Staff Publication

An unusual cause of fetomaternal distress at term: uterine vessel rupture in pregnancy (2015)

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Type of publication:
Journal article

Author(s):
Calcott G.A., Gaber M., Freedman J., Patni S.

Citation:
BMJ Case Reports, August 2015, vol./is. 2015

Abstract:
This report describes a case of spontaneous bleeding from uterine vessels presenting as hyperstimulation and fetomaternal distress at term. A 40-week primigravid woman underwent an emergency caesarean section for fetal distress, which unexpectedly revealed a spontaneous haemoperitoneum. Clinical assessment and investigations postoperatively gave a diagnosis of a rightsided uterine artery aneurysm that, it was believed, had ruptured, causing the haemoperitoneum. This was successfully treated postnatally using interventional radiological techniques leading to expeditious maternal recovery and discharge home.

Link to full-text: http://casereports.bmj.com/content/2015/bcr-2014-209004.full.pdf

Validation of the English translation of the low anterior resection syndrome score (2015)

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Type of publication:
Journal article

Author(s):
Juul T., Christensen P., Janjua A.Z., Laurberg S., Emmertsen K.J., Moran B., Khan R.B., Kurasz C., Waldron E., Battersby N.J., Janjau Z., Moran B.J., Shahir T., Chan K., Glynne-Jones R., Kelly S., Evans K., Hughes R., Smith F., Heath B., Leinhardt D., Norton A., Jayne D., Moriarty C., Laing E., Mawdsley S., Bourner L., Narula N., Ward J., *Lacy-Colson J., *Moore H., *Potts S., Branagan G., Bell L., Chave H., Carter V., Mirza N., Pereira G., Williams J.G., Last K., Todd J., Woodcock N.

Citation:
Colorectal Disease, October 2015, vol./is. 17/10(908-916)

Abstract:
Aim: Many patients having anterior resection for rectal cancer suffer from severe long-term bowel dysfunction, known as low anterior resection syndrome (LARS). The LARS score was developed in Denmark, and Swedish, Spanish and German versions have been validated. The aim of this study was to validate the English translation of the LARS score in British rectal cancer patients. Method: Rectal cancer patients who underwent an anterior resection in 12 UK centres received the LARS score questionnaire, the EORTC QLQ-C30 and a single ad hoc quality of life question. A subgroup of patients received the LARS score questionnaire twice. Results: The response rate was 80% and 451 patients were included in the analyses. A strong association between LARS score and quality of life (convergent validity) was found (P < 0.01), discriminative validity was good (P < 0.02) and the test-retest reliability was high (intraclass correlation coefficient 0.83). Conclusion: The English translation of the LARS score has shown good psychometric properties comparable with recently published results from an international multicentre study. Thus, the English translation of the LARS score can be considered a valid and reliable tool for measuring LARS.

Thrombolysis for stroke in pregnancy at 39 weeks gestation with a subsequent normal delivery (2015)

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Type of publication:
Journal article

Author(s):
*Ritchie J., *Lokman M., *Panikkar J.

Citation:
BMJ Case Reports, August 2015, vol./is. 2015

Abstract:
Stroke during pregnancy is fortunately a rare event, however, it can have severe consequences, with 9.5% of all maternal deaths being related to stroke. The most common presentation is an ischaemic stroke. There has been much debate as to the correct treatment for such cases' and whether thrombolysis can be used safely in pregnancy. Our case describes a 28-year-old woman with a previous normal vaginal delivery presenting in her third trimester with a sudden onset of dense left hemiparesis. She was successfully treated with alteplase, an intravenous recombinant tissue-type plasminogen activator, and made a full recovery after normal delivery of a healthy infant. This case report highlights one of the first documented successful outcomes from thrombolysis for this condition in the UK and may help inform future management of these women.

Link to full-text: http://casereports.bmj.com/content/2015/bcr-2015-209563.full.pdf

Understanding the needs of people with dementia and family carers (2015)

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Type of publication:
Journal article

Author(s):
Bray, Jennifer, Evans, Simon, Thompson, Rachel, Bruce, Mary, Carter, Christine, Brooker, Dawn, Milosevic, Sarah, *Coleman, Helen, *McSherry, Wilf

Citation:
Nursing Older People, 01 September 2015, vol./is. 27/7 (18-23)

Abstract:
This is the first in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. When a person with dementia is in hospital, poor understanding of individual needs and preferences can contribute to a lack of person-centred care. Similarly, the needs of family carers can often be overlooked and staff do not always appreciate these needs at such a stressful time. This article illustrates how three NHS trusts have addressed these issues. To help staff get to know patients with dementia, Salford Royal NHS Foundation Trust has implemented a patient passport. Similarly, The Shrewsbury and Telford Hospital NHS Trust has implemented a carer passport that overcomes the restrictions imposed by hospital visiting hours. Royal Devon and Exeter NHS Foundation Trust also focused on carers, holding a workshop to elicit feedback on what was important to them. This was a useful means of engaging with carers and helped staff to realise that even simple changes can have a significant effect.

Percutaneous endoscopic gastrostomy (PEG) in disabled children - a bench marking exercise (2015)

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Type of publication:
Conference abstract

Author(s):
*Saran S.S., *Wasala D.W., *Ayub N.A.

Citation:
Archives of Disease in Childhood, April 2015, vol./is. 100/(A196)

Abstract:
Background: The Paediatric Gastroenterology Unit based at the Royal Shrewsbury Hospital provides a service for two hospitals. Its subsequent management is supported by the Community Paediatric Nurses. A benchmarking exercise of the PEG Service was undertaken and audited against the European Society for Parenteral and Enteral Nutrition (ESPEN) Guidelines. Methods All children with a PEG in-situ were identified from the Community Nurses PEG database. The electronic records of these patients were accessed for relevant data and input into a Microsoft Excel 2010 database by a single researcher. The ESPEN standards were used to audit the service in the relevant domains. Results 53 children with a PEG were identified. There was a clearly documented indication for a PEG in 96%, with neurologically disabled children at risk of aspiration comprising the largest group (47%). Feeding difficulties and Failure to thrive (FTT) made up 30% while other indications were Sensory Feeding Disorder in combination with other primary disorders (13%) dysmotility (4%) and metabolic causes (2%). The primary diagnosis was neurological in 55%, gastrointestinal 11%, renal 4% and cardiovascular, respiratory and endocrine 2% each. There were multiple diagnoses in 11% Nasogastric feeds were instituted and documented prior to the PEG in 94% and may have been used in a further 2% but not documented. More than half the children had their PEG sited at the age of 13-36 months (52%), a further 15% under 13 months while 20% were after the age of 36 months. Almost one third of the children (29%) had no complications from the PEG. Localised infection was the commonest complication (28%) with granulation tissue (13%), mechanical problems (dislodgement 8%, blockage 4%), skin ulceration (10%) and leakage (8%) as other complications. PEG feeds were succesful in improving the weight centiles of these patients. Parental satisfaction with the service could not be evaluated retrospectively. Conclusions The PEG Service at the Shrewsbury and Telford Hospitals NHS Trust adheres to ESPEN standards in the majority of patients and is associated with a low complication rate. Parental Satisfaction with the service should be sought prospectively.

Link to full-text: http://adc.bmj.com/content/100/Suppl_3/A196.1.full.pdf+html

Treatment of the first episode of childhood idiopathic nephrotic syndrome: A systematic review and meta-analysis (2015)

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Type of publication:
Conference abstract

Author(s):
Zolotas E., *Leontsinis I.

Citation:
Archives of Disease in Childhood, April 2015, vol./is. 100/(A208-A209)

Abstract:
Background and objective Corticosteroids induce remission in 80% of children with idiopathic nephrotic syndrome (INS). However 90% of steroid responders experience at least one relapse and 40% of them suffer from frequent relapses. The optimal treatment for the first episode of INS in terms of preventing subsequent relapses remains controversial. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCT). We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials without language restriction. We also searched proceedings from international conferences and we contacted investigators. We only included RCT which compared different regimens for the treatment of the first episode of INS in children. Results 26 RCT were included. Nine studies compared the classic two-month steroid regimen with prolonged steroid courses ranging from three to seven months. Meta-analysis of those studies showed no difference in the number of children with frequent relapses [RR: 0.79, 95% CI (0.57, 1.08)] (Figure 1) and number of relapses per patient [WMD: -0.37, 95% CI (-0.85, 0.1)]. Cumulative steroid dose was significantly higher with prolonged courses [SMD: 0.48 95% CI (0.16, 0.81)] (Figure 2). Eight studies compared three months with six months of steroid treatment. Similarly there was no difference in frequent relapses [RR: 0.63, 95% CI (0.36, 1.10)] (Figure 3) and relapses per patient [WMD: -0.32, 95% CI (-0.65, 0.00)]. Three RCT explored the potential benefit of adding cyclosporine, azithromycin or sarei-to, a Chinese herb, to steroids. Only sarei-to was showed to improve frequent relapses and number of relapses per patient. Conclusion This meta-analysis showed no sufficient evidence that prolonged steroid courses for the first episode of INS can prevent future relapses. The cumulative steroid dose was significantly higher with prolonged courses suggesting a potential for increased toxicity, even though the incidence of side effects was similar. In conclusion, the current evidence cannot support that prolongation of steroid treatment for the first episode of INS for more than two to three months is beneficial. Abbreviations RR relative risk, CI confidence intervals, WMD weighted mean difference, SMD standardised mean difference (Figure Presented).

Link to full-text: http://adc.bmj.com/content/100/Suppl_3/A208.2.full.pdf+html

Current trends in head and neck surgery: Use of recurrent laryngeal nerve monitoring (RLNM) (2014)

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Type of publication:
Conference abstract

Author(s):
Babatola O., *Karamchandani D., *Ahsan S.F.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S39)

Abstract:
Introduction: Aim is to understand the patterns of use of nerve monitoring in UK surgical practice. Methods: An electronic questionnaire was sent to the 434 members of the ENT-UK expert panel in 2012. 86 members (22.4%) of the panel identified themselves as having an interest or subspecialty related to thyroid surgery. The survey contained 8 questions on their current practice in thyroid or parathyroid surgery, their typical use of the recurrent laryngeal nerve stimulator and any patient selection criteria that they may have. Demographic data on the surgeon's year of gaining consultancy and number of procedures performed per annum was also obtained. Results: Of 100 respondents (23.04% response rate) of this panel, 50 of these surgeons performed thyroid and/or parathyroid surgery on a regular basis and the following results pertain to this group. 58.3% use the RLNS in almost all cases that they perform. A further 12.5% used it in fewer than half of their cases. 29.2% did not use the stimulator at all. Conclusions: Currently there appears to be no true consensus among the surgeons performing thyroid surgery on use of RLNS in thyroid surgery.

Link to more details or full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00373-2/pdf

Laparoscopic anti-reflux surgery (LARS): Determine the hiatal defect repair using the intra-operatively calculated surface area (SA) cm2 (2014)

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Type of publication:
Conference abstract

Author(s):
*Sukha A., *Adjepong S., *Pattar J., *Sigurdsson A.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S100)

Abstract:
Introduction: The aim of this study was to evaluate laparoscopic antireflux surgery (LARS) techniques when repairing hiatal defects using the intra operatively calculated surface area (SA) at single-centre Upper Gastrointestinal Laparoscopic Unit. Methods: 100 patients (mean age = 59, average BMI 31) with symptoms of GORD underwent LARS. The SA (cm2) was calculated using an endoscopic ruler and the formula;(1/2 x base x height) x2. The method of closure; Surgisis +/-simple tension free sutures, was recorded for each hiatal closure. Results: The mean calculated SA repaired was 9.0cm2 and there was a 2%(2) recurrence rate. There were 3 modalities of repair; 1) Surgisis, posterior and anterior sutures (mean SA=10.0cm2, average BMI = 28); 2) Surgisis and posterior sutures (mean SA=9.5cm2, average BMI=29); 3) posterior sutures only (mean SA =6.1cm2, average BMI=32, mean number of sutures 3). Conclusions: It was found that the greater the average SA cm2 of the hiatus hernia the greater the number of modalities of repair used. There was no correlation found between BMI and the surface area of the hiatus hernia. Currently there are no set standard for method of repair based on the SA of the defect; however guidelines have been derived from this study.

Link to more details or full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00735-3/pdf

Mortality following acute native artery embolecotmy for arterial embolism unrelated to peripheral arterial disease (PAD): 18 year review (2014)

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Type of publication:
Conference abstract

Author(s):
*Lambert J., *Premaratne S., *Jaipersad A., *Houghton A., *Fox A., *Merriman K.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S114)

Abstract:
Introduction: Arterial embolism unrelated to peripheral vascular disease (AEUPAD) is known to be associated with risk factors such as malignancy, atrial fibrillation and thrombophilias. This study aimed to determine survival following embolecotmy of native arteries for AEUPAD. Methodology: Retrospective analysis was performed of a prospectively maintained database in a single vascular centre for the past 18 years, for all native artery embolectomies. Patients with PAD and graft embolectomies were excluded. Kaplan-Meier survival analysis was performed to calculate overall survival. Relationship between death and known risk factors were also assessed. Results: From 1994 to 2012, 192 patients had 204 native artery embolectomies for AEUPAD. 11 had multiple embolectomies. 100(49%) were male, mean age 72.5 (range: 9-102) years. Embolectomies performed; femoral 115 (56%), popliteal 47(23%), brachial 40 (17%), iliofemoral 1(0.4 %) and tibial 2(0.8%). 80 (41.60%) of patients were alive at the time of analysis. Kaplan-Meier estimates 69.77% survival 12 months post embolecotmy, decreased to 46.42% and 18.61% within 2 and 5 years respectively. Age (p<0.0001) and male sex (p=0.0451) were associated with death. Smoking had a negative correlation with mortality (p=0.0080). Conclusions: There is high mortality following embolecotmy. Though basic investigations are performed, further assessment may be necessary to prevent high mortality.

Link to full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00812-7/pdf

Incidence of malignancy in solitary thyroid nodules (2015)

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Type of publication:
Journal article

Author(s):
Keh, S M, *El-Shunnar, S K, Palmer, T, *Ahsan, S F

Citation:
Journal of Laryngology and Otology, Jul 2015, vol. 129, no. 7, p. 677-681

Abstract:
This study aimed to investigate the prevalence and clinical significance of solitary thyroid nodules in patients who underwent thyroid surgery. A retrospective review was performed of the case notes of all adult patients who underwent thyroid surgery from January 2003 to December 2009. All patients with solitary thyroid nodules identified by ultrasonography were included. In total, 225 patients underwent thyroid surgery. The prevalence of solitary thyroid nodules was 27.1 per cent (61 out of 225 patients). Seventy-two per cent of patients were women and the mean age at presentation was 52 ± 16 years. In all, 75.4 per cent of solitary nodules had neoplastic pathology and the malignancy rate was 34.4 per cent. The sensitivity and specificity of fine needle aspiration cytology for neoplasm detection were 73.9 per cent and 80.0 per cent, respectively. There was no association between the various ultrasonography parameters and malignancy risk (p > 0.05). Solitary thyroid nodules should be investigated thoroughly with a high index of suspicion because there is a high probability (34.0 per cent) of malignancy.