A rare case of isolated laryngeal metastasis 23 years after nephrectomy for clear cell renal carcinoma (2021)

Type of publication:
Journal article

Author(s):
*Eastwood, Michael J ; *Ahsan, Syed F; *Harris, Richard

Citation:
British Journal of Hospital Medicine; Aug 2021; vol. 82 (no. 8); p. 1-3

Abstract:
The article describes the case of isolated laryngeal metastasis 23 years after nephrectomy for clear cell renal
carcinoma in an 84-year-old man.

The experience of implementing a discovery system in a pandemic (2021)

Type of publication:
Journal article

Author(s):
*Curtis, Jason

Citation:
HLG Nursing Bulletin; Jan 2021; vol. 40 (no. 1); p. 6-11

Abstract:
The article explores the transition of Shropshire Health Libraries from a legacy library management system
(OLIB) to a full discovery system using Worldshare Management Services and WorldCat Discovery in 2020.
Topics discussed include the advantages of the discovery system such as access to the WorldCat global catalog
for co-operative cataloguing, project management training given by Online Computer Library Center (OCLC) to
Shropshire, and disadvantages of WorldShare for Shropshire.

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Predictors of in-hospital mortality in Covid-19: A study across two peripheral district general hospitals in UK (2021)

Type of publication:
Journal article

Author(s):
Samanta N.K.; Bandyopadhyay S.K.; *Herman D.; Chakraborty B.; *Marsh A.; *Kumaran S.; *Burnard L.; *Gnanaseelan G.; *Gibson S.; *Florence B.; Ganguly S.

Citation:
British Journal of Medical Practitioners; Jul 2021; vol. 14 (no. 1)

Abstract:
Aim-The mortality from Coronavirus Disease 2019 (COVID-19) has remained a significant medical challenge. Internationally, patient demographics and pre-existing co-morbidities are significant determinants of mortality from COVID-19. The mortality-risk in a local population is difficult to determine. The objective of our study is to examine the risk posed by epidemiological and demographic variables, and co-morbidities in our local population. Method-A retrospective, observational study was conducted on confirmed COVID-19 patients, identified from the local microbiology database. A search of the electronic patient records was performed to collect demographic details and co-morbidities. Chi-square test and logistic regression analysis of the demographic variables and co-morbidities were utilised to calculate the predictive-risk for in-hospital mortality of adult COVID-19 patients. Results-Final analysis included 263 samples. Univariate logistic regression analysis was performed using age as an independent categorical predictor with two cohorts – those <60 and those >=60 years old. Age (2=17.12, p<0.001) was found to be an independent predictor of mortality – this was independent of sex (2=1.784, p<0.182). Charlson Comorbidity Index (CCI) score was found to be a significant predictor of adverse outcome. The odds of death for patients with CCI scores 0-4 was less than half (44.8%) of those with CCI scores >=5 (p=0.005). Patients with no pre-existing medical conditions had a lower mortality-risk (OR=0.181, p=0.022) than those with known medical conditions. Pre-existing renal disease predicted a poor outcome (OR=1.996, p=0.027). The odds of death for the patients coming from their own-home was only 26% of the odds for those from a long-term care-home. Long-term care facility, advanced age (OR=1.058, p <0.001), and long-term oral steroid (OR=3.412, p=0.016) use were all associated with a poor prognosis. Conclusion People aged >=60 years, residence in a long-term care-home, pre-existing renal diseases, a high CCI score and long-term oral steroids use were associated with an increased mortality-risk.

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Upgrading of hospital discharge summary software to optimise COVID-19 documentation and safeguard infection prevention in the community (2021)

Type of publication:
Journal article

Author(s):
*Donati-Bourne J.; *Lo N.; *Selvan M.; *O’dair J.; Mohamed W.; Kasmani Z.

Citation:
British Journal of Medical Practitioners; Jul 2021; vol. 14 (no. 1)

Abstract:
Aims: Early review of 50 discharge summaries at Royal Shrewsbury Hospital (SATH) in April 2020 revealed only 27% documented the patient’s in-hospital COVID-19 test result and 2% outlined any recommended self isolation advice following hospital discharge. This had potential adverse implications for community infection control as well as medico-legal sequalae for the Trust were the discharged patient to spread COVID-19 to other cohabitants. The urology team worked with SATH IT to amend the existing discharge summary software, to add two tabs to make COVID-19 test result and self-isolation documentation mandatory for successful sign-off. The aim of this quality improvement project was to evaluate the impact of updating the discharge summary software on documentation accuracy related to COVID-19 on discharge paperwork.
Method(s): Following the implementation of the modified software, 50 consecutive discharge summaries for patients admitted under the urology team starting 1st October 2020 were retrospectively reviewed for documentation of COVID-19 result and self-isolation advice.
Result(s): 90% of discharge summaries included COVID-19 test result and 100% included self-isolation advice for the patient, or alternatively confirmed that no self-isolation was required.
Conclusion(s): This simple modification of an existing IT system greatly improved compliance with COVID-19 discharge summary documentation. We propose all hospitals consider adopting similar measures in the interest of infection prevention, public safety and potential medico-legal sequalae.

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Results of DARS: a randomised phase III trial of dysphagia-optimised intensity modulated radiotherapy (DO-IMRT) versus standard IMRT (S-IMRT) in oropharyngeal (OPC) and hypopharyngeal (HPC) cancer (2021)

Type of publication:
Conference abstract

Author(s):
Nutting C.; Roe J.; Tyler J.; Bhide S.; Rooney K.; Foran B.; *Pettit L.; Beasley M.; Finneran L.; Sydenham M.; Emson M.; Hall E.; Petkar I.; Frogley R.

Citation:
Oral Oncology; Jul 2021; vol. 118 Supplement ; p. 10-11

Abstract:
Presented by: Chris Nutting (Chris.Nutting@rmh.nhs.uk) Introduction Most newly diagnosed OPC & HPC are treated with (chemo)RT with curative intent but at the consequence of adverse effects on quality of life. DARS (ISRCTN:25458988) tested if using DO-IMRT to reduce RT dose to the dysphagia/aspiration related structures (DARS) improved swallowing function compared to S-IMRT. Materials and Methods Patients with T1-4, N0-3, M0 OPC/HPC were randomised 1:1 to S-IMRT (65 Gray (Gy)/30 fractions (f) to primary & nodal tumour; 54 Gy/ 30f to remaining pharyngeal subsite & nodal areas at risk of microscopic disease) or DO-IMRT. The volume of the superior & middle pharyngeal constrictor muscle (PCM) (OPC) or inferior PCM (HPC) lying outside the high-dose target volume was set a mandatory mean dose constraint in DO-IMRT. Treatment allocation was by minimisation balanced by centre, use of induction/concomitant chemotherapy, tumour site & AJCC stage. Primary endpoint was mean MD Anderson Dysphagia Inventory (MDADI) composite score 12 months after RT with 102 patients needed to detect a 10 point improvement (assuming S-IMRT score of 72, standard deviation (SD) 13.8; 90% power, 2-sided 5% alpha). Patients were blind to treatment allocation. Secondary endpoints assessing swallowing function included University of Washington (UW)-Qol & Performance Status Scale Head & Neck (PSS-HN) scores. Results 112 patients (56 S-IMRT, 56 DO-IMRT) were randomised from 22 UK centres from 06/2016 to 04/2018. Mean age was 57 years; 80% were male; 97% had OPC; 90% had AJCC stage 3&4 disease; 86% had concomitant chemotherapy only, 4% induction & concomitant and 10% no chemotherapy. 111/112 had RT doses as prescribed (1 patient died before RT). Median of the mean inferior PCM dose was SIMRT 49.8 Gy (IQR 47.1-52.4) vs. DO-IMRT 28.4 Gy (21.3-37.4), p < 0.0001; superior & middle PCM dose was
S-IMRT 57.2 Gy (56.3-58.3) vs. DO-IMRT 49.7 Gy (49.4-49.9), p < 0.0001. At 12 months, DO-IMRT had significantly higher MDADI scores: S-IMRT mean: 70.5 (SD 17.3) vs. DO-IMRT 77.7 (16.1), p = 0.037. At 12 months the proportion of patients reporting UW-QoL as being able to swallow “as well as ever” was 40.4% for DO-IMRT & 15.2% for S-IMRT; scores of?>50 were reported for PSS-HN normalcy of diet by 70.6% DO-IMRT & 58.1% S-IMRT patients & for eating in public scores by 84.3% DO-IMRT & 74.4% S-IMRT. Conclusions DOIMRT reduced RT dose to the DARS and improved patient reported swallowing function compared with S-IMRT. This is the first randomised study to demonstrate functional benefit of swallow-sparing IMRT in OPC.

Intra-operative use of biological products: Are we aware of their derivatives? (2021)

Type of publication:
Journal article

Author(s):
Bhamra, Navdeep; Jolly, Karan; Darr, Adnan; *Bowyer, Duncan J; Ahmed, Shahzada K

Citation:
International Journal of Clinical Practice; Oct 2021; vol. 75 (no. 10); p. 1-6

Abstract:
INTRODUCTION Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention. METHODS A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral and maxillofacial surgery and plastic surgery. RESULTS Data were collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. Our results demonstrate that most participants in this study do not routinely consent (81%) to the intra-operative use of biological materials. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable. DISCUSSION This study highlights deficiencies in knowledge that results in potential compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intraoperative use of biological products and what their derivatives may be. CONCLUSION Modernising the current consent process to reflect the development and use of surgical biological products will help to ensure improved patient satisfaction, fewer future legal implications as well as a better surgeon-patient relationship.

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Role of multimodal anaesthetic in post-operative analgesic requirement for robotic assisted radical prostatectomy (2021)

Type of publication:
Journal article

Author(s):
*Masilamani, Murugu Kalai Selvan; Sukumar, Aiswarya; Cooke, Pete William; Rangaswamy, Chandrashekar

Citation:
Urologia; Aug 2021 [epub ahead of print]

Abstract:
PURPOSE Robotic assisted laparoscopic radical prostatectomy (RARP) is considered as standard of care for surgical management of localised prostate cancer. Procedure specific postoperative pain management (PROSPECT) guidelines are available for open radical prostatectomy. There is a lack of evidence for optimal pain management protocol in patients undergoing robotic radical prostatectomy. This study investigates the impact of multimodal anaesthetic on post-operative analgesic requirements. METHODS AND MATERIALS In our Institute, RARP is performed with a multimodal anaesthetic technique. Forty-one consecutive cases from October 2018 to March 2019 operated on by the same surgeon and anaesthetised by the same anaesthetic consultant were included in the study. All the patients received standardised multimodal anaesthetic technique. Data from visual analogue pain scores, nausea, vomiting and requirement of analgesics were collected from hospital records and results were analysed. RESULTS Our results showed that 60% of patients reported either no pain or mild pain. None of the patients required stronger opioids or parenteral analgesic. Only three patients required antiemetic. Length of hospital stay was 1.19 days which is comparable to published outcomes from high volume centres performing RARP. CONCLUSION Our study adds to the currently published literature that RARP when combined with the multimodal anaesthetic technique can significantly reduce stronger opioid analgesic requirement in the post-operative period without compromising LOS

Multidisciplinary team approach to diagnosing lymphangioleiomyomatosis (2021)

Type of publication:
Journal article

Author(s):
Okoh, Magnus; Khan, Rosina; *Ahmad, Nawaid

Citation:
BMJ Case Reports; Aug 2021; vol. 14 (no. 8)

Abstract:
A 42-year-old woman with chronic obstructive pulmonary disease was referred to the respiratory team due to shortness of breath on exertion and significant deterioration in pulmonary function tests. Her symptoms were progressively getting worse. This prompted a referral to the specialist team where further investigations were undertaken including a high-resolution CT scan followed by lung biopsy, which eventually revealed a diagnosis of lymphangioleiomyomatosis (LAM). Successful referral to the National LAM Centre in Nottingham provided the key therapeutic approach required to manage this rare condition. Diagnosing this rare condition was due to the multidisciplinary team approach, which involved input from the general practitioner, radiologist and
respiratory consultant. The patient has been making good progress with pharmacological management.

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An unusual presentation of dysarthria in a young patient, a stroke mimic (2021)

Type of publication:
Journal article

Author(s):
*Simpson D.; *David O.; Nasr F

Citation:
Acute Medicine; Jun 2021; vol. 20 (no. 2); p. 140-143

Abstract:
Internal carotid artery dissection commonly affects younger patients. We present a case of a previously fit and well 43-year-old gentleman who presented with a sudden onset of slurring of speech, with right-sided tongue deviation and fasciculation on examination. Signs and symptoms began following participation in a home workout class. Magnetic resonance angiography revealed right-sided extracrainal internal carotid artery dissection leading to right-sided unilateral twelfth cranial nerve palsy.