Type of publication:
Service improvement case study
Author(s):
*Yvonne Herbert *Alison Lynn
Citation:
SaTH Improvement Hub, October 2023
Abstract:
Ensure all stock items are available, easily accessible and appropriate stock levels are agreed by October 2023, complying with IPC and Healthy and Safety regulations, including a reduction of 1% in holding
stock by October 2023.
Type of publication:
Service improvement case study
Author(s):
*Rachel Hanmer *Jackie Jones
Citation:
SaTH Improvement Hub, October 2023
Abstract:
To reduce the time taken to obtain the equipment and documentation required for a lumbar puncture
procedure by 75% by 1st October 2023.
Type of publication:
Service improvement case study
Author(s):
*Yvonne Herbert *Gary Francis
Citation:
SaTH Improvement Hub, October 2023
Abstract:
Ensure all stock items are available, easily accessible and appropriate stock levels are agreed by October 2023, complying with IPC and Healthy and Safety regulations, including a reduction of 1% in holding
stock by October 2023.
Type of publication:
Journal article
Author(s):
White, Billy; Ng, S M; Agwu, J C; Barrett, T G; Birchmore, N; Kershaw, M; Drew, J; Kavvoura, F; Law, J; Moudiotis, C; Procter, E; Paul, P; Regan, F; Reilly, P; Sachdev, P; *Sakremath, R; Semple, C; Sharples, K; Skae, M; Timmis, A; Williams, E; Wright, N; Soni, A.
Citation:
BMC Medicine. 22(1):144, 2024 Apr 02.
Abstract:
BACKGROUND: Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS: Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
Ayyaz, F M; Joyner, J; *Cheetham, M; Briggs, Twr; Gray, W K.
Citation:
Annals of the Royal College of Surgeons of England. 2024 Apr 02.
Abstract:
INTRODUCTION: The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS: This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic
cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS: Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December
2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of
prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS: Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
Polwart C.; Root T.; Tezcan S.; Meehan S.; Wetherill B.; Waterson C.; *Burnett B.; Chauhan R.; Al-Modaris I.; Walters-Davies R.
Citation:
medRxiv. (no pagination), 2024. Date of Publication: 11 Feb 2024.
Abstract:
Drug stability and compatibility are critical factors influencing cost and logistics of treatment delivery, therapeutic effectiveness, and patient safety. This is particularly significant in the realm of cancer chemotherapeutics, where stability and compatibility studies play a vital role in ensuring rational and safe medicine administration. Oxaliplatin, fluorouracil, and irinotecan, commonly used in various combination for gastrointestinal cancers, are complemented by co-administration of folinic acid in certain protocols. Notably, some folinic acid preparations include trometamol as an excipient, potentially impacting the stability of the chemotherapeutic agents if infused concomitantly. This study seeks to establish guidelines for oncology multidisciplinary teams, addressing potential risks associated with the combination of trometamol-containing folinic acid and chemotherapeutics. To achieve this, a quantitative questionnaire was distributed to members of the British Oncology Pharmacy Association (BOPA) and non-BOPA members through an online survey. Nineteen healthcare professionals with oncology experience, comprising 18 pharmacists and 1 nurse, completed the questionnaires. Each participant rated the validity and clarity of statements on a 5-point scale. The Delphi process concluded after the fourth round, consolidating the findings and recommendations from the multidisciplinary team. Twelve recommendations for safe practice have been made.
Link to full-text [open access - no password required]
Type of publication:
Journal article
Author(s):
*Butterworth J.; Los L.
Citation:
Medicine (United Kingdom). 52(3) (pp 174-180), 2024. Date of Publication: March 2024.
Abstract:
Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocyte concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal- and non-gastrointestinal-related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with symptoms suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.
Type of publication:
Journal article
Author(s):
Lauri, Chiara; Noriega-Alvarez, Edel; *Chakravartty, Riddhika M; Gheysens, Olivier; Glaudemans, Andor W J M; Slart, Riemer H J A; Kwee, Thomas C; Lecouvet, Frederic; Panagiotidis, Emmanouil; Zhang-Yin, Jules; Martinez, Jose Luis Lazaro; Lipsky, Benjamin A; Uccioli, Luigi; Signore, Alberto.
Citation:
European Journal of Nuclear Medicine & Molecular Imaging. 2024 Mar 27.
Abstract:
PURPOSE: Consensus on the choice of the most accurate imaging strategy in diabetic foot infective and non-infective complications is still lacking. This document provides evidence-based recommendations, aiming at defining which imaging modality should be preferred in different clinical settings. METHODS: This working group includes 8 nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), 3 radiologists and 3 clinicians (one diabetologist, one podiatrist and one infectious diseases specialist) selected for their expertise in diabetic foot. The latter members formulated some clinical questions that are not completely covered by current guidelines. These questions were converted into statements and addressed through a systematic analysis of available literature by using the PICO (Population/Problem-Intervention/Indicator-Comparator-Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria. RESULTS: Nine clinical questions were formulated by clinicians and used to provide 7 evidence-based recommendations: (1) A patient with a positive probe-to-bone test, positive plain X-rays and elevated ESR should be treated for presumptive osteomyelitis (OM). (2) Advanced imaging with MRI and WBC scintigraphy, or [18F]FDG PET/CT, should be considered when it is needed to better evaluate the location, extent or severity of the infection, in order to plan more tailored treatment. (3) In a patient with suspected OM, positive PTB test but negative plain X-rays, advanced imaging with MRI or WBC scintigraphy + SPECT/CT, or with [18F]FDG PET/CT, is needed to accurately assess the extent of the infection. (4) There are no evidence-based data to definitively prefer one imaging modality over the others for detecting OM or STI in fore- mid- and hind-foot. MRI is generally the first advanced imaging modality to be performed. In case of equivocal results, radiolabelled WBC imaging or [18F]FDG PET/CT should be used to detect OM or STI. (5) MRI is the method of choice for diagnosing or excluding Charcot neuro-osteoarthropathy; [18F]FDG PET/CT can be used as an alternative. (6) If assessing whether a patient with a Charcot foot has a superimposed infection, however, WBC scintigraphy may be more accurate than [18F]FDG PET/CT in differentiating OM from Charcot arthropathy. (7) Whenever possible, microbiological or histological assessment should be performed to confirm the diagnosis. (8) Consider appealing to an additional imaging modality in a patient with persisting clinical suspicion of infection, but negative imaging. CONCLUSION: These practical recommendations highlight, and should assist clinicians in understanding, the role of imaging in the diagnostic workup of diabetic foot complications.
Link to full-text [open access - no password required]
Altmetrics:
Type of publication:
Journal article
Author(s):
*Stock, Joanne; *Deshpande, Sanjeev A.
Citation:
Archives of Disease in Childhood. 109(4):351-353, 2024 Mar 19.
Abstract:
Link to full-text [no password required]
Altmetrics:
Type of publication:
Conference abstract
Author(s):
Abdelkhalek M.; Elshahat A.; *Aboshehata A.; Baidoun H.; Turk S.; Rashed M.A.; Rzk F.M.; Ellabban M.H.; Elneny M.
Citation:
JACC: Cardiovascular Interventions. Conference: CRT 2024, Cardiovascular Research Technologies. Washington Hilton, Washington, DC United States. 17(4 Supplement) (pp S31-S32), 2024. Date of Publication: 26 Feb 2024.
Abstract:
Background: Rivaroxaban, a novel oral anticoagulant, inhibits factor Xa and has gained significant usage in clinical settings since the onset of the COVID-19 pandemic. It is widely believed that Rivaroxaban effectively reduces the occurrence of thromboembolic events in individuals who have contracted COVID-19. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Rivaroxaban in preventing thromboembolic events in patients with COVID-19 infection. Method(s): A comprehensive literature search was conducted, and randomized controlled trials (RCTs) and observational studies comparing Rivaroxaban with control groups were included. The primary outcomes assessed were venous thromboembolism, mortality. Safety outcomes, specifically bleeding events. Result(s): A total of 9 studies involving 5484 patients were included in the final analysis. The meta-analysis showed that Rivaroxaban has a significant advantage in preventing venous thromboembolism (RR=0.17, 95% CI [0.06 to 0.54], P=0.002). Regarding mortality, Rivaroxaban was associated with a lower risk compared to the control group (RR=0.55, 95% CI [0.31 to 0.96], P=0.04), particularly in the cardiovascular mortality subgroup (RR=0.14, 95% CI [0.05 to 0.45], P=0.0008). The Rivaroxaban had a higher risk of bleeding events (RR=3.28, 95%CI [1.54 to 6.97], P=0.002). Conclusion(s): This systematic review and meta-analysis suggest that Rivaroxaban effectively reduces mortality and prevents venous thromboembolism. However, it was associated with a higher risk of bleeding events compared to the control group. These findings provide valuable insights into using Rivaroxaban to prevent thromboembolic events. [Formula presented]
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.