Staff Publication

The SSS revolution in fungal diagnostics: speed, simplicity and sensitivity (2023)

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Type of publication:
Journal article

Author(s):
*Baker, Jacob; Denning, David W.

Citation:
British Medical Bulletin. 147(1):62-78, 2023 Sep 12.

Abstract:
INTRODUCTION: Fungal disease has historically presented a diagnostic challenge due to its often non-specific clinical presentations, relative infrequency and reliance on insensitive and time-intensive fungal culture. SOURCES OF DATA: We present the recent developments in fungal diagnostics in the fields of serological and molecular diagnosis for the most clinically relevant pathogens; developments that have the potential to revolutionize fungal diagnosis through improvements in speed, simplicity and sensitivity. We have drawn on a body of evidence including recent studies and reviews demonstrating the effectiveness of antigen and antibody detection and polymerase chain reaction (PCR) in patients with and without concurrent human immunodeficiency virus infection. AREAS OF AGREEMENT: This includes recently developed fungal lateral flow assays, which have a low cost and operator skill requirement that give them great applicability to low-resource settings. Antigen detection for Cryptococcus, Histoplasma and Aspergillus spp. are much more sensitive than culture. PCR for Candida spp., Aspergillus spp., Mucorales and Pneumocystis jirovecii is more sensitive than culture and usually faster. AREAS OF CONTROVERSY: Effort must be made to utilize recent developments in fungal diagnostics in clinical settings outside of specialist centres and integrate their use into standard medical practice. Given the clinical similarities of the conditions and frequent co-infection, further study is required into the use of serological and molecular fungal tests, particularly in patients being treated for tuberculosis. GROWING POINTS: Further study is needed to clarify the utility of these tests in low-resource settings confounded by a high prevalence of tuberculosis. AREAS TIMELY FOR DEVELOPING RESEARCH: The diagnostic utility of these tests may require revision of laboratory work flows, care pathways and clinical and lab coordination, especially for any facility caring for the immunosuppressed, critically ill or those with chronic chest conditions, in whom fungal disease is common and underappreciated.

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Correlative effect between sac regression and clinical outcomes following endovascular repair in abdominal aortic aneurysm: fact or myth? (2023)

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Type of publication:
Journal article

Author(s):
Al-Tawil, Mohammed; Muscogliati, Eduardo; Jubouri, Matti; Saha, Priyanshu; *Patel, Ravi; Mohammed, Idhrees; Bailey, Damian M; Williams, Ian M; Bashir, Mohamad

Citation:
Expert Review of Medical Devices. 1-8, 2023 Jun 16

Abstract:
INTRODUCTION: Endovascular aneurysm repair (EVAR) has rapidly become the preferred management of abdominal aortic aneurysm (AAA). Sac regression status post-EVAR has been linked to clinical outcomes as well as the choice of EVAR device. The aim of this narrative review is to investigate the relationship between sac regression and clinical outcomes post-EVAR in AAA. Another aim is to compare sac regression achieved with the main EVAR devices. AREAS COVERED: We carried out a comprehensive literature search on multiple electronic databases. Sac regression was usually defined as a decrease in the sac diameter (>10 mm) over follow-up. This revealed that individuals who had sac regression post-EVAR had significantly lower mortality, and higher event-free survival rates. Further, lower rates of endoleak and reintervention were observed in patients with regressing aneurysm sacs. Sac regression patients also had significantly lower odds of rupture compared to counterparts with stable or expanded sacs. The choice of EVAR device was also shown to impact regression, with the Fenestrated Anaconda showing favorable results. EXPERT OPINION: Sac regression post-EVAR in AAA is an important prognostic factor as it translates to improved mortality and morbidity. Therefore, this relationship must be seriously taken into consideration during follow-up.

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Cardiovascular disease morbidity is associated with social deprivation in subjects with familial hypercholesterolaemia (FH): a study comparing FH individuals in UK primary care and the UK Simon Broome register linked with secondary care records (2022)

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Type of publication:
Conference abstract

Author(s):
Iyen B.; Qureshi N.; Roderick P.; *Capps N.; Durrington P.N.; McDowell I.F.W.; Cegla J.; Soran H.; Schofield J.; Neil H.A.W.; Kai J.; Weng S.; Humphries S.E.

Citation:
Atherosclerosis Plus. Conference: HEART UK 35th Annual Medical & Scientific Conference. Virtual. 49(Supplement 1) (pp S4-S5), 2022. Date of Publication: October 2022

Abstract:
Background: Measures of social deprivation are associated with higher cardiovascular diseases (CVD) morbidity and mortality. To determine if this is also seen in subjects with Familial Hypercholesterolaemia (FH), CVD morbidity has been examined in participants in the UK primary care database (CPRD) and in the UK Simon Broome (SB) register using linkage to the UK secondary care Hospital Episodes Statistics (HES). Method(s): A composite CVD outcome was analysed (first HES outcome of coronary heart disease, myocardial infarction, stable or unstable angina, stroke, TIA, PVD, heart failure, PCI and CABG). The measure of socio-economic status/deprivation used was the English index of multiple deprivation (IMD). Cox proportional hazards regression estimated hazards ratios (HR) for incident CVD and mortality [95% CI] in each IMD quintile. <br/>Result(s): We identified 4,309 patients with FH in UK CPRD primary care database (followed from 1988 to 2020), free from CVD, and 2988 SB register participants, with linked secondary care HES records. In both groups, the prevalence of FH was considerably lower in the most deprived quintile (60% in CPRD and 52% in SB). CPRD patients in the most deprived quintile (IMD-5) had the highest prevalence of obesity and of smoking compared to those from IMD quintiles 1,2,3 and 4 (p-value for trend, all <0.001). Compared to least deprived, the most deprived individuals had the highest risk of composite CVD (unadjusted HR 1.71 [CI 1.22-2.40]), however, on adjustment for smoking and alcohol consumption, there were no statistical differences in CVD risk between socio-economic groups. In the FH Register patients there was an increase in the incidence rates and hazards ratios for composite CVD with increasing quintiles of deprivation. After adjustment for age, sex, smoking and alcohol consumption, this effect remained statistically significant (quintile 5 vs 1, HR = 1.83 [1.54-2.17]. Conclusion(s): Patients with FH are underdiagnosed in lower socio-economic groups. In both CPRD and the SB Register the most deprived FH patients had the highest risk of CVD and mortality, but in CPRD but not in the SB register this was largely explained by smoking and alcohol consumption. Clinicians should adopt more effective strategies to detect FH in lower socio-economic groups, and to optimise risk factor management and to support lifestyle changes and medication adherence for this group.

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Home for Christmas MADE 3 of 3 RSH (2023)

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Type of publication:
Service improvement case study

Citation:
SaTH Improvement Hub, 2023

Abstract:
Multi Agency Discharge Events (MADEs) are held to work with internal and external partners across the Integrated Care System to maximise discharges to provide capacity in the acute setting. This case study focuses on the outcomes at RSH.

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Home for Christmas MADE 2 of 3 PRH (2023)

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Type of publication:
Service improvement case study

Citation:
SaTH Improvement Hub, 2023

Abstract:
Multi Agency Discharge Events (MADEs) are held to work with internal and external partners across the Integrated Care System to maximise discharges to provide capacity in the acute setting. This case study focuses on the outcomes at PRH

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Home for Christmas MADE 1 of 3 SaTH (2023)

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Type of publication:
Service improvement case study

Citation:
SaTH Improvement Hub, 2023

Abstract:
Multi Agency Discharge Events (MADEs) are held to work with internal and external partners across the Integrated Care System to maximise discharges to provide capacity in the acute setting.

Link to PDF poster [no password required]

Virtual Ward MaDE (2023)

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Type of publication:
Service improvement case study

Citation:
SaTH Improvement Hub, 2023

Abstract:
As part of the 8 MADEs for 2023 the first focus will be in time for the February half term starting 20th February 2023. The focus for this event will be on patients who are suitable for the virtual wards.

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To increase clinic capacity through the RSH pre-assessment department (2022)

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Type of publication:
Service improvement case study

Author(s):
*Rachael Bollands (Pre-Op Manager)

Citation:
SaTH Improvement Hub, 2022

Abstract:
The demand for a pre-operative assessment is growing and the current process results in many patients having to attend an additional appointment which is severely impacting on capacity. To overcome this, it was agreed to test out a “One-Stop Triage” process that would result in increasing capacity, while also improving patient satisfaction, which was extremely low. Following engagement with patients and colleagues, a new triage process was agreed and tested for 10 days. Following the trial, the data showed significant improvements to an increase to capacity, due to a decrease in additional appointments, while also significantly improving patient satisfaction. The aim now is to roll out the process to PRH and make this the new standard practice for our patients who require a pre-operative assessment.

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Neurological Observations (2022)

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Type of publication:
Service improvement case study

Author(s):
*Clare Walsgrove, *Leeanne Morgan, *Ward Managers

Citation:
SaTH Improvement Hub, May 2022

Abstract:
In order to maintain the overall health of our patients, it is important to monitor patients at risk of falls and the post fall care received.

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Provision of IV Zoledronic Acid for Neck of Femur fracture patients on Ward 4, Princess Royal Hospital (PRH), SaTH NHS Trust (2023)

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Type of publication:
Service improvement case study

Author(s):
*Dr. Sairah Anjum (FY2)

Citation:
SaTH Improvement Hub, May 2023

Abstract:
Guidance was recently approved and uploaded to the SaTH intranet (early April 2023), stating that high risk NOF fracture patients or those unable to tolerate oral bisphosphonates are more likely to benefit from a single 4mg infusion of zoledronic acid followed by 2 weeks of calcium & Vitamin D supplementation, with an overall aim of increasing bone density and reducing risk of further fragility fractures by ~50% by 10th May 2023.

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