2023

Improvement to assessment and provision of analgesia for patients with suspected Neck of Femur Fracture in ED (2023)

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Type of publication:
Service improvement case study

Author(s):
*Oleg Lujanschi

Citation:
SaTH Improvement Hub, November 2023

Abstract:
To improve the assessment and provision of analgesia (where required) for patients presenting in ED with a suspected Neck of Femur Fracture to ensure all patients meet the national standard by 15 December 2023. Additionally, the aim is to improve the percentage of patients who receive an x-ray when presenting to ED with a suspected Neck of Femur Fracture in line with the national standard of 90 minutes by 15 December 2023.

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Improved efficiency and safety Drugs Trolley- Ward 27 Getting to Good: Fundamentals in Care (2023)

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Type of publication:
Service improvement case study

Author(s):
*Layla Brice

Citation:
SaTH Improvement Hub, December 2023

Abstract:
To improve the drugs round process to facilitate improved patient care. Standardisation of ward 27 drugs trolley to focus on improving patient and staff experience by the end of January 2023

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Sustainable QR solutions for patient information (2023)

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Type of publication:
Service improvement case study

Author(s):
*Umesh Parampalli *Ruchir Mashar *Jefferson George *Anchal Gupta *Florence Quarshie

Citation:
SaTH Improvement Hub, December 2023

Abstract:
To improve patient access to up-to-date and accurate healthcare information by the start of December 2023. A secondary aim was to use a sustainable approach to achieve this.

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PRH Emergency Department: Perfect Week (2023)

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Type of publication:
Service improvement case study

Author(s):
*Laura Wild

Citation:
SaTH Improvement Hub, December 2023

Abstract:
I will improve the number of walk-in patients triaged within 15 minutes by 3rd of December 2023. To improve patient flow within the department from initial assessment to Fit to Sit by 3rd December 2023.

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Improving Inpatient Therapy staff engagement in Therapy Centre metrics (2023)

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Type of publication:
Service improvement case study

Author(s):
*Erin Tsang

Citation:
SaTH Improvement Hub, August 2023

Abstract:
To improve the visibility of Inpatient Therapy data to drive engagement with Quality Improvement activities within the Inpatient Therapy team by December 2023.

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Low Risk Meets High Stakes: Unraveling the Mystery of Low D-dimer Pulmonary Embolism (2023)

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Type of publication:
Journal article

Author(s):
Kasanga, Sadat; Khashan, Abdallah; Salik, Ahsan; *Aboshehata, Ahmed M; Casillas, Sebastian; Islam, Mohammed

Citation:
Cureus. 15(12):e51045, 2023 Dec.

Abstract:
Pulmonary embolisms (PEs) are potentially life-threatening emergencies that carry significant morbidity and mortality. Advances in treatment options and the safety of existing procedures have effectively reduced the long-term and short-term effects of the condition. Therefore, it is important to make an early diagnosis so that treatment options can be thoroughly explored. The D-dimer is an important tool in the early diagnosis of PEs. It is especially useful in ruling out the diagnosis in patients with a low to moderate suspicion of the disease. We present a case of a 22-year-old male who presented with exertional dyspnea, congestion, and rhinorrhea for one day and was noted to have persistent hypoxia and tachycardia. The influenza test was positive, and he was started on oseltamivir. Due to persistent hypoxia, a CT pulmonary angiogram was ordered and revealed filling defects in the left lower lobe segmental vessels suggestive of PE, as well as multifocal multilobar bilateral ground-glass opacities. He was initially treated with a heparin drip and subsequently switched to eliquis. After a significant improvement in his hypoxia, he was discharged home for outpatient follow-up, includinga hypercoagulable workup. This case demonstrates that despite the usefulness of the D-dimer as a diagnostic tool for PEs, it cannot solely or fully replace the full gamut of screening tools used to determine the risk of PE. Although rare, false-negative scores do occur; therefore, the tool should always be used in conjunction with other scoring systems, physician gestalt, and within the specific clinical context.

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Pre-treatment plasma proteomics-based predictive biomarkers for immune related adverse events in non-small cell lung cancer (2023)

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Type of publication:
Conference abstract

Author(s):
Naidoo J.; Reinmuth N.; Puzanov I.; Bar J.; Kamer I.; Koch I.; Moskovitz M.; Levy-Barda A.; Agbarya A.; Zer A.; Abu-Amna M.; Farrugia D.; Lotem M.; Price G.; Harkovsky T.; Hassani A.; Katzenelson R.; *Chatterjee A.; Yelin B.; Sela I.; Dicker A.; Elon Y.; Harel M.; Leibowitz R.

Citation:
Journal for ImmunoTherapy of Cancer. Conference: 38th Annual Meeting of the Society for Immunotherapy of Cancer's, SITC 2023. San Diego, CA United States. 11(Supplement 1) (pp A1356), 2023. Date of Publication: November 2023.

Abstract:
Background Immune-related adverse events (irAEs) resulting from immune checkpoint inhibitors (ICIs) can substantially affect patient quality of life and treatment trajectory. Currently, there are no reliable pre-treatment biomarkers for predicting the development of irAEs; hence, there is a clinical need for irAE predictive biomarkers. Methods Plasma samples were obtained at baseline from 426 non-small cell lung cancer (NSCLC) patients treated with ICIs as part of an ongoing multi-center clinical trial (NCT04056247; approved by local IRB committees from each site) with irAE-related information. Proteomic profiling of plasma samples was performed using the SomaScan assay (SomaLogic Inc.), enabling deep coverage of approximately 7000 proteins in each sample. A machine learning-based model was developed to predict significant irAEs arising up to 3 months from treatment initiation; significant irAEs were defined as irAEs with CTCAE grade >=3 or irAEs that induced treatment discontinuation. Using the model, we identified a set of plasma proteins, termed Toxicity Associated Proteins (TAPs), that serve as indicators of irAEs depending on their plasma level in the individual patient. Bioinformatic analysis was performed to decipher the biology underlying immunerelated toxicity implied by the TAPs. Results Overall, 60 patients experienced significant irAEs at early onset; 197 patients had low grade irAEs, irAEs at late onset or AEs that are not immune-related; and 169 patients did not display any adverse event. A computational model was generated to predict significant irAEs, showing a strong correlation between the predicted probability of significant irAEs and the observed rate of such events (R2= 0.92; pvalue <0.0001), implying good prediction capabilities. The prediction was based on a set of 449 TAPs. Interestingly, nearly half of these TAPs were previously identified as proteins associated with clinical benefit from ICI therapy, suggesting a close relationship between irAEs and clinical benefit, in accordance with previous reports. A detailed examination of the TAPs revealed some key findings. Patients who experienced irAEs had a larger number of TAPs related to neutrophils, inflammation, and cell death resistance, while the number of lymphocyte-related TAPs was low in these patients. Patients who did not experience irAEs displayed higher levels of extracellular matrix-related proteins. Conclusions We describe a novel computational model for predicting significant irAEs in patients with NSCLC based on proteomic profiling of pre-treatment plasma samples. The TAPs provide insights into the biological processes underlying irAEs. Early prediction of irAEs could enable personalized management plans and mitigation strategies to reduce the risk of irAEs in NSCLC.

A Survey on the Type and Prevalence of Medical Interventions during Labor and Childbirth in Greek Pregnant Women (2023)

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Type of publication:
Journal article

Author(s):
*Papoutsis D.; Chatzipanagiotidou N.

Citation:
Clinical and Experimental Obstetrics and Gynecology. 50(12) (no pagination), 2023. Article Number: 258. Date of Publication: December 2023.

Abstract:
Background: The purpose of this study was to identify the type and prevalence of medical interventions during labor and birth in Greek pregnant women. Method(s): We constructed a 49-item web-based questionnaire to capture demographic data, obstetric data and the medical interventions performed during the most recent childbirth of participants. The questionnaire was posted on nationwide electronic media between November 2022 to January 2023. All women who had given birth at least once were eligible for the study, and results were stratified by the timing of their last birth. Result(s): There was a total of 954 women participating in the survey, with 809 women giving birth within the last 10 years and 145 women giving birth between 10 to 20 years ago. In those that gave birth within the past 10 years, the majority had a low-risk pregnancy (78.8%) and the overall cesarean section rate was 42.8%. During labor, women were allowed to change positions and to mobilize in about half of cases, whereas the lithotomy position at birth was reported by 81.4%. Almost 2 in 3 women reported a vaginal examination every hour or even more frequently, with approximately 30% sustaining more than 5 examinations intrapartum. Oxytocin use was reported in 36.9%, epidural use in 69.6%, and episiotomy in 47.3% of women. Women who had their last birth 10-20 years ago when compared to those who gave birth within the last 10 years seem to have experienced higher rates of medical interventions during labor and birth. Conclusion(s): The survey results demonstrate the medicalization of childbirth in Greek pregnant women over the past 20 years. These findings may serve as a benchmark against which to compare and identify possible changes in future birthing practices and to determine which measures to promote normality at birth should be implemented.

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Counselling and management of women with genetic predisposition to gynaecological cancers (2023)

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Type of publication:
Journal article

Author(s):
*Malik, Naushabah; *Sahu, Banchhita

Citation:
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 294:44-48, 2023 Nov 09.

Abstract:
OBJECTIVE: To review the literature with reference to counselling and management of women with genetic predisposition to gynaecological cancers. METHODS: Histochemical analysis, ultrasound, blood investigations, genetic testing, screening and risk-reducing surgery (RRS) are important tools for the management of gynaecological cancers and mortality reduction. Counselling can assist in timely management of gynaecological cancers. Systematic reviews, review articles, observational studies and clinical trials on PubMed, published in the English language, were included in this review. RESULTS: The management of women with genetic predisposition to gynaecological cancers through screening tests and RRS has led to a significant decrease in the risk of malignancy through RRS in cases with BRCA1 and BRCA2 gene mutations. RRS and screening have also been found to reduce the mortality rate and increase the survival rate in women with BRCA1 and BRCA2 gene mutations. The efficacy of endometrial cancer surveillance in women with Lynch syndrome is still unproven. RRS has not been reported to be effective in women with Cowden syndrome. The risk of ovarian malignancies in individuals with germline mutations remains minimal in the general population in comparison with genetic mutations. CONCLUSION: Genetic testing and RRS should be implemented in addition to genetic counselling for proper management and mortality reduction of women predisposed to gynaecological cancers.