Staff Publication

Hybrid-Closed Loop Pump in Type 1 Diabetes (T1D) Improves Clinical Outcome More Than Quality of Life (QoL) Compared to Nonclosed Loop Pumps Supported By CGM (2024)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A327), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) and continuous glucose monitoring(CGM) have made significant improvements in management of T1D. We studied benefits of Hybrid closed loop(HCL) over non-closed loop(NCL) CSII in a cohort of adults with T1D. Method(s): We analysed a live database of patients managed in a single centre on CSII. Clinical parameters assessed included %Time in range(TIR), %hypoglycaemia(%hypo) and HbA1c. QOL was assessed with Diabetes Treatment Satisfaction Questionnaire( DTSQ), Hypoglycaemia Fear Survey(HFS), Type 1 Diabetes Distress score(T1DDS). Data was analysed using the SPSS software. Result(s): Data on 281 patients were included, mean age was 44 years(range 19-81), 57% females. 218 were on HCL (Medtronic 780G with Guardian G4 sensor or Tandem T-Slim with Dexcom G6 sensor) and 63 (Omnipod DASH with Dexcom G6 or Freestyle Libre 2). For HCL vs NCL systems, clinical parameters improved with mean HbA1c (52 vs 57mmol/mol, p < 0.005), TIR (71% vs 62%, p < 0.005) and %hypo (1.64% vs 2.64%, p = 0.08). QOL improvement favoured HCL, but were non-significant with mean DTSQ (36.3 vs 35.5, p = 0.21), HFS (33.6vs34.9, p = 0.71) and T1DDS (47.2 vs 49.3, p = 0.40). There was no significant difference in clinical or QOL parameters between Medtronic 780G and Tandem T-Slim HCL systems. Conclusion(s): HCL systems studied had clear benefits in terms of clinical outcome parameters compared to NCL, but this was not reflected in improved patient perceptions on QOL. All patients on NCL being on CGM may be a possible explanation, with the reassurance of CGM making the biggest impact on patients perceived QOL.

Effect of Long Disease Duration on Clinical and Patient Perceived Satisfaction Outcomes in Patients with Type 1 Diabetes (T1DM) on CSII And CGM (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A326), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Patients with longstanding T1DM tend to have more glycaemic variability. Patient perceptions towards chronic disease change over time. We examined outcomes in patients on CSII with different DM durations. Method(s): A single adult service outcome database of T1DM patients was analysed for Hba1c, %Time in range(%TIR), %hypoglycaemia(%hypo). For Hybrid closed loop(HCL) patients, Diabetes Treatment satisfaction Questionnaire(DTSQ), Type 1 Diabetes Distress score(T1DDS), Hypoglycaemia fear survey(HypoFS) and Insulin dosing systems, perceptions, ideas, reflections and expectations(INSPIRE) scores were analysed. Results were compared across different disease duration groups. Result(s): A cohort of 302 patients with T1DM were studied. 218 were on HCL, 21 partial closed loop and 63 were nonclosed loop CSII. All were on CGM. Mean diabetes duration was 25 years (range 2-61), male:female 43:57. Mean Hba1c(53.8mmol/mol), %TIR(68.7%) and %hypo(1.79%) were similar except 21-30year duration group who had better Hba1c and TIR. Correlation(r) for Hba1c(r = -0.111,p = 0.055), TIR(r = 0.206, p < 0.001) and %hypo(r = -0.106, p = 0.067) suggest better outcomes with longer duration of diabetes. HypoFS(r = -0.169,p = 0.016) and T1DDS(r = -0.192,p = 0.006) scores correlated inversely, DTSQ(r = 0.148, p = 0.035) positively and INSPIRE(r = -0.127, p = 0.069) did not correlate with diabetes duration. Conclusion(s): CSII and CGM glycaemic outcomes were similar in patients with all diabetes durations, highest in the 20- 30 years duration group. Reasons for this remains uncertain. Longer duration correlated with better outcomes on Hba1c, TIR and satisfaction scores. Hypo fear and diabetes distress was greater with shorter duration though hypo frequency was not statistically correlated to diabetes duration. These may be due to human factors, better disease acceptance and perceptions with longer duration.

Clinical and Patient Satisfaction Outcomes in People with Type 1 Diabetes from Different Social Background Treated with CSII and CGM (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A326-A327), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: There may be a bias towards use of expensive technological innovations in people from higher socioeconomic classes. We explored patient experiences and outcomes in different socioeconomic backgrounds with T1diabetes( T1DM) treated with insulin pumps. Method(s): Index of Multiple Deprivation (IMD), an official statistic based on income, education, employment, health, housing, crime and living environment was used to stratify patients into quintiles based on socioeconomic status. HbA1c, time in range(%TIR), %hypoglycaemia(%hypo), Diabetes Treatment Satisfaction Questionnaire (DTSQ), Type 1 Diabetes Distress score (T1DDS), Hypoglycaemia fear survey (HypoFS) and Insulin dosing systems, perceptions, ideas, reflections and expectations (INSPIRE) scores in different IMD quintiles were analysed. Result(s): 302 patients were included: mean age 44 years (range 19-81), male:female 43:57 diabetes duration 25years (range 2- 61). 218 were on hybrid closed-loop, 21 partial closed-loop and 63 on non-closed-loop CSII. All were on CGM. Mean HbA1c (53.7vs52.6mmol/mol, correlation r = -0.059,p = 0.3), %TIR (67.7vs70.1%,r = -0.053,p = 0.36) and %hypo (2.29vs1.58%,r = -0.117,p = 0.043) had a trend to be worse in lower socioeconomic classes but correlation was not statistically significant apart from in %hypo. Mean DTSQ and INSPIRE scores were similar between social classes but mean T1DDS (52.8vs41.8,r = -0.189,p = 0.007) and HypoFS (41.7vs29.9,r = -0.145,p = 0.038) scores were worse in lowest compared to highest social quintile. Conclusion(s): Outcomes on CSII and CGM were broadly similar across all social backgrounds. There was statistically significant correlation, albeit low, between lower socioeconomic class and hypoglycaemia. This may explain the higher greater diabetes distress and hypoglycaemia fear in lower socioeconomic classes. Diabetes treatment satisfaction including with HCL were similar.

Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft (2025)

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Type of publication:

Journal article

Author(s):

*Carmont, Michael R; *Saha, Arunansu; *Rhind, John-Henry; Nilsson, Niklas; Karlsson, Jon; Nilsson-Helander, Katarina.

Citation:

Video Journal of Sports Medicine. 1(5):26350254211021859, 2021 Sep-Oct.

Abstract:

Background: Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function.

Indications: The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap.

Technique Description: The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion.

Discussion/Conclusion: Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.

Link to full-text [open acces - no password required]

Mercury exposure, pink disease and Young's syndrome: a forgotten public health disaster (2025)

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Type of publication:

Journal article

Author(s):

Brown, Megan; Hendley, Victoria; *Ahmad, Nawaid.

Citation:

BMJ Case Reports. 18(4), 2025 Apr 26.

Abstract:

Pink disease was once a widespread phenomenon, known to physicians throughout the Western world. Its prevalence declined massively once the source, mercury, was identified in several products. In modern medicine, pink disease rarely forms a differential and is known only to few physicians, despite the long-term effects of this illness. This report details a case of a man who suffered from pink disease as a child following his mother applying teething powder containing inorganic mercury to his gums for 12 weeks, from the age of 6 months. He received no treatment at the time. Throughout his lifetime, however, the man (in his 70s) has been diagnosed as infertile, and with bronchiectasis, despite a lack of convincing history to suggest an aetiology. The cause of these pathologies remains elusive, either organically occurring or components of Young's syndrome.

Link to full-text [NHS OpenAthens account required]

Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory (2025)

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Type of publication:

Journal article

Author(s):

Rai, Tanvi; Hinton, Lisa E; Mackay, Rosa; Black, Mairead; Sanders, Julia; Slade, Pauline; *Elsmore, Amy; Dhadda, Amrit; *Parry-Smith, William; Collis, Rachel; Petrou, Stavros; Stanworth, Simon; Pallman, Philip; Townson, Julia; Fye, Haddy; Geden, Ayse Gur; Collins, Peter; Bell, Sarah.

Citation:

PLoS ONE [Electronic Resource]. 20(4):e0320754, 2025.

Abstract:

BACKGROUND: Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being implemented across 36 sites in the rest of the UK through the OBS UK stepped-wedge cluster randomised controlled trial. We conducted a qualitative evaluation of the OBS care bundle five years after its adoption to inform plans for optimising its implementation across the UK.

METHODS: We conducted ethnographic observations, informal conversations and qualitative interviews with multidisciplinary teams (MDT) in four maternity units in Wales. Data were analysed thematically and usingNormalisation Process Theory.

RESULTS: The OBS Cymru protocol was used daily and MDT members believe it improves the quality and safety of PPH management. The paper proforma supporting OBS Cymru was the 'boundary object' that kept the care bundle in view while clarifying individualised roles across the MDT during a PPH and prompting improved and continuous communication as bleeding progressed. The standardisation of processes through the care bundle was seen as enabling all staff with an overall knowledge of PPH care, while situating the prominence of their particular roles within a greater whole. Enacting the bundle in practice varied slightly across different settings, according to staffing structures (e.g., in delivery rooms versus theatre births) and caseload, and some residual tensions remained regarding expectations from different staff members and levels of support provided regarding OBS Cymru.

CONCLUSIONS: Despite some small-scale variations, OBS care bundle has become normalised as standard PPH care in Wales. Insights from this evaluation, such as the centrality of the proforma in holding the bundle together, and need for greater clarity in staff role expectations, have informed implementation plans for the OBS UK trial.

Link to full-text [open access - no password required]

Is It Cost-Effective to Induce Labour Early to Prevent Shoulder Dystocia? Evidence From the Big Baby Trial (2025)

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Type of publication:

Journal article

Author(s):

Naghdi, Seyran; Petrou, Stavros; Underwood, Martin; *Deshpande, Sanjeev; Quenby, Siobhan; Ewington, Lauren; Gardosi, Jason; Mistry, Hema.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology. 2025 May 01. [epub ahead of print]

Abstract:

BACKGROUND: The cost-effectiveness of early induction of labour for suspected large-for-gestational-age foetuses to prevent shoulder dystocia is unknown.

METHODS: A within-trial economic evaluation of induction at 38 + 0 to 38 + 4 weeks' gestation for suspected large-for-gestational-age foetuses. Resource use and costs were measured to 6 months postpartum. We estimated incremental cost per case of shoulder dystocia prevented and incremental cost per maternal quality-adjusted life year (QALY) gained. We collected data for planned caesarean sections in a cohort study.

FINDINGS: Mean combined woman and infant costs in the induction arm were 89 (95% confidence interval (CI): -79, 257) higher than the standard care arm, driven by increased neonatal costs. The incremental cost of preventing one case of shoulder dystocia was 11 879 and the incremental cost per maternal QALY gained was 39 518. The probability of early induction being cost-effective was 0.65 at a cost-effectiveness threshold of 20 000 per case of shoulder dystocia prevented, but 0.36 at a cost-effectiveness threshold of 20 000 per maternal QALY gained. The cohort study found the mean cost was 310 (95% CI: 74, 545) higher in the induction arm than in the planned caesarean group.

INTERPRETATION: Early induction of labour increased neonatal care costs. It is not a cost-effective approach when effects are restricted to maternal QALYs. Planned caesarean section might be cost-saving when compared to early induction, although we did not assess longer-term effects such as an increased risk of repeat caesarean sections. Assessments of long-term effects on the mother and infant should be
incorporated into future studies.

TRIAL REGISTRATION: ISRCTN18229892.

Link to full-text [open access - no password required]

Improving compliance to follow-up alerts in chest X-rays with consolidation through clinician education (2025)

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Type of publication:

Conference abstract

Author(s):

*Adeniran-Babatunde S.F.; *Gbede O.; *Oguntoye O.; *Alkhouly M.

Citation:

Clinical Radiology. Conference: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 83(Supplement 1) (no pagination), 2025. Article Number: 106889. Date of Publication: 01 May 2025.

Abstract:

Category: Chest Background to the audit: Timely follow-up of abnormal chest X-rays (CXRs) showing consolidation as recommended by the radiologist can aid prompt diagnosis and treatment of other serious conditions with subsequent good outcomes. Research has shown that significant morbidity can occur from delay and lack of follow-up in patients with consolidation or other abnormalities on initial CXR, which is why the British Thoracic Society (BTS) recommends follow-up CXRs at around six weeks after completing treatment for all patients with consolidation on CXR to ensure resolution. This formed the premise for our audit looking into how to improve compliance to this protocol in our trust and thereby improve patient safety. Standard: BTS recommendation. Indicator: We assessed source of referral. We assessed if repeat CXR has been performed as suggested by the radiologist. We assessed the time frame suggested for the repeat CXR. We compared the actual time frame of the repeat imaging with the time frame suggested. Target: 100% compliance to follow-up alert. 100% compliance to recommended time frame. Methodology: In the first round, retrospective review of random 100 CXRs done in the trust with follow-up alert. Data collected include patient's referral source, date of the initial image, recommended time frame for repeat image and date of the follow-up CXR. The data were analysed and presented in percentages. The exact similar process was repeated for the second round three months after the intervention. Results of first audit round: 43% of the patients were referred from emergency department (ED), 39% from GP and 18% from the wards. 79% of the patients had repeat CXRs, 14% did not and 7% had died. Of those that had repeat CXRs, 46% had it done at the recommended time, 43% were done at a later date and 11% were done earlier. First action plan: Audit was presented at clinical meetings to educate clinicians on the need to request follow-up CXRs to ensure patient safety. Results of second audit round: 54% were from ED, 31% from GP and 15% from the wards. 95% had repeat CXRs while the remaining 5% had died. 78% had repeat CXRs within the recommended time, 14% were done later and 8% were done earlier. Second action plan: Presentation and teaching at clinical meetings to further reinforce and improve on follow-up compliance.

Image-guided brachytherapy for locally advanced cervical cancer: audit of practice at UHNM 2023 and re-audit 2024 (2025)

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Type of publication:

Conference abstract

Author(s):

Perera J.; Bhana R.; *Choudhury Y.; Devleena D.; Seedhouse I.; Tsui S.M.

Citation:

Clinical Oncology. Conference: SUPP: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 40(Supplement 1) (no pagination), 2025. Article Number: 103820. Date of Publication: 01 May 2025.

Abstract:

Category: Gynaecology Background to the audit: Standard treatment for locally advanced cervix cancer consists of chemoradiotherapy followed by brachytherapy. Trial data show shortening overall treatment time and escalation of doses to the high-risk clinical target volume (HR-CTV) to be associated with better local control. Image-guided brachytherapy (IGBT) enables greater dose conformity and local control.<sup>1-6</sup>UHNM commenced a magnetic resonance-based IGBT service for cervical cancer in 2016. Standard: BGCS/ESGO/ESTRO/ESP/ASTRO guidelines on management of cervical cancer.<sup>7-9</sup>1. Overall treatment time should not exceed 49-56 days. 2. Total equivalent dose in 2 Gy fractions (EQD2) to 90% of the HR-CTV (D90) to be >=85 Gy. Indicator: Percentage of patients meeting each standard. Target: 100% having overall treatment less than 56 days. 90% achieving the dose to HR-CTV targets keeping organs at risk(OAR) within tolerence. Methodology: Retrospective analysis of data on IGBT for radical cervical cancer treatments from 1 January 2021 to end of March 2023 done and reviewed at May 2023 UHNM brachytherapy meeting. Initial time span selected to minimise impact of COVID. Action plan implemented and patient data for April 2023 to April 2024 re-audited. Results of first audit round: 43 UHNM and Shrewsbury patients treated. Overall treatment time data available only for 20 UHNM patients. 1 (5%) had exceeded 56 days and 7 (35%) had taken 50-56 days to complete. 37/43 (86.1%) had received a D90 HR-CTV of >85 Gy. A linear relationship between external beam radiation therapy (EBRT) completion to brachytherapy start with total treatment duration identified. First action plan: Pathway changes made to commence chemoradiotherapy on Monday/Tuesday and to schedule the whole course of chemoradiotherapy and brachytherapy at the time of referral. Ring and tandem commissioned as a priority to allow more applicator options. Results of second audit round: All 26 (100%) UHNM and Shrewsbury patients had completed treatments within 56 days. 73.1% within 49 days. 1 outside patient's chemoradiotherapy data incomplete. HR-CTV D90 >85 Gy in 85.2%. 8 patients treated with ring and tandem with 60% more needle use compared with ovoids. No patient exceeded mandatory OAR tolerences. Second action plan: Proactively scheduling brachytherapy, liaising with the regional network monthly to optimise timing and resources usage. To continue with dosimetric data collection to optimise needle placement and to review impact of needles on OAR doses and clinical outcomes in the next audit.