Author(s) Sur A.; Paria A.
Source European Journal of Pediatrics; 2020
Language English
Publication Date 2020
Despite robust evidence in favour of maintaining optimal oxygen saturation targets in the preterm infants, the titration of oxygen is largely dependent on manual observations and transcription. Similarly, notwithstanding the gaining popularity of non-invasive modalities like high-flow nasal therapy, the practices of weaning and escalating support are largely individualized and based on point of care observations. These are often erroneous and lack objectivity. Histogram analysis from patient monitors is an easy and objective way of quantifying vital parameters and their trends. We review the technology and evidence available behind this practice. .

• Available in full text at European journal of pediatrics from Unpaywall

Author(s) Gray A.; Mackie C.; Price W.; Coupe E.; Holgate S. et al.
Source Pharmacy; Dec 2020; vol. 8 (no. 4); p. 1-19
Language English
Publication Date Dec 2020
The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as 'let's make things better'. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy. However, like all Trusts, we have many electronic systems which offer interoperability, or can support making it easier for the pharmacy team to do a good job. This article describes the many fronts we have worked on over the last ten plus years. Taken individually, the elements cannot be considered as revolutionary; together, they have helped us develop and deliver the safe, personal and effective pharmacy service that we call dedicated ward pharmacy.Copyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

• Available in full text at Pharmacy (Basel, Switzerland) from Unpaywall

Author(s) Byrne E.; Watkinson S.
Source Journal of orthodontics; Nov 2020
Language English
Publication Date Nov 2020
OBJECTIVE: To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised. 

Author(s) Garg S.; Chichareon P.; Kogame N.; Takahashi K.; Modolo R. et al.
Source Catheterization and Cardiovascular Interventions; Dec 2020; vol. 96 (no. 7); p. 1369-1378
Language English
Publication Date Dec 2020
Objective: To investigate the impact of different anti-platelet strategies on outcomes after percutaneous coronary intervention (PCI) in patients with established cardiovascular disease (CVD). 

Author(s) Donovan T.; Milan S.J.; Wang R.; Banchoff E.; Bradley P. et al.
Source The Cochrane database of systematic reviews; Dec 2020; vol. 12
Language English
Publication Date Dec 2020
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of hospital admissions, disease-related morbidity and mortality. COPD is a heterogeneous disease with distinct inflammatory phenotypes, including eosinophilia, which may drive acute exacerbations in a subgroup of patients. Monoclonal antibodies targeting interleukin 5 (IL-5) or its receptor (IL-5R) have a role in the care of people with severe eosinophilic asthma, and may similarly provide therapeutic benefit for people with COPD of eosinophilic phenotype. 

• Available in full text at The Cochrane database of systematic reviews from Cochrane Collaboration (Wiley)

Author(s) Hui L.; Shin E.-S.; Jun E.J.; Kim T.-H.; Sohn C.-B.; Choi B.J.; Yuan S.L.; Kun L.; Zhi W.; Hao J.; Zhentao S.; Qiang T.; Bhak Y.; Garg S.
Source Yonsei Medical Journal; Dec 2020; vol. 61 (no. 12); p. 1004-1012
Language English
Publication Date Dec 2020
Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions. 

• Available in full text at Yonsei medical journal from EBSCO (MEDLINE Complete)

Author(s) Takahashi K.; Kawashima H.; Ono M.; Hara H.; Wykrzykowska J.J. et al.
Source International Journal of Cardiology; Dec 2020; vol. 320 ; p. 27-34
Language English
Publication Date Dec 2020
Backgrounds: Data on optimal antiplatelet therapy in patients undergoing stenting of the proximal left anterior descending artery (LAD) are limited. Method(s): This is a post-hoc analysis of the GLOBAL LEADERS trial, a prospective, multi-center, randomized controlled trial, comparing the experimental strategy (1-month dual anti-platelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) with the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in relation to stenting of the proximal LAD. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction (MI) and key secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at two years. Result(s): Among 15,845 patients included in the analysis, 3823 (23.9%) patients underwent stenting of the proximal LAD, while 12,022 (75.2%) did not. In the proximal LAD stenting group, there was no significant difference in the risk of the primary endpoint between the two antiplatelet strategies (3.38% vs. 3.93%; hazard ratio [HR]:0.86; 95% CI:0.62-1.20; Pinteraction = 0.951). However, the risk of any MI (2.63% vs. 3.88%; HR:0.68; 95% CI:0.47-0.97; Pinteraction = 0.015) and any revascularization (7.84% vs. 9.94%; HR:0.78; 95% CI:0.63-0.97; Pinteraction = 0.058) was significantly lower in the experimental strategy group, while demonstrating a similar risk of BARC type 3 or 5 bleeding between the two antiplatelet strategies (1.93% vs. 1.99%; HR:0.98; 95% CI:0.62-1.54; Pinteraction = 0.981). Conclusion(s): The present study showed patients having stenting to the proximal LAD could potentially benefit from the experimental strategy with lower ischaemic events without a trade-off in major bleeding at two years.Copyright © 2020 Elsevier B.V.

Author(s) Gao C.; Wang R.; van Geuns R.-J.; Tomaniak M.; Takahashi K. et al.
Source Cardiovascular Diabetology; Dec 2020; vol. 19 (no. 1)
Publication Date Dec 2020
Background: Patients with both diabetes mellitus (DM) and chronic kidney disease (CKD) are a subpopulation characterized by ultrahigh ischemic and bleeding risk after percutaneous coronary intervention. There are limited data on the impact of ticagrelor monotherapy among these patients. 

• Available in full text at Cardiovascular diabetology from EBSCO (MEDLINE Complete)

Author(s) Anderson D.C.; Grimes D.S.
Source Clinical Medicine, Journal of the Royal College of Physicians of London; Nov 2020; vol. 20 (no. 6)
Language English
Publication Date Nov 2020

• Available in full text at Clinical medicine (London, England) from EBSCO (MEDLINE Complete)

​Author(s) Cousin G.C.; Yousaf I.
Source BMJ; Nov 2020; vol. 371
Language English
Publication Date Nov 2020

• Available in full text at BMJ (Clinical research ed.) from BMJ Publishing Group

Author(s) Abdulqawi R.; Satia I.; Kanemitsu Y.; Khalid S.; Holt K. et al.
Source The journal of allergy and clinical immunology. In practice; Nov 2020
Language English
Publication Date Nov 2020
BACKGROUND: Refractory chronic cough (RCC) is a debilitating condition for which there are no licensed treatments. Lidocaine is a non-selective inhibitor of voltage gated sodium channels (VGSC) with potential anti-tussive effects, but randomized placebo-controlled studies evaluating its efficacy in RCC are lacking. 

​Author(s) Badenoch J.; Cross B.; Hafeez D.; Song J.; Watson C.; Butler M.; Nicholson T.R.; Rooney A.G.
Source Psychological medicine; Nov 2020 ; p. 1-5
Language English
Publication Date Nov 2020

• Available in full text at Psychological medicine from Unpaywall

Author(s) Bhatia K.; Columb M.; Bewlay A.; Eccles J.; Hulgur M. et al.
Source Anaesthesia; 2020
Language English
Publication Date 2020
At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39-0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29-0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.Copyright © 2020 Association of Anaesthetists

• Available in full text at Anaesthesia from Unpaywall

Author(s) Hansrani V.; Moughal S.; Elmetwally A.; Al-Khaffaf H.
Source Journal of Vascular Surgery: Venous and Lymphatic Disorders; Nov 2020; vol. 8 (no. 6); p. 1104-1110
Language English
Publication Date Nov 2020
Objective: To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18. Method(s): We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards. 

Author(s) Halim U.A.; Elbayouk A.; Javed S.; Ali A.M.; Cullen C.M.
Source Bone and Joint Journal; Nov 2020 (no. 11); p. 1446-1456
Language English
Publication Date Nov 2020
Aims Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. methods A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. Results Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. conclusion GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty.Copyright © 2020 The British Editorial Society of Bone & Joint Surgery

Author(s) Rashed R.A.; Abdalaziz A.; Veivenn V.Y.; Tetali S.R.; Choudry Q.A. et al.
Source Injury; Nov 2020; vol. 51 (no. 11); p. 2676-2681
Language English
Publication Date Nov 2020
DOI 10.1016/j.injury.2020.07.045
ISSN 0020-1383
Database EMBASE
Hide Abstract
Introduction: The incidence of heterotopic ossification after total hip replacement is variable in the literature. If symptomatic, it may cause pain and reduced range of motion. Dual mobility total hip replacements have been considered a valuable option for the treatment of femoral neck fractures in the active patients, achieving good range of motion with reduced risk of dislocation. The occurrence of HO may have detrimental effect on this type of articulation and may accelerate polyethylene wear and predispose to intra-prosthetic dislocation. We compared the incidence of HO in DMC versus conventional THR in femoral neck fracture patients across 3 large trauma institutes 

Author(s) Gray W.K.; Day J.; Morton M.
Source British Journal of Oral and Maxillofacial Surgery; Nov 2020; vol. 58 (no. 9); p. 1151-1157
Language English
Publication Date Nov 2020
When patients attend the emergency department with facial fractures that require surgery and are immediately admitted, surgery can be delayed as theatre time is prioritised for other more urgent patients. One solution is to send the patient home and admit them as an elective patient at a later date. The aim of this study was to investigate the outcomes of patients admitted directly and those seen as elective patients following fracture of the mandible or zygomatic complex. Data were taken from the hospital episodes statistics (HES) dataset for 2011-2018, and all hospital admissions for mandibular and zygomatic complex fractures within the National Health Service (NHS) in England were extracted. Patients were categorised as those admitted on attendance at the emergency department and given definitive treatment during the admission, and those not admitted on attendance at the emergency department but discharged home and seen as elective admissions within 30 days of attendance. Data were available for 39 606 patients. For both types of fracture there was substantial variation between NHS trusts in the proportion of patients admitted electively and the proportion admitted directly as emergencies. Elective admission was independently associated with shorter overall stay and lower emergency readmission rates. We found no evidence that delays to definitive surgery through elective admission had a negative impact on emergency readmission rates. Patients admitted electively had a significantly shorter hospital stay.Copyright © 2020

Author(s) Gray W.K.; Day J.; Morton M.
Source British Journal of Oral and Maxillofacial Surgery; 2020

When patients attend the emergency department with facial fractures that require surgery and are immediately admitted, surgery can be delayed as theatre time is prioritised for other more urgent patients. One solution is to send the patient home and admit them as an elective patient at a later date. The aim of this study was to investigate the outcomes of patients admitted directly and those seen as elective patients following fracture of the mandible or zygomatic complex. Data were taken from the hospital episodes statistics (HES) dataset for 2011-2018, and all hospital admissions for mandibular and zygomatic complex fractures within the National Health Service (NHS) in England were extracted. Patients were categorised as those admitted on attendance at the emergency department and given definitive treatment during the admission, and those not admitted on attendance at the emergency department but discharged home and seen as elective admissions within 30 days of attendance. Data were available for 39 606 patients. For both types of fracture there was substantial variation between NHS trusts in the proportion of patients admitted electively and the proportion admitted directly as emergencies. Elective admission was independently associated with shorter overall stay and lower emergency readmission rates. We found no evidence that delays to definitive surgery through elective admission had a negative impact on emergency readmission rates. Patients admitted electively had a significantly shorter hospital stay.Copyright © 2020

Author(s) Halim U.A.; Elbayouk A.; Javed S.; Ali A.M.; Cullen C.M.
Source The bone & joint journal; Sep 2020 ; p. 1-11

AIMS: Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. 

Author(s) Jun E.J.; Yuan S.L.; Shin E.-S.; Garg S.
Source Cardiology Journal; 2020; vol. 27 (no. 4); p. 429-430

• Available in full text at Cardiology Journal from EBSCO (MEDLINE Complete)

Author(s) Jabbar T.; Mills S.; Simpson R.; Jones A.; Campbell I. et al.
Source Journal of Endoluminal Endourology; 2020; vol. 3 (no. 3)

Aims The principal aim of this multicentre, international cohort study is to explore the safety concerns of clinicians when performing urodynamic studies (UDS) during the COVID-19 pandemic. This study will also assess provider preference on personal protective equipment (PPE) during UDS and awareness of relevant international guidelines. The outcome is to offer a practical means of reducing the risk of aerosol transmission during UDS, to include a protocol for screening patients, and to consider safer methods of inducing urethral leak-point pressure. 

• Available in full text at Journal of Endoluminal Endourology from Unpaywall

Author(s) Eden J.K.; Borgen R.
Source The British journal of radiology; Sep 2020 ; p. 20200423

OBJECTIVE: The study aims to explore the perceptions of Advanced Practice Radiographers (APRs) currently giving benign biopsy results to extend their role to deliver NHS Breast Screening Programme (NHSBSP) malignant outcomes. In the UK, APRs are appropriately trained to deliver results, yet traditionally have been cultured not to. Increasing pressures on NHSBSP units are a key driver for APR evolvement. A significant lack of published research provides the rationale for the study, combined with an identified service need. 

• Available in full text at The British journal of radiology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Rimmer L.; Heyward-Chaplin J.; South M.; Bashir M.; Gouda M.
Source Journal of Cardiac Surgery; 2020
Background: Type A acute aortic dissection (TAAD) during pregnancy is a life-threatening event for both the mother and the unborn baby. Pregnancy has been recognized as an independent risk factor for TAAD, postulated to be due to physiological changes that cause hyperdynamic circulation. This review seeks to outline the current controversies around this unique group. 

• Available in full text at Journal of cardiac surgery from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Langton S.; Cousin G.C.S.; Pluddemann A.; Bankhead C.R.
Source British Journal of Oral and Maxillofacial Surgery; Oct 2020; vol. 58 (no. 8); p. 898-917

Oral cancer is referred to specialists by both general practitioners (GPs) and dentists, with varying proportions reported in different studies. However, some have noted that dentists more commonly refer oral cancer in the absence of patient-perceived symptoms and may refer at an earlier stage. Unfortunately, approximately half the UK adult population do not receive regular dental care. We have conducted a systematic review of studies that compare GPs and dentists in the referral of oral cancer and have focused on three aspects: the proportion of diagnosed oral cancers, stage on presentation, and delay. Searches of the databases Medline, Embase, Scopus, Google Scholar, Web of Science, and CINAHL, together with additional searches of reference lists, authors, and conference proceedings, found 22 studies from 10 countries, which included a total of 4953 oral cancers. The percentage of medical referrals ranged from 13% to 86%; dental referrals ranged from 15% to 80%. Random-effects meta-analysis indicated a combined relative risk of medical referral to dental referral of 1.36 (95% CI: 0.99 to 1.86). For UK-based studies, the relative risk was also 1.36 (95% CI: 1.05 to 1.76). There was considerable heterogeneity for all studies and for a subgroup of UK studies: I296.4% (95% CI 95.4 to 97.1) and 81.0% (95% CI 63.3 to 90.1), respectively. Several studies showed a lower stage for dentally-referred cancers; the combined risk for dentists and GPs referring early (stages 1 and 2) disease was 1.37 (95% CI: 1.17 to 1.60), and one cause may be the much higher number of cases referred by dentists in the absence of symptoms. No studies showed a significant difference in delay. Oral cancer is referred by both GPs and dentists, typically about 50% and 40%, respectively, although there is a wide range, probably depending on local circumstances. Both groups require skills in oral examination, recognition of lesions, and knowledge of the risk factors. Effectively, regular dental attenders are a select group that is regularly screened for oral cancer, and it is likely that screening is not delivered to those with the highest risk. We suggest that further work is required on how to access high-risk individuals both for possible screening and preventive interventions.Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons

Author(s) Hubbard G.P.; Fry C.; Sorensen K.; Stratton R.J.; Casewell C. et al.
Source European Journal of Pediatrics; Sep 2020; vol. 179 (no. 9); p. 1421-1430
Publication Date Sep 2020

Children with or at risk of faltering growth require nutritional support and are often prescribed oral nutritional supplements (ONS). This randomised controlled trial investigated the effects of energy-dense paediatric ONS (2.4 kcal/ml, 125 ml: cONS) versus 1.5 kcal/ml, 200 ml ONS (sONS) in community-based paediatric patients requiring oral nutritional support. Fifty-one patients (mean age 5.8 years (SD 3)) with faltering growth and/or requiring ONS to meet their nutritional requirements were randomised to cONS (n = 27) or sONS (n = 24) for 28 days. Nutrient intake, growth, ONS compliance and acceptability, appetite and gastro-intestinal tolerance were assessed. Use of the cONS resulted in significantly greater mean total daily energy (+ 531 kcal/day), protein (+ 10.1 g/day) and key micronutrient intakes compared with the sONS group at day 28 and over time, due to high ONS compliance (81% of patients >= 75%), maintained intake from diet alone and improved appetite in the cONS group, compared with the sONS group. Although growth increased in both intervention groups, results were significant in the cONS group (weight (p = 0.007), height (p < 0.001) and height z-score (p = 0.006)). Conclusion(s): This study shows that use of energy-dense (2.4 kcal/ml) low-volume paediatric-specific ONS leads to improved nutrient intakes, growth and appetite in paediatric patients requiring oral nutrition support compared with standard energy density ONS. Trial registration: The trial is registered at clinicaltrials.gov, identification number NCT02419599.What is Known:* Faltering growth is the failure of children to achieve adequate growth at a normal rate for their age and requires nutritional support, including the use of oral nutritional supplements (ONS).* Energy-dense, low-volume ONS have benefits over standard ONS in adults.What is New:* This is the first RCT to investigate the effects of energy-dense, low-volume ONS (2.4 kcal/ml, 125 ml) in children with faltering growth, showing significant improvements in total nutrient intake and increased growth.* Energy-dense, low-volume ONS can play a key role in the management of faltering growth.Copyright © 2020, The Author(s).

• Available in full text at European Journal of Pediatrics from Unpaywall