: via e-mail helen.moore@sath.nhs.uk

A Model for care: 6 year experience of recruitment into breast cancer trials - a single centre perspective (2015)

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Type of publication:
Poster presentation

Author(s):
Dr S Khanduri Consultant Clinical Oncologist and Sr H Moore Trust Lead Research Nurse

Citation:
Poster presented at the National Clinical Research Institute Cancer Conference, November 2015

Abstract:
The National Institute for Health research has been advised of the need to see sustained improvement in the performance of NHS providers in initiating and delivering clinical research. At Shrewsbury and  Telford NHS Trust a dedicated trials team have supported the breast oncology service to improve trials recruitment.

Over a 6 year period 1373 patients were identified as potentially eligible for opportunity to enter clinical trials and 39.8% accepted, 25.8% declined, 5 % were subsequently ineligible. A comprehensive  screening program with a dedicated clinical trials team to support patients with information can  enhance clinical trial recruitment and improve patient care. We support this as a model for care.

Link to more details or full-text: Available by e-mail from the author

An audit of the Shrewsbury and Telford two week wait CNS malignancy pathway referrals over six months (2015)

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Type of publication:
Poster presentation

Author(s):
*Metcalfe R, *Bowen J

Citation:
West Midlands Regional Neuroscience Meeting, 13 Nov 2015

Abstract:

An audit of the Shrewsbury and Telford two week wait CNS malignancy pathway referrals
over six months. By Metcalfe R*, Bowen J**
*Final year medical student, Keele University Medical School.
**Consultant Neurologist, Shrewsbury and Telford Hospital NHS trust (SaTH).
Word Count: 232 words.

Introduction:

  • The overall incidence of brain tumours in the U.K. is around 7/100,001
  • To promote early diagnosis a fast track “2 week wait” pathway exists for prompt diagnosis and initiation of management of brain/CNS tumours
  • In SaTH standardised suspected CNS malignancy referral proformas2 are faxed to meet 2 week targets appointments

Aim:

To undertake an audit to address the following:

  • Did referrals adhere to proforma criteria?
  • What proportion was seen within two weeks?
  • Is the process fit for purpose?

Methodology:

  • Case note review of all patients referred via the two week CNS Cancer pathway over a sixth month period from 1st July 2014 to 1st January 2015

Results:

  • Over the 6 months >98 % (120/122) referred via the two week wait pathway fulfilled the
    criteria on the proforma
  • Only 5.7% (7/122) were not seen within two weeks
  • 2 patients were diagnosed with brain metastases
  • No patients were diagnosed with a primary brain tumour

Conclusions:

  • Despite adherence of over 98% no case of primary brain tumour was detected over the six month period and 2 (1.6%) of patients referred had brain metastases
  • The current system is not effective at picking up brain tumours

Suggestions:

  • These results will be shared with local primary care groups and the referral criteria refined
  • A reaudit to assess impact of changes will be undertaken

References:
1. McKinney PA. J Neurol Neurosurg Psychiatry 2004;75:ii12-ii17
2. Shrewsbury and Telford Hospital NHS trust. Brain and CNS Cancer Two Week Wait
Referral Proforma. [internet] 2012 [Cited 6th October 2015] Available from:
www.sath.nhs.uk/Library/Documents/gpconnect/gpinfo/Brain%20and%20CNS
%20Cancer%20TWW%20Referral%20Proforma%20_V1_.pdf