​Author(s): Joseph F.; Wolfendale H.; Hyatt R.; Holmes A.
Source: Osteoporosis International; Dec 2018; vol. 29
Publication Date: Dec 2018
Publication Type(s): Conference Abstract
Abstract:Background: Vertebral fractures (VF) are themost common osteoporotic fracture; however around 70% are undiagnosed. VF are powerful predictors for further fracture (relative risk 2.8 for hip; 5.4 for further VF) (1). Method(s): CT scans containing the spine of patients aged >50 years from December 2015-October 2016 were analysed for VF using the Optasia Aspire?service; a commercial case-finding service combining machine learning with radiologist over-read. Diagnosed fractures were graded (2) and only moderate or severe VF included. The data were also interrogated for clinical variables.A combination of case notes, clinical portal and FLS database were used. Result(s): 47/325 (14.5%) scans showed moderate-severe VF. 18/47 patients had died by commencement of this audit; in 5, data were insufficient. Data was collected from March-April 2018. 13 (54%) of patients were female; 7 (29%) were aged 50-69; 12 (50%) 70-89; 5 (21%) were 90-100. Patients had 1-12 comorbidities (average 6.4). 54%(13) had prior fracture(s); of these, 46% had VF. 6 (25%) were on bone sparing treatment; but only 2 (8%) known to FLS. 6 (25%) of reports used the terms: Bosteoporotic fracture/loss of vertebral height/wedge fracture; 18 (75%) made no mention of VF. 8 (33%) had prior spinal X rays, of which 6 (75%)were reported as VF. 3 (12%) were admitted with fragility fractures after the CT scan. Discussion(s): The majority of CT reports made no mention of VF. VF was more frequently reported on plain X-ray. Most patientswere over 70; with multiple comorbidities. The majority had prior fractures; many VF. Only a minority were on bone sparing treatment and few known to FLS. Significant numbers were admitted with fragility fracture after their CT. Conclusion(s): This sample confirms that VF is common; and important to detect. A significant number of patients were admitted shortly after the CT with a further fragility fracture, potentially preventable. Although we have FLS locally; it has recruited few patients with VF. This study will prompt it to expand its scope to cover vertebral fractures. The trust is also looking at implementing a VF assessment and treatment pathway.
Database: EMBASE

​Author(s): Staal J.; Peters A.; Kariki E.; Hyatt R.; Javaid K.; Russell E.; O'Neill T.; Poole K.; Chappell D.; Rajak R.
Source: Osteoporosis International; Dec 2018; vol. 29
Publication Date: Dec 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Vertebral Fragility Fractures (VFFs) are an early manifestation of osteoporosis. VFFs may triple the risk of future hip fracture1 yet VFF patients are often underrepresented in Fracture Liaison Services (FLSs). We assessed the rate of opportunistic VFFs in Computed Tomography (CT) scans of the Thorax, Abdomen and Pelvis and reviewed whether they had been previously reported.We also investigated whether the identified VFF patients had been referred to an FLS. Materials andMethods:We retrospectively audited pseudonymised CT scans of patients 50 years and older, containing the spine. The scans were performed over a 12-month period at 5 NHS hospitals in the UK (Cambridge, Croydon, East Lancashire, Oxford and Salford). We used the Optasia Medical ASPIRETM service, a commercial VFF case-finding service combining machine learning with radiologist over-read (EK). VFFs were classified using the Genant-SQ method2 and only moderate and severe VFFs were included. We compared our findings with the original radiology reports. Result(s): We collected meta-data from 47,889 scans (50.1% female) and used a sample of 1,638 scans for analysis. Of these, 237 patients (53.4% female) had VFFs (14.5% +/- 1.7%, 95% CI). VFF prevalence between sites was not significantly different. Four sites (Cambridge, Croydon, East Lancashire, Oxford) checked the original radiology reports and FLS referral. The median reporting rate was 67.7% (IQR 55.7%, 74.5%) and the median FLS referral was 13.3% (IQR 10.8%, 22.0%). Conclusion(s): On average, 1 in 7 patients had at least one moderate VFF with a median of only 13.3% being seen by the FLS. Whilst men are underrepresented in FLSs3, nearly as many men as women in this cohort were found to have VFFs. Opportunistic diagnosis of VFF can greatly increase the number of patients referred to FLSs, potentially protecting the patients' quality of life and decreasing the economic burden of osteoporosis4.
Database: EMBASE
 

​Author(s): Pietrasz, Daniel; Fuks, David; Donatelli, Gianfranco; Ferretti, Carlotta; Portigliotti, Luca; Ward, Marc; Cowan, Jane; Nomi, Takeo; Gayet, Brice; Subar, Daren; Lamer, Christian; Beaussier, Marc
Source: Surgical Endoscopy; Dec 2018; vol. 32 (no. 12); p. 4833-4840
Publication Date: Dec 2018
Publication Type(s): Academic Journal
PubMedID: 29770886
Abstract:Background: Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH.Methods: All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH.Results: Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH.Conclusion: LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.
Database: CINAHL

Author(s): Robertson, Sarah Kathryn; Manson, Kristina; Fioratou, Evridiki
Source: BMC Health Services Research; Dec 2018; vol. 18 (no. 1)
Publication Date: Dec 2018
Publication Type(s): Academic Journal
PubMedID: 30594185
Available  at BMC Health Services Research -  from EBSCO (MEDLINE Complete)
Abstract:Background: Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality. They were set out in the Millennium Development Goals. Each guideline was established separately so the purpose of this study was to understand how these systems have been integrated in a primary care setting and identify barriers and facilitators to this integration using a systems approach.Method: Interviews were carried out with members of staff of different levels within a primary healthcare clinic in Malawi. 

Author(s): Spiby H.; Sheen K.; Collinge S.; Maxwell C.; Pollard K.; Slade P.
Source: Nurse education today; Dec 2018; vol. 71 ; p. 226-232
Publication Date: Dec 2018
Publication Type(s): Article
PubMedID: 30317160
Abstract:BACKGROUND: Midwifery students can experience events on clinical placements that they perceive to be traumatic. There is currently no requirement to provide training about the nature of trauma, normal responses, or the most helpful ways of self-managing these. The POPPY programme, developed for qualified midwives, incorporates educational (the POPPY workshop) and supportive resources to prevent the development of Post-Traumatic Stress Disorder in midwives. As part of the feasibility evaluation of POPPY, the POPPY workshop element was adapted for pre-registration midwifery students (PreR-POPPY). Attention to this issue during pre-registration education could improve student experience and support student retention. 
Database: EMBASE
 

Author(s): Petridis C.; Navarini A.A.; Dand N.; Saklatvala J.; Trembath R.C.; Simpson M.A.; Baudry D.; Duckworth M.; Allen M.H.; Pink A.E.; McGrath J.A.; Smith C.H.; Barker J.N.; Curtis C.J.; Lee S.H.; Burden A.D.; Layton A.; Bataille V.; Spector T.D.; Carlavan I.; Voegel J.J.; Alexandroff A.; Anstey A.; Azad J.; Aziz O.; Cutler T.; Hood S.; Rallan D.; Burrows N.; Butt A.; Cartwright P.; Chapman A.; Clayton T.H.; Cliff S.; Daly B.; Darvay A.; DeGiovanni C.; Downs A.; Dwyer C.; English J.; Ferguson A.; Fleming C.; Fraser-Andrews E.; Goodfield M.; Grattan C.E.; Hempel H.; Hughes B.; Ladoyanni E.; Lyon C.; Mahmud A.; Malik M.; Mallon E.; Meggitt S.; Messenger A.; Moosa Y.; Munn S.; Ormerod A.; Ross J.; Salvary I.; Wachsmuth R.; Wahie S.; Walton S.; Walsh S.; Williamson D.; Willis C.
Source: Nature Communications; Dec 2018; vol. 9 (no. 1)
Publication Date: Dec 2018
Publication Type(s): Article
PubMedID: 30542056
Available  at Nature Communications -  from Europe PubMed Central - Open Access
Abstract:Acne vulgaris is a highly heritable common, chronic inflammatory disease of the skin for which five genetic risk loci have so far been identified. Here, we perform a genome-wide association study of 3823 cases and 16,144 controls followed by meta-analysis with summary statistics from a previous study, with a total sample size of 26,722. We identify 20 independent association signals at 15 risk loci, 12 of which have not been previously implicated in the disease. Likely causal variants disrupt the coding region of WNT10A and a P63 transcription factor binding site in SEMA4B. Risk alleles at the 1q25 locus are associated with increased expression of LAMC2, in which biallelic loss-of-function mutations cause the blistering skin disease epidermolysis bullosa. These findings indicate that variation affecting the structure and maintenance of the skin, in particular the pilosebaceous unit, is a critical aspect of the genetic predisposition to severe acne.Copyright © 2018, The Author(s).
Database: EMBASE

​Author(s): Green, Carl M.; Zeiton, Moez; Foulkes, Katherine; Barrie, Jim
Source: Journal of Patient Safety; Dec 2018; vol. 14 (no. 4); p. 202-205
Publication Date: Dec 2018
Publication Type(s): Academic Journal
Abstract:Objectives: This study assesses fall prevention measures and subsequent incident reporting of falls resulting in an "inpatient fracture neck of femur (FNOF)" within a single NHS Trust, with the aim of identifying potential areas of improvement and changing practice within a Trust. Methods: Forty patients (mean age, 82.6 years) sustained an injury while being treated in hospital for an unrelated cause between January 2012 and June 2013. Case notes and incident reports were analyzed retrospectively. Results: Thirty-three (82.5%) of 40 patients had at least 1 fall screen on admission, with 27 patients (81.8%) identified as a fall risk. Fifteen patients (37.5%) had at least one fall before sustaining a FNOF. Fifteen falls occurred between midnight—0500 hours and only 4 falls were witnessed. Thirty-nine of 40 falls were reported, but none were rated as "severe" injuries. Twenty-eight (71.8%) of 39 patients had a root cause analysis performed for the injury, but only 10 root cause analyses (25.6%) produced an action plan. Fifty percent of patients died within 1 year of injury. Conclusion: Accurate fall risk assessments and adequate patient supervision are essential to minimize risks of falls, as the inpatient FNOF is linked to a higher mortality rate than patients injured in the community. A standardized method of analyzing such incidents and dissemination of the results of investigation are also required to reduce the risk of similar incidents from occurring within the hospital environment.
Database: CINAHL

​Author(s): Parker C.C.; Dearnaley D.P.; James N.D.; Brawley C.D.; Ritchie A.W.S.; Gilson C.; Langley R.E.; Millman R.; Amos C.L.; Parmar M.K.B.; Sydes M.R.; Clarke N.W.; Hoyle A.P.; Ali A.; Tran A.T.H.; Attard G.; Chowdhury S.; Cross W.; Gillessen S.; Jones R.J.; Russell J.M.; Malik Z.I.; Eswar C.; Mason M.D.; Matheson D.; Thalmann G.N.; Alonzi R.; Bahl A.; Birtle A.; Din O.; Douis H.; Gale J.; Gannon M.R.; Jonnada S.; Khaksar S.; Lester J.F.; O'Sullivan J.M.; Parikh O.A.; Pedley I.D.; Pudney D.M.; Sheehan D.J.; Srihari N.N.
Source: The Lancet; Dec 2018; vol. 392 (no. 10162); p. 2353-2366
Publication Date: Dec 2018
Publication Type(s): Article
PubMedID: 30355464
Abstract:Background: Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostate cancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostate cancer, with and without radiotherapy. Method(s): We did a randomised controlled phase 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostate cancer. 

Author(s): Doherty C.; Bowler M.; Perkins R.; Neal R.; English C.; Cooke J.; Wyatt M.; Atkinson D.; Moore J.; McGrath B.A.; Bates L.; Monks S.; Bruce I.A.; Bateman N.; Russell J.
Source: Anaesthesia; Nov 2018; vol. 73 (no. 11); p. 1400-1417
Publication Date: Nov 2018
Publication Type(s): Article
Available  at Anaesthesia -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.Copyright © 2018 Association of Anaesthetists
Database: EMBASE

Author(s): Hosny K.; Aboelsoud M.
Source: Arab Journal of Urology; Nov 2018; vol. 16
Publication Date: Nov 2018
Publication Type(s): Conference Abstract
Available  at Arab Journal of Urology
Abstract:Objective: To assess the usefulness of the R.E.N.A.L nephrometry score in surgical decision making in patients with renal cell carcinoma (RCC). The R.E.N.A.L nephrometry score parameters are radius, exophytic/endophytic properties, nearness of the tumour to the collecting system or sinus, anterior or posterior location, and location relative to the polar lines. Classification of RCC according to nephrometry score: low complexity score 4-6, moderate complexity 7-9, and high complexity score 10-12 points. Methods: We looked retrospectively at the imaging of 70 cases of RCC against the operative procedure that was performed.

​Results: There were 20 cases with low complexity scores: seven (35%) underwent radical nephrectomy (RN) and 13 (65%) underwent partial nephrectomy (PN). There were 32 cases of moderate complexity: 24 (75%) underwent RN and eight (25%) underwent PN. There were 18 cases of high complexity and all of them (100%) underwent RN. Conclusion: Of the 20 (35%) cases with low complexity scores the T1a RCC tumours should have been offered PN. Of the 32 cases with moderate complexity scores, 24 (75%) patients with T1b RCC tumours should have been offered PN after discussion of an 8% risk of positive surgical margins. Nephron-sparing surgery should be offered to patients with low or moderate complexity and the R.E.N.A.L nephrometry score can used to aid this decision.Copyright © 2018
Database: EMBASE

Author(s): Hosny K.; Abdelhafez A.
Source: Arab Journal of Urology; Nov 2018; vol. 16
Publication Date: Nov 2018
Publication Type(s): Conference Abstract
Available  at Arab Journal of Urology -  from Europe PubMed Central - Open Access
Abstract:Objective: To review the usefulness of prostate-specific antigen (PSA) testing in men presenting to an urgent clinic with haematuria in our practice in a District hospital in the UK.

Methods: We reviewed the retrospective data of 200 patients who presented with visible haematuria (VH) and non-visible haematuria (NVH), aged between 50 and 79 years, between January 2016 and June 2017. All patients underwent digital rectal examination (DRE) and PSA testing as part of our standard investigation for haematuria.

Results: In all, 200 cases were included. A total of 155 cases had VH, 134 of them had a benign DRE and normal PSA level. One of the other 21 cases had an abnormal DRE and elevated PSA level and was diagnosed with Gleason 8 prostate cancer. Three of 21 cases had abnormal DREs and normal PSA levels, two of these patients underwent transrectal ultrasonography (TRUS)-guided prostate biopsy, which revealed Gleason 6 prostate cancer in one of them but showed no evidence of malignancy in the other patient. Whilst, 17 of the 21 cases had normal DREs and elevated PSA levels, 11 of the 17 cases had a repeat PSA test which came back normal, while the other six cases were further investigated with magnetic resonance imaging of the prostate and/or TRUS biopsies, but no malignancy was found. A total of 45 cases presented with NVH, all of them had benign DREs. Only four cases with elevated PSA levels with no malignancy were detected in further investigations. Overall, the number of patients who underwent further investigations was 14/200 (7%). Overall, the rate of prostate cancer diagnosis was 1%; the rate of diagnosis with VH was 1.29% and 0% with NVH.

​Conclusion: Despite using PSA as a standard investigation for patients who presented to the urgent clinic with haematuria, the rate of cancer diagnosis was very low (1%) and detected in patients with abnormal DRE rather than elevated PSA levels. Our cancer detection rate of 1% is less than those from the European Randomized Study of Screening for Prostate Cancer (ERSPC; 8.2%), Prostate Testing for Cancer and Treatment (ProtecT; 2.2%) and the Prostate, Lung, Colorectal, and Ovarian cancer screening trial (PLCO; 1.4%). PSA level measurement should not be considered as a useful test in standard investigations of haematuria, unless an abnormal DRE is found during examination.Copyright © 2018
Database: EMBASE

Author(s): Balata H.; Blandin Knight S.; Barber P.; Evison M.; Booton R.; Crosbie P.A.J.; Colligan D.; Taylor S.; Tonge J.; Waplington S.; Crosbie E.J.; Duerden R.; Greaves M.; Sawyer R.; Sharman A.; Smith E.; Elton P.; Howells J.; Irion K.; Karunaratne D.; Kirwan M.; Slevin K.; Macnab A.; Miller C.; Mellor S.; Newton T.; Novasio J.; Taylor B.; Walsham A.; Whittaker J.
Source: Lung Cancer; Oct 2018; vol. 124 ; p. 148-153
Publication Date: Oct 2018
Publication Type(s): Article
Abstract:Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention.

Methods: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk >=1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (+/-5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score >=10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score.

​Results: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 +/- 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention.

Discussion: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.Copyright © 2018 Elsevier B.V.
Database: EMBASE

Author(s): Simpson, Rosalind C.; Murphy, Ruth; Bratton, Daniel J.; Sydes, Matthew R.; Wilkes, Sally; Nankervis, Helen; Dowey, Shelley; Bell, Hazel; Cruickshank, Margaret; Gibbon, Karen; Green, Cathy M.; Wong, Christina; Owen, Caroline M.; London, Kate; Haque, Shaheen; Thomas, Kim S.
Source: Journal of Lower Genital Tract Disease; Oct 2018; vol. 22 (no. 4); p. 405-408
Publication Date: Oct 2018
Publication Type(s): Academic Journal
Database: CINAHL

Author(s): Hosni, Sara; Burnside, Girvan; Watkinson, Simon; Harrison, Jayne E.
Source: American Journal of Orthodontics & Dentofacial Orthopedics; Oct 2018; vol. 154 (no. 4); p. 545-553
Publication Date: Oct 2018
Publication Type(s): Academic Journal
Abstract:Introduction: Knowledge of a patient's stage of growth and development plays a vital role in diagnosis, treatment planning, results, and stability of the outcome. Cervical vertebral maturation (CVM) predicts the stage of growth and development, but its validity has only been investigated restrospectively, using historic samples. Our objective was to assess prospectively whether a correlation exists between CVM stage and statural height growth velocity.

Methods: Participants were aged between 8 and 18 years and of both sexes. Standing height was measured every 6 weeks with participants barefoot and in natural head position. CVM stage was assessed from lateral cephalograms taken at the start of treatment. Intraobserver and interobserver reliability of CVM staging and statural height measurements were assessed using the Cohen weighted kappa, percentage of agreement, intraclass correlation coefficient, and Bland-Altman plots, respectively. Analysis of variance was used to test for statistically significant differences between growth velocities at the CVM stages.Results: We analyzed 108 participants. The peak in statural height growth velocity occurred at CVM stage 3 (P = 0.001). There was a statistically significant difference in the mean annualized growth velocity between all CVM stages except stages 2 and 4. Girls had their peak pubertal growth spurt an average of 1.2 years earlier than did boys.

​Conclusions: This study suggests that there is a significant relationship between CVM stage and statural height velocity.
Database: CINAHL

Author(s): Hill, Daniel S.; Marynissen, Hans
Source: Spine (03622436); Oct 2018; vol. 43 (no. 20)
Publication Date: Oct 2018
Publication Type(s): Academic Journal
Abstract:
Study Design: A retrospective cross-sectional analysis.

Objective: The aim of this study was to describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and to quantify the time taken to obtain definitive management plans while under prescribed spinal immobilization.

Summary Of Background Data: Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist center.

Methods: A retrospective review of 104 patients admitted following vertebral trauma during a 12-month period. The British Orthopaedic Association Standards for Trauma consensus that "spinal immobilisation is not recommended for more than 48 hours" was the standard of care measured against.

​Results: One hundred patients occupied a total of 975 hospital inpatient bed days. One hundred and seventeen radiological investigations were requested after the point of external referral [47 computed tomography (CT)-scans, 37 magnetic resonance imaging (MRI)-scans, and 33 weight-bearing radiographs]. The period between initial referral to the regional spinal service and then receiving a definitive final management plan had a median value of 72 hours and a range of 0 and 33 days. Patients will have been under some form of prescribed spinal immobilization until the definitive management plan was communicated. Thirty-four patients (34% of the overall cohort) had a definitive management plan in place within 48 hours. Eighty patients had vertebral injuries (73 stable, six unstable), three patients had prolapsed intervertebral disks, one had metastatic disease, and 17 did not have evidence of an acute injury following evaluation.

​Conclusion: Patients are being placed under prescribed immobilization for longer than is recommended. Delays in obtaining radiological imaging were an important factor, together with the time taken to receive a definitive management plan. Limitations in social care provision and delays in arranging this were additional barriers to hospital discharge following the final management plan.
Database: CINAHL

Author(s): Staal J.; Kariki E.; Hyatt R.; Javaid M.K.; Russell E.; aO'Neill T.; Poole K.; Chappell D.; Rajak R.
Source: Osteoporosis International; 2018; vol. 29 (no. 1)
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objective: Vertebral fragility fractures (VFFs) are an early manifestation of osteoporosis. VFFs may triple the risk of future hip fracture1 yet VFF patients are often underrepresented in Fracture Liaison Services (FLSs). We assessed the rate of VFFs in computed tomography (CT) scans of the thorax, abdomen and pelvis and reviewed whether they had been previously reported. We also investigated whether the identified VFF patients had been referred to an FLS. Methods: We retrospectively audited pseudonymised CT scans of patients 50 years and older, containing the spine, and performed over a 12-month period at 5 NHS hospitals in the UK (Cambridge, Croydon, East Lancashire, Oxford and Salford). We used the Optasia Medical ASPIRETM service, a commercial casefinding service combining machine learning with radiologist overread (EK). VFFs were classified using the Genant-SQ method and only moderate and severe VFFs were included. We compared our findings with the original radiology reports. Results:We collected 47,889 scans (50.1%) and used a sample of 1638 scans for analysis. Of these, 237 patients (53.4% ) had VFFs (14.5%+/-1.7%, 95%CI). VFF prevalence between sites was not significantly different. Four sites (Ca., Cr., E.L., Ox.) checked the original radiology reports and FLS referral. The median reporting rate was 67.7% (IQR 55.7%, 74.5%) and the median FLS referral was 13.3% (IQR 10.8%, 22.0%). Conclusions: On average, 1 in 7 patients had at least one moderate VFF with a median of 13.3% being seen by the FLS. Whilst men are underrepresented in FLSs2, nearly as many men as women were found to have VFFs. Opportunistic diagnosis of VFF can greatly increase the number of patients referred to FLSs, potentially protecting the patients' quality of life and decreasing the economic burden of osteoporosis.
Database: EMBASE
​

​Author(s): Al-Mula Abed, Omar W. S.; Srirangam, Shalom J.; Wemyss-Holden, Guy D.
Source: Oman Medical Journal; Sep 2018; vol. 33 (no. 5); p. 374-379
Publication Date: Sep 2018
Publication Type(s): Academic Journal
Available  at Oman Medical Journal -  from Europe PubMed Central - Open Access
Abstract:Objectives: Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. Methods: We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. Results: In total, 57 patients (aged 23--95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Conclusions: Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.
Database: CINAHL

​Author(s): Schram C.M.H.
Source: Obstetrician and Gynaecologist; 2018; vol. 20 (no. 2); p. 125-131
Publication Date: 2018
Publication Type(s): Article
Available  at The Obstetrician & Gynaecologist -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Key content: Appraisal is a formative and developmental process; annual appraisals are the cornerstones of revalidation. Supporting information for an appraisal should cover the whole scope of work of an obstetrician and gynaecologist, including any educational, managerial or academic work over a 5-year revalidation cycle. The quality of supporting information, including reflection, is more important than the quantity. Supporting information for an appraisal can be found in many day-to-day clinical activities. Learning objectives: To be familiar with the guiding principles of appraisal and revalidation. To appreciate how to provide supporting information that satisfies appraisal and revalidation requirements. To know how to prepare efficiently and effectively for appraisal and revalidation.Copyright © 2018 Royal College of Obstetricians and Gynaecologists
Database: EMBASE

​Author(s): Ryan N.A.J.; Crosbie E.J.; Evans D.G.; Blake D.; Cabrera-Dandy M.; Glaire M.A.
Source: Systematic Reviews; Aug 2018; vol. 7 (no. 1)
Publication Date: Aug 2018
Publication Type(s): Article
Available  at Systematic reviews -  from BioMed Central
Abstract:Background: Lynch syndrome is the most common inherited cancer syndrome, which predisposes individuals to a number of different cancers, principally colorectal and endometrial cancer. The early diagnosis of Lynch syndrome enables colorectal surveillance, which has been shown to save lives through the detection and removal of premalignant polyps and earlier detection of invasive disease. Endometrial cancer, which is often the sentinel cancer in women, provides an opportunity to diagnose Lynch syndrome and thus enable colorectal surveillance as well as the cascade testing for Lynch syndrome in other family members. These potential benefits have led to a call for the universal screening of women with endometrial cancer for Lynch syndrome, a practice that is now commonplace in colorectal cancer. Healthcare providers and clinicians are however restricted by insufficient knowledge about the prevalence of Lynch syndrome in women with endometrial cancer, with estimates varying as widely as 1-10%. The aim of this study is to perform a systematic review with a meta-analysis of the current literature base in order to estimate the prevalence of Lynch syndrome among women with endometrial cancer to inform this discussion. 
Database: EMBASE

​Author(s): Ahad T.; Riley A.; Martindale E.; von Bremen B.; Owen C.
Source: Pediatric Dermatology; 2018; vol. 35 (no. 1)
Publication Date: 2018
Publication Type(s): Article
PubMedID: 29159956
Available  at Pediatric Dermatology -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Vulvar swelling is a rare manifestation of metastatic Crohn's disease in children. It often predates gastrointestinal symptoms and can be the first presentation of pediatric Crohn's disease. We report three cases of pediatric Crohn's disease presenting with vulvar swelling. We discuss this rare presentation and its treatment and highlight the importance of recognizing it so that prompt investigation and appropriate management can be initiated.Copyright © 2017 Wiley Periodicals, Inc.
Database: EMBASE

Author(s): Tian T.M.; Daly B.M.; Owen C.M.
Source: BMJ (Online); 2018; vol. 361
Publication Date: 2018
Publication Type(s): Note
Available  at BMJ   
Database: EMBASE

​Author(s): Her A.-Y.; Kim Y.H.; Shin E.-S.; Garg S.
Source: Coronary Artery Disease; Aug 2018; vol. 29 (no. 5); p. 403-408
Publication Date: Aug 2018
Publication Type(s): Article
Abstract:Objectives Periprocedural myocardial infarction (PMI) is reported to be associated with adverse long-term clinical outcomes. This study compared the rates of PMI following treatment of de novo coronary lesions using either a paclitaxel-coated balloon (PCB) or a newer-generation drug-eluting stent (DES). 

​Author(s): Stewart H.; Abed O.; Wemyss-Holden G.; Srirangam S.
Source: Journal of Clinical Urology; Jun 2018; vol. 11 ; p. 66
Publication Date: Jun 2018
Publication Type(s): Conference Abstract
Abstract:Introduction: We investigated the incidence of upper urinary tract (UUT) abnormalities in males with initial and/or terminal visible haematuria (VH) suggesting a lower urinary tract (LUT) cause. Is extensive UUT imaging really necessary? Materials/Method: Two-armed (retrospective (n=419) and prospective (n=1173)) study of all consecutive male patients with VH over 5 years. All patients underwent flex-ible cystoscopy (FC) and UUT imaging (USS+/-IVU/CT urogram). Those with initial and/or terminal VH were scrutinised further. Results: 62/419 (14.8%) of patients in the retrospective group (R-G) and 183/1173 (15.6%) in the prospective group (P-G) presented with initial and/or terminal VH. In the R-G, FC revealed these LUT abnormalities: 4 bladder calculi; 3 bladder tumours; 1 urethral stricture. Only one UUT malignancy was identified (single case of renal cell carcinoma detected on USS and IVU). 

​Author(s): Hosny K.; Luk A.
Source: Annals of the Royal College of Surgeons of England; Jul 2018; vol. 100 (no. 6)
Publication Date: Jul 2018
Publication Type(s): Article
PubMedID: 29962297
Available  at Annals of the Royal College of Surgeons of England -  from EBSCO (MEDLINE Complete)
Abstract:Schistosoma haematobium is the species primarily responsible for the manifestation of schistosomiasis in the genitourinary tract. It is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma, which can result in acute and chronic manifestation. We report a case of urinary schistosomiasis that initially presented as advanced bladder cancer with pulmonary metastasis on initial computed tomography scan.