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Does tranexamic acid really matter in reducing blood loss? A critical evaluation of its efficacy in orthognathic surgery through a comprehensive systematic review and meta-analysis (2024)

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Type of publication:
Systematic Review

Author(s):
Mortada, Hatan; Hussain, Samar Ali; Liyanage, Dinithi Dilruvi; Zou, Yutong; Subbiah, Praveen; *George, Jefferson; Mansour, Hamid Reza Khademi; Khajuria, Ankur.

Citation:
British Journal of Oral & Maxillofacial Surgery. 2024 Jul 09.

Abstract:
Tranexamic acid (TXA) is acknowledged for reducing blood loss and transfusion requirements in various surgical specialties, yet its role in orthognathic procedures is less defined. Our study seeks to fill this knowledge gap by reviewing the available data and summarising the efficacy and clinical outcomes of TXA in orthognathic surgery. We performed a systematic review and meta-analysis, searching five databases for studies until 16 April, 2023. Our key outcome measures were intraoperative blood loss, postoperative bleeding, and transfusion rate. Previous weaknesses in systematic review and meta-analyses (SRMA) were identified using Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2). The risk of bias was evaluated with the RoB-2 tool. A total of 15 studies were included, involving a combined total of 1060 patients. Compared with the control, the TXA group demonstrated significant reductions in intraoperative blood loss (mean difference -135.60 mL; p < 0.00001; 95% CI, -177.51 to -93.70 mL), Hb level drop (mean difference: 2.67 [-0.63, 5.98]), and improved surgical field visibility [p < 0.00001. (MD -0.99) (CI -1.11 to -0.86)]. No significant differences were observed in postoperative haematocrit levels (mean difference: -0.42 [-2.19, 1.35]; p = 0.003; I2 = 75%), operation duration (p = 0.21), or duration of hospital stay (p = 0.63) between TXA and control groups. In orthognathic surgery, TXA effectively minimises blood loss, demonstrating both safety and efficiency. Well-designed, larger studies and comparisons with other haemostatic agents could solidify TXA evidence.

Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study (2024)

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Type of publication:
Journal article

Author(s):
Connor, Martin J; Genie, Mesfin; Dudderidge, Tim; Wu, Hangjian; Sukumar, Johanna; Beresford, Mark; Bianchini, Diletta; Goh, Chee; Horan, Gail; Innominato, Pasquale; Khoo, Vincent; Klimowska-Nassar, Natalia; Madaan, Sanjeev; Mangar, Stephen; McCracken, Stuart; Ostler, Peter; Paisey, Sangeeta; Robinson, Angus; Rai, Bhavan; Sarwar, Naveed; *Srihari, Narayanan; Jayaprakash, Kamal Thippu; Varughese, Mohini; Winkler, Mathias; Ahmed, Hashim U; Watson, Verity.

Citation:
European Urology Oncology. 2024 Jul 06. [epub ahead of print]

Abstract:
BACKGROUND AND OBJECTIVE: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. METHODS: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. KEY FINDINGS AND LIMITATIONS: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. PATIENT SUMMARY: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.

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Automating incidence and prevalence analysis in open cohorts (2024)

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Type of publication:
Journal article

Author(s):
Cockburn, Neil; Hammond, Ben; Gani, Illin; Cusworth, Samuel; Acharya, Aditya; Gokhale, Krishna; Thayakaran, Rasiah; Crowe, Francesca; Minhas, Sonica; *Smith, William Parry; Taylor, Beck; Nirantharakumar, Krishnarajah; Chandan, Joht Singh.

Citation:
BMC Medical Research Methodology. 24(1):144, 2024 Jul 04.

Abstract:
MOTIVATION: Data is increasingly used for improvement and research in public health, especially administrative data such as that collected in electronic health records. Patients enter and exit these typically open-cohort datasets non-uniformly; this can render simple questions about incidence and prevalence time-consuming and with unnecessary variation between analyses. We therefore developed methods to automate analysis of incidence and prevalence in open cohort datasets, to improve transparency, productivity and reproducibility of analyses. IMPLEMENTATION: We provide both a code-free set of rules for incidence and prevalence that can be applied to any open cohort, and a python Command Line Interface implementation of these rules requiring python 3.9 or later. GENERAL FEATURES: The Command Line Interface is used to calculate incidence and point prevalence time series from open cohort data. The ruleset can be used in developing other implementations or can be rearranged to form other analytical questions such as period prevalence. AVAILABILITY: The command line interface is freely available from https://github.com/THINKINGGroup/analogy_publication

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Supporting Quality Improvement within the Stroke and Rehab Therapy Team (2022)

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Type of publication:
Service improvement case study

Author(s):
*Erin Tsang (Therapy Quality Improvement Lead)

Citation:
SaTH Improvement Hub, 2022

Abstract:
NHS Staff Survey results, staff listening events and informal feedback indicated reduced levels of staff engagement and opportunities for Quality Improvement within the inpatient therapy teams at PRH and RSH. Despite embedding national job planning initiatives within the Therapy Centre, staff reported feeling unable to take their allocated Supporting Professional Activities (SPA) time and felt unable to meet the conflicting demands of their job. A model of monthly Quality Improvement Half Day (QIHD) was trialed in October and November 2022 in the Stroke and Rehab Therapy team to offer therapy staff an opportunity for regular, protected SPA time as a whole team. As a result 90% of the team felt that the sessions allowed them to develop and demonstrate their leadership skills and the team were able to implement a number of service improvement projects.

Link to PDF poster [no password required]

Pharmacy Storeroom, PRH (2022)

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Type of publication:
Service improvement case study

Author(s):
*Kirsty Heathcock, *Imogen Brown

Citation:
SaTH Improvement Hub, October 2022

Abstract:
The pharmacy team noted that a store room area was cluttered and contained unnecessary equipment. Additionally, it was noted that there was a requirement for pharmacy students to have a dedicated study space. A study space was created for use during the 5S intervention.

Link to PDF poster [no password required]

Improved efficiency and safety Drugs Trolley (2022)

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Type of publication:
Service improvement case study

Author(s):
*Mary Tanes (Ward Manager) and *David Strachan

Citation:
SaTH Improvement Hub, November 2022

Abstract:
Colleagues are currently covering multiple staffing gaps and each drugs trolley has a variety of drugs and a different layout. Variation can result in delays to patients receiving their medication or receiving the wrong medication in error along with poor staff satisfaction. Following a meeting with the Deputy Director of Nursing- Medicine, it was requested that all wards within the division reviewed the drugs trolleys on the ward area and were encouraged to utilise 5S principles.

Link to PDF poster [no password required]