Authors: Stables RH; Mullen LJ; Elguindy M et al.
Source: Circulation [Circulation] 2022 Aug 10, pp. 101161CIRCULATIONAHA121057793. Date of Electronic Publication: 2022 Aug 10.
Abstract:
Background: Measurement of fractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention. We tested the hypothesis that, at the stage of diagnostic invasive coronary angiography, systematic FFR-guided assessment of coronary artery disease would be superior, in terms of resource use and quality of life, to assessment by angiography alone.
Methods: We performed an open-label, randomized, controlled trial in 17 UK centers, recruiting 1100 patients undergoing invasive coronary angiography for the investigation of stable angina or non-ST-segment-elevation myocardial infarction. Patients were randomized to either angiography alone (angiography) or angiography with systematic pressure wire assessment of all epicardial vessels >2.25 mm in diameter (angiography+FFR). The coprimary outcomes assessed at 1 year were National Health Service hospital costs and quality of life. Prespecified secondary outcomes included clinical events.
Results: In the angiography+FFR arm, the median number of vessels examined was 4 (interquartile range, 3-5). The median hospital costs were similar: angiography, £4136 (interquartile range, £2613-£7015); and angiography+FFR, £4510 (£2721-£7415; P =0.137). There was no difference in median quality of life using the visual analog scale of the EuroQol EQ-5D-5L: angiography, 75 (interquartile range, 60-87); and angiography+FFR, 75 (interquartile range, 60-90; P =0.88). The number of clinical events was as follows: deaths, 5 versus 8; strokes, 3 versus 4; myocardial infarctions, 23 versus 22; and unplanned revascularizations, 26 versus 33, with a composite hierarchical event rate of 8.7% (48 of 552) for angiography versus 9.5% (52 of 548) for angiography+FFR ( P =0.64).
Conclusions: A strategy of systematic FFR assessment compared with angiography alone did not result in a significant reduction in cost or improvement in quality of life.

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Authors: Dean J; Jones M;  Dyer P
Source: Future healthcare journal [Future Healthc J] 2022 Jul; Vol. 9 (2), pp. 125-132.
Abstract:
Changing population demographics and needs are resulting in a continual rise in acute medical admissions. This review draws on the observations of the NHS GIRFT programme across England. Fundamental aspects of acute medical care are not universally provided, resulting in preventable hospitalisation and over-use of emergency departments. Such aspects include care outside hospitals; appropriately sized, staffed, located and configured acute medical units; multispeciality same-day emergency care (SDEC) pathways; multidisciplinary care on wards; and readmission prevention. 'Hospital at home' services are developing, and require local evaluation. SDEC is expanding. Digital technologies make it possible to provide acute care in and across more settings. Addressing the fundamentals of acute medical care, evaluating new service opportunities, strong clinical and managerial partnerships, better data for analytics, and a multispeciality, multiprofessional approach will enable a better level of care to be achieved.

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Authors: Zhou J; Onuma Y; Garg S; 
Source: Expert review of cardiovascular therapy [Expert Rev Cardiovasc Ther] 2022 Jul; Vol. 20 (7), pp. 549-566. Date of Electronic Publication: 2022 Aug 09.
Abstract:
Introduction: Non-obstructive coronary arteries (NOCA) are present in 39.7% to 62.4% of patients who undergo elective angiography. Coronary microcirculation (<400 µm) is not visible on angiography therefore functional assessment, invasive or noninvasive plays a prior role to help provide a more personalized diagnosis of angina.
Area Covered: In this review, we revisit the pathophysiology, clinical importance, and invasive assessment of the coronary microcirculation, and discuss angiography-derived indices of microvascular resistance. A comprehensive literature review over four decades is also undertaken.
Expert Opinion: The coronary microvasculature plays an important role in flow autoregulation and metabolic regulation. Invasive assessment of microvascular resistance is a validated modality with independent prognostic value, nevertheless, its routine application is hampered by the requirement of intravascular instrumentation and hyperemic agents. The angiography-derived index of microvascular resistance has emerged as a promising surrogate in pilot studies, however, more data are needed to validate and compare the diagnostic and prognostic accuracy of different equations as well as to illustrate the relationship between angiography-derived parameters for epicardial coronary arteries and those for the microvasculature.

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Authors: Kageyama, Shigetaka a, Serruys, Patrick W;  Garg, Scot 
Source: In International Journal of Cardiology January 2022
Abstract:
Aims To investigate geographic disparity in long-term mortality following revascularization in patients with complex coronary artery disease (CAD).
Conclusion In the era of globalization, knowledge, and understanding of geographic disparity are of paramount importance for the correct interpretation of global studies.

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Authors: Garg S et al.
Source: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology [EuroIntervention] 2022 Aug 19; Vol. 18 (6), pp. 492-502.
Abstract:
Background: In the TALENT study, the sirolimus-eluting ultrathin strut Supraflex stent was non-inferior to the XIENCE stent for a device-oriented composite endpoint (DoCE: defined as cardiac death, target vessel myocardial infarction [TV-MI], or clinically indicated target lesion revascularisation [CI-TLR]) at 12 months.
Aims: This study investigated the 3-year outcomes of the TALENT trial and long-term impact of ultrathin drug-eluting stents (DES), compared to the XIENCE everolimus-eluting thin stent.
Methods: The TALENT trial is a prospective, multicentre, randomised all-comers trial comparing the Supraflex sirolimus-eluting stent with the XIENCE everolimus-eluting stent, with planned follow-up for 3 years.
Results: The TALENT trial enrolled 1,435 patients (Supraflex n=720, XIENCE n=715) with 3-year follow-up data available in 97.8% in the Supraflex group, and in 98.9% in the XIENCE group. At 3 years, DoCE occurred in 57 patients (8.1%) in the Supraflex group, and in 66 patients (9.4%) in the XIENCE group (p=0.406). There were no significant between-group differences in rates of cardiac death, TV-MI or CI-TLR. The rates of definite or probable stent thrombosis were low and similar between groups (1.1% vs 1.4%; p=0.640). In a meta-analysis of long-term follow-up (3-5 years), ultrathin strut DES tended to reduce DoCE (relative risk 0.89 [0.79-1.01]; p=0.068), compared to thicker strut DES. The risks for cardiac death and definite or probable stent thrombosis were similar between ultrathin strut DES and thicker strut DES.
Conclusions: At 3-year follow-up, the use of the Supraflex stent was at least as safe and efficacious as the XIENCE stent in an all-comers population.

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Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2022 Aug 12, pp. JCO2200405. Date of Electronic Publication: 2022 Aug 12.
Publication Model: Ahead of Print
Abstract:
Purpose: A DNA repair deficiency (DRD) phenotype exists within a subset of metastatic urothelial carcinomas (mUC) predicting benefit from platinum-based chemotherapy. We tested switch maintenance therapy with the poly ADP-ribose polymerase inhibitor rucaparib, following chemotherapy, for DRD biomarker-positive mUC.
Methods: DRD biomarker-positive mUC patients, within 10 weeks of chemotherapy, and without cancer progression, were randomly assigned (1:1) to maintenance rucaparib 600 mg twice a day orally, or placebo, until disease progression. The primary end point was progression-free survival (PFS). Statistical analysis targeted a hazard ratio of 0.5 with a 20% one-sided α for this signal-seeking trial. PFS (RECIST 1.1) was compared between trial arms, by intention to treat, within a Cox model.
Results: Out of 248 patients, 74 (29.8%) were DRD biomarker-positive and 40 were randomly assigned. A total of 12 (60%) and 20 (100%) PFS events occurred in the rucaparib and placebo arms, respectively (median follow-up was 94.6 weeks in those still alive). Median PFS was 35.3 weeks (80% CI, 11.7 to 35.6) with rucaparib and 15.1 weeks (80% CI, 11.9 to 22.6) with placebo (hazard ratio, 0.53; 80% CI, 0.30 to 0.92; one-sided P = .07). In the safety population (n = 39) treatment-related adverse events were mostly low grade. Patients received a median duration of 10 rucaparib or six placebo cycles on treatment. Treatment-related adverse events (all grades) of fatigue (63.2% v 30.0%), nausea (36.8% v 5.0%), rash (21.1% v 0%), and raised alanine aminotransferase (57.9% v 10%) were more common with rucaparib.
Conclusion: Maintenance rucaparib, following platinum-based chemotherapy, extended PFS in DRD biomarker-selected patients with mUC and was tolerable. Further investigation of poly ADP-ribose polymerase inhibition in selected patients with mUC is warranted.

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Authors: Hughes D; Ng SM; Smyth D et al.
Source: Annals of the Royal College of Surgeons of England [Ann R Coll Surg Engl] 2022 Jul 29. Date of Electronic Publication: 2022 Jul 29.
Publication Model: Ahead of Print
Abstract:
Introduction: Recent evidence suggests that acute emergency management of mandible fractures does not improve surgical outcomes yet is associated with increased financial burden. Current NHS policy advocating for increased adoption of day-case and semi-elective surgical procedures to reduce bed strain must be balanced with providing timely, effective treatment. Our research aims to determine patient groups currently managed via semi-elective admission and whether this can be extended to other groups to provide safe and effective management of mandible fractures.
Methods: A multi-national trainee-led audit of mandibular fractures across 49 units was completed by the Maxillofacial Trainee Research Collaborative (MTReC). Each unit prospectively collected data on fractures on admission and at follow-up. Data collected included patient demographics, behaviour, health, injury, timing to intervention and surgical complications.
Results: Data were collected on 947 mandibular fractures. Of the surgically managed patients, 649 (90%) were managed via acute emergency admission at the time of presentation, while 68 (10%) were managed semi-electively. Patient demographics, injury pattern and mechanism appeared to significantly affect timing of management, whereas patient behaviour, health status, timing of injury and presentation did not. Semi-elective management was associated with a significantly shorter inpatient duration (0.9 versus 1.9 days, p =0.000) with no differences in readmission, antibiotic usage or surgical complications ( p =1.000, RR 1.030).
Conclusion: Our study demonstrates the efficacy of planned admissions and semi-elective management of mandibular fractures. Simple mandibular fractures in compliant patients are suitable for semi-elective treatment. Holistic patient assessment and tailored surgical planning is crucial in determining admission modality to effectively manage mandibular trauma.

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Authors: Coulson I; East Lancashire NHS Trust, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire, UK.
Source: The British journal of dermatology [Br J Dermatol] 2022 Jul 29. Date of Electronic Publication: 2022 Jul 29.
Publication Model: Ahead of Print

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​Authors: Wrench E;  Rattley K;  Lambert JE; 
Source:Acta diabetologica [Acta Diabetol] 2022 Aug 05. Date of Electronic Publication: 2022 Aug 05.
Publication Model: Ahead of Print
Abstract:
Aims: Aerobic exercise is well recognised as an effective treatment for people with type 2 diabetes but the optimal amount of aerobic exercise to improve glycaemic control remains to be determined. Thus, the aim of this meta-analysis and meta-regression was to assess the impact of volume and intensity of aerobic exercise on glycaemic control.
Methods: Medline, Cochrane, Embase, and Web of Science databases were searched up until 15 December 2020 for the terms "aerobic exercise AND glycaemic control", "type 2 diabetes AND exercise", and "exercise AND glycaemic control AND Type 2 diabetes AND randomised control trial". We included (i) randomised control trials of ≥ 12 weeks, (ii) trials where participants had type 2 diabetes and were aged 18 or over, and (iii) the trial reported HbA1c concentrations pre- and post-intervention. Two reviewers selected studies and extracted data. Data are reported as standardised mean difference (SMD) and publication bias was assessed using funnel plots.
Results: A total of 5364 original titles were identified. Sixteen studies were included in the meta-analysis. Aerobic exercise reduced HbA1c versus control (SMD = 0.56 (95% CI 0.3-0.82), p < 0.001). There were also significant reductions in BMI (SMD = 0.76 (95% CI 0.25-1.27), p < 0.05). There was no dose-response relationship between improvement in HbA1c and the intensity and volume of the intervention (p > 0.05).
Conclusions: Twelve-week or longer aerobic exercise programmes improve glycaemic control and BMI in adults with type 2 diabetes. Longer or more intense interventions appear to confer no additional benefit on HbA1c.

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Authors: Blong J; Hoggett L; Robinson H; Bokhari SA; Sloan A; 
Source:Musculoskeletal care [Musculoskeletal Care] 2022 Aug 09. Date of Electronic Publication: 2022 Aug 09.
Publication Model: Ahead of Print

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Authors:  Lynch, Elizabeth A.; Connell, Louise A.; Carvalho, Lilian B.; Bird, Marie-Louise
Source: Disability & Rehabilitation (DISABIL REHABIL), Jul2022; 44(15): 4118-4125. (8p)
Abstract:
To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally. Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research. Data from 833 respondents from 30 countries were included. Locally developed guidelines were available in 22 countries represented in the sample. Respondents from high-income countries were more aware of local guidelines compared with respondents from low- and middle-income countries. Local contextual factors such as management support and a culture of valuing evidence-based practice were reported to positively influence guideline use, whereas inadequate time and shortages of skilled staff inhibited the delivery of guideline-recommended care. Processes reported to improve guideline use included education, training, formation of workgroups, and audit-feedback cycles. Broader contextual factors included accountability (or lack thereof) of health professionals to deliver rehabilitation consistent with guideline recommendations. While many health professionals were aware of clinical guidelines, they identified multiple barriers to their implementation. Efforts should be made to raise awareness of local guidelines in low- and middle-income countries. More attention should be paid to addressing local contextual factors to improve guideline use internationally, going beyond traditional strategies focused on individual health professionals. Systems are required so people and organisations are held accountable to deliver evidence-based care in stroke rehabilitation. Locally developed stroke rehabilitation guidelines should be promoted to boost awareness of these guidelines in low- and middle-income countries. In all regions, strategies to influence or adapt to the local setting, are required to optimise guideline use.

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​Authors: Melvin C et at.
Source: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2022 Aug 10; Vol. 22 (1), pp. 634. Date of Electronic Publication: 2022 Aug 10.
Abstract:
Background: Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS).
Methods: A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks' gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8).
Results: Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited.
Conclusions: Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities.

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Authors: Wynne, Matthew David; Shah, Manu
Source: Nephrology Nursing Journal (NEPHROL NURS J), May/Jun2022; 49(3): 277-278. (3p)
Abstract:
Basal cell carcinoma is the most common type of skin cancer, and patients receiving hemodialysis are at increased risk of developing them. This article describes a case of a patient with a basal cell carcinoma in which the diagnosis was delayed due to the lesion masquerading as granulation tissue at the site of a previous tunnelled hemodialysis catheter. Early detection of basal cell carcinomas is important because delayed detection increases the risk of local invasion and the requirement for more complex surgical management.

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Authors: Sutherland A; Jones MD; Howlett M et al.
Source: Drug safety [Drug Saf] 2022 Aug; Vol. 45 (8), pp. 881-889. Date of Electronic Publication: 2022 Jul 15
Abstract:
Avoidable harm associated with medication is a persistent problem in health systems and the use of preprogrammed infusion devices ('smart pumps') and data monitoring is seen as a core approach to mitigating and reducing the incidence of these harms. However, smart pumps are costly to procure, configure and maintain (in both human and financial terms) and are often poorly implemented. Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, and a strategic human-centred approach is needed to support their implementation. 

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Authors: Sutherland A; Gerrard WS; Patel A; et al.
Source: BMJ open quality [BMJ Open Qual] 2022 Jul; Vol. 11 (3)
Abstract:
Introduction: The use of intravenous administration systems with dose error reduction software (DERS) is advocated to mitigate avoidable medication harm. No large-scale analysis of UK data has been attempted. This retrospective descriptive study aimed to estimate the prevalence of hard limit events and to estimate the potential severity of DERS events.

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Authors: Kent S; Regan A;  McDonald C et al.
Source:  British dental journal [Br Dent J] 2021 Feb 24. Date of Electronic Publication: 2021 Feb 24
Abstract:
Introduction Gender differences have been documented in prevalence and morbidity of caries, gingivitis and oral health, but not previously in cervicofacial infection. Identification and minimisation of gender inequalities is a World Health Organisation priority, and there are physiological, behavioural and cultural reasons to suspect that sex and gender differences may be present.Methods Analysis was carried out of the MTReC National Snapshot audit of cervicofacial infections. This database was created by oral and maxillofacial surgery trainees in 2017 and records over 400 variables in 1,002 individual patients admitted to hospital with severe odontogenic infection.Results Records were available for 1,002 patients with cervicofacial infection (456 females and 546 males). There were significant differences between recorded gender in those presenting with airway compromise (male 7% vs female 2%, p = 0.001), severe inflammatory response syndrome (male 60% vs female 39%, p = 0.007) and requirement for awake fibre-optic intubation on admission (male 4% vs female 1%, p = 0.014).Discussion These results suggest that male patients access healthcare later in their disease than female patients, and with more severe systemic compromise. This may be due to prevalent cultural and behavioural norms. As equality of access is the responsibility of the administrator, we discuss methods which might improve timely presentation in males with cervicofacial infections.

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Authors: Teh LS et al
Source: Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2022 Jun 29. Date of Electronic Publication: 2022 Jun 29.
Abstract:
Objectives: Hydroxychloroquine (HCQ) and azathioprine (AZA) are used to control disease activity and reduce risk of flare during pregnancy in patients with SLE. The aim of this study was to determine outcomes of children born to mothers with SLE exposed to HCQ or AZA during pregnancy and breast-feeding.
Methods: Women attending UK specialist lupus clinics with children ≤17 years old, born after SLE diagnosis, were recruited to this retrospective study. Data were collected using questionnaires and from clinical record review. Factors associated with the outcomes of low birth weight and childhood infection were determined using multivariable mixed effects logistic regression models.
Results: We analysed 284 live births of 199 mothers from 10 UK centres. The first pregnancies of 147/199 (73.9%) mothers was captured in the study. 150/248 (60.4%) and 87 (31.1%) children were exposed to HCQ and AZA respectively. There were no significant differences in the frequency of congenital malformations or intrauterine growth restriction (IUGR) between children exposed or not to HCQ or AZA. AZA use was increased in women with a history of hypertension or renal disease. Although AZA was associated with low birth weight in univariate models, there was no significant association in multivariable models. In adjusted models, exposure to AZA was associated with increased reports of childhood infection requiring hospital management (OR 2.283 [1.003, 5.198], p= 0.049).
Conclusions: There were no significant negative outcomes in children exposed to HCQ in pregnancy. AZA use was associated with increased reporting of childhood infection which warrants further study.

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Authors: Ono M; Hara H; Gao C et al.
Source: Heart (British Cardiac Society) [Heart] 2022 Jun 22. Date of Electronic Publication: 2022 Jun 22.
Abstract:
Objective: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).
Methods: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.
Results: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, p interaction =0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; p interaction =0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.
Conclusions: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.

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Authors: Taib, Adnan; Killick, Rebecca; Hussain, Kamran et al.
Source: In HPB November 2021 23(11):1732-1743
Abstract:
Background Gallstone related pathology (GRP) accounts for a significant proportion of general surgery admissions. The aim of this study is to investigate if seasonal variation for GRP admissions exist in England allowing improved resource allocation and planning.
Results A total of 396 879 GRP related admissions were recorded during the specified period, accounting for 1.44% of all emergency admissions. Our study suggests a significant seasonal peak in Summer (n = 102 620) based cumulative admissions per season and a linear regression model (p < 0.001), followed by Autumn (n = 102 267), then Spring (n = 97 807) and finally Winter (n = 94 185). Spectral analysis confirmed there is seasonality in the emergency GRP admissions every 12 months. A forecasting model was shown to be reliable; all observed admissions for 2019 were within the 95% prediction intervals for each month for the proportion of emergency GRP admissions.
Conclusion Resource allocation towards the Summer months to target seasonal peaks in GRP should be considered.

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Authors: Wynne, Matthew David; Shah, Manu
Source: Nephrology Nursing Journal (NEPHROL NURS J), May/Jun2022; 49(3): 277-278. (3p)
Abstract:
Basal cell carcinoma is the most common type of skin cancer, and patients receiving hemodialysis are at increased risk of developing them. This article describes a case of a patient with a basal cell carcinoma in which the diagnosis was delayed due to the lesion masquerading as granulation tissue at the site of a previous tunnelled hemodialysis catheter. Early detection of basal cell carcinomas is important because delayed detection increases the risk of local invasion and the requirement for more complex surgical management.

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Authors: Atwal A; Snowsill T; Dandy MC et al.
Source: International journal of cancer [Int J Cancer] 2022 Jun 15. Date of Electronic Publication: 2022 Jun 15.
Abstract:
Ovarian cancer (OC) is the least survivable gynecological malignancy and presents late. Five-year survival for OC is around 45% increasing the need for innovative treatments. Checkpoint inhibitors have shown significant clinical efficacy in mismatch repair deficient (MMRd) cancers and could be a powerful treatment in OC. However, their application in OC is limited due to the lack of data on the prevalence of MMRd. The aim of our study was to conduct a systematic review of the literature and meta-analysis to provide an accurate estimate of the prevalence of MMRd in OC.

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Authors: Matthew L Costa , Juul Achten, Alexander Ooms et al.
Source: Health Technology Assessment, Vol 26, Iss 11 (2022)
Abstract:
Patients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking. Objective: To compare functional outcomes, quality-of-life outcomes, complications and resource use among patients with a dorsally displaced fracture of the distal radius treated with manipulation and surgical fixation with Kirschner wires (K-wires) and those treated with manipulation and moulded cast.

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Authors: Hamer, Oliver; Lowther, Hayley; Harrison, Helen; Hill, James
Source:  British Journal of Neuroscience Nursing (BR J NEUROSCI NURS), Jun2022; 18(3): 142-145. (4p)
Abstract:
Stroke remains one of the leading causes of death worldwide. To tackle the negative impacts of stroke, a high standard of clinical practice and a commitment to continuous quality improvement is needed across the stroke care pathway. One approach to quality improvement is the formation and implementation of quality improvement collaboratives. However, there are several barriers to the implementation of a quality improvement collaborative for stroke care which may impact on its success. This article critically appraises a systematic review that assessed the effectiveness of quality improvement collaboratives for driving improvements in stroke care and explored the barriers to implementing a quality improvement collaborative to improve care.

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Authors: Demain LAM;  Metcalfe K;  Boetje E; E et al.
Source: Reproductive biomedicine online [Reprod Biomed Online] 2022 May 13. Date of Electronic Publication: 2022 May 13.
Abstract:
Research Question: Does a genetic condition underlie the diagnosis of primary ovarian insufficiency (POI) in a 13-year-old girl with primary amenorrhoea?
Design: A case report of a next-generation sequencing panel of 24 genes associated with syndromal and non-syndromal POI was conducted.
Results: A homozygous missense variant c.1076C>T, p.(Pro359Leu) in BMP15 was identified.

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Authors: Kent S;  Adatia A;  James P et al.
Source: Oral and maxillofacial surgery [Oral Maxillofac Surg] 2022 Jul 05. Date of Electronic Publication: 2022 Jul 05.
Abstract:
Introduction: Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures.
Methods: The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome.
Results: Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation.
Discussion: We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.

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