Open access

Fear of reinjury after acute Achilles tendon rupture is related to poorer recovery and lower physical activity postinjury (2024)

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Type of publication:

Journal article

Author(s):

Larsson, Elin; LeGreves, Agnes; Brorsson, Annelie; Eliasson, Pernilla; Johansson, Christer; *Carmont, Michael R; Nilsson Helander, Katarina.

Citation:

Journal of Experimental Orthopaedics. 11(4):e70077, 2024 Oct.

Abstract:

Purpose: The aim of this study was to investigate how fear of reinjury to the Achilles tendon affects return to previous levels of physical activity and self-reported Achilles tendon Total Rupture Score (ATRS) outcomes.

Methods: Data were collected from a large cohort of patients treated for an acute Achilles tendon rupture at Sahlgrenska University Hospital Molndal between 2015 and 2020. The ATRS and additional questions concerning fear of reinjury, treatment modality, satisfaction of treatment and recovery were analyzed 1-6 years postinjury. Analysis was performed to determine the impact of fear of reinjury on patient-reported recovery and physical activity.

Results: Of a total of 856 eligible patients, 550 (64%) answered the self-reported questionnaire and participated in the follow-up. Of the participants, 425 (77%) were men and 125 (23%) were women. ATRS, recovery in percentage, satisfaction of treatment, recovery on a 5-point scale and physical activity level post- versus preinjury were significantly related to fear of reinjury (p < 0.001). Of the nonsurgically treated patients, 59% reported fear of reinjury compared to 48% of the surgically treated patients (p = 0.024) Patients that reported fear of reinjury had a 15-point lower median ATRS score than those who did not (p < 0.001).

Conclusion: More than half of patients who have suffered an Achilles tendon rupture are afraid of reinjuring their tendon. Patients who reported fear of reinjury exhibited a significantly lower ATRS score. This indicates the importance of addressing psychological aspects in the treatment after this injury.

Level of Evidence: Level II.

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Monoclonal Gammopathy of Multisystemic Significance: A Challenging Diagnosis of Light Chain Amyloidosis (2024)

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Type of publication:

Journal article

Author(s):

*Owolabi, Olasunkanmi; *Yera, Hassan O; *Jenkins, Kathryn; *Pakala, Vijay; *Kundu, Suman.

Citation:

Cureus. 16(10):e72010, 2024 Oct.

Abstract:

We present a case of a 51-year-old woman diagnosed with light chain amyloidosis associated with monoclonal gammopathy of undetermined significance (MGUS). Initially, she presented with symptoms of heart failure, including palpitations, chest tightness, and shortness of breath, which were attributed to myocarditis based on cardiac magnetic resonance (CMR) imaging findings. However, her condition rapidly deteriorated, with recurrent admissions for worsening heart failure, cardiogenic shock, and stroke. A cardiac biopsy ultimately confirmed light chain amyloidosis, a rare complication of MGUS, which has a long-term risk of 0.8% in patients with light chain MGUS. Despite aggressive treatment, including chemotherapy and biventricular assist device implantation, her condition continued to decline, and she became ventilator-dependent and subsequently passed away. This case highlights the importance of considering amyloidosis in patients with MGUS and underscores the need for early diagnosis and intervention to prevent catastrophic outcomes.

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Enhancing Junior Doctors' Preparedness and Satisfaction in Trauma and Orthopaedics: A Quality Improvement Project With the Development of a Comprehensive Guidebook (2024)

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Type of publication:

Journal article

Author(s):

Mohammed, Ghulam Dastagir Faisal; *Younis, Zubair; Amin, Jebran; Mansoor, Zaina; Lingnau, Leonie; Jesudason, Edwin P.

Citation:

Cureus. 16(9):e70061, 2024 Sep.

Abstract:

BACKGROUND: Junior doctors often feel underprepared for their trauma and orthopaedics (T&O) rotation due to limited exposure during medical school and inadequate support. This project aimed to enhance junior doctors' preparedness and satisfaction during their T&O rotation by developing a comprehensive guidebook that addresses key orthopaedic knowledge and logistical challenges. METHODS: A quality improvement project (QIP) was conducted at Ysbyty Gwynedd Hospital. Initial surveys identified factors contributing to poor experiences during the trauma and orthopaedics rotation, including limited knowledge of orthopaedic emergencies and a lack of useful reference resources. A guidebook was developed and refined through multiple plan-do-study-act (PDSA) cycles. The guidebook covered topics such as orthopaedic emergencies, common injuries, referral pathways, and hospital logistics, presented in an accessible flowchart format. RESULTS: The primary objective of achieving 75% satisfaction among junior doctors was successfully met, with satisfaction increasing from four (40%) to eight (80%) doctors in the most recent survey. Secondary outcomes included a marked improvement in the understanding of quality improvement projects, rising from three (30%) to eight (80%) doctors. Orthopaedic knowledge also saw a significant enhancement, increasing from four (40%) to nine (90%) doctors. Confidence in handling night on-call duties improved dramatically, with all 10 doctors (100%) reporting increased confidence, compared to four (40%) doctors initially. Additionally, seven doctors (70%) expressed a greater interest in pursuing a career in orthopaedic surgery. CONCLUSION: The comprehensive guidebook significantly improved junior doctors' preparedness and satisfaction during their T&O rotation. While the guidebook is a valuable resource, ongoing mentorship and hands-on experience remain essential for long-term success. Replication of this project across other departments and hospitals is recommended to assess its broader applicability and impact.

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Hypoxia-associated gene signatures are not prognostic in high-risk localised prostate cancers undergoing androgen deprivation therapy with radiotherapy (2024)

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Type of publication:

Journal article

Author(s):

Reardon, Mark D; Bibby, Becky As; Thiruthaneeswaran, Niluja; Pereira, Ronnie R; Mistry, Hitesh; More, Elisabet; Tsang, Yatman; Vickers, Alexander; Reeves, Kimberley; Henry, Ann; *Denley, Helen; Wylie, James; Spratt, Daniel; Hakansson, Alex; Ryu, Monica; Smith, Tim Ad; Hoskin, Peter J; Bristow, Robert; Choudhury, Ananya; West, Catharine Ml.

Citation:

International Journal of Radiation Oncology, Biology, Physics. 2024 Oct 16.

Abstract:

PURPOSE: Men with high-risk prostate cancer (PCa) are treated with androgen deprivation therapy (ADT) and radiotherapy, but the disease reoccurs in 30% of patients. Biochemical recurrence of PCa after treatment is influenced by tumour hypoxia. Tumours with high levels of hypoxia are aggressive, resistant to treatment, and have increased metastatic capacity. Gene expression signatures derived from diagnostic biopsies can predict tumour hypoxia and radiosensitivity, but none are in routine clinical use, due to concerns about the applicability of these biomarkers to new patient cohorts. There has been no or limited testing in cohorts of high-risk PCa. METHODS AND MATERIALS: We generated transcriptomic data for cohorts of high-risk PCa patients. Patients were treated with ADT followed by external beam radiotherapy with or without a brachytherapy boost. Biomarkers curated from the literature were calculated from pre-treatment biopsy gene expression data. The primary endpoint for survival analyses was biochemical recurrence-free survival (bRFS) and the secondary endpoints were distant metastasis-free survival (DMFS) and overall survival. RESULTS: The performance of the selected biomarkers was poor, with none achieving prognostic significance for bRFS or DMFS in any cohort. The brachytherapy boost cohort received shorter durations of ADT than the conventionally fractionated or hypofractionated cohorts (Wilcoxon rank sum test, p=2.1×10-18 and 2.3×10-10 respectively) and had increased risk of distant metastasis (log-rank test, p=8×10-4). There were no consistent relationships between biomarker score and outcome for any of the endpoints. CONCLUSIONS: Hypoxia and radiosensitivity biomarkers were not prognostic in high-risk PCa patients treated with ADT plus radiotherapy. We speculate that the lack of prognostic capability could be caused by the variable hypoxia-modifying effects of the ADT that these high-risk patients received before and during definitive treatment with radiotherapy. A deeper understanding of biomarker construction, performance and inter-cohort transferability in relation to patient characteristics, sample handling and treatment modalities is required before hypoxia biomarkers can be recommended for routine clinical use in the pre-treatment setting.

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The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research (2024)

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Type of publication:

Journal article

Author(s):

*Elsmore, Amy; Rai, Tanvi; Pallmann, Philip; Townson, Julia; Kotecha, Sarah; Black, Mairead; Sanders, Julia; Collis, Rachel; Collins, Peter; Karunakaran, Bala; Wu, Pensee; Bell, Sarah; *Parry-Smith, William

Citation:

Trials. 25(1):629, 2024 Sep 27.

Abstract:

BACKGROUND: Obstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. traditionally, decisions regarding site selection are based on desire to complete trials on target in 'tried and tested' research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK. METHOD: Using routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard. RESULTS: The dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented. CONCLUSION: The NIHR equality, diversity and inclusion strategy states studies must widen

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Interpretable Machine Learning for Predicting Multiple Sclerosis Conversion from Clinically Isolated Syndrome (2024)

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Type of publication:
Journal article

Author(s):
Daniel E.C.; Tirunagari S.; Batth K.; Windridge D.; *Balla Y.

Citation:
medRxiv. (no pagination), 2024. Date of Publication: 19 Jul 2024. [preprint]

Abstract:
Background: Machine learning (ML) prediction of clinically isolated syndrome (CIS) conversion to multiple sclerosis (MS) could be used as a remote, preliminary tool by clinicians to identify high-risk patients that would benefit from early treatment. Objective(s): This study evaluates ML models to predict CIS to MS conversion and identifies key predictors. Method(s): Five supervised learning techniques (Naive Bayes, Logistic Regression, Decision Trees, Random Forests and Support Vector Machines) were applied to clinical data from 138 Lithuanian and 273 Mexican CIS patients. Seven different feature combinations were evaluated to determine the most effective models and predictors. Result(s): Key predictors common to both datasets included sex, presence of oligoclonal bands in CSF, MRI spinal lesions, abnormal visual evoked potentials and brainstem auditory evoked potentials. The Lithuanian dataset confirmed predictors identified by previous clinical research, while the Mexican dataset partially validated them. The highest F1 score of 1.0 was achieved using Random Forests on all features for the Mexican dataset and Logistic Regression with SMOTE Upsampling on all features for the Lithuanian dataset. Conclusion(s): Applying the identified high-performing ML models to the CIS patient datasets shows potential in assisting clinicians to identify high-risk patients.

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Clinical decision support systems for maternity care: a systematic review and meta-analysis. (2024)

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Type of publication:
Journal article

Author(s):
Cockburn N.; Osborne C.; Withana S.; *Elsmore A.; *Nanjappa R.; South M.; *Parry-Smith W.; Taylor B.; Chandan J.S.; Nirantharakumar K.

Citation:
eClinicalMedicine. 76 (no pagination), 2024. Article Number: 102822. Date of Publication: October 2024.

Abstract:
Background: The use of Clinical Decision Support Systems (CDSS) is increasing throughout healthcare and may be able to improve safety and outcomes in maternity care, but maternity care has key differences to other disciplines that complicate the use of CDSS. We aimed to identify evaluated CDSS and synthesise evidence of their impact on maternity care. Method(s): We conducted a systematic review for articles published before 24th May 2024 that described i) CDSS that ii) investigated the impact of their use iii) in maternity settings. Medline, CINAHL, CENTRAL and HMIC were searched for articles relating to evaluations of CDSS in maternity settings, with forward- and backward-citation tracing conducted for included articles. Risk of bias was assessed using the Mixed Methods Assessment Tool, and CDSS were described according to the clinical problem, purpose, design, and technical environment. Quantitative results from articles reporting appropriate data were meta-analysed to estimate odds of a CDSS achieving its desired outcome using a multi-level random effects model, first by individual CDSS and then across all CDSS. PROSPERO ID: CRD42022348157. Finding(s): We screened 12,039 papers and included 87 articles describing 47 unique CDSS. 24 articles (28%) described randomised controlled trials, 30 (34%) described non-randomised interventional studies, 10 (11%) described mixed methods studies, 10 (11%) described qualitative studies, 7 (8%) described quantitative descriptive studies, and 7 (8%) described economic evaluations. 49 (56%) were in High-Income Countries and 38 (44%) in Low- and Middle-Income countries, with no CDSS trialled in both income categories. Meta-analysis of 35 included studies found an odds ratio for improved outcomes of 1.69 (95% confidence interval 1.24-2.30). There was substantial variation in effects, aims, CDSS types, context, study designs, and outcomes. Interpretation(s): Most CDSS evaluations showed improvements in outcomes, but there was heterogeneity in all aspects of design and evaluation of systems. CDSS are increasingly important in delivering healthcare, and Electronic Health Records and mHealth will increase their availability, but traditional epidemiological methods may be limited in guiding design and demonstrating effectiveness due to rapid CDSS development lifecycles and the complex systems in which they are embedded. Development methods that are attentive to context, such as Human Centred Design, will help to meet this need.

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To study morbidity and mortality related to ileostomy/colostomy closure at tertiary care hospital (2024)

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Type of publication:
Journal article

Author(s):
Gilani S.S.; *Shahzeb M.; Salman D.M.; Nadeem M.; Khan S.; Thomas J.J.; Almesri A.

Citation:
Journal of Population Therapeutics and Clinical Pharmacology. 31(8) (pp 853-858), 2024. Date of Publication: 01 Aug 2024.

Abstract:
Background and Aim: Gastrointestinal stomas main function is to divert the flow away from a difficult anastomoses or intestinal obstruction. There is now a trend toward avoiding permanent stomas, and temporary loop stomas often used to protect anastomotic or distal bowel segments in high-risk patients. The present study aimed to determine the morbidity-mortality after ileostomy or colostomy closure. Patients and Methods: This comparative observational study investigated 42 cases of ileostomy and colostomy closure in the Surgical Unit of Jinnah Hospital, Lahore from January 2020 to January 2024. Patients were divided into two groups; Group-I (Ileostomy closure) and Group-II (Colostomy closure). Demographic details such as age and gender, Clinical details such as indications, types of stoma technique used, and operative times, length of hospital stay, morbidity, and mortality recorded. SPSS version 26 was used for data analysis. Result(s): The overall mean age was 46.8+/-6.52 years (15-75 years). Out of 42 cases, 28 (66.7%) underwent ileostomy and 14 (33.3%) underwent colostomy closure. The most prevalent indication for closure was protection of anastomosis in both stoma groups. The interval between creation and closure of stoma was shorter (117.8 days) in Group-I than Group-II (162.4 days). The incidence of hand sewing sutures and stapled technique was 32 (76.2%) and 10 (23.8%), respectively. The Group-II patients took 107.9+/-5.24 minutes as operative time which was significantly higher than 82.96+/-8.84 minutes in Group-I. The prevalence of morbidity in Group-I and Group-II was 10.7% (n=3) and 14.3% (n=2), respectively. Prolong hospital stay was required in Group-II. No mortality case reported in both stoma groups. Conclusion(s): The present study observed that Stomatal closure well tolerated procedure, with low morbidity and mortality. The results suggest that ileostomy closure is a relatively simple procedure.

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Parenteral Therapy in Domiciliary and Outpatient Setting: A Critical Review of the Literature (2023)

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Type of publication:
Journal article

Author(s):
*Puzovic M.; Morrissey H.; Ball P.A.

Citation:
Archives of Pharmacy Practice. 14(2) (pp 1-12), 2023. Date of Publication: 2023.

Abstract:
The clinical homecare sector is often associated with high-cost drug parenteral (injectable) therapy treatments and has been rapidly growing in the United Kingdom (UK) at a 20% annual rate. It was estimated that this could further rise to 60% if extended to all medicines that are considered to be suitable for care at home. The latest data shows that the homecare medicines services sector continues to grow in number and complexity, with over 500,000 patients and a spend of UK3.2 billion in 2021. Given the extent of the National Health Service (NHS) expenditure and the number of patients involved, it is essential to understand and explore the patients' and HCPs' experiences, views, and perceptions of this therapy. As identified during this literature review, homecare provides opportunities for improved cost savings and improved patient experience, but several issues have already been reported worldwide. Patient education, training, support, and regular supervision, as well as the competency of HCPs to manage these patients, have all been identified as factors that contribute to the success or failure of self-administration of parenteral therapy at home, which might impact treatment outcomes and adherence. This is an area that needs urgent research.

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Altered body image, disordered eating, and suboptimal glycaemic control in type 1 diabetes: Is technology and GLP1 agonists an option? (2024)

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Type of publication:
Conference abstract

Author(s):
*Basavaraju N.; *Jones M.; *Moulik P.

Citation:
British Journal of Diabetes. Conference: ABCD Diabetes Update. Loughborough United Kingdom. 24(1) (pp 112-113), 2024. Date of Publication: June 2024.

Abstract:
Introduction: Disordered eating in type 1 diabetes (T1DM) is associated with diabetes distress and suboptimal glycaemic control. We present a case of T1DM with binge eating disorder, discussing the benefits of GLP-1 analogues with continuous subcutaneous insulin infusion (CSII) therapy. Case: A 35-year-old female was diagnosed with T1DM in 2012, at 24 years of age, and commenced on basal bolus insulin. She had two pregnancies over the next seven years with good glycaemic control. There was pronounced dawn phenomenon post-pregnancy which was reflected in her erratic Freestyle Libre glucose readings. CSII therapy with Tandem T-slim was commenced a year later, in October 2020. Over the next 12-18 months, she was diagnosed with depression and hypertension, missed her outpatient diabetes clinic appointments, and struggled with diabetes management and fear of hypoglycaemia. During mid-2022 she developed mental health issues, with hallucinations and binge eating and a likely diagnosis of bipolar personality disorder. Later in the year, she was commenced on Tandem T-slim CSII and Dexcom G6 with Basal IQ technology. There was no evidence of retinopathy or neuropathy on annual diabetes screening. During outpatient diabetes review in February 2023, there was recurrent insulin pump auto-suspend followed by rebound hyperglycaemia and hence overnight basal insulin was reduced. Six months later, her weight had increased and glycaemic control worsened due to continued binge eating, missing pre-meal boluses, and she continued to be under the mental health liaison team. Her insulin was changed from Novorapid to Lyumjev (after discussion with the patient due to licensing criteria with the insulin pump) to accommodate binge eating hyperglycaemia and she was supported by motivational interviewing whilst awaiting review by eating disorders services. A month later, in October 2023, after CSII MDT discussion, she was commenced on control IQ – hybrid closed loop (HCL). In November 2023, her GMI (Glucose Management Indicator) improved, and she was commenced on dulaglutide after full discussion and patient consent including licensing criteria in T1DM. A month later, her food cravings reduced, she felt more positive about diabetes self-management and her insulin requirement reduced from 108 units to 98 units (basal 38%, bolus 62%). Her weight, BMI, HbA1c and ambulatory glucose profile data are shown in the Table. Discussion(s): HCL helped to improve glycaemic control by increasing TIR and reducing HbA1c. GLP-1 analogues have shown positive effects on reducing binge eating and weight loss. The combination of HCL and GLP-1 analogue in this patient resulted in lower insulin doses, positive attitude towards diabetes self-management along with improved clinical parameters and patient satisfaction. Binge eating disorders are associated with obesity and increase in cardiovascular risk. GLP-1 analogues in obese T1DM patients improve metabolic profile, weight, HbA1c and insulin requirement, with no increase in incidence of diabetic ketoacidosis or hypoglycaemia. There are no reported cases of T1DM with binge eating disorder on GLP-1 analogues in the literature and hence further studies are warranted.

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