The arthritis component of the sledai should only be scored if there is joint swelling
Author(s) Mahmoud K.; Md Yusof M.Y.; Dutton K.; Conaghan P.G.; Emery P. et al.
Source Annals of the Rheumatic Diseases; Jun 2021; vol. 80 ; p. 625
Background: SLE disease activity tools do not optimally define disease activity and response. The SLEDAI arthritis item is common, and sufficient to define SRI response. Lupus patients with arthralgia often have no swelling. Glossary definitions of arthritis in different versions of the SLEDAI have included: swelling, swelling between visits, effusion, tenderness, warmth and erythema. MSK ultrasound in SLE can identify synovitis without swelling, ultrasound synovitis is associated with worse symptoms and serology, predicts response to therapy, and is more responsive to therapy than clinical variables. Objective(s): To validate different glossary definitions for SLEDAI arthritis using musculoskeletal ultrasound.
Author(s) Pedersen A.; Greenhalgh M.; Tan M.; Terry R.; Royle C. et al.
Source Age and Ageing; Jun 2021; vol. 50
Introduction: In the first wave of the COVID-19 pandemic, it was recognised there would be an increased demand on clinicians to provide patients and relatives with bad news. The national ban on hospital visiting rapidly changed the way in which this news would be delivered. In recognition of these new challenges, our team sought to design a teaching course that could be implemented quickly and cost effectively, with the aim of improving clinician's confidence around these difficult skills.
Author(s) Idhrees A.M.; Suthakaran P.K.; Valooran G.J.; Bashir M.
Source International Journal of Angiology; Jun 2021; vol. 30 (no. 2); p. 155-159
Infection with the novel coronavirus, SARS-CoV2, produces the clinical syndrome COVID-19. COVID-19 is a systemic illness inducing hyperinflammation and cytokine storm affecting multiple organs including the myocardium which is reflected in elevated cardiac biomarkers such as troponin, lactate dehydrogenase, and creatinine kinase MB. Furthermore, COVID-19 has been implicated in increased predilection to thromboembolic phenomena. Hence, mortality in patients with associated cardiovascular disease has been higher compared with the cohort with no cardiovascular comorbidity. It is entirely unknown how remdesivir will change the facet of cardiovascular medicine and surgery. In the present constantly changing climate, this review of remdesivir and its association with cardiovascular disease is comprehensive as of June 17, 2020 and it highlights the science behind this drug and its potential implications to cardiovascular practice. Copyright © 2020. International College of Angiology. All rights reserved.
Rehabilitation following proximal humeral fracture in the UK National Health Service: A survey of publicly facing information
Author(s) Rohun J.; May P.; Littlewood C.
Source Musculoskeletal care; Jun 2021; vol. 19 (no. 2); p. 193-198
INTRODUCTION: Proximal humeral fractures (PHF) are a common injury in the older population but there is limited research evaluating rehabilitation following PHF. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following PHF as a platform for conducting future research.
Out-patient physiotherapy service delivery post COVID-19: opportunity for a re-set and a new normal?
Author(s) Rawlinson G.; Connell L.
Source Physiotherapy; Jun 2021; vol. 111 ; p. 1-3
10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease
Author(s) Ono M.; Hara H.; Kawashima H.; Takahashi K.; Wykrzykowska J.J. et al.
Source Journal of the American College of Cardiology; Jun 2021; vol. 77 (no. 22); p. 2761-2773
Background: The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear.
Microvascular anastomotic coupler devices versus hand-sewn technique for arterial anastomosis: a systematic review
Author(s) Adam D.; Broderick D.; Kyzas P.; Vassiliou L.
Source British Journal of Oral and Maxillofacial Surgery; Jun 2021; vol. 59 (no. 5); p. 524-533
The use of microvascular anastomotic coupling devices (MACD) is an established technique for venous anastomosis. However, literature on arterial MACD is conflicting. We report, to our knowledge, the first registered systematic review of its kind to evaluate the safety and efficiency of arterial MACD in free flaps. We performed a PRISMA-guided systematic review (PROSPERO-registered) and identified reports using a search algorithm in MEDLINE/EMBASE. The rate of arterial thrombosis was set as the primary outcome. Secondary outcomes included flap survival, failure rates, and comparison of MACD and the conventional hand-sewn technique. From the 17 studies identified, 2672 free flap reconstructions were performed and 640 arterial anastomoses with MACD attempted (622 completed, 97.2%). The pooled incidence of arterial thrombosis was 2.1% (13/622), and overall flap failure rate 4.34% (116/2672). The total number of arterial MACD procedures performed first time, with no perioperative complications, revisions, or thrombosis, was 88.9% (569/640). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality analysis revealed low quality and significant heterogeneity. The use of arterial MACD is a safe and efficient alternative to hand-sewn anastomosis, with more recent literature showing excellent results. However, further evaluation is required with controlled trials.Copyright © 2020
Real-world comparison of curative open, laparoscopic and robotic resections for sigmoid and rectal cancer-single center experience
Author(s) Ansari S.A.; Javed M.A.; Hedayat F.; Harris C.; Gill M. et al.
Source Journal of Robotic Surgery; 2021
There has been an increase in the utilization of robotic surgery in addition to traditional open or laparoscopic approaches. Aim of this study is to compare the short-term outcomes for open, laparoscopic, and robotic surgery for rectal and sigmoid cancer. One hundred and forty-seven patients (open n = 48, laparoscopic n = 49, robotic n = 50) undergoing curative resections by two surgeons between 2013 and 2020 were included. Data analyzed included patient demographics, tumor characteristics, length of stay, post-operative outcomes, and pathologic surrogates of oncologic results, including total mesorectal excision (TME) quality, circumferential resection margin (CRM) involvement and lymph node (LN) yield. Median age of population was 68 years (IQR 59-73), majority (68%) were males. Median distance from anal verge in the robotic surgery group was 8 cm, compared to 15 and 14.5 cm in the open and laparoscopic groups, respectively, p = 0.029, (laparoscopic vs robotic, p = 0.005 and open vs robotic, p = 0.027). Proportion of patients who received neoadjuvant radiotherapy in robotic surgery group was higher, p = 0.04. In sub-group of tumors between 3 and 7 cm from anal verge more patients in the robotic surgery group had sphincter preservation, p = 0.006. Length of stay, maximum C-reactive protein, and white blood cell rise favored minimally invasive approaches compared to open surgery. There were no differences in post-operative complications, lymph node yield or CRM positivity rate between the three groups. Robotic surgery approach is safe and allows sphincter preservation without compromising TME quality in rectal cancer surgery.Copyright © 2021, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
Comparison of four high-throughput, automated immunoassays for the detection of SARS-CoV-2 antibodies
Author(s) Oakey J.; Haslam S.; Houghton B.; Brown A.; Eglin J. et al.
Source Annals of Clinical Biochemistry; 2021
Background: A number of immunoassays have been developed to measure antibodies specific to SARS-CoV-2. More data is required on their comparability, particularly among those with milder infections and in the general practice population. The aim of this study was to compare four high-throughput automated anti-SARS-CoV-2 assays using samples collected from hospitalized patients and healthcare workers with confirmed SARS-CoV-2 infection. In addition, we collected general practice samples to compare antibody results and determine seroprevalence.
Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial
Author(s) Okeke Ogwulu C.B.; Williams E.V.; Roberts T.E.; Chu J.J.; Devall A.J. et al.
Source BJOG: An International Journal of Obstetrics and Gynaecology; 2021
Objective: To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage. Design(s): Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS). Setting(s): Twenty-eight UK NHS early pregnancy units.
Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives
Author(s) Rogers J.P.; Smakowski A.; Watson C.J.; Badenoch J.; Cross B. et al.
Source Journal of neurology, neurosurgery, and psychiatry; Jun 2021
There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.
A new consultation, Assessment and reflection model (CARM) used in child and adolescence mental health services (CAMHS)
Author(s) Mansell L.; Hughes K.; Heyes J.-W.; Brownlee A.; Charm C. et al.
Source Clinical child psychology and psychiatry; Jun 2021
UK National Guidelines stress the importance of reducing waiting times for mental health assessments and interventions for children. They stress the importance of early help, multidisciplinary working, and collaboration with families regarding treatment plans. We piloted a new assessment model (CARM) within a CAMHS service to: reduce non-attendance rates and subsequently waiting times; increase staff and patient satisfaction; and improve the quality of assessment. All waiting list patients and new referrals over a three-month period were contacted to self-book an hour session to meet two clinicians who utilised collaborative reflection and formulation to produce a care plan (CARM). Results revealed that non-attendance rates dropped from 33% over the month prior to CARM to 7% during CARM. Satisfaction levels were high. Qualitative feedback regarding satisfaction revealed the most common themes was feeling listened to and having the opportunity to listen to staff reflections. The themes of staff satisfaction included 'feeling more supported' and 'feeling safer in their decision making'. All assessments were completed in the one appointment. A formulation-driven care plan was developed and discussed with the family. This approach has the potential to make services more effective, efficient and satisfying for both staff and families.
The automaton as a surgeon: the future of artificial intelligence in emergency and general surgery
Author(s) Rimmer L.; Bashir M.; Howard C.; Picca L.
Source European journal of trauma and emergency surgery : official publication of the European Trauma Society; Jun 2021; vol. 47 (no. 3); p. 757-762
BACKGROUND: Artificial intelligence (AI) is a field involving computational simulation of human intelligence processes; these applications of deep learning could have implications in the specialty of emergency surgery (ES). ES is a rapidly advancing area, and this review will outline the most recent advances. METHOD(S): A literature search encompassing the uses of AI in surgery was conducted across large databases (Pubmed, OVID, SCOPUS). Two doctors (LR, CH) both collated relevant papers and appraised them. Papers included were published within the last 5 years, and a "snowball effect" used to collate further relevant literature. RESULT(S): AI has been shown to provide value in predicting surgical outcomes and giving personalised patient risks based on inputted data. Further to this, image recognition technology within AI has showed success in fracture identification and breast cancer diagnosis. Regarding theatre presence, supervised robots have carried out suturing and anastomosis of bowel in controlled environments to a high standard. CONCLUSION(S): AI has potential for integration across surgical services, from diagnosis to treatment, and aiding the surgeon in key decision-making for risks per patient. Fully automated surgery may be the future, but at present, AI needs human supervision.
Sexual function is adversely affected in the majority of men presenting with penile lichen sclerosus
Author(s) Shah M.
Source Clinical and Experimental Dermatology; Jun 2021; vol. 46 (no. 4); p. 723-726
Male genital lichen sclerosus (MGLS) is a chronic inflammatory condition that can present with a range of debilitating symptoms. Sexual dysfunction is reported by most women with lichen sclerosus but by relatively few men. This prospective study looked at 78 men with MGLS. Sexual difficulties were experienced by 64 (82%) patients, with 54 of the 64 attributing their sexual dysfunction directly to their MGLS. Sexual dysfunction appears to be more common in MGLS than other genital diseases such as psoriasis and sexually transmitted infections. Penile soreness due to active inflammation is the commonest cause of dyspareunia. Psychological factors are also important. Assessment and management of MGLS must include sexual history as men will not usually volunteer this information. Monitoring sexual function may be useful to assess disease outcome.Copyright © 2021 British Association of Dermatologists
Author(s) Yee C.S.; Stevens R.; Farewell V.; Akil M.; Lanyon P. et al.
Source Annals of the Rheumatic Diseases; Jun 2021; vol. 80 ; p. 602
Background: BILAG-2004 Index (BILAG-2004) has undergone construct and criterion validity and is used to assess disease activity in SLE. However, its predictive validity has yet to be established. Objective(s): This study was to determine if disease activity according to BILAG-2004 was predictive of development of damage in an inception cohort.
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