Staff Publication

Failure of drip and suck in postoperative ileus: A faulty non-perforated NG tube (2019)

Posted on by

Type of publication:
Journal article

Author(s):
*Bristow D.; *Shaw J.

Citation:
BMJ Case Reports; Jun 2019; vol. 12 (no. 6)

Abstract:
A 55-year-old woman developed a postoperative ileus with associated nausea and vomiting following an
elective laparotomy. A wide bore nasogastric (NG) tube was inserted for gastric decompression and symptom
relief. Aspiration of the tube was unsuccessful and the patient continued to vomit. Imaging to investigate the
acute abdomen demonstrated the nasogastric tube to be correctly sited and within pooled gastric contents.
Gentle initial attempts were made to unblock the NG but to no avail and therefore it was removed. On
inspection it was discovered that the NG tube had no distal perforations to allow drainage, causing failure and
increasing the patient's risk of aspiration. The aim of this report is draw attention to the importance of
scrutinising all medical equipment prior to use to prevent avoidable and potentially serious patient harm.

Link to full-text [NHS OpenAthens account required]

Local experience at DGH shows combination Pertuzumab and Herceptin nearly doubles PCR rate of Neo-adjuvant Chemotherapy (NAC) in HER2 positive breast cancer (2018)

Posted on by

Type of publication:
Poster presentation

Author(s):
*Blossom Lake, *Donna Appleton, *Abel Zachariah, *Habib Khan, *Kerry Flemming, *Jennifer Neill, *Laura Pettit

Citation:
Presented at BASO: The Association for Cancer Surgery

Link to poster [PDF]

Respiratory workload and medical staffing in uk local neonatal units (LNUS) and special care units (SCUS)-time for a rethink (2019)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Tyler W.; Fox G.F.; Fenton A.C.

Citation:
Archives of Disease in Childhood; May 2019; vol. 104

Abstract:
Introduction: The majority of UK neonatal care occurs in SCUs and LNUs with a smaller volume of highly complex care delivered by NICUs. Whilst the significant shortfall in nursing numbers nationally has been highlighted, medical staffing has received little attention. Aim To determine levels of medical staffing in UK LNUs/ SCUs, days of respiratory support provided and admissions weighing <1.5 kg. Methods Questionnaire sent to every LNU and SCU requesting details of medical tier staffing. ODNs provided the number of
respiratory care days (RCD – invasive and non-invasive mechanical respiratory support) delivered 2013-15 and numbers of admissions weighing <1.5 kg. Results 78 (86.7%) LNUs and 38 (95%) SCUs responded. 11/ 90 LNUs delivered <365 RCDs annually. Of these 9 admitted <25 infants weighing <1.5 kg. 6/40 SCUs delivered >365 RCDs annually. Significant numbers of LNUs and SCUs employed nontraining grade medical staff and ANNPs to cover rotas; neonatal CST holders or equivalent support many units (Tables 1 & 2). The 8/11 low-activity LNUs who responded provided partially separate Tier 1 staffing from paediatrics, consistent with SCU staffing recommendations only. Half of the high activity LNUs and all high activity SCUs did not achieve staffing standards for NICUs or LNUs respectively. Conclusions A wide range of activity is undertaken by UK LNUs and SCUs, with moderate overlap of workload between unit types. These data should inform potential unit redesignation as part of the current national reviews. Current medical and ANNP staffing is a major barrier to implementing change. (Table Presented).

Link to full-text [NHS OpenAthens account required]

1200-P: Diabetes. Predictors of glycaemic and weight gain response to empagliflozin treatment: The ABCD Nationwide Empagliflozin Audit. (2019)

Posted on by

Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:
Introduction: We investigated clinical parameters that are potentially associated with improved empagliflozin treatment response.

Methods: We obtained data from a large-scale audit of empagliflozin use in the UK. We analyzed the association between patients’ baseline age, HbA1c, weight, diabetes duration, alanine aminotransferase (ALT), sex, chronic kidney disease (CKD) stage, empagliflozin dose (25 vs. 10mg), use of GLP-1RAs and use of insulin with HbA1c and weight changes at 26 weeks of treatment.

Results: Among 1436 patients, HbA1c reduced by, mean[95% CI], 1.35%[1.27,1.42] (p<0.0001) from a baseline of, mean±SD, 9.41±1.41%. Among 1381 patients, weight reduced by 3.6 kg[3.3,3.9] (p<0.0001) from a baseline of 100.2±20.7 kg. Results of univariate analyses are shown in Table 1. In multivariate analysis, higher baseline HbA1c (p<0.0001), lower CKD stage (p=0.002) and higher ALT (log transformed)(p=0.02) were associated with greater HbA1c reduction. Higher baseline weight (p<0.001) and non-insulin use (p<0.0001) were associated with greater weight reduction.

Conclusion: As expected, HbA1c reduction was associated with baseline HbA1c and background renal function, while weight reduction was associated with baseline weight. The interactions between HbA1c reduction and ALT levels, and weight reduction with insulin treatment status warrant further investigations.

Link to full-text [no password required]