Staff Publication

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

Can hospital early warning score systems be used to predict mortality and readmissions in patients with chronic obstructive pulmonary disease exacerbations requiring hospitalisation? (2014)

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Type of publication:
Conference abstract

Author(s):
*Crawford E.-J.T., *A lvarez E., *Moudgil H., *Naicker T.R., *Srinivasan K.S.

Citation:
American Journal of Respiratory and Critical Care Medicine, 2014, vol./is. 189/

Abstract:
Rationale: Predicting mortality in chronic obstructive pulmonary disease (COPD) can be complex as disease progression does not often follow a smooth downward trajectory. Identifying patients with COPD approaching the end of the ir life is important as it allows clinicians to initiate appropriately time d discussions centred around advance care planning and palliative care. High rates of early readmission to hospital (within 30 days of discharge) for patients with COPD is also of some national concern and to date, effective strategies to reduce this readmission rate have been limited. The use of early warning score (EWS) systems are now widespread in UK hospitals and are used primarily to alert nursing and medical staff to the severity of, or changes in, a patient's condition. This study aimed to understand whether the EWS systems could be used to predict 30 or 90 day mortality, or readmission rates in patients admitted to hospital with a COPD exacerbation. Met hods Data was collected from 73 consecutive patients admitted to hospital over a three month period (May to August, 2013) with an acute exacerbation of COPD. Collected data included early warning scores on admission, discharge and the peak EWS score. Data regarding in-hospital death, death within 30 and 90 days of admission date and readmission within 30 days of discharge was also collected. Results One patient (1.4%) died during their hospital admission. Four patients (5%) had died within 30 days of admission and 11 pa tients (15%) had died within 90 days of admission. 17 patients were re-admitted within 30 days of discharge (23%). There was no significant difference between median admission, peak and discharge early warning scores in those patients who had died within either 30 or 90 days of admission or who were readmitted within 30 days compared to the median values for the rest of th e group (see table). Conclusions According to the findings of this study, measurement of early warning scores cannot be used in clinical practice to p redict readmission rates, 30 or 90 day mortality in patients admitted to hospital with an acute exacerbation of COPD. (Table Presented).

Inadvertent returns to theatre within 30 days (IRT30) of surgery: an educational tool to monitor surgical complications and improve our performance as surgeons (2015)

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Type of publication:
Journal article

Author(s):
*Sukha A., *Li, E. , *Sykes T., *Fox A., *Schofield A., *Houghton A.

Citation:
Clinical Governance, October 2015, vol./is. 20/4(208-214 )

Abstract:
Purpose – When a patient unexpectedly has to go back to the operating theatre, there is often a perceived problem with the primary operation. An IRT30 is defined as any patient returning to the operating theatre within 30 days of the index procedure. IRT30 has been suggested to be a useful quality indicator of surgical standards and surgeon performance. The purpose of this paper is to evaluate t he usefulness of this validated tool, by assessing all IRT30 over a 12-month period. Learning points for individual surgeons, surgical subspecialty units and the clinical governance leads were reviewed. Design/methodology/app roach – Consecutive series of general and vascular surgical patients undergoing elective and emergency procedures between July 2012 and 2013. Prospective data collection of all IRT30s classified as Types 1-5 by a single-rater and in-depth discussion of Types 3-5 cases at the clinical governance meetings. The individual case learning points were recorded and the collective data monitored monthly. Findings – There were 134 IRT30s. In total 84 cases were discussed: Type 3 (n=80), Type 4 (n=4) and Type 5 (n =0). In total 50 cases were not discussed: Type 1 (n=27), Type 2 (n=2 3). Originality/value – It is crucial that surgeons continue to learn throughout their surgical career by reflecting on their own and their colleague's results, complications and surgical performance. Analysing Types 3 and 4 IRT30s within the governance meetings has identified learning points related to both surgical technique and surgical decision making. By embracing these learning points, surgical technique and individual as well as group surgeon performance can be modified and opportunities for training and focused supervision created.

Growth plate injuries and management (2015)

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Type of publication:
Journal article

Author(s):
*Dover C., Kiely N.

Citation:
Orthopaedics and Trauma, August 20 15, vol./is. 29/4(261-267)

Abstract:
The growth plate, or physis, is the name given to the area of cartilaginous tis sue found between the epiphysis and metaphysis of skeletally immature bone. The developing growth plate is weaker than surrounding ossified bone and, therefore, at risk of injury before its closure. Previous studies have shown that fractures account for 10-25% of all paediatric injuries, with growth plate injuries accounting for 15-30% of all paediatric bony injury. The upper limb is most likely to be affected, with the distal radius found to be the most common site of fractures in children. The Salter-Harris classification describes growth plate injuries based upon location and likelihood of growth arrest. In addition to growth arrest, injury to the growth plate often stimulates bone repair, which can lead to limb length discrepancy, bone b ridge formation between the metaphysis and epiphysis, and angulation of the bone. The treatment of growth plate fractures ranges from conservative management to operative fixation and bone grafting. Outcome is varied and dependent upon site and grade of the fracture as well as the age of the patient. Regardless of Salter-Harris classification, an important component of management is counselling the parents about the potential risk of future growth arrest and associated sequelae.

Hormone therapy for breast cancer in men (2015)

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Type of publication:
Journal article

Author(s):
Khan M.H., *Allerton R., *Pettit L.

Citation:
Clinical Breast Cancer, 2015, vol./is. 15/4(245-250)

Abstract:
Breast cancer in men is rare, but its incidence is increasing, in keeping with the aging population. The majority of breast cancers in men are estrogen receptor positive. There is a paucity of clinical trials to inform practice, and much has been extrapolated from breast cancer in women. Hormone therapy represents the mainstay of adjuvant and palliative therapy but may have contraindications or poor tolerability. We review the evidence for choice of hormone therapy in both the adjuvant and palliative setting in breast cancer in men.