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Author(s) Evans W. (Mbchfwe2@doctors.org.uk); Buchanan J.; Goel R.; Hardy S.
Institution(s) (Evans, Buchanan, Goel, Hardy) Department of Vascular Surgery, East Lancashire Hospitals NHS Trust, Blackburn, UK, United Kingdom Source Annals of Vascular Surgery; Jan 2022; vol. 78 ; p. 321-327 Language English Database EMBASE AbstractBackground: Omniflow II biosynthetic grafts are a commonly used alternative to autologous grafts in vascular bypass procedures. They are chosen for their purported resilience to infection, often in instances of existing graft failure or infection. We examined the short term, 1-3 year outcomes of Omniflow grafts in terms of patency, limb survival and mortality in a sample of 24 individuals. Method(s): This is a single centred retrospective study of Omniflow II grafts implanted between September 23, 2015 and April 05, 2018 in our department. It includes grafts in all anatomical locations. Primary outcome measures were overall patient survival and time to this, primary graft patency (patency with no intervention) and then limb survival at 1 and 3 years. Kaplan-Meier survival analysis was plotted for the 3 primary outcome measures. Result(s): A total of 24 grafts from 24 individuals were included with mean age 71.4 +/- 11.7. We included 5 female and 19 male patients. The commonest indication was rest pain/claudication (N = 8) followed by graft occlusion (N = 6). Femoro-popliteal bypass (N = 13) and Femoro-distal bypass (N = 5) were the commonest procedures. Kaplan-Meier survival analysis demonstrated that 1 and 3-year primary patency rates were 54.2% and 37.5% respectively with Limb survival probability of 75% at 1 year and 70.8% at 3 years. These rates were all considerably lower than those found in previous comparative studies. Mortality however, compared favourably with 1 and 3-year survival probability 91.7% and 87.5% on average 296 days (range 95-451 days) after graft implantation. Conclusion(s): We found that rates of primary patency and limb salvage for this graft type were markedly lower than in comparable studies. Further work in the form of a RCT is indicated.Copyright © 2021
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Author(s) Al-Tawil M.; Chikhal R.; Abdelhaliem A. (amrhaliem@gmail.com)
Institution(s) (Al-Tawil) Faculty of Medicine, Al-Quds University, Jerusalem, Palestine (Chikhal) Hull York Medical School, University of York, York, United Kingdom (Abdelhaliem) Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom Source Journal of Cardiac Surgery; 2021 Language English Database EMBASE AbstractBackground: Uncomplicated Type B aortic dissection (un-TBAD) is still managed conservatively with optimal medical therapy (OMT) despite evidence in favour of thoracic endovascular aortic repair (TEVAR) for un-TBAD. OMT aims to regulate heart rate and blood pressure and patients require long-term follow-up to evaluate the extent of dissection, however, many un-TBAD patients are lost to follow-up. Several trials and observational studies evaluated the use of TEVAR in combination with OMT in un-TBAD and proved the safety, effectiveness, and comparability of TEVAR relative to OMT alone. What remains in question is the optimal time window to intervene with TEVAR. This was recently addressed in a fascinating review by Jubouri et al. Aim(s): This commentary aims to discuss the recent review by Jubouri et al. which further proved that TEVAR is safe and effective in un-TABD and investigated the optimal timing of TEVAR in un-TBAD. Material(s) and Method(s): We carried out a literature search using multiple electronic databases including PUBMED and Scopus in order to collate research evidence on intervention timeframe and outcomes of TEVAR in un-TBAD. Result(s): Performing TEVAR during the subacute phase of dissection (15-90 days since symptom onset) seems to be associated with less periprocedural complications compared to the acute phase, however, late outcomes (>30 days post-TEVAR) are comparable between the two groups and are superior to the chronic phase. Discussion(s): The introduction of TEVAR in un-TBAD presents a paradigm shift in the management of un-TBAD and a potential move towards becoming the gold-standard treatment option for un-TBAD. Intervening with TEVAR within the first 90 days since symptom onset (acute and subacute un-TBAD) gives favourable outcomes relative to intervention in the chronic phase of dissection (>90 days since symptom onset), this is due to the dissecting septum becoming less compliant over time. Conclusion(s): TEVAR is a safe and effective treatment modality for un-TBAD with a survival benefit compared to OMT alone. Offering TEVAR during the subacute phase of dissection yields optimal results which are comparable to the acute phase but superior to the chronic phase.Copyright © 2021 Wiley Periodicals LLC Author(s) Lewis J.A.; Kinross J.M.; Souvatzi M.; Khan S.; Singh B.; Tilney H.S.; Wilson J.M.; Vitone L.J.
Institution(s) (Lewis, Kinross) Department of Surgery and Cancer, Imperial College London, London, United Kingdom (Lewis, Souvatzi, Kinross) Imperial College Healthcare National Health Service Trust, London, United Kingdom (Khan, Singh) University Hospitals of Leicester National Health Service Trust, Leicestershire, United Kingdom (Tilney) Frimley Health National Health Service Foundation Trust, Frimley, United Kingdom (Wilson) Whittington Health National Health Service Trust, Whittington, United Kingdom (Vitone) East Lancashire Hospitals National Health Service Trust, Blackburn, United Kingdom Source Diseases of the colon and rectum; Dec 2021; vol. 64 (no. 12) Language English Publication Date Dec 2021 Database EMBASE AbstractBACKGROUND: This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view. PRELIMINARY RESULTS: Fifty patients underwent outpatient (n = 25) and surgical rectal assessment (n = 25), with a mean age of 60 years. This included 31 men and 19 women with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48 (96%) of 50 uses, images were captured in 48 (96%) of 50 uses, and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a kappa of 0.225 (95% CI, 0.144-0.305) when assessing whether the target pathology was adequately visualized. IMPACT OF INNOVATION: The improved views afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video that can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, "watch and wait," and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training, and it now requires prospective trials to validate its diagnostic accuracy against more costly flexible sigmoidoscopy systems.Copyright © The ASCRS 2021. Author(s) Jubouri M.; Abdelhaliem A. (amrhaliem@gmail.com)
Institution(s) (Jubouri) Hull York Medical School, University of York, York, United Kingdom (Abdelhaliem) Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom Source Journal of Cardiac Surgery; 2021 AbstractBackground: The introduction of the single-step total arch replacement (TAR) with frozen elephant trunk (FET) has revolutionised the field of aortic surgery. TAR is indicated when the aortic arch is involved in aortic pathologies such as Type A aortic dissection and thoracic aortic aneurysms. Several FET devices are available commercially for global use, and example is the E-Vita Open NEO hybrid prosthesis (HP) developed by CryoLife-JOTEC. Unlike other FET devices available, this HP in particular features a design that puts it at a disadvantage as it does not incorporate gelatine or collagen in its structure, which makes it permeable to blood. Several studies have reported incidence of post-anastomotic blood oozing through the E-Vita Open NEO right after weaning from cardiopulmonary bypass. Aim(s): This commentary aims to discuss the recent study by Tan et al. which investigated E-Vita NEO device oozing as well as the implications of using BioGlue to overcome this serious complications. Method(s): We carried out a literature search on multiple electronic databases including PUBMED and Scopus in order to collate research evidence on E-Vita NEO device oozing, BioGlue health risks, and other commercially available and globally used FET devices such as Thoraflex Hybrid. Result(s): It is proven fact that the E-Vita NEO excessively oozes blood, and while BioGlue is a safe and effective agent when used in small amounts, the amount needed to coat the E-Vita Open NEO and achieve haemostasis exceeds this by a wide margin which poses patients to great potential health risks. The Thoraflex Hybrid Prosthesis developed by Terumo Aortic is a commercially available and globally used FET device with long-standing favourable outcomes. Discussion(s): Tan et al. recently conducted an interesting study which proved that the E-Vita NEO HP does excessively ooze blood and tackled the issue of pre-emptive BioGlue use to tackle this complication as suggested by Ho et al. This leads on to the main question, is the use of BioGlue with E-Vita Open NEO to overcome oozing a long-term sustainable solution or is it merely a band aid?. Conclusion(s): In the face of fierce commercial competition, the choice of design and material of the E-Vita Open NEO HP would benefit from reconsideration.Copyright © 2021 Wiley Periodicals LLC Author(s) Papamichail M. (mp1977gr@googlemail.com); M P.; ND H.; Pizanias M.; Heaton N.D.
Institution(s) (Papamichail, M, M, ND) Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn, UK BB2 3HH, United Kingdom (Pizanias, M, M, ND) Department of General Surgery, Whittington Hospital, London, UK N19 5NF, United Kingdom (Heaton, M, M, ND) Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, UK SE5 9RS, United Kingdom Source Hepatobiliary and Pancreatic Diseases International; 2021 Publication Type(s) Review Database EMBASE AbstractBackground: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for-size syndrome (SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specific modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Result(s): Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusion(s): With those techniques the indications of radical treatment for patients with liver tumors have significantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modification of interventions and the right timing of surgery.Copyright © 2021 Authors:
Taylor AK; School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK annaktaylor@doctors.org.uk. Chang D; Department of General Surgery, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK. Chew-Graham C; School of Medicine, Keele University, Keele, UK. Rimmer L; Department of General Surgery, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK. Kausar A; Department of General Surgery, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK. Source: BMJ open 2021 Dec 16; Vol. 11 (12), pp. e050016. Date of E-Publication: 2021 Dec 16. Publication Type: Journal Article Abstract: Objectives: Ten per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. There is limited previous research focusing on psychological well-being; unmet support needs impact negatively on quality of life. This paper reports the psychological impact of a pancreatic cancer diagnosis and subsequent pancreaticoduodenectomy, exploring how patients' lives alter following surgery and how they seek support. Design: Inductive qualitative study involving in-depth semistructured interviews with 20 participants who had undergone pancreaticoduodenectomy for pancreatic or distal biliary duct cancer. Interviews were audiorecorded, transcribed and anonymised, and thematic analysis used principles of constant comparison. Setting: Single National Health Service Trust in Northwest England. Participants: Patients were eligible for inclusion if they had had pancreaticoduodenectomy for head of pancreas cancer, periampullary cancer or distal cholangiocarcinoma between 6 months and 6 years previously, and had completed adjuvant chemotherapy. Results: Analysis identified the following main themes: diagnosis and decision making around surgery; recovery from surgery and chemotherapy; burden of monitoring and ongoing symptoms; adjusting to 'a new normal'; understanding around prognosis; support-seeking. Participants seized the chance to have surgery, often without seeming to absorb the risks or their prognosis. They perceived that they were unable to control their life trajectory and, although they valued close monitoring, experienced anxiety around their appointments. Participants expressed uncertainty about whether they would be able to return to their former activities. There were tensions in their comments about support-seeking, but most felt that emotional support should be offered proactively. Conclusions: Patients should be made aware of potential psychological sequelae, and that treatment completion may trigger the need for more support. Clinical nurse specialists (CNSs) were identified as key members of the team in proactively offering support; further training for CNSs should be encouraged. Understanding patients' experience of living with cancer and the impact of treatment is crucial in enabling the development of improved support interventions. Available at BMJ Open Author(s) Mahmoud; Zayat, Ahmed S; Yusof, Md Yuzaiful Md; Dutton, Katherine; Teh, Lee Suan; Yee, Chee-Seng; D'Cruz, David; Ng, Nora; Isenberg, David; Ciurtin, Coziana; Conaghan, Philip G; Emery, Paul; Edwards, Christopher J; Hensor, Elizabeth M A; Vital, Edward M
Source Rheumatology; Nov 2021; vol. 60 (no. 11); p. 5194-5204 Language English Database CINAHL AbstractObjectives To determine whether SLE patients with inflammatory joint symptoms and US synovitis/tenosyovitis achieve better clinical responses to glucocorticoids compared with patients with normal scans. Secondary objectives included identification of clinical features predicting US synovitis/tenosynovitis. Methods In a longitudinal multicentre study, SLE patients with physician-diagnosed inflammatory joint pain received intramuscular methylprednisolone 120 mg once. Clinical assessments, patient-reported outcomes and bilateral hand/wrist USs were collected at 0, 2 and 6 weeks. The primary outcome (determined via internal pilot) was the early morning stiffness visual analogue scale (EMS-VAS) at 2 weeks, adjusted for baseline, comparing patients with positive (greyscale ≥2 and/or power Doppler ≥1) and negative US. Post hoc analyses excluded FM. Results Of 133 patients, 78 had a positive US. Only 53 (68%) of these had one or more swollen joint. Of 66 patients with one or more swollen joint, 20% had a negative US. A positive US was associated with joint swelling, symmetrical small joint distribution and serology. The primary endpoint was not met: in the full analysis set (N = 133) there was no difference in baseline-adjusted EMS-VAS at week 2 [−7.7 mm (95% CI −19.0, 3.5); P = 0.178]. After excluding 32 patients with FM, response was significantly better in patients with a positive US at baseline [baseline-adjusted EMS-VAS at 2 weeks −12.1 mm (95% CI −22.2, −0.1); P = 0.049]. This difference was greater when adjusted for treatment [−12.8 mm (95% CI −22, −3); P = 0.007]. BILAG and SLEDAI responses were higher in US-positive patients. Conclusion In SLE patients without FM, those with a positive US had a better clinical response to therapy. Imaging-detected synovitis/tenosynovitis may be considered to decide on therapy and enrich clinical trials. Author(s) Wong ; Viyasar, Thevarajah; Layton, Benjamin; Lauder, Joshua
Source British Journal of Hospital Medicine (17508460); Nov 2022; vol. 82 (no. 11); p. 369-376 Language English Publication Date Nov 2022 DOI 10.12968/hmed.2021.0322 ISSN 17508460 Database CINAHL Nitrous oxide, also known as 'laughing gas', is one of the most widely used recreational drugs among teenagers in the UK. Copious inhalation of nitrous oxide may increase intra-alveolar pressure, resulting in barotrauma secondary to alveolar rupture. Pneumomediastinum and subcutaneous emphysema are common clinical findings in nitrous oxide-associated barotrauma. Prolonged nitrous oxide misuse may inactivate vitamin B12 through the alteration of its metabolism, causing demyelination of the central and peripheral nervous system. A spectrum of neurological manifestations has been reported, including peripheral neuropathy, myelopathy and subacute combined degeneration of the spinal cord. Medical therapies and psychosocial interventions aiming at nitrous oxide cessation are important treatment steps to achieve partial or complete recovery from the adverse effects associated with inhalation of nitrous oxide. Author(s) Hossain M.I.; Sen R.; Adiyodi J.; Hampson P.; Nowell C.; Khan S.; Sundararaman S.; Basu S.
Institution(s) (Hossain, Sen, Adiyodi) East Lancashire Hospitals NHS Trust, Burnley, United Kingdom (Hampson, Nowell) The Binding Site, Birmingham, United Kingdom (Khan) Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom (Sundararaman) West Midlands University Hospitals Coventry and Warwickshire, Coventry, United Kingdom (Basu) The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Source Blood; Nov 2021; vol. 138 ; p. 3007 Language English Database EMBASE AbstractIntroduction Patients with Multiple Myeloma (MM) often have a significant delay between onset of symptoms and diagnosis of disease. As a result, a significant number of patients present via emergency routes with severe co-morbidities which affect survival rates. Timely diagnosis relies on the early recognition of symptoms and blood test results which may indicate disease. Methods We examined the medical records of 142 newly diagnosed MM patients (121 intact immunoglobulin and 21 light chains) across 2 UK Hospitals. Patients included had not previously been diagnosed with a plasma cell dyscrasia, including Monoclonal Gammopathy of Undetermined Significance (MGUS). Clinical symptoms and blood test results were examined from the time of initial presentation to the healthcare system with symptoms indicative of MM, to the point of diagnosis in order to highlight patterns of symptoms and blood tests results which may give an early indication of disease. Blood tests results recorded included globulin, calcium, creatinine, erythroid sedimentation rate and haemoglobin. Time to diagnosis from presentation with symptoms indicative of MM was also measured as well as the patient pathway from the point of presentation to the point of diagnosis. Results The median time to diagnosis from initial presentation was 77 days (range 0 - 12,986). Initial presentation was most commonly via primary care (58.1%). Urgent secondary care presentation was documented in 28.5% which included acute medical unit (15.6%), the emergency department (7.1%), and other secondary care specialities (5.7%) respectively. Multiple GP visits were common prior to haematology referral with a median of 3 visits (range 1 - 40). Initial presenting symptoms varied, but of those with data recorded (n=107) back/bone pain was the most common (58.2%) followed by anaemia (18.7%), fracture (7.5%), recurrent infection (7.5%) and renal impairment (3.7%) respectively. Interestingly, analysis of evaluable blood test results revealed a raised globulin was most often evident prior to diagnosis with 58% of patients recording an abnormal globulin a median of 140 days (range 3 - 4297) prior to diagnosis of disease. Conclusions Multiple GP visits prior to establishing a diagnosis of myeloma is very common. Inclusion of abnormal globulin to reflex electrophoresis request and serum free light chain assay may serve as a useful trigger for investigation when interpreted alongside presenting symptoms and other blood test results. Increased awareness of myeloma warning signs in primary care may reduce diagnostic delay and avoid presentation with severe co-morbidities in emergency settings. Disclosures: No relevant conflicts of interest to declare.Copyright © 2021 American Society of Hematology Author(s) Haque A. (adam.haque@manchester.ac.uk); Al-Khaffaf H.
Institution(s) (Haque, Al-Khaffaf) Cumbria and Lancashire Vascular and Endovascular Centre, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, United Kingdom Source Annals of Vascular Surgery; 2021 Language English Database EMBASE AbstractBackground: The association of dialysis fistulas and heart failure is believed to be due to high cardiac output. N-terminal pro-B-Type Natriuretic Peptide (pro-BNP) which is secreted by the cardiac ventricles in response to excessive stretching of the myocytes has been used as a marker of heart failure with 90% sensitivity. We report our early experience using pro-BNP levels to test the efficacy of the novel 'secondary extension technique' (SET) in improving myocardial function by reducing fistula flow. Method(s): Eleven patients with high fistula flows (>3000 mL/m, all brachio-cephalic) and raised pro-BNP underwent SET between 2011 and 2015. SET involves extending the anastomosis from brachial to either proximal radial or ulnar arteries. We measured pro-BNP levels, fistula flow and clinical improvements both pre and post operatively. Result(s): SET resulted in a median (IQR) flow rate decrease of 57.9 (11.9)% which correlated with a fall in pro-BNP of 69.6 (39)%. Seven of the 11 patients in the series pro-BNP level returned to a normal value at average follow-up of 3 months post SET. All patients had HOF-related symptom resolution post-procedure and remained asymptomatic at last follow-up Conclusion(s): Our pilot data suggests that SET is an effective way of reducing fistula flow. It also shows that BNP may be a reliable biomarker in assessing the impact of the technique on cardiac function. These results warrant further investigation in the form of a definitive, multicenter study.Copyright © 2021 Author(s) Puglia F.A.; Hills A.; Dawoud B.; Magennis P.; Chiu G.A. et al.
Source British Journal of Oral and Maxillofacial Surgery; Oct 2021; vol. 59 (no. 8); p. 867-874 Language English Publication Date Oct 2021 DOI 10.1016/j.bjoms.2020.12.021 ISSN 0266-4356 Database EMBASE Abstract We assess the effect of coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. From 1 April 2020 until 31 July 2020, OMF surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information included clinical presentation, mechanism of injury, how it was managed, and whether or not treatment included surgery. Participants were also asked to compare the patient's care with the treatment that would normally have been given before the crisis. Twenty-nine units across the UK contributed with 2,229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and, for hard tissues, mandibular fractures (13%). Of 876 facial fractures, 79 patients' treatment differed from what would have been normal pre-COVID, and 33 had their treatment deferred. Therefore the care of 112 (14%) patients was at variance with normal practice because of COVID restrictions. The pattern of OMFS injuries changed during the first COVID-19 lockdown. For the majority, best practice and delivery of quality trauma care continued despite the on-going operational challenges, and only a small proportion of patients had changes to their treatment. The lessons learnt from the first wave, combined with adequate resources and preoperative testing of patients, should allow those facial injuries in the second wave to receive best-practice care. Author(s) Ali Z.; Al-Janabi A.; Warren R.B.; Matthews R.
Source Expert Review of Clinical Immunology; 2021; vol. 17 (no. 10); p. 1073-1081 Language English Publication Date 2021 DOI 10.1080/1744666X.2021.1967748 ISSN 1744-666X Database EMBASE Abstract Introduction: Interleukin (IL)-17 is critical in the pathogenesis of psoriasis and psoriatic arthritis (PsA) with most data suggesting that IL-17A alone was the key cytokine. However, in vitro and in vivo studies have suggested dual blockade of IL-17A and IL-17 F may be more effective than IL-17 A blockade alone. Bimekizumab is the first human monoclonal antibody to exert simultaneous specific inhibition of IL-17A and IL-17 F, and has been studied in several phase II/III trials for psoriasis and PsA. Areas covered: Bimekizumab is not currently licensed for use. A literature search identified clinical trials examining the efficacy and safety of bimekizumab for psoriasis and PsA, and these were critically appraised. Expert opinion: Clinical trials of bimekizumab have been promising, demonstrating a rapid onset of response and superior efficacy compared to three currently licensed biologics: secukinumab, ustekinumab, and adalimumab. Bimekizumab maintains a high level of efficacy with maintenance dosing intervals of 8 weeks, compared with 4 weeks for currently licensed IL-17A antagonists. No unexpected adverse events have been identified, although mild-to-moderate fungal infections occur in approximately 10%. Studies over longer time periods involving additional active comparators would be valuable in further defining the role of bimekizumab amongst currently available treatments. Author(s) Wang R.; Gao C.; Tao L.; Kawashima H.; Ono M. et al.
Source Clinical Research in Cardiology; Oct 2021; vol. 110 (no. 10); p. 1680-1691 Language English Publication Date Oct 2021 DOI 10.1007/s00392-021-01922-y ISSN 1861-0684 Database EMBASE Abstract Aims: To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Method(s): The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Result(s): Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08-1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83-1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in >= 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11-4.23, p < 0.001) compared to those without CVD. Conclusion(s): The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Author(s) Tan S.Z.C.P.; El Santawy H.; Abdelhaliem A. Source Journal of Cardiac Surgery; Oct 2021; vol. 36 (no. 10); p. 3831-3833 Language English Publication Date Oct 2021 DOI 10.1111/jocs.15828 ISSN 0886-0440 Database EMBASE Abstract Thoracic endovascular aortic repair (TEVAR) has quickly become the mainstay of treatment for acute aortic dissection, in particular cases of acute complicated Stanford Type B dissection (co-TBAD). Necessarily, TEVAR carries with it the risk of postoperative complications, including stroke and renal failure. As a result, the management of patients with uncomplicated type B aortic dissection (un-TBAD), which is generally accepted as being less severe, is safely managed via optimal medical therapy (OMT) alone. However, despite OMT, patients with un-TBAD are at substantial risk of severe disease progression requiring delayed intervention. The cost-benefit ratio associated with TEVAR for un-TBAD is therefore of key interest. Howard and colleagues produced a fascinating systematic review and meta-analysis investigating the clinical outcomes of TEVAR for complicated and uncomplicated TBAD. Their data suggest that there is no significant difference in in-hospital mortality or 5-year survival between TEVAR for un-TBAD and co-TBAD, although the 30-day mortality rate appeared to be higher in the co-TBAD cohort. Patients with co-TBAD appeared to also be at a higher risk of postoperative stroke and TEVAR endoleak, while un-TBAD patients were at a higher risk of postoperative renal failure. Further prospective research into these relationships is recommended to fully elucidate the comparative efficacies of TEVAR for un-TBAD and co-TBAD. Author(s) Mansell; Hughes, Kirsty; Heyes, Jane-Ward; Brownlee, Adrian; Charm, Clare; Blake, Daniel; Collinge, Sarah; Smith, Jason
Source Clinical Child Psychology & Psychiatry; Oct 2021; vol. 26 (no. 4); p. 1046-1052 Publication Type(s) Academic Journal Database CINAHL AbstractUK 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. Author(s) Wang R.; Onuma Y.; Serruys P.W.; van Geuns R.J.; Takahashi K. et al.
Source Clinical Research in Cardiology; Oct 2021; vol. 110 (no. 10); p. 1543-1553 Language English Publication Date Oct 2021 DOI 10.1007/s00392-020-01802-x ISSN 1861-0684 Database EMBASE Abstract Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and Results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04-1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54-2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624). Conclusion(s): Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. Meta-analysis derivation concedes clinical significance in democratization of health care.29/10/2021 Author(s) Bashir ; Mohammed, Idhrees; Mousavizadeh, Mostafa; Rezaei, Yousef; Hosseini, Saeid
Source Journal of Cardiac Surgery; Oct 2021; vol. 36 (no. 10); p. 3994-3995 Language English Publication Date Oct 2021 DOI 10.1111/jocs.15837 ISSN 08860440 Database CINAHL Author(s) Cadilhac ; Bagot, Kathleen L; Demaerschalk, Bart M; Hubert, Gordian; Schwamm, Lee et al.
Source Journal of Telemedicine & Telecare; Oct 2021; vol. 27 (no. 9); p. 582-589 Language English Publication Date Oct 2021 DOI 10.1177/1357633X19899262 ISSN 1357633X Database CINAHL Abstract Introduction: Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes.Methods: An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers (n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email.Results: Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme (n = 12), (2) details about initiating hospital (n = 10), (3) telestroke consultation (n = 17), (4) patient characteristics (n = 7), (5) presentation to hospital (n = 5), (6) general clinical care within first 24 hours (n = 10), (7) thrombolysis treatment (n = 10), (8) endovascular treatment (n = 13), (9) neurosurgery treatment (n = 8), (10) processes of care beyond 24 hours (n = 7), (11) discharge information (n = 5), (12) post-discharge and follow-up data (n = 6).Discussion: The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services. Author(s) Puglia F.A.; Ubhi H.; Dawoud B.; Magennis P.; Chiu G.A.
Source British Journal of Oral and Maxillofacial Surgery; Oct 2021; vol. 59 (no. 8); p. 875-880 Language English Publication Date Oct 2021 DOI 10.1016/j.bjoms.2020.12.017 ISSN 0266-4356 Database EMBASE Abstract On 25 March 2020, the Chief Dental Officer issued national guidance restricting the provision of all routine, non-urgent dental services in response to the spread of COVID-19. We analysed odontogenic cervicofacial infections (CFI) presenting to oral and maxillofacial surgery (OMFS) departments during the first wave of COVID-19 in the United Kingdom. From 1 April 2020 until 31 July 2020 a database was used to prospectively collect records for all patients with CFI who presented to oral and maxillofacial teams. Information gathered included clinical presentation, location/origin of infection, and how this was managed. The OMFS units were asked to compare the patient's care with the treatment that would usually have been given prior to the crisis. A total of 32 OMFS units recorded 1381 cases of CFI in the UK. Most of the infections were referred via the emergency department (74%). Lower first or second molars were the most common origin, contributing 40% of CFI. Collaborators reported that patients' treatments were modified as a response to COVID in 20% of cases, the most frequently cited reason being the application of COVID-19 hospital policy (85%). The impact of the first wave of COVID modified the management of a significant number of patients presenting with CFI, and there was a proactive move to avoid general anaesthetics where possible. Some patients who presented to secondary care were given no treatment, suggesting they could have been managed in primary dental care if this had been available. We recommend that OMFS units and urgent dental care centres (UDCCs) build strong communication links not only to provide the best possible patient care, but to minimise COVID exposure and the strain on emergency departments during the pandemic. Author(s) Kumar A.; Taggarsi M.
Source BMJ Evidence-Based Medicine; Oct 2021; vol. 26 (no. 5); p. 228-230 Language English Publication Date Oct 2021 DOI 10.1136/bmjebm-2020-111525 ISSN 2515-446X Database EMBASE Abstract Evidence-based practice forms an integral part of modern-day practice. It is so indispensable that modern healthcare cannot be imagined if evidence and its quality is ignored. However, evidence-based medicine is not as perfect as it is thought. Time and again, researchers have questioned the quality of evidence (QOE) in present era’s researches. The evidence in this regard can be found in the article published in The Lancet by the editor himself. Horton argued that much of the scientific literature, nearly 50%, might be false or untrue because of inclusion of small sample size studies, researches with statistically insignificant effects, unfitting analyses, atrocious conflicts of interest, together with an unrestricted fascination to pursue fashionable trends of dubious importance. Camouflaged application of evidence-based medicine can be precarious to the patients and may hamper the idea of promoting healthy society. According to National Institute for Clinical Excellence, approximately 62% of publications used to formulate the guidelines and recommendations of primary care were based on dubious researches and were judged of uncertain relevance to patients. Author(s) Bashir B.; Banerjee M.; Fahmy A.A.; Raza F.
Source Postgraduate Medical Journal; Oct 2021; vol. 97 (no. 1152); p. 667-671 Language English Publication Date Oct 2021 DOI 10.1136/postgradmedj-2020-138513 ISSN 0032-5473 Database EMBASE Abstract The genesis of ketone bodies by organisms is a protective mechanism. This metabolic process helps organisms to survive acute metabolic derangements in times of nutrient deficiency. When prolonged, ketogenesis leads to ketoacidosis, which is a potentially life-threatening metabolic disorder due to the accumulation of keto-acids in the body. The most common cause is diabetic ketoacidosis, though starvation ketoacidosis and alcoholic ketoacidosis are not uncommon. The presentation of all ketoacidotic states is similar - being generally unwell, abdominal pain, rapid and shallow breathing, vomiting and dehydration. Non-diabetic ketoacidotic states are very commonly overlooked due to relative unawareness among the clinicians, leading to misdiagnosis and thereby inappropriate management culminating in added mortality and morbidity. We describe here six cases of alcoholic and starvation ketoacidosis, review the literature currently available and discuss the common pitfalls in managing such cases. Author(s) Ahmed N.; Obeidallah R.; Subar D.
Institution(s) (Ahmed, Obeidallah, Subar) Royal Blackburn Hospital, Blackburn, United Kingdom Source British Journal of Surgery; Oct 2021; vol. 108 Language English Database EMBASE AbstractAims: To ascertain the impact of ''Cost effective home-based pre-rehabilitation'' on post-operative outcomes in patients undergoing major hepatic and pancreatic oncological surgery. Method(s): In this non-randomized comparative study (2019-2021), we included 36 patients having pancreatic or hepatic malignancy. In group I, patients were signed up for home-based pre-rehabilitation program and dietary modification. Group II; included patients who did not have rehabilitation. The two groups were compared for post-operative outcomes (post-operative complications, length of ITU and hospital stay) Results: Mean age was 69.05+/-9.68 years in group I and 67.50+/-8.75 years in group II (p-value 0.61). Open approach was used in 02 (11.0%) patients in group I and in 09 (50%) patients in group II (p-value 0.01). More patients in group II needed admission in intensive care unit (ICU); 18 (100%) versus 11 (61.1%) in group II (p-value 0.0003). The group I had shorter length of hospital stay as compared to Group II (p-value 0.0001). There was no significant difference in post-operative complications between the groups. Conclusion(s): Home based pre-rehabilitation, has shown beneficial outcomes in terms of less requirement for ITU admission post operatively, shorter length of hospital stay and cost effective method of pre rehabilitation. Author(s) Sawhney R.; Seite E.; Fedder A.
Institution(s) (Sawhney, Seite, Fedder) East Lancashire Hospitals NHS Trust Source British Journal of Surgery; Oct 2021; vol. 108 Database EMBASE AbstractAims: The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19. Method(s): Admissions to the unit over a 5-day period (n=92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks. Result(s): Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p<0.05). This was not significantly (p=0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p<0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p<0.05) without. The major theme identified was deferring to the 'senior review' section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking. Conclusion(s): Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking. Author(s) Yang N.P.C.; Nijjar P.S.; Phyu S.; Barkeji M.; Butt M.A.J.
Institution(s) (Yang, Nijjar, Phyu, Barkeji) West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust (Butt) Royal Blackburn Hospital Source British Journal of Surgery; Oct 2021; vol. 108 Database EMBASE AbstractAims: Nipple discharge is a presentation commonly seen at breast clinics. It is conventionally evaluated with physical examination and sonography( or mammography). The aim of this study is to investigate the diagnostic value of magnetic resonance imaging (MRI) as an additional imaging tool in the evaluation of potential malignancy in patients presented with nipple discharge. Method(s): A retrospective evaluation of 85 patients with nipple discharge who underwent breast ultrasound (USS) and MRI between 04/ 06/2008 and 25/10/2019 was conducted. Clinical notes, radiographic reports and biopsy results were reviewed. Sensitivity, specificity, positive predictive value and negative predictive value of USS and MRI were calculated. Result(s): Out of the 85 patients (all female; mean age 45.33 +/- 12.93 years old) with nipple discharge, 11 were found to have biopsy-proven malignancy (invasive ductal carcinoma/ ductal carcinoma in situ; 12.94% risk). USS failed to identify seven malignancies (27.27% sensitivity) while MRI missed three malignancies (72.72% sensitivity). USS falsely identified four malignancies from 74 patients with no malignancy (94.59% specificity) while MRI only falsely identified one case (98.65% specificity). For patients with negative USS results (U1/U2/U3) or negative MRI results (BI-RADS category 1,2 or 3), the negative predictive values of USS is 89.74% while that of MRI is 96.05%. The positive predictive values of USS and MRI are 42.86% and 88.88% respectively. Conclusion(s): Compared to USS, MRI has a higher sensitivity, specificity, positive predictive value and predictive value. It will be a valuable addition to the standard nipple discharge evaluation workup to help rule out malignancy. Author(s) Taib A.; Hammill C.; Abraham A.; Subar D.; Fakim B.; Garstang P.
Institution(s) (Taib, Hammill, Abraham, Subar) Blackburn Research Innovation, Development Group in General Surgery (BRIDGES), Blackburn, United Kingdom (Taib, Hammill, Abraham, Fakim, Subar) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, United Kingdom (Garstang) Women's and Children's Division, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom Source British Journal of Surgery; Oct 2021; vol. 108 Database EMBASE AbstractAims: Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Method(s): This was a retrospective cohort study including all patients who had a minor 'lumps and bumps' procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Result(s): A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n=907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (21.72) more on average than those on SACP lists (56.55 vs 34.83 median respectively, p<0.001) due to excess staff for these cases. Conclusion(s): A dedicated and independent SACP 'lumps and bumps' list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases. |
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