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
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.
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.
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
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.
Type of publication:
Journal article
Author(s):
James N.D., Sydes M.R., Clarke N.W., Mason M.D., Dearnaley D.P., Spears M.R., Ritchie A.W.S., Parker C.C., Russell J.M., Attard G., De Bono J., Cross W., Jones R.J., Thalmann G., Amos C., Matheson D., Millman R., Alzouebi M., Beesley S., Birtle A.J., Brock S., Cathomas R., Chakraborti P., Chowdhury S., Cook A., Elliott T., Gale J., Gibbs S., Graham J.D., Hetherington J., Hughes R., Laing R., McKinna F., McLaren D.B., O'Sullivan J.M., Parikh O., Peedell C., Protheroe A., Robinson A.J., *Srihari N., Srinivasan R., Staffurth J., Sundar S., Tolan S., Tsang D., Wagstaff J., Parmar M.K.B.
Citation:
The Lancet, March 2016, vol./is. 387/10024(1163-1177)
Abstract:
Background
Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone.
Methods
Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m<sup>2</sup>) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2.5% one-sided alpha for hazard ratio (HR) 0.75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544).
Findings
2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0.94, 95% CI 0.79-1.11; p=0.450), 81 months (41 to not reached) for SOC + Doc (0.78, 0.66-0.93; p=0.006), and 76 months (39 to not reached) for SOC + ZA + Doc (0.82, 0.69-0.97; p=0.022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc.
Interpretation
Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy.
Funding
Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research.
Link to more details or full-text: http://www.sciencedirect.com/science/article/pii/S0140673615010375
Type of publication:
Conference abstract
Author(s):
*Lake B., *Fuller H.R., *Rastall S., *Usman T.
Citation:
Cancer Research, February 2016, vol./is. 76/4 SUPPL. 1(no pagination)
Abstract:
Introduction
Cancer survivorship is the process of living through and beyond cancer; a key part is how a patient copes with their diagnosis. Breast cancer is the most common malignancy of women worldwide and is known to be a severe stressor. Research has determined that the coping strategies used by women with breast cancer are vital to adjustment to their disease. Immediate breast reconstruction at the time of mastectomy with preservation of the breast form has been shown to be a positive influence on breast cancer patients however there are currently no studies to show whether breast reconstruction changes mechanisms of coping for such patients. The aim of this study, therefore, was to conduct a prospective cohort study to determine whether immediate breast reconstruction following mastectomy changes the way women with breast cancer cope with their diagnosis, compared to those who have mastectomy alone.
Method
A standardised questionnaire, the Brief Cope Scale was sent to two cohorts of patients who had a mastectomy and immediate reconstruction or mastectomy alone over an 11 year period 2003 to 2014 in Shropshire, England. It is a 28-point item with a four point Likert scale, which measures 14 different coping mechanisms: self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning humour, acceptance, religion and self-blame. The inclusion criteria for this study was all woman who had mastectomy with immediate breast reconstruction in Shropshire between 2003 and 2014 for either Ductal carcinoma in situ (DCIS) or breast cancer which was node negative (cohort 1). The principle exclusion criteria were: men, node positive cancer, prophylactic mastectomy and breast reconstruction. Each index patient was matched for year of diagnosis, adjuvant therapy and age to woman who had mastectomy alone for DCIS or breast cancer which was node negative (cohort 2). An anonymous questionnaire was sent out to all patients identified who were still living, with a reminder letter at six weeks.
Results
Questionnaires were sent to a total of 234 patients; 117 patients in each cohort. Preliminary results indicate a response rate of 46%, with 60 responses from reconstruction cohort and 48 from mastectomy. The mean age was 50, with range 29 to 70 for reconstruction cohort, and the mean age of mastectomy cohort was 52, with range 32 to 70. Common coping styles for the reconstruction cohort were acceptance, active coping and use of emotional support. Common coping styles for mastectomy cohort were acceptance, use of emotional support and positive reframing. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.88 at P value 0.02). Significantly less patients coped by active venting in reconstructive cohort compared to mastectomy cohort; (T value 1.91 at P value 0.03).
Conclusion
Breast reconstruction alters coping mechanisms in breast cancer patients allowing less venting coping style and more active coping. Understanding how breast surgery changes coping mechanisms allows clinicians to understand cancer survivorship in breast cancer patients and helps to provide needed support.
Type of publication:
Journal article
Author(s):
*Papoutsis D., *Panikkar J., *Gornall A., *Blundell S.
Citation:
Journal of Obstetrics and Gynaecology, February 2016, vol./is. 36/2(251-256)
Abstract:
The objective of our study was to determine whether removing multiple pieces of cervical tissue during large loop excision of the transformation zone (LLETZ) reduced the margin positivity of excision and cytology recurrence rates at follow-up. We conducted an observational cohort study and identified 462 women having had a single LLETZ treatment for cervical intraepithelial neoplasia (CIN) over a two-year period. Women with previous cervical treatment, cervical cancer on the excised tissue or missing follow-up data were excluded. Multiple regression analysis showed that removal of cervical tissue in multiple pieces did not offer any benefit in removing more disease and less recurrence rates. When multiple pieces were taken there was a four-fold increased risk for inconclusive excision margins as reported by the histopathologist. Removal of multiple pieces led to significantly more tissue being removed which may expose the patient to an increased risk of preterm delivery in a future pregnancy.
Type of publication:
Journal article
Author(s):
Katali H.M., *Parry-Smith W.R., Eliot R.L., Omahony F.
Citation:
Journal of Obstetrics and Gynaecology, February 2016, vol./is. 36/2(227-229)
Abstract:
Much discussion in the literature centres on how best to teach medical students the intricacies of gynaecological assessment and the subsequent formulation of a management plan. At Keele University skills are initially developed in a simulated setting and then transferred to the workplace where students continue to develop their skills. A dedicated undergraduate gynaecology teaching clinic has been developed and comprises of 2-3 students and a tutor. All 38 students rotating through the department between January and June 2013 were invited to complete an anonymous questionnaire to evaluate this clinic and 36 (95%) of them responded. Respondents felt significantly more comfortable taking a gynaecology history, ensuring privacy during examination and formulating a management plan post-clinic (all p < 0.001), with female students feeling significantly more comfortable than their male counterparts (p = 0.04). The use of this clinic shows great promise to help students learn an unfamiliar and challenging skill.
Type of publication:
Conference abstract
Author(s):
Kumar S., Olaitan A., Danino J., Scott A.
Citation:
Otorhinolaryngologist, 2016, vol./is. 9/1(9-13)
Abstract:
Introduction: We aimed to assess whether MRI scans for screening of vestibular schwannoma (VS) are a cost effective tool and how best to maximise their positive yield. Materials and Methods: We undertook a retrospective analysis of 1000 scans to assess the diagnostic yield and the sensitivity and specificity of four published protocols Results: Of 756 patients included 8 patients were positively identified with a VS. If only patients who had either a 15dB or 20dB hearing loss at any single frequency underwent screening the number of negative scans would have been reduced by over 50%. No patients with unilateral tinnitus alone and normal hearing (8.6%) were diagnosed with VS. Discussion: To reduce the burden of MRI scans all departments should scan in accordance with a published protocol.
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Find out more by visiting either the Improvement Hub Intranet pages (only available on a Trust PC) or the Improvement Hub page on the SaTH website.