Author: Jason Curtis

PROMPTS RCT of screening MRI for spinal cord compression in prostate cancer (ISRCTN74112318) (2022)

Posted on by

Type of publication:Conference abstract

Author(s):Dearnaley D.; Hinder V.; Hijab A.; Horan G.; *Srihari N.; Rich P.; Houston G.; Henry A.; Gibbs S.; Venkitaraman R.; Cruickshank C.; Hassan S.; Mason M.; Pedley I.; Payne H.; Brock S.; Wade R.; Robinson A.; Din O.; Lees K.; Murray J.; Parker C.; Griffin C.; Sohaib A.; Hall E.

Citation:Radiotherapy and Oncology. Conference: ESTRO 2022. Copenhagen Denmark. 170(Supplement 1) (pp S78-S80), 2022. Date of Publication: May 2022.

Abstract:Purpose or Objective Early diagnosis of malignant spinal cord compression (SCC) is crucial as pre-treatment neurologic status is the major determinant of outcome. In metastatic castrate resistant prostate cancer (mCRPC) SCC is a significant cause of diseaserelated morbidity. In the PROMPTS trial we investigated whether screening for SCC with spinal MRI, with pre-emptive treatment if radiological SCC (rSCC) was detected, reduced the incidence of clinical SCC (cSCC) in asymptomatic mCRPC patients. Materials and Methods PROMPTS is a phase III parallel-group, randomised controlled superiority trial. CRPC patients aged at least 18 years with spinal metastases without related back pain or neurological symptoms, no previous SCC, and no spinal MRI in previous 12 months were eligible. Participants were randomly allocated (1:1 ratio) to control (no MRI) or screening spinal MRI. Allocation was not masked. A validated epidural spinal cord compromise scale (ESCC) was used. Pre-emptive treatment and 6-monthly spinal MRI were offered to patients with screen-detected rSCC. The primary endpoint was incidence of cSCC at 12 months. Results Between Feb 26, 2013 and April 25, 2017, we randomly assigned 420 men from 45 UK centres to control (n=210) or screening MRI (n=210). Median age was 74 years (IQR:68-79), 53% (222/420) had normal alkaline phosphatase and median PSA was 48.0ng/ml (IQR:17-162). rSCC was detected at screening in 61/200 (30.5%) intervention group patients. Concordance of local and central assessments of rSCC was good (92.4%). At 12 months, the cumulative incidence of cSCC was 6.7% (95% CI 3.8-10.6) in the control group and 4.3% (2.1-7.7) in the intervention group (Gray's test p=0.119, HR:0.64 95%CI:0.37-1.11, Fig 1). In the intervention group cSCC developed more commonly in the rSCC +ve cases (11.5%) than the rSCC -ve cases (1.3%) and the rSCC-ve group had significantly less cSCC than the control group (Gray's test p=0.04, Fig2). Intervention for rSCC was with radiotherapy (RT) in 50/61 (82%) cases, only 4% progressed at the treated sites. RT was not given to 18 sites with early rSCC (ESCC 1a-b,17: 1c, 1) but none progressed at 6 months. At the time of cSCC 70% of patients were ambulant and 18% of non-ambulant patients regained function post-RT. More spinal RT was given in the intervention than control group (86vs49 courses) but the use of additional systemic therapy was significantly less by 12 months (54%vs70%, Gray's test p=0.003). Conclusion We found no statistically significant differences in incidence of cSCC between the intervention and control groups. MRI screen-detected early rSCC lesions do not always progress to cSCC with contemporary systemic management of CRPC and observation may be reasonable for ESCC grade 1a/b lesions. However these patients remain at substantial risk of developing new sites of cSCC. Further efforts to better identify patients at high risk for rSCC and cSCC are warranted to refine selection of groups for screening spinal MR.

Crucial, complex, caring: a new professional development framework for Lung Cancer Nurse Specialists (2022)

Posted on by

Type of publication:Conference abstract

Author(s):Roberts J.; Barton P.; Clayton K.; Fenemore J.; Ivey S.; *McAdam J.; Shepherd P.

Citation:Lung Cancer. Conference: 20th Annual British Thoracic Oncology Group Conference 2022. Virtual, Online. 165(Supplement 1) (pp S40), 2022. Date of Publication: March 2022.

Abstract:Introduction: Lung cancer specialist nursing is a varied, valuable and rewarding career, and the need for lung cancer nurse specialists (LCNS) is increasing. Lung Cancer Nursing UK (LCNUK) wants to encourage nurses to aspire to becoming an LCNS, and to support those already working in lung cancer teams to flourish professionally. We want employers to recognise LCNS' capabilities and to recruit and reward them accordingly. LCNUK therefore set out to draft the first professional development framework for LCNS. The Framework is intended to guide nurses, line managers and employers on the core skills, knowledge and expertise that LCNS will gain and demonstrate as they progress in role. Method(s): LCNUK convened a working group which reviewed exemplars and supporting literature. The team produced a draft framework setting out the qualifications, skills and capabilities needed by nurses operating at different levels, aligned with the (Figure Presented) four pillars of advanced practice. Feedback on the draft was sought from expert stakeholders before the final document was approved by the LCNUK Steering Committee. The Framework was developed in a collaboration between LCNUK and MSD, who funded a policy consultancy to provide secretariat support. LCNUK retained editorial independence of the framework content. Result(s): The Framework sets out the qualifications, clinical skills, knowledge, leadership and management and research capabilities that LCNUK expects aspiring and existing LCNS to demonstrate or be working towards. It includes case studies of nurses' career journeys and an example of a successful case for job matching and re-banding. The Framework is available on the LCNUK website at www.lcnuk.org. Conclusion(s): The Framework asserts the crucial role of LCNS in managing safety-critical and complex patient care and in leading service delivery and improvement. We hope it will prove a valuable tool to nurses, employers and policymakers in understanding the complexity and importance of this essential role.

CT coronary angiography significantly changes treatment targets versus coronary artery calcium scoring in high-risk dyslipidaemia patients (2022)

Posted on by

Type of publication:Conference abstract

Author(s):Graby J.; Sellek J.; Bayly G.; Avades T.; *Capps N.; Shipman K.; Mbagaya W.; Luvai A.; Khavandi A.; Loughborough W.; Hudson B.; Downie P.; Rodrigues J.;

Citation:Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2022. Manchester United Kingdom. 108(Supplement 1) (pp A135-A136), 2022. Date of Publication: June 2022.

Abstract:Introduction Dyslipidaemia accelerates atherosclerosis. Patients with genetic dyslipidaemias, Familial Hypercholesterolaemia (FH) being the most common, are at heightened risk of premature cardiovascular events. However, this risk is heterogeneous within identical genotype diseases, and modifiable with treatment. Coronary imaging identifies subclinical atherosclerosis, personalises risk stratification and treatment targets. Coronary artery calcium scoring (CACS) is first-line for primary prevention. However, calcification is a late-stage process in CAD pathogenesis and the CACS has low specificity in young patients with severe FH. CT coronary angiography (CTCA) may identify non-calcific CAD and high risk plaque (HRP) features unseen with CACS. This study aimed to quantify the impact of CTCA vs traditional CACS on clinical management in real-world asymptomatic Lipid Clinic patients. Methods A retrospective single-centre review of asymptomatic Lipid Clinic electronic patient records with both CACS and CTCA from May 2019 to December 2020. A vignette was compiled for each patient providing all relevant clinical data. CACS was recorded as Agastston score and CTCA as the Coronary Artery Disease – Reporting and Data System (CAD RADS) grading of anatomical stenosis with a modifier for HRP features.Findings were compiled into an anonymised online survey which Consultant Biochemists from across the UK were invited to complete. Data was revealed in a stepwise fashion to the participating clinician: (i) vignette only, (ii) CACS, and (iii) CAD RADS. Clinicians were asked their lipid target and management after each data-point was unblinded. Background information on CACS and CTCA result interpretation was provided prior to participation. Statistical analysis was performed using SPSS v.21 and significance was defined as two-tailed p<0.05. Results 45 asymptomatic patients (55+/-9 years, 49% female) were included. 7 Consultant Biochemists from 6 institutions (4 [67%] tertiary/teaching Hospitals and 2 [33%] district general Hospitals) participated.CACS and CAD RADS assessment of disease burden is presented in Figure 1, with CTCA re-classifying CAD severity vs CACS in 28/45 (62%) patientsLipid targets were altered significantly more frequently with CTCA vs CACS (19% vs 12%; chi2 57.0, p<0.005), even after CACS result available (Figure 2). The LDL target selected was altered by CACS in 12%, and in a further 19% when CAD RADS result was unblinded, which was statistically significant (c2 57.0, p<0.005). This finding was consistent across FH and non-FH patients. Increasing CACS and CAD RADS severity were significantly associated with change in lipid target (c2 54.2, p<0.001; chi2 27, p<0.001), the latter even after a high CACS result was available, as did presence of HRP (chi2 9.3, p=0.002). Conclusion In high-risk asymptomatic dyslipidaemia, CTCA alters treatment targets beyond CACS by demonstrating higher CAD severity burden and HRP. This may differentiate high risk and very high risk patients in an important population.

Link to full-text [no password required]

A multi-dimensional approach towards implementing the effective use of remote electrocardiographic monitoring - evaluation of clinical correlation and patient experience (2022)

Posted on by

Type of publication:Conference abstract

Author(s):*Asad M.; Younas W.; *Kazi S.I.; Alaguraja P.; *Makan J.

Citation:Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2022. Manchester United Kingdom. 108(Supplement 1) (pp A74-A75), 2022. Date of Publication: June 2022.

Abstract:Background Inappropriate use of telemetry results in the overuse of limited resources, disrupted provider workflow, higher costs of care, and false alarms with resultant alarm fatigue. Moreover, identifying a useful implementation blueprint is an important component of promoting its appropriate use. Telemetry can influence patient experience during their stay as potentially it can disturb sleep, contribute to delirium, and increase patient frustration and anxiety. We stipulate that even minor adjustments to monitoring practices can influence optimised patient care. We aimed to evaluate the co-existing standards of practice regarding use of telemetry across Shrewsbury and Telford Hospital NHS Trust (SaTH). We implemented a patient-centred approach towards quality improvement by incorporating record of patient experience as a tool to guide effective use of this limited resource across our district general hospital settings. Methods Patients across two hospital sites were selected to conduct a prospective health service evaluation related to the use of telemetry. A likert scale survey was conducted to record patient perspective of telemetry monitoring including a section with an opportunity to provide feedback towards service improvement. The data of patients receiving telemetry was collected from December 2021 to February 2022.American Heart Association (AHA) consensus statement for remote electrocardiographic monitoring was utilized to evaluate the proposed indication for telemetry. However, the rating system helped group patients receiving telemetry monitoring as Class I (definitely indicated), Class II (maybe indicated), or Class III (not indicated). Clinical notes and electronic telemetry system was employed to record parameters including patient demographics; presenting complaint; class (I-III) of indication; whether an indication for telemetry was documented; the length of telemetry; and the details of any significant events that occurred during monitoring including escalation. Where possible, patients were asked to anonymously provide feedback via set questionnaire focusing on quality of care received by the patient. Result(s):Among the 30 patients who were included in our analysis, 7 were females and the average age in our cohort was found to be 72.8. In about 56% of the patients, there was no clear indication mentioned in the clinical notes regarding continuation/discontinuation of telemetry. Based on proposed indication, about 36.66% (11 patients out of which 2 were female) were identified to be at significant risk of an immediate life-threatening arrhythmia (Class I). Among this group, 2 patients were reported to have significant arrhythmia event necessitating treatment. Further analysis revealed that from our cohort, 46.66% (14 patients) had a Class II indication for their telemetry monitoring out of which only 2 patients had a significant event recorded. However, only 16.66% (5 patients) were found to meet the eligibility for Class III indications and none of them encountered a significant arrhythmia. From anonymously filled patient questionnaires, around two-third of the patients reported not being informed about the utility of telemetry and its predicted duration of stay. One-third of patients reported the device to be inconvenient, intrusive and heavy. Conclusions To accomplish a sustainable improvement, a patient-centred approach should be exercised to help identify the gaps in quality of care delivered. Our analysis showed that significant number of patients received telemetry when it was not clinically indicated. The proposed interventions include adopting formal request process for telemetry, predicting its duration, use of patient education tools and exploring compatibility of telemetry device used. Larger scale studies are required to gain more insight into the appropriateness and impact of telemetry in a hospital setting.

Link to full-text [no password required]

Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab (2022)

Posted on by

Type of publication:Journal article

Author(s):Lin S.; Kennedy N.A.; Saifuddin A.; Sandoval D.M.; Reynolds C.J.; Seoane R.C.; Kottoor S.H.; Pieper F.P.; Lin K.-M.; Butler D.K.; Chanchlani N.; Nice R.; Chee D.; Bewshea C.; Janjua M.; McDonald T.J.; Sebastian S.; Alexander J.L.; Constable L.; Lee J.C.; Murray C.D.; Hart A.L.; Irving P.M.; Jones G.-R.; Lees C.W.; Altmann D.M.; Boyton R.J.; Goodhand J.R.; Powell N.; Kok K.B.; Bokth F.; Cipriano B.; Francia C.; Khalid N.; Khatun H.; Kingston A.; Lee I.; Lehmann A.; Naik K.; Pabriaga E.; Plaatjies N.; Samuels K.; Saich R.; Cousins H.; Thomas R.; Brown M.; White B.; Tilley B.; Muhammed R.; Bi R.; Cotter C.; Grove J.; Hong K.; Howman R.; Clayton S.; Sultan S.; Rooney M.; Cottrill C.; Singh S.; Dawe C.; Hull R.; Silva N.; Manning J.; Finlayson L.; Roebuck A.; Dawson J.; Sonwalkar S.; Chambers N.; Robinson M.; Haigh A.; Matapure L.; Raine T.; Kapizioni C.; Strongili K.; Thompson T.; Ahmed M.; Kontos C.; Bourges C.; Barbutti I.; Gozzard M.E.; Hendy P.; Bull R.; Costa P.; Davey L.; Hannington H.; Nundlall K.; Martins C.; Avanzi L.; Carungcong J.; Barr S.; Appleby R.; Johnson E.; Phillis K.; Gascoyne R.; Crowder A.; Whileman A.; London I.; Grounds J.; Martin E.; Price J.; Cawley K.; Dhar A.; Brown E.; Cowton A.; Warner B.; Stuart C.; Lacey L.; de Silva S.; Allcock C.; Harvey P.; Jones L.; Cooke E.; Brooks J.; Baker P.; Beadle H.; Cruz C.; Potter D.; Collum J.; Masters F.; Kumar A.; Coetzee S.; Peiu M.; Icke B.; Raj M.; Gaynor E.; Chadokufa S.; Huggett B.; Meghari H.; El-Khouly S.; Kiparissi F.; Girshab W.; Claridge A.; Fowler E.; McCafferty L.; Christodoulides K.; Clifford A.; Dawson P.; Honap S.; Lim S.; Luber R.; Mahiouz K.; Meade S.; Reynolds R.; Stanton A.; Tripoli S.; Hare N.; Balachandran S.; North E.; North J.; Browne B.; Jameson E.; Siaw Y.H.; Manzano L.; Segal J.; Al-Bakir I.; Khakoo I.; Thoua N.; Davidson K.; Miah J.; Canclini L.; Hall A.; Hayes M.; Myers S.; Talbot A.; Turnbull J.; Whitehead E.; Stamp K.; Pattinson A.; Mathew V.; Sherris L.; Harvey A.; Hicks L.; Byrne T.-M.; Cabreros L.; Downing-Wood H.; Hunter S.; Prabhudev H.; Balarajah S.; Ibraheim H.; Torkizadeh M.; Lo J.W.; Liu Z.; Sutherland H.; Wilhelmsen E.; Mackintosh K.; Verma A.M.; Sebastian J.; Peerally M.F.; Raymode P.; Guerdette A.-M.; Kent A.; Choong L.M.; Pantaloni B.; Ravdas P.; Vadamalayan B.; Foley S.; Arnold B.; Heeley C.; Lovegrove W.; Sowton D.; Allsop L.; Gregory H.; Smith P.J.; Bretland G.; King S.; Lofthouse M.; Rigby L.; Subramanian S.; Tyrer D.; Martin K.; Probert C.; Kamperidis N.; Adedoyin T.; Baden M.; Chacko F.; Cicchetti M.; Saifuddin M.A.; Yesupatham P.; Gowda R.; Williams M.; Kemp K.; Akhand R.; Gray G.; John A.; John M.; Mohammed T.; Sathe D.; Jones N.; Soren J.; Sprakes M.; Burton J.; Kane P.; Lupton S.; Bartholomew J.; MacFaul G.; Scaletta D.; Siamia L.; Williams F.; Green C.; Ver Z.; Lamb C.A.; Doona M.; Hogg A.; Jeffrey L.; King A.; Speight R.A.; Doyle J.; Owen R.; Mowat C.; Rice D.; MacFarlane S.; MacLeod A.; Mohammed S.; Murray S.; Elliott A.; Morris M.A.; Coke L.; Hindle G.; Kolokouri E.; Wright C.; Lee C.; Ward N.; Dann A.; Lockett M.; Cranfield C.; Jennings L.; Srivastava A.; Ward L.; Jeynes N.; Ranga P.; Rajasekhar P.; Gallagher L.; Patterson L.; Ward J.; Basnett R.; Murphy J.; Parking L.; Lawson E.; Short S.; Devadason D.; Moran G.; Khan N.; Tarr L.; Olivia C.; Limdi J.; Goulden K.; Javed A.; McKenzie L.; Bhandari P.; Baker-Moffatt M.; Dash J.; Le Poidevin A.; Downe H.; Bombeo L.; Blackman H.; Wiles A.; Bloxham H.; Dias J.; Nadar E.; Curgenven H.; Macdonald J.; Finan S.; McMeeken F.; Mahmood M.; Shields S.; Seenan J.P.; DeSilva D.; Malkakorpi S.; Carson R.; Whiteoak S.; Edger-Earley K.; Vamplew L.; Ingram S.; Botfield S.; Hammonds F.; James C.; Ahmad T.; Aspinall G.; Hawkins S.; Marriott S.; Redstone C.; Windak H.; Adam A.-M.; Mabb H.; Murray C.; Diaba C.; Joseph F.; Pakou G.; Gleeson Y.; Berrill J.; Stroud N.; Pothecary C.; Roche L.; Turner K.; Deering L.; Israel L.; Baker E.; Cutler S.; Evans R.M.; Nash M.; Mallison G.; Roynon A.; Gordon J.; Levell E.; Zagalo S.; Fraser W.; Hoad I.; Kirkineziadis N.; Russell R.; Henderson P.; Millar M.; Fagbemi A.; Jennings F.; Mayor I.; Wilson J.; Alexakis C.; Michalak N.; Saunders J.; Burton H.; Cambridge V.; Clark T.; Ekblad C.; Hierons S.; Katebe J.; Saunsbury E.; Perry R.; Brookes M.; Davies K.; Green M.; Plumbe A.; Ormerod C.; Christensen H.; Keen A.; Ogor J.; Anthony A.; Newitt E.; Trim F.; Casey R.; Seymour K.; Fogden E.; Russell K.; Phillips A.; Abdulla M.; *Butterworth J.; *Adams C.; *Buckingham E.; *Childs D.; *Magness A.; *Stickley J.; *Motherwell N.; *Tonks L.; *Gibson H.; *Pajak S.; Thomas C.; Brinkworth E.; Connor L.; Cook A.; Rees T.; Harford R.; Wesley E.; Moss A.; Lucas J.; Lorimer C.; Oleary M.; Dixon M.; Ramadas A.; Tregonning J.; Okeke O.; Jackson W.; Koumoutsos I.; George V.; Kunhunny S.; Laverick S.; Anderson I.; Smith S.; Patel K.; Ali M.; Mhandu H.; Rana A.; Spears K.; Teixeira J.; Pollok R.; Mencias M.; Seaward A.; Sousa J.; Said N.; Soomaroo M.; Raspa V.; Tacouri A.; Reps N.; Martin R.; Selinger C.; Carbonell J.; Onovira F.; Quartey D.; L'Anson A.; Ashworth A.; Bailey J.; Dunn A.; Mahmood Z.; Campbell R.; Marsh L.; Rahman M.; Davies S.; Habibi R.; Jessup-Dunton E.; Joefield T.; Layug R.; Patel V.; Vere J.; Turner V.; Kilroy S.; Walker G.; Atkins S.; Growdon J.; McNeill C.; Cooney R.; Bennett L.; Bowlas L.; Shariff S.; Fraser A.; Punnette D.; Bishop-Hurman C.; Undrell E.; Belfield K.; Din S.; Addleton C.; Appleby M.; Brown J.; Holding K.; Hooper P.; deCaestecker J.; Watchorn O.; Hayward C.; Inniss S.; Pritchard L.; Rudge K.; Carney A.; Andreyev J.; Hayhurst C.; Lockwood C.; Osborne L.; Roper A.; Warner K.; Hindle J.; Watt C.; Szymiczek K.; Mehta S.; Bell J.; Blad W.; Whitley L.; Dhamaraj D.; Baker M.; Sivamurugan E.J.; Evans M.; Cummings F.; Harris C.; Jones A.; Krauze L.; Rahmany S.; Earl M.; Vowles J.; Torokwa A.; Petrova M.; Procter A.; Stanley J.; Silvamoniz C.; Bettey M.; Wahid A.; Morrison Z.; Thomas-Turner R.; Yendle L.; Muller J.; Mitchell M.; Kirkwood J.; Barnes A.; Chaudhary R.; Claridge M.; Ellis C.; Kemp C.; Tobi O.; Milton J.; Johnston E.; Oblak M.; Godden J.; Lees C.; Alexander D.; Covil K.; Derikx L.; Siakavellas S.; Baxter H.; Robertson S.; Smith L.; Poulose B.; Colemam A.; Balint M.; Rhys-Jones G.; Johns K.; Hughes R.; Phipps J.; Taylor A.; MacPhee C.; Brooks S.; Smith K.; Howard L.; Wood D.; Muddu A.; Barman L.; Mallinson J.; Neale T.; Ionita D.; Elliot K.; Turnball A.; Thomas I.; Andrews K.; Sutton J.; Jones C.M.; Roberts J.; Bishop J.

Citation:Nature Communications. 13(1) (no pagination), 2022. Article Number: 1379. Date of Publication: December 2022 [epub ahead of print]

Abstract:Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 – 27.5] vs 47.6 days [45.5 – 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 – 36.8] vs 58.0 days [55.0 – 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.

Link to full-text [open access, no password required]

Altmetrics:

Womens' labour and birth experiences in Greece: A cross-sectional study (2022)

Posted on by

Type of publication:Conference abstract

Author(s):Ioannidou M.; Antonakou A.; *Papoutsis D.

Citation:BJOG: An International Journal of Obstetrics and Gynaecology. Conference: Royal College of Obstetricians and Gynaecologists World Congress, RCOG 2022. London United Kingdom. 129(Supplement 1) (pp 220-221), 2022. Date of Publication: June 2022.

Abstract:Objective: We aimed to investigate womens' emotional status, labour and childbirth data, pain relief methods, satisfaction from the midwifery-obstetric team, and the nutrition methods of newborns in Greece. Design(s): We used a modified version of the validated Early Labour and Experience Questionnaire (ELEQ) to capture the experiences of women and events during their labour and childbirth. Method(s): The questionnaire consisted of 64 items and was posted online through the social media between March to May 2021. All women who had given birth were eligible for the study. Upon closure of the study period, statistical analysis was applied to the collected data. Result(s): A total of 3.127 participants responded to the online questionnaire. Increased intervention rates were recorded with 41.1% of participants having an induction of labour, 58.7% having an epidural analgesia and 33.5% a cesarean section. Only 37.6% of respondents reported a spontaneous onset of labor with no interventions at all and a normal vaginal birth. 42.8% of women reported attending prenatal classes, with these women experiencing higher rates of normal vaginal birth. Higher rates of breastfeeding were observed when women had attended prenatal classes and when their vaginal birth had a spontaneous onset of labor. Women who gave birth at home or in a private maternity hospital were more satisfied when compared to women delivering in public hospitals. Women who had a spontaneous vaginal birth had more positive emotions and greater satisfaction levels from their midwife and obstetrician when compared to an induced vaginal birth or a cesarean section. Conclusion(s): Women in Greece experience high rates of interventions during labour and childbirth, which seems to negatively affect their emotional state. Prenatal classes are important as they are correlated with higher rates of normal deliveries and exclusive breastfeeding. Further research is needed to identify the factors that affect womens' experiences during labour and childbirth within the Greek maternity healthcare system in order to improve and shape the current midwifery-obstetric care policy.

Link to full-text [NHS OpenAthens account required]

Masseter muscle defined sarcopenia and survival in head and neck cancer patients (2022)

Posted on by

Type of publication:
Journal article

Author(s):
*McGoldrick D.M.; *Yassin Alsabbagh A.; *Shaikh M.; *Pettit L.; *Bhatia S.K.;

Citation:
British Journal of Oral and Maxillofacial Surgery. 60(4) (pp 454-458), 2022. Date of Publication: May 2022.

Abstract:
Sarcopenia is increasingly recognised as a poor prognostic factor in older patients undergoing cancer treatment. Recently, masseter muscle cross sectional area (MMCSA) has been shown to accurately identify sarcopenic patients. We aimed to apply this novel technique to a head and neck cohort to identify any potential relationship with survival. A retrospective review was undertaken of patients over 65 years, diagnosed with squamous cell carcinoma of the head and neck and treated with curative intent in our unit between October 2009 and October 2017. MMCSA was measured on staging CT scans using a validated technique. Patients were categorised into tertiles and also high and low MMCSA groups based on gender based tertile and mean MMCSA values. Survival analysis was performed using the Kaplan-Meier and Cox regression methods. A total of 111 patients were included in the study. The average age was 74 years (range 65-92 years) and 69% were male. The majority of patients had malignancies of the oral cavity (41%) or larynx (37%). The overall survival was 46% with a follow-up between 24 and 60 months. MMCSA was significantly associated with worse overall survival when defined using a gender based mean cut-off point (p=0.038) or tertile groupings (p=0.026), but did not maintain significance in multivariable analysis. Masseter muscle defined sarcopenia was associated with worse survival in our cohort in univariate analysis. Opportunistic measurement of this new factor on staging scans may aid prognostication and management in older patients.

Altmetrics:

Reducing intra-hospital telephone communication time using app technology (2020)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Hamid M.

Citation:
BMJ Leader. Conference: Leaders in Healthcare Conference 2020. Virtual. 4(Supplement 1) (pp A42), 2020. Date of Publication: November 2020.

Abstract:
Background Lengthy switchboard waiting times result in delayed communication between healthcare professionals in a hospital. Wasted time impedes patient care, costs the Trust a substantial financial sum and impacts healthcare professional's morale. Aim(s): To reduce intra-hospital telecommunication time utilising the Induction phone application, an easy to use, regularly updated telephone directory. Method(s): Initial audit: Five chosen specialities were contacted between 9-10 AM from the Emergency department for 2 consecutive weeks. The time taken to reach each speciality via switchboard was recorded. A survey seeking the number of calls made per day, the preferred method of contact and the feelings associated with telephone waiting times was sent to department doctors. PDSA cycle 1: One-month application advertisement and re-audit. PDSA2: Eye-catching tele-directory board with the most used extensions and bleeps displayed in the department. Satisfaction survey sent post PDSA2. Sustainability: New doctors were provided induction information. Result(s): Initial average waiting time via switchboard was 48 seconds. The average calls made per doctor each day was 12. This calculated to a total departmental loss of 20.16 hours per week waiting on the phone, equating an annual loss of 26, 208. PDSA1: Average waiting times reduced to 12 seconds utilising the application; saving an estimate ~19,656 per annum. PDSA2: Instant availability of contact details on the display board further reduced waiting times to an average 6 seconds. 84% of doctors (n=16) disliked waiting more than 20 seconds, with associated feelings of frustration. 100% preferred the display board, then the use of the application before resorting to switchboard. 100% Sustainability was recorded one year later. Conclusion(s): The use of application technology reduces wasted time which hampers patient care; reduces Trust running costs; and improves health care professional's morale at work.

Link to full-text [no password required]

High-fidelity simulation on shoulder dystocia management in Greek Midwives: the SAFE study (2022)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Papoutsis D.; Klazoglou P.; Valasoulis G.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology. Conference: Royal College of Obstetricians and Gynaecologists World Congress, RCOG 2022. London United Kingdom. 129(Supplement 1) (pp 128), 2022. Date of Publication: June 2022.

Abstract:
Objective: The SAFE study is funded from the Hellenic Foundation for Research and Innovation and its primary objective is to explore and quantify how the knowledge and skills on shoulder dystocia management of Greek Midwives may improve following high-fidelity simulation. Design(s): A high-fidelity simulator that consisted of a pelvic model and a computerised neonatal mannequin with a built in force-monitoring system was utilised for the purposes of shoulder dystocia management in a one-day workshop. Registered midwives were invited to participate in groups of five in a 90-min training session during the workshop. Method(s): The training session consisted of a 30-minute initial assessment, a 30-minute theoretical and hands-on training from the instructor, and a 30-minute final assessment of participants. The outcomes measured involved the performance of maneuvers, the force applied on the neonatal head, the level of communication skills and self-reported confidence. These outcomes were recorded at the start and end of the training session. The checklist of performance involved 20 items in accordance with the RCOG guideline on shoulder dystocia. The force applied on the neonatal head was recorded with the force-monitoring system of the simulator. The communication skills and the self reported confidence of participants were measured on a numerical scale. The pre-and after-training scores of all four outcomes were compared and statistical analysis was applied. Result(s): There were n = 6 one-day workshops with 81 midwives participating in total (October-November 2021). Their mean age was 30.6 +/- 11.1 years old (median:25 years). Prior to training, only 6/81 (7.4%) managed to successfully deliver the impacted shoulder (defined as successful delivery of the posterior arm), with this increasing to 77/81 (95%) after training. The force applied to the neonatal head was similar pre-and after-training (pre:102.20 +/- 38.1 Newtons vs after: 102.13 +/- 27.7 Newtons), with a convergence of the outliers to the mean value. Performance scores (scale:0- 20) improved significantly almost three-fold (pre:5.75 +/- 3.8 vs after:15.63 +/- 2.5), and the self-reported confidence of participants (scale:0-10) increased almost two-fold (pre:3.2 +/- 1.9 vs after: 7.8 +/- 1.4). The communication skills of the participants (scale:0-5) also improved (pre: 2.90 +/- 1.1 vs after: 4.78 +/- 0.5). Those with the most improvement in their confidence were the participants with less clinical experience (r = ?0.329, p = 0.03). Conclusion(s): High-fidelity simulation on the management of shoulder dystocia at childbirth, even after a single training session, can significantly improve the performance score of maneuvers, the levels of confidence and the communication skills of Midwives.

Link to full-text [NHS OpenAthens account required]