Staff Publication

Is the MMR vaccination programme failing to protect women against rubella infection? (2014)

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Type of publication:
Journal article

Author(s):
*Skidmore S., Boxall E., Lord S.

Citation:
Epidemiology and Infection, 2014, vol./is. 142/5(1114-1117), 0950-2688;1469-4409 (2014)

Abstract:
In recent years the number of pregnant women susceptible to rubella has increased markedly. In the West Midlands the proportion has risen from 1.4% in 2004 to 6.9% in 2011. Locally, the proportion of non-immune women ranges from 1.6% in those born prior to 1976 to 17.8% in those born since 1986. The latter group comprises those given MMR in their second year with no further booster doses. The number of non-immune women will continue to rise as a consequence of low MMR uptake in the late 1990s. Repeat testing of samples with values

Link to more details or full-text: http://www.ncbi.nlm.nih.gov/pubmed/23953764

 

Rapid sequence induction in urgent care settings. (2014)

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Type of publication:
Journal article

Author(s):
*Fenwick R

Citation:
Emergency Nurse, 03 2014, vol./is. 21/10(16-24), 1354-5752;1354-5752 (2014 Mar)

Abstract:
In the management of critically ill patients in emergency departments, rapid sequence induction (RSI) of anaesthesia is often required. This article examines the elements of RSI that are necessary before before endotracheal tube placement and reviews the findings of a national audit project, conducted by Royal College of Anaesthetists and Difficult Airway Society. It also considers the role of nurses in RSI procedures.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2012497882&authtype=athens&site=ehost-live

 

Major trauma training for emergency nurses (2014)

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Type of publication:
Journal article

Author(s):
*Fenwick R

Citation:
Emergency Nurse, 04 2014, vol./is. 22/1(12-6), 1354-5752;1354-5752 (2014 Apr)

Abstract:
The Midlands regional trauma network was established in March 2012 to improve and standardise the care offered to patients with major trauma. This article discusses the results of a survey of formal training in, and self-assessed knowledge of, trauma management among emergency department nurses working in the network. Less than one third of the nurses had received formal training against which standards can be benchmarked, and the article recommends that nurse education standards are reinstated as key performance indicators in the region.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2012531636&authtype=athens&site=ehost-live

 

Video Q&A: state-of-the-art therapy for the elite and non-elite athlete: an interview with Mike Carmont (2014)

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Type of publication:
Journal article

Author(s):
*Carmont MR

Citation:
BMC Medicine, 2014, vol./is. 12/(8), 1741-7015;1741-7015 (2014)

Abstract:
In this video Q&A, Mr Mike Carmont answers questions about state-of-the-art treatments for elite athletes, and the progress and challenges behind translating these into successful therapies for the non-elite athlete.

Link to more details or full-text: http://europepmc.org/abstract/PMC/PMC3896799

 

Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial (2014)

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Type of publication:
Randomised Controlled Trial

Author(s):
Dutton SJ,Ferry DR,Blazeby JM,Abbas H,Dahle-Smith A,Mansoor W,Thompson J,Harrison M,*Chatterjee A,Falk S,Garcia-Alonso A,Fyfe DW,Hubner RA,Gamble T,Peachey L,Davoudianfar M,Pearson SR,Julier P,Jankowski J,Kerr R,Petty RD

Citation:
Lancet Oncology, 07 2014, vol./is. 15/8(894-904), 1470-2045;1474-5488 (2014 Jul)

Abstract:
BACKGROUND: Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer.METHODS: For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0-2, and with measurable or evaluable disease on CT scan. Participants were recruited from 48 UK centres and randomly assigned (1:1) to gefitinib (500 mg) or matching placebo by simple randomisation with no stratification factors. Patients, clinicians, and trial office staff were masked to treatment allocation. Treatment continued until disease progression, unacceptable toxicity, or patient choice. The primary outcome was overall survival, analysed by intention to treat. This trial is registered, number ISRCTN29580179.FINDINGS: Between March 30, 2009, and Nov 18, 2011, 450 patients were randomly assigned to treatment groups (one patient withdrew consent; 224 patients allocated gefitinib and 225 allocated placebo included in analyses). Overall survival did not differ between groups (median 373 months, 95% CI 323-450, for gefitinib vs 367 months, 95% CI 297-437, for placebo; hazard ratio 090, 95% CI 074-109, p=029). Among the prespecified patient-reported outcomes (110 patients on gefitinib and 121 on placebo completed both baseline and 4 week questionnaires and were included in analyses), odynophagia was significantly better in the gefitinib group (adjusted mean difference -861, 95% CI -1449 to -273; n=227; p=0004), whereas the other outcomes were not significantly improved compared with placebo: global quality of life (269, 95% CI -233 to 772, n=231, p=0293), dysphagia (-318, 95% CI -836 to 200, n=231, p=0228), and eating (-411, 95% CI -996 to 175, n=229, p=0168). Median progression-free survival was marginally longer with gefitinib than it was with placebo (157 months, 95% CI 123-190 in the gefitinib group vs 117 months, 95% CI 107-137 in the placebo group; HR 080, 95% CI 066-096, p=0020). The most common toxicities were diarrhoea (36 [16%] of 224 patients on gefitinib vs six [3%] of 225 on placebo) and skin toxicity (46 [21%] vs two [1%]), both mostly grade 2. The commonest grade 3-4 toxicities were fatigue (24 [11%] vs 13 [6%] patients) and diarrhoea (13 [6%] vs two [1%]). Serious adverse events were reported in 109 (49%) of 224 patients assigned to gefitinib and 101 (45%) of 225 on placebo. 54 (24%) of patients in the gefitinib group achieved disease control at 8 weeks, as did 35 (16%) of patients on placebo (p=0023).INTERPRETATION: The use of gefitinib as a second-line treatment in oesophageal cancer in unselected patients does not improve overall survival, but has palliative benefits in a subgroup of these difficult-to-treat patients with short life expectancy. Future research should focus on identification of predictive biomarkers to identify this subgroup of benefiting patients.FUNDING: Cancer Research UK. Copyright 2014 Elsevier Ltd. All rights reserved.

Link to more details or full-text: http://www.sciencedirect.com/science/article/pii/S1470204514700245

 

Brachialis muscle tendon insertion avulsion fracture in a 6-year-old child (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Mbah CA, *Hussain A, *Turner R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 6-year-old boy, who fell while playing at school, presented to the fracture clinic with a suspected right distal radius fracture. On examination, the child was tender over the dorsal aspect of the distal radius and also had pain and stiffness around the elbow joint with a lack of the last 25° of elbow flexion. An acute haemarthrosis was also suspected at presentation. Plain anteroposterior (AP) and lateral radiographs of the elbow joint revealed an abnormal calcification superimposed on the anterior aspect of the coronoid process (figure 1A, B), which had not been visualised on plain radiographs in A&E.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202420.extract

 

Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). (2014)

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Type of publication:
Journal article

Author(s):
*Chandra A, *Clarke R, *Shawkat H

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202864.abstract

 

A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy (2014)

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Type of publication:
Journal article

Author(s):
*Moores KL, *Wood MG, *Foon RP

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation. Emergency caesarean section was performed and the 180degree uterine torsion was diagnosed intraoperatively. Posterior hysterotomy was required for delivery prior to detorsion of the uterus. This report describes that prompt recognition and intraoperative vigilance can achieve a successful maternal and fetal outcome in this rare and difficult obstetric scenario.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202974.abstract

Chest pain with raised troponin, ECG changes but normal coronary arteries (2014)

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Type of publication:
Journal article

Author(s):
*Amjad A,  *Ali A, *Bashir A,  *Ali M,  *Azam MN

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered.

Link to more details:

Link to full-text: http://casereports.bmj.com/content/2014/bcr-2013-201975.abstract