Staff Publication

Effect of hyperventilation on rate corrected QT interval of children (2013)

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Type of publication:
Journal article

Author(s):
*A Kannivelu, V Kudumula, V Bhole

Citation:
Archives of Disease in Childhood. 2013 Feb;98(2):103-6

Abstract:
BACKGROUND: Hyperventilation is known to cause ST segment changes and QT variability in adults, but this has not been systematically studied in children.
AIM: To investigate the effect of hyperventilation on rate corrected QT interval (QTc) in children.
METHODS AND RESULTS: 25 children (male=10) with a median age of 14 (range 8.3-17.6) years were asked to hyperventilate for 1 min before exercise testing using the modified Bruce protocol. Mean QTc at rest, after hyperventilation, at peak exercise and at 1 min of recovery was 425(±31), 460(±30), 446(±38) and 420(±32) ms, respectively. Mean increase (95% CI) in QTc after hyperventilation was 35(19 to 51) ms (p<0.001), while there was minimal difference between QT interval at rest and after hyperventilation (mean QT 352(±41) vs 357(±44) ms). In six children, there were abnormalities in T wave morphology following hyperventilation. The QTc increment following hyperventilation was more pronounced in children with resting QTc <440 ms (n=14, mean increment (95% CI): 55 (33 to 78) ms) compared to children with QTc ≥440 ms (n=11, mean increment (95% CI): 9 (-4 to 22) ms) (p=0.001). QTc prolongation following hyperventilation was seen in children with both low and intermediate probability of long QT syndrome (LQTS). Peak exercise and early recovery did not cause a statistically significant change in QTc in either of these groups.
CONCLUSIONS: Hyperventilation produces repolarisation abnormalities, including prolongation of QTc and T wave abnormalities in children with low probability of LQTS. The likely mechanism is delayed adaptation of QT interval with increased heart rate. Thus, a hyperventilation episode can be misdiagnosed as LQTS, especially in an emergency department.

Link to more details or full-text: http://adc.bmj.com/content/early/2012/12/13/archdischild-2012-302663.full.pdf

Enhance It - Enhancing Hospital Laboratory Standards for Continuing Professional Development: Transnational Evaluation of a Novel CPD Activity for Specialists in Laboratory Medicine (2014)

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Type of publication:
Conference abstract

Author(s):
Martin J, Gasljevic V, Sálek T, Horvath A, Borg C, Flegar-Meštrić Z, Jakovcic M, Silhavik J, Adonics A, Szlamka Z, Brincat I, Buttigieg D, Ciantar N, Sciortino AL, Mifsud A, Adkins A, *Bennett T, Rice K, Taylor Y.

Citation:
The Future of education 2014

Abstract:
A project which has received funding of over 100,000 euros from the European Union’s Lifelong Learning Leonardo Program is developing good practice in continuing professional development (CPD) for Specialists in Laboratory Medicine. The Partnership is developing an EU-toolkit for delivery of high quality CPD activities provided by European hospital laboratories. This paper reports on the first stage of the project which is transnational evaluation of a novel European CPD activity by hospital laboratories in Croatia, Czech Republic, Malta and the United Kingdom. An innovative CPD activity was designed to facilitate participation by Specialists in Laboratory Medicine in all partner countries. The topic of Health and Safety was chosen to enable maximum European participation as it is a multi-disciplinary topic of relevance to all Specialists in Laboratory Medicine in all partner countries. A series of thirty images of either good or bad laboratory practice in Health and Safety were provided to participants who were required to state whether the photograph depicted good or bad practise. If bad practise was shown Specialists in Laboratory Medicine were asked to explain what further actions would be taken including reporting procedures. On completion of the exercise, participants took part in a discussion group, completed a reflective learning sheet and filled in an evaluation questionnaire. Subsequently, in order to contextualise the CPD activity within their own laboratories participants will be asked to note any poor practice in their laboratory, discuss with colleagues, develop an action plan, repeat at monthly intervals and report on Health and Safety improvements. Over one hundred Specialists in Laboratory Medicine from four different European countries Croatia (n=14), Czech Republic (n= 10), Malta (n=65) and UK (n=29) took part in this new CPD activity. Several different grades of laboratory staff evaluated the activity and indicated that the exercise had been useful and appropriate to their scope of practice (99.2%) and relevant for their own CPD (97%). For over 80% of participants, this was the first time that they had taken part in this novel format of CPD activity. Discussion with colleagues following completion of the activity provided useful enhancement to both scope of practice (92%) and CPD (87%). Subsequent completion of a reflective learning sheet was shown to be beneficial for 86% of participants. We conclude that participation in this novel CPD activity which demonstrated a 100% overall satisfaction rate, has facilitated enhanced European cooperation between participating hospital laboratories and will provide a platform for future more intensive European co-operation by Specialists in Laboratory Medicine to work closely together to harmonise their practice and profession throughout the European Union.

Link to more details or full-text: http://conference.pixel-online.net/FOE/acceptedabstracts_scheda.php?id_abs=554#null

 

How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study (2015)

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Type of publication:
Journal article

Author(s):
Strong S., Blencowe N., Bhangu A., Panagiotopoulou I.G., Chatzizacharias N., Rana M., Rollins K., Ejtehadi F., Jha B., Tan Y.W., Fanous N., Markides G., Tan A., Marshal C., Akhtar S., Mullassery D., Ismail A., Hitchins C., Sharif S., Osborne L., Sengupta N., Challand C., Pournaras D., Bevan K., King J., Massey J., Sandhu I., Wells J.M., Teichmann D.A., Peckham-Cooper A., Sellers M., Folaranmi S.E., Davies B., Potter S., Egbeare D., Kallaway C., Parsons S., Upchurch E., Lazaridis A., Cocker D., King D., Behar N., Loukogeorgakis S.P., Kalaiselvan R., Marzouk S., Turner E.J.H., Kaptanis S., Kaur V., Shingler G., Bennett A., Shaikh S., Aly M., Coad J., Khong T., Nouman Z., Crawford J., Szatmary P., West H., MacDonald A., Lambert J., Gash K., Hanks K.A., Griggs E., Humphreys L., Torrance A., Hardman J., Taylor L., Rex D., Bennett J., Crowther N., McAree B., Flexer S., Mistry P., Jain P., Hwang M., Oswald N., Wells A., Newsome H., Martinez P., Alvarez C.A.B., Leon J., Carradice D., Gohil R., Mount M., Campbell A., Iype S., Dyson E., Groot-Wassink T., Ross A.R., Charlesworth P., Baylem N., Voll J., Sian T., Creedon L., Hicks G., Goring J., Ng V., Tiboni S., Palser T., Rees B., Ravindra P., Neophytou C., Dent H., Lo T., Broom L., O'Connell M., Foulkes R., Griffith D., Butcher K., Mclaren O., Tai A., Yano H., Torrance H.D.T., Moussa O., Mittapalli D., D.Watt, Basson S., Gilliland J., Pilgrim S., Wilkins A., Yee J., Cain H., Wilson M., Pearson J., Turnbull E., Brigic A., Yassin N.A., Clarke J., Mallappa S., Jackson P., Jones C., Lakshminarayanan B., Sharma A., Velineni R., Fareed K., Yip G., Brown A., Patel N., Ghisel M., Tanner N., Jones H., Witherspoon J., Phillips M., Ho M.F., Ng S., Mak T., Campain N., Mukhey D., Mitchell W.K., Amawi F., Dickson E., Aggarwal S., Satherley L.K., Asprou F., Keys C., Steven M., Johnstone M., Muhlschlegel J., Hamilton E., Yin J., Dilworth M., Wright A., Spreadborough P., Singh M., Mockford K., Morgan J., Ball W., Royle J., Lacy-Colson J., Lai W., Griffiths S., Mitchell S., Parsons C., Joel A.S., Mason P.F., Harrison G.J., Steinke J., Rafique H., Battersby C., Hawkins W., Gurram D., Hateley C.A., Penkethman A., Lambden C., Conway A., Dent P., Yacob D., Oshin O.A., Hargreaves A., Gossedge G., Long J., Walls M., Futaba K., Pinkney T., Puig.S, Boddy A., Jones A., Tennuci C., Battersby N., Wilkin R., Lloyd C., Sein E., McEvoy K., Whisker L., Austin S., Colori A., Sinclair P., Loughran M., Lawrence A., Horsnell J., Bagenal J., Pisesky A., Mastoridis S., Solanki K., Siddiq I., Merker L., Sarmah P., Richardson C., Hanratty D., Evans L., Mortimer M., Bhalla A., Bartlett D., Beral D., Cornish J., Haddow J.B., Hall N.J.

Citation:
International Journal of Surgery, March 2015, vol./is. 15/(107-112)

Abstract:
Background: Convincing arguments for either removing or leaving in-situ a macroscopically normal appendix have been made, but rely on surgeons' accurate intra-operative assessment of the appendix. This study aimed to determine the inter-rater reliability between surgeons and pathologists from a large, multicentre cohort of patients undergoing appendicectomy. Materials and methods: The Multicentre Appendicectomy Audit recruited consecutive patients undergoing emergency appendicectomy during April and May 2012 from 95 centres. The primary endpoint was agreement between surgeon and pathologist and secondary endpoints were predictors of this disagreement. Results: The final study included 3138 patients with a documented pathological specimen. When surgeons assessed an appendix as normal (n=496), histopathological assessment revealed pathology in a substantial proportion (n=138, 27.8%). Where surgeons assessed the appendix as being inflamed (n=2642), subsequent pathological assessment revealed a normal appendix in 254 (9.6%). There was overall disagreement in 392 cases (12.5%), leading to only moderate reliability (Kappa 0.571). The grade of surgeon had no significant impact on disagreement following clinically normal appendicectomy. Females were at the highest risk of false positives and false negatives and pre-operative computed tomography was associated with increased false positives. Conclusions: This multi-centre study suggests that surgeons' judgements of the intra-operative macroscopic appearance of the appendix is inaccurate and does not improve with seniority and therefore supports removal at the time of surgery.

Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000 (2015)

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Type of publication:
Journal article

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

Citation:
BMC Cancer, December 2014, vol./is. 14/1, 1471-2407 (December 17, 2014)

Abstract:
Background: Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors. Methods: We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires. Discussion: This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.

Link to full-text: http://europepmc.org/articles/PMC4301458

Case report of generalized pustular psoriasis of von Zumbusch associated with hypothyroidism (2014)

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Type of publication:
Conference abstract

Author(s):
*Mirhadi S., Moazenzade M.

Citation:
British Journal of Dermatology, December 2014, vol./is. 171/6(e147-e148), 0007-0963 (December 2014)

Abstract:
Generalized pustular psoriasis (GPP), a rare subtype of psoriasis, is characterized by abrupt extensive pustular eruptions with potentially fatal outcome. This report describes a case of GPP associated with hypothyroidism. A 28-year-old Iranian woman presented 5 years ago with pustular lesions with underlying erythematous background, which spread over > 50% of her body and was particularly severe in her calf and lower abdomen. The size of lesions was 4-20 cm. She also had systemic symptoms including fever, rigors, arthralgia, loss of appetite and severe depression. In addition, she had peripheral oedema and lymphadenopathy in the submental and anterior cervical chain. She had no significant past medical history. Her family history included mild localized psoriasis in her mother. She was admitted on five occasions, for 2 weeks, at intervals of 6-12 months with acute relapses. The attacks occurred mainly during the winter and summer. No drugs have been implicated. Skin biopsy confirmed pustular psoriasis. Unbroken pustules were sterile. The main biochemical abnormalities were elevated erythrocyte sedimentation rate, leucocytosis, iron-deficiency anaemia, hyperlipidaemia and hypoproteinaemia in the acute phase. During her third attack, it was noticed that she had hypothyroidism. She was treated with low-dose systemic corticosteroid for her acute attacks. Both the skin lesions and peripheral oedema started to respond on day 5 of steroids. Weaning of steroids was commenced in week 3. Among systemic drugs, she tolerated only a retinoid (Neotigason) and she had longer remissions with retinoids. Following the correction of her anaemia, hypothyroidism and peripheral circulation using tensile bandage, and additional family support, her condition is now improving. She occasionally gets small localized lesions that respond well to combined topical steroid with mupirocin. Following resolution of her pustules, topical Daivonex (calcipotriol) and steroid are used. The plan is to reduce the dose of Neotigason gradually. Multiple trigger factors for GPP have been described, including low thyroid activity. GPP is associated with autoimmune conditions such as hypothyroidism. Its prognosis is better in younger age and when the pustular psoriasis is preceded by ordinary psoriasis. In conclusion, we report a typical case of GPP with systemic symptoms, raised inflammatory markers, leucocytosis, hypoalbuminaemia, anaemia, hyperlipidaemia and hypothyroidism. Pharyngitis and emotional stress were identified as triggers. Her management was quite complicated and the disease finally responded to steroids, retinoid and calcipotriol. This patient did not develop any life-threatening complication.

Link to more details or full-text:
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Current evidence and future perspectives on the effective practice of patient-centered laboratory medicine (2015)

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Type of publication:
Journal article

Author(s):
*Hallworth M.J., Epner P.L., Ebert C., Fantz C.R., Faye S.A., Higgins T.N., Kilpatrick E.S., Li W., Rana S.V., Vanstapel F.

Citation:
Clinical Chemistry, April 2015, vol./is. 61/4(589-599), 0009-9147;1530-8561 (01 Apr 2015)

Abstract:
BACKGROUND: Systematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally. CONTENT: This review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care. SUMMARY: To maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation (2015)

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Type of publication:
Journal article

Author(s):
*Carmont M.R., Gravare Silbernagel K., Brorsson A., Olsson N., Maffulli N., Karlsson J.

Citation:
Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, April 2015, vol./is. 2/2(49-55), 2214-6873 (01 Apr 2015)

Abstract:
Background Rupture of the Achilles tendon may result in reduced functional activity and reduced plantar flexion strength. These changes may arise from elongation of the Achilles tendon. An observational study was performed to quantify the Achilles tendon resting angle (ATRA) in patients following Achilles tendon rupture, surgical repair, and rehabilitation, respectively. Methods Between May 2012 and January 2013, 26 consecutive patients (17 men), with a mean (standard deviation, SD) age of 42 (8) years were included and evaluated following injury, repair, and at 6 weeks, 3 months, 6 months, 9 months, and 12 months, respectively (rehabilitation period). The outcome was measured using the ATRA, Achilles tendon total rupture score (ATRS), and heel-rise test. Results Following rupture, the mean (SD) absolute ATRA was 55 (8)degree for the injured side compared with 43 (7)degree(p < 0.001) for the noninjured side. Immediately after repair, the angle reduced to 37 (9)degree(p < 0.001). The difference between the injured and noninjured sides, the relative ATRA, was -12.5 (4.3)degree following injury; this was reduced to 7 (7.9)degree following surgery (p < 0.001). During initial rehabilitation, at the 6-week time point, the relative ATRA was 2.6 (6.2)degree(p = 0.04) and at 3 months it was -6.5 (6.5)degree(p < 0.001). After the 3-month time point, there were no significant changes in the resting angle. The ATRS improved significantly (p < 0.001) during each period up to 9 months following surgery, where a score of 85 (10)degreewas reported. The heel-rise limb symmetry index was 66 (22)% at 9 months and 82 (14)% at 12 months. At 3 months and 6 months, the absolute ATRA correlated with the ATRS (r = 0.63, p = 0.001, N = 26 and r = 0.46, p = 0.027, N = 23, respectively). At 12 months, the absolute ATRA correlated with the heel-rise height (r = -0.63, p = 0.002, N = 22). Conclusion The ATRA increases following injury, is reduced by surgery, and then increases again during initial rehabilitation. The angle also correlates with patient-reported symptoms early in the rehabilitation phase and with heel-rise height after 1 year. The ATRA might be considered a simple and effective means to evaluate Achilles tendon function 1 year after the rupture.

Extrication time prediction tool (2015)

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Type of publication:
Journal article

Author(s):
Nutbeam, Tim, *Fenwick, Rob , Hobson, Charles, Holland, Vikki, Palmer, Michael

Citation:
Emergency medicine journal : EMJ, May 2015, vol. 32, no. 5, p. 401-403 (May 2015)

Abstract:
Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time. To derive a tool to predict the time taken to extricate patients from MVCs. A prospective, observational derivation study was carried out in the West Midland Fire Service's metropolitan area. An expert group identified factors that may predict extrication time-the presence and absence of these factors was prospectively recorded at eligible extrications for the study period. A step-down multiple regression method was used to identify important contributing factors. Factors that increased extrication times by a statistically significant extent were: a physical obstruction (10 min), patients medically trapped (10 min per patient) and any patient physically trapped (7 min). Factors that shortened extrication time were rapid access (-7 min) and the car being on its roof (-12 min). All these times were calculated from an arbitrary time (which assumes zero patients) of 8 min. This paper describes the development of a tool to predict extrication time for a trapped patient. A number of factors were identified which significantly contributed to the overall extrication time.

Link to full-text: http://emj.bmj.com/content/32/5/401.abstract