Type of publication:
Service improvement case study
Author(s):
*Rebekah Tudor
Citation:
SaTH Improvement Hub, November 2024
Abstract:
Type of publication:
Service improvement case study
Author(s):
*Rebekah Tudor
Citation:
SaTH Improvement Hub, 2024
Abstract:
To increase improvement engagement by 50% as measured by the number of ideas submitted via the Improvement Hub email by 30th June 2024
Type of publication:
Service improvement case study
Author(s):
*Nat Rose
Citation:
SaTH Improvement Hub, November 2024
Abstract:
To reduce the time that patients spend in Fit to Sit, improving flow across the department by October 2024.
Type of publication:
Journal article
Author(s):
*Khaliq, Tayyib; *Pummiram, Srivarshini; *Iqbal, Naeem; *Jenyon, Tom.
Citation:
BMJ Case Reports. 18(1), 2025 Jan 27.
Abstract:
Approximately 3% of individuals in road traffic accidents suffer ocular injuries. We present a case of a man in his late 80s who presented with bilateral corneal decompensation following airbag deployment during a road traffic accident. Ocular examination revealed multilevel ocular injury with severe bilateral corneal oedema. This was managed with topical steroids, mydriatics and antibiotic therapy. At 1-month follow-up, the left eye had persistent corneal oedema. Specular microscopy was performed which confirmed endothelial cell loss making the patient a candidate for a corneal endothelial graft. We observed blunt trauma from airbag deployment causing endothelial cell loss and subsequent corneal decompensation. Our findings suggest that patients presenting to the emergency department with facial trauma from airbag injury should be referred for comprehensive ophthalmological assessment and that the reviewing ophthalmologist should have endothelial cell loss in mind during examination.
Link to full-text [NHS OpenAthens account required]
Type of publication:
Conference abstract
Author(s):
*Abugassa E.; *Bosher O.; *Makan N.; *Crawford E.; *Saleem M.A.; *Srinivasan K.; *Moudgil H.
Citation:
European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA3010), 2024. Date of Publication: 01 Sep 2024.
Abstract:
Background: Although mucus plugging occluding medium to large sized airways in COPD is associated with increased long term all-cause mortality, acute exacerbations require further investigation, particularly where, despite reducing morbidity and improving quality of life, long-term use of mucolytics remains controversial. Objectives were (1) to quantify chest CT evidence of mucus plugging, (2) relate findings to mucolytics, and (3) investigate mucus plugging association with short term mortality.
Method(s): Retrospective review of 100 patients admitted with exacerbation of COPD (105 admissions).comparative analysis by chi square (x2) and logistic regression, significant p<.05.
Result(s): Mean (SD, range) age was 74.7 (10.5, 41-97) years with 54% male; mean FEV1/FVC 55% with FEV1 1.2(0.59, 0.4-3.6) litres at 49% predicted. 23 were on long term oxygen (LTOT). Mean stay was 6.3 (1-41) days. 24 died in the first 6 months. Where a historical or admission chest CT was available (n=82), 12 (15%) had mucus plugging with mucolytics prescribed to 6 (50%) compared to 32/70 (46%) without plugging (x2 0.057, NS). 9/56 (16%) with mucus plugging vs 3/26 (12%) without (x2 0.2921, NS) had emphysema and 3/13 (23%) vs 9/69 (13%) without (x2 1.016, NS) bronchiectasis. Regression investigating mortality at 6 months showed adverse outcomes for male sex, lower FEV1, and LTOT.
Conclusion(s): 15% with acute COPD admissions have current or historical evidence of mucus plugging. Mucolytics are prescribed for 45% irrespective of prior CT radiology. Mortality (24%) at 6 months is high but not shown related to mucus plugging or reduced by mucolytics.
Link to full-text [no password required]
Type of publication:
Conference abstract
Author(s):
*George S.; *Moudgil H.;
Citation:
European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA1475), 2024. Date of Publication: 01 Sep 2024.
Abstract:
Background: Economic data inform public health measures; a co-ordinated approach to TB contact tracing, guided by Public Health England (PHE), was undertaken assessing a non English speaking Eastern European immigrant population seasonally employed at an agricultural farm and we (1) report direct costs, (2) identify cultural issues and risks employing such a population Methods: After an initial pilot study of work-based contacts of an index case, contact lists incorporating workforce in every shift pattern back-dated two years to his UK entry were identified. Direct costs included T-spot testing (Oxford Immunotec) and translators (Romanian, Polish, Lithuanian, Italian) along with secondary care charges at tariff with uniform cross-charge among providers. TB drug costs (managing latent or disease) were from the British National Formulary.
Result(s): 258/331 (78%) workers took up testing. 80 (31%) were then referred for contact screening; of these, 47 had latent and 3 active disease. 16 defaulted, 5 declined, 4 were pregnant, and 5 lost moved elsewhere. Most had no registered General Practitioner and no pre-employment health check, BCG or radiology. Anecdotally, several returned to their parent countries for healthcare advice despite measures to overcome language barriers. Main direct costs (51,497-52) equated to 199-60/person screening and 1029-95/person treated for either latent or TB disease.
Conclusion(s): Language and cultural barriers are challenges to TB screening/contact tracing. Direct costs are 200 (UK pound sterling = 1.17 Euro) per patient screened and five times this amount treating latent or active disease.
Link to full-text [no password required]
Type of publication:
Conference abstract
Author(s):
Mannan S.; Waseem T.; Safwan N.; Ganaie M.;
Citation:
Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK.
Abstract:
Background: Pleural infection remains a significant burden on mortality and morbidity in the Western world even with the advancement of clinical management.
Objective(s): This paper aims to study the clinical course of empyema thoracic patients managed in a tertiary hospital in the UK.
Method(s): We did a retrospective observational study of the hospital's electronic records of patients who were diagnosed and managed for empyema thoracic from January 2021 to December 2022.
Result(s): The total cohort was 104 empyema thoracic patients. The mean age was 60. The affected males were almost double than females (68 vs 36). We did a retrospective RAPID score of our cohort. The RAPID score could not be calculated for 35 patients due to the unavailability of pleural fluid data. High inpatient mortality (23%) was observed in the medium- risk (RAPID score 3-4) group and high 3-month mortality (25%) was observed in the high-risk (RAPID score 5-7) group. The majority of the patients were managed conservatively. No difference was noticed in the median length of hospital stay (11d) in all the risk groups. A high rate of (37%) surgical management was observed in the low-risk (RAPID score 0-2) group.
Conclusion(s): Our cohort's data comply with the predicted mortality risk of the RAPID score. We emphasize that RAPID score calculation can be a significant tool in the management of empyema thoracic patients.
Link to full-text [no password required]
Type of publication:
Conference abstract
Author(s):
Haider R.; Finn E.; *Zeb S.; *Bharwana F.; Fitzgerald A.; Iftikhar S.; Hussain I.;
Citation:
European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA1345), 2023. Date of Publication: 01 Sep 2023.
Abstract:
Intro: Active smoking plays a crucial role in cardiovascular disease. We looked at the rate of attendance to primary and secondary care amongst current smokers with increased QRISK and CAT scores.
Methodology: Data were drawn retrospectively from electronic medical records from a large tertiary care hospital covering Staffordshire region over a one year period 2019-2020. Data was extracted from lung cancer screening cohort.
Result(s): The data comprised of 1232 patients (516 female, 716 male). Of these, 566 were exsmokers and 666 current smokers. Average age was 62 years. Analysis was done using ANOVA. This confirms that current heavy smokers, had an increased QRISK score >10 (p value <0.05, 95% CI 0.00 to 0.02). 1 year mortality in this group was 2.8%. Heavy smokers were not at an increased risk of attending primary care (p value 0.862) or at increased risk of unplanned secondary care admissions (p value 0.09) as compared to light smokers. Median length of hospital stay was 8 (0 – 16) bed days in heavy smokers as compared to 4 bed days (0 – 8) in ex smokers. Female ex smokers had fewer hospital attendances as compared to female current smokers, male current and ex smokers (p value <0.05, tests statistic 4.207). A high CAT score was documented as >20 denoting impact of COPD on patient's life. It was not identified as a predictor of increased attendance to primary or secondary care.
Conclusion(s): Heavy smokers have a higher economic burden on acute secondary care on account of higher number of bed days. Early smoking cessation intervention may help reduce attendance into secondary care.
Link to full-text [no password required]
Type of publication:
Conference abstract
Author(s):
*Gohir Q.; *Mcadam J.; *Crawford E.; *Bosher O.; *Saleem M.; *Srinivasan K.; *Moudgil H.;
Citation:
European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA3444), 2023. Date of Publication: 01 Sep 2023.
Abstract:
Background: Prognosis with pleural mesothelioma depends not only on histological typing but also distribution of metastatic disease (including stage 4 with distant spread) and performance status. Analysing all patients presenting at his hospital Trust over 10 years, this work (1) reports the pattern of metastatic disease and, accepting the complex multi-modality approach to treatment, (2) relates findings to survival.
Method(s): Retrospective computer based analysis conferring with oncology and radiology records. 169 patients (84% male) with mean (range) age 74.4 (44 to 93) years.
Result(s): Respectively, performance status was 0 (16%), 1 (34%), 2 (26%), 3 (18%) and 4 (1%). 70% only had thoracic disease (pleural, pericardial, mediastinal, pulmonary) and 30% extrathoracic extension (chest wall/extrapleural, diaphragmatic, peritoneal/omental/ascites), liver/spleen/adrenal, spine and bone, and other (including brain and brachial plexus). Overall, 94% were diagnosed on tissue samples; where histology was clarified, 63% with epithelioid survived longer at (mean) 15 months compared to the 37% with 12.6 months for sarcomatoid or biphasic typing. Although active treatments often involved the complexity of multimodality, 34% had best supported care (usually worse performance status).
Conclusion(s): Findings highlight the aggressive nature of pleural mesothelioma confirming at least 30% had extrathoracic metastases and marginally improved outcomes with epithelioid histology.
Link to full-text [no password required]
Type of publication:
Journal article
Author(s):
*Self A.; Cavallaro A.; Collins S.L.;
Citation:
Obstetrician and Gynaecologist. (no pagination), 2025. Date of Publication: 2025.
Abstract:
Key content: Antenatal imaging is a screening tool integral to ensuring women are cared for in the most appropriate setting. The pretest probability of PAS should be considered before any imaging is performed. PAS is an iatrogenic disease. Any process which disrupts the endometrium increases the risk. Caesarean birth is the most common cause. Specialist placental assessment in asymptomatic women should be offered between 24 and 28 weeks. Ultrasound and MRI have similar diagnostic value, and MRI should only be used as an adjunct following ultrasound assessment by a specialist in placental imaging. Learning objectives: To understand the pathophysiology of PAS. To understand the distinction between screening for and diagnosis of PAS. To increase confidence in the interpretation of sonographic features of PAS. To provide a rationale for PAS care being provided in centres of excellence. Ethical issues: If women increasingly prefer caesarean section over vaginal birth, it is likely that this trend will result in increasing numbers of complex caesarean deliveries and PAS cases. Many studies have shown decreased morbidity and mortality if PAS cases are managed by an experienced multi-disciplinary team (MDT) in a PAS centre of excellence; therefore, accurate screening and timely referral are vital to improve patient care for women with risk factors.
Link to full-text [open access - no password required]
Shrewsbury and Telford Hospital NHS Trust has an active Research and Innovation Department.
Find out more by visiting either the R&I Intranet pages (only available on a Trust PC) or the R&I pages on the SaTH website.
Shrewsbury and Telford Hospital NHS Trust has an active Improvement Hub.
Find out more by visiting either the Improvement Hub Intranet pages (only available on a Trust PC) or the Improvement Hub page on the SaTH website.