Author: Jason Curtis

Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress (2019)

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Type of publication:
Journal article

Author(s):
Combes G.; Damery S.; Sein K.; Allen K.; *Nicholas J. ; Baharani J.

Citation:
PLoS ONE; 2019; vol. 14 (no. 11)

Abstract:
Objectives To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.
Methods Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory.
Results Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to.
Conclusions Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.

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Pitfalls in the study of neovascularisation in achilles and patellar tendinopathy: a review of important factors for clinicians to consider and the need for greater standardisation (2019)

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Type of publication:
Journal article

Author(s):
Fallows, R. and *Lumsden, G.

Citation:
Physical Therapy Reviews; Dec 2019 Vol. 24(6) p.346-357

Abstract:
Background: The search for new vessels in pathological tendons is a relatively new field. In spite of a rapid growth in research and clinical experience, there is still poor agreement in the musculoskeletal community regarding the significance and measurement of so called “neovascularisation”. Any relationship between vascularity, tendon healing, degeneration and pain is not yet clear, as it has been considered as a normal physiological adaptation to loading yet also seen in chronic painful Achilles tendons. An expression of the degree of “neovascularisation” could potentially have significance if the amount of neovascularisation could be related to the degree of symptoms or dysfunction caused by the pathology in the tendon.
Objectives: This review examines the potential variables that can affect the quantification of the Doppler signal in Achilles and patellar tendinopathy under three perspectives. Firstly, the variables that arise from the actual technology that allows the capturing of the Doppler signal from intra-tendinous microvasculature flow, secondly by an awareness of known and highly likely physiological factors that may alter the rate of flow and thirdly by an exploration describing the actual methods and qualities of acquiring quantitative data of the microvascular flow with Doppler.
Methods: A literature search was conducted across AMED, CINAHL, Google Scholar, SPORTDiscus, MEDLINE and NCBI (PubMed) for studies related to the qualitative or quantitative measure of the Doppler signal in relation to a clinical outcome of Achilles or patellar tendinopathy. Parameters regarding machine settings and examination conditions were extracted to identify the utilisation of important factors and consistency with a narrative analysis.
Discussion: Many of these influential factors have never been controlled for in previous studies and the methods have been unreliable and poorly reported. There is a need for international agreement on a standardised protocol in the assessment of the microvascularity of tendons, which could then help determine if the quantification of “neovascularisation” is a reliable and clinically relevant finding.

 

Audit of Brivaracetam in a Secondary Level Epilepsy Service (2019)

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Type of publication:
Poster presentation

Author(s):
Rowe, J., Youssef, C., Tittensor, P., Manfredonia, F., *Smyth, C., Doherty, C.

Citation:
Poster presentation at ILAE British Branch Annual Scientific Meeting, 2-4 October 2019, Birmingham

Abstract:
A multicentre audit of the use Brivaracetam was carried out. Data were collated from 3 sites, The Royal Wolverhampton NHS Trust, Shrewsbury and Telford Hospitals NHS Trust and Walsall Healthcare NHS Trust Brivaracetam has shown efficacy and good tolerability and our experience suggests that it is a suitable add-on treatment for patients with refractory focal epilepsy. The very low rate of discontinuation for mood or behaviour reasons, particularly in the ID patients, indicates that it has the potential to be a positive choice for people with ID where issues have been noted on other medications, most notably Levetiracetam.

 Final Poster [PDF]

Patients’ and partners’ views of care and treatment provided for metastatic castrate‐resistant prostate cancer in the UK (2019)

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Type of publication:
Journal article

Author(s):
Catt S, Matthews L, May S, Payne H, Mason M, Jenkins V.

Citation:
European Journal of Cancer Care. 2019 Nov;28(6):e13140.

Note:
14 of the 37 participants were recruited from the Royal Shrewsbury Hospital

Abstract:
OBJECTIVE: Documentations of the experiences of patients with advanced prostate cancer and their partners are sparse. Views of care and treatment received for metastatic castrate-resistant prostate cancer (mCRPC) are presented here.
METHODS: Structured interviews conducted within 14 days of a systemic therapy for mCRPC starting and 3 months later explored the following: treatment decisions, information provision, perceived benefits and harms of treatment, and effects of these on patients' and partners' lives.
RESULTS: Thirty-seven patients and 33 partners recruited from UK cancer centres participated. The majority of patients (46%) reported pain was their worst symptom and many wanted to discuss its management (baseline-50%; 3 months-33%). Patients and partners believed treatment would delay progression (>75%), improve wellbeing (33%), alleviate pain (≈12%) and extend life (15% patients, 36% partners). At 3 months, most men (42%) said fatigue was the worst treatment-related side effect (SE), 27% experienced unexpected SEs and 54% needed help with SEs. Most patients received SE information (85% written; 75% verbally); many additionally searched the Internet (33% patients; 55% partners). Only 54% of patients said nurse support was accessible.
CONCLUSION: Pain and other symptom management are not optimal. Increased specialist nurse provision and earlier palliative care links are needed. Dedicated clinics may be justified.

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Home haemodialysis: barriers and stepping stones (2019)

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Type of publication:
Journal article

Author(s):
*Nair, Sunita; *Kanbar, Ammar; Bajo, Maria

Citation:
Journal of Kidney Care; Sep 2019; vol. 4 (no. 5); p. 240-245

Abstract:
Despite national recommendations and well-chronicled benefits for extended hours home haemodialysis, uptake remains poor. The issues surrounding this are multifactorial. There are barriers to uptake at all levels of care—patient, clinician and commissioning. This article looks at some of those barriers and addresses them.

6 versus 12 months of adjuvant trastuzumab for HER2-positive early breast cancer (PERSEPHONE): 4-year disease-free survival results of a randomised phase 3 non-inferiority trial (2019)

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Type of publication:
Randomised controlled trial

Author(s):
Helena M Earl, Louise Hiller, Anne-Laure Vallier, Shrushma Loi, Karen McAdam, Luke Hughes-Davies, Adrian N Harnett, Mei-Lin Ah-See, Richard Simcock, Daniel Rea, Sanjay Raj, Pamela Woodings, Mark Harries, Donna Howe, Kerry Raynes, Helen B Higgins, Maggie Wilcox, Chris Plummer, Janine Mansi, Ioannis Gounaris, Betania Mahler–Araujo, Elena Provenzano, Anita Chhabra, Jean E Abraham, Carlos Caldas, Peter S Hall, Christopher McCabe, Claire Hulme, David Miles, Andrew M Wardley, David A Cameron, Janet A Dunn on behalf of PERSEPHONE Steering Committee and Trial Investigators.

Randomising consultants at the Royal Shrewsbury Hospital were: *Huzeifa Gadir, *Laura Pettit, *Rajiv Agrawal, and *Sheena Khanduri. Principal investigator at the Royal Shrewsbury Hospital was: *Laura Pettit.

Citation:
Lancet 2019; 393: p. 2599–612

Abstract:
Background: Adjuvant trastuzumab significantly improves outcomes for patients with HER2-positive early breast cancer. The standard treatment duration is 12 months but shorter treatment could provide similar efficacy while reducing toxicities and cost. We aimed to investigate whether 6-month adjuvant trastuzumab treatment is noninferior to the standard 12-month treatment regarding disease-free survival.
Methods: This study is an open-label, randomised phase 3 non-inferiority trial. Patients were recruited from 152 centres in the UK. We randomly assigned patients with HER2-positive early breast cancer, aged 18 years or older, and with a clear indication for chemotherapy, by a computerised minimisation process (1:1), to receive either 6-month or 12-month trastuzumab delivered every 3 weeks intravenously (loading dose of 8 mg/kg followed by maintenance doses of 6 mg/kg) or subcutaneously (600 mg), given in combination with chemotherapy (concurrently or sequentially). The primary endpoint was disease-free survival, analysed by intention to treat, with a non-inferiority margin of 3% for 4-year disease-free survival. Safety was analysed in all patients who received trastuzumab. This trial is registered with EudraCT (number 2006–007018–39), ISRCTN (number 52968807), and ClinicalTrials.gov (number NCT00712140).
Findings: Between Oct 4, 2007, and July 31, 2015, 2045 patients were assigned to 12-month trastuzumab treatment and 2044 to 6-month treatment (one patient was excluded because they were double randomised). Median follow-up was 5·4 years (IQR 3·6–6·7) for both treatment groups, during which a disease-free survival event occurred in 265 (13%) of 2043 patients in the 6-month group and 247 (12%) of 2045 patients in the 12-month group. 4-year disease-free survival was 89·4% (95% CI 87·9–90·7) in the 6-month group and 89·8% (88·3–91·1) in the 12-month group (hazard ratio 1·07 [90% CI 0·93–1·24], non-inferiority p=0·011), showing non-inferiority of the 6-month treatment. 6-month trastuzumab treatment resulted in fewer patients reporting severe adverse events (373 [19%] of 1939 patients vs 459 [24%] of 1894 patients, p=0·0002) or stopping early because of cardiotoxicity (61 [3%] of 1939 patients vs 146 [8%] of 1894 patients, p<0·0001).
Interpretation: We have shown that 6-month trastuzumab treatment is non-inferior to 12-month treatment in patients with HER2-positive early breast cancer, with less cardiotoxicity and fewer severe adverse events. These results support consideration of reduced duration trastuzumab for women at similar risk of recurrence as to those included in the trial.

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

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Midwifery Identification, Stabilisation and Transfer of the Sick Newborn (MIST) (2019)

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Type of publication:
E-learning package

Author(s):
*Wendy Tyler, Alan Fenton, Scott Mountifield, Leanne Hargreaves, Claire Beattie

Citation:
e-Learning for Healthcare

Abstract:
This e-learning programme is aimed at midwifery and ambulance personnel to support the treatment plan for newborn babies who are, or have the potential to become, unwell following delivery in a community setting. The resources are designed to equip maternity and emergency teams with the knowledge required to extend care beyond the first minutes after birth, up to and including handover to the neonatal team.

The programme consists of four e-learning sessions and covers several clinical scenarios from normal variation to significant illness.

It is expected that by completing all four sessions within this programme, you will be able to:

  • Recognise normal and abnormal infant colour (anaemia and cyanosis)
  • Recognise normal and abnormal feeding patterns and abdominal signs
  • Support an infant born unexpectedly preterm
  • Support a baby born in an unexpectedly poor condition

Each session will cover identification, management including stabilisation and communication, and transfer to a neonatal unit.

This programme is the result of a collaboration between Health Education England’s e-Learning for Healthcare, The Shrewsbury and Telford Hospital NHS Trust and The Newcastle upon Tyne Hospitals NHS Foundation Trust. It was also made possible through the support of Shrewsbury and Telford Hospital NHS Trust, as part of a successful bid from HEE.

All the resources for this programme have been written by subject specialists and experts in this field.

Link to full-text [registration required to use package]

Breast Screening Age Extension; High Cancer Pick up Rate of Small Breast Cancers Amenable to Breast and Axillary Conservation (2019)

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Type of publication:
Conference abstract

Author(s):
*Cielecki L. ; *Burley S.; *Lake B.; *Williams S.; *Appleton D.

Citation:
European Journal of Surgical Oncology; Nov 2019; vol. 45 (no. 11); p. 2212-2213

Abstract:
Background: In 2012, Public Health England (PHE) extended the age range for breast screening up to 73. For screening to be an effective tool, one of the Wilson criteria is to detect disease that could be treated at an early stage. This audit aimed to measure the effectiveness of the upper age screening extension in Shropshire by comparing the cancer diagnosis rate to general screening population, size of cancer, and the ability to perform breast conservation.
Method(s): Retrospective analysis of Breast Screening age extension of women invited to be screened aged 71 to 73 years old in Shropshire. Data included number of women invited, uptake rate, recall rate, cancer diagnosis and surgical treatment.
Result(s): 5517 older women were invited into Shropshire Breast Screening Programme as part of the AgeX trial by PHE since September 2014. 4801 women attended and were screened; 87% uptake rate, which exceeds BSP attendance rate of >80%. 104 women were recalled to assessment (2.1%) which is below BSP standard of <5% recall rate for incident screens. 46.1% (48) of women recalled to assessment were given a cancer diagnosis, this is compared to 30.5% in general screening population. 41.6% of the invasive cancer was <15mm. 95.8% of patients had surgery, with 70.8% of patients having breast and axillary conservation surgery.
Conclusion(s): BSP Standards uptake rate and recall rate have been exceeded by upper age extension. Our experience shows high cancer pick up rate of small cancers with the majority patients able to have breast conserving surgery.

A case series of vulvar Paget's disease in women from two different clinical settings (2019)

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Type of publication:
Conference abstract

Author(s):
*Papoutsis D.; Borella F.

Citation:
Journal of Lower Genital Tract Disease; Oct 2019; vol. 23 (no. 4S):S37-S81

Abstract:
Objectives: Vulvar Paget's disease (VPD) is an extremely rare neoplasm that accounts for less than 1% of vulvar pre-malignancies/malignancies. We present four cases of women diagnosed with VPD.
Method(s): The databases of two tertiary hospitals (one in the United Kingdom and one in Italy) were searched for cases of VPD and information was retrieved. We present the clinical manifestation and management of four cases of VPD.
Result(s): The first case involved a 77-year old woman with vulvar soreness for more than two months unresponsive to topical antifungals. On examination a 2 cm velvety-red colored left labial lesion was noted. Due to the small-sized lesion she was offered vulvar surgery and at follow-up she has no signs of recurrence. The second case involved a 62-year old woman with a history of stage T1b breast cancer. She presented with a 5×3 cm left labial lesion that extended to the perianal areas. Due to the large lesion size she was offered topical
imiquimod and at follow-up she has no recurrence. The third case involved a 62-year old woman presenting with vulvar itching for about 18 months. She had a previous history of colon cancer that was surgically treated. She underwent wide local excision of the vulvar lesion that measured 5 cm . Due to VPD recurrence after 4 months she was further treated with imiquimod and at follow-up she is disease-free. The fourth case involved a 64-year old woman complaining of vulvar itching and burning for about 8 months. She was initially treated with
imiquimod but due to disease persistence she had a hemivulvectomy. At follow-up she has signs of VPD but declines any other treatment.
Conclusion(s): We report four cases of VPD. The clinical features of VPD were similar and the treatment was dictated by the vulvar lesion size, the multidisciplinary team consensus, and the patient's choice.