Staff Publication

The influence of the Covid pandemic on the epidemiology of Achilles tendon ruptures in east Shropshire, United Kingdom (2023)

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Type of publication:Journal article

Author(s):*Carmont MR; *Morgan F; *Fakoya K; Heaver C; Brorsson A; Nilsson-Helander K

Citation:Journal of ISAKOS : joint disorders & orthopaedic sports medicine, Journal of Isakos. 8(2):94-100, 2023

Abstract:Objectives: Management strategies of the Covid pandemic included isolation to prevent transmission. This study aimed to determine if the pandemic of 2020 influenced the epidemiology of Achilles Tendon Rupture (ATR).Methods: The demographics of presentations from the local population to xxx hospital, Shropshire, United Kingdom with an ATR were analysed and compared together with the season, month, and year of the injury.Results: From 2009 to 2019 there was no significant change in the incidence of ATR over time with mean (SD) incidence of 13.3 per 100,000. In 2020, there was a decrease in injuries with an incidence of 8.4 per 100,000, with an increase in 2021 to 22.4 per 100,000. In 2021, there was an increase in injuries from March with numbers maintained until October. The most common activity of ATR was Team sport (36.2%), followed by Activities of Daily Living (28.9%), Other physical activities (21.0%) and Racket sports (13.9%). In 2020 there was the lowest number of injuries sustained in Team and Racket sports, however in 2021 they accounted for over half of Injuries.Conclusions: There were significantly more patients sustaining ATR in 2021, the year after the covid pandemic and mandatory isolation. This was considered to be related to altered activity and Team and Racket sports during 2020.Levels of Evidence: IV Case series.

A quantitative cross-sectional study assessing the surgical trainee perception of the operating room educational environment (2022)

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Type of publication:Journal article

Author(s):Rupani N; Evans A; *Iqbal M

Citation:BMC Medical Education, 2022 Nov 08; Vol. 22 (1), pp. 764

Abstract:Background: Limited hours and service provision are diminishing training opportunities, whilst increasing standards of surgical proficiency is being sought. It is imperative to maximise the value of each educational event. An objective measure of higher surgical trainee perception of the operating room environment in England has not been performed before and this can steer future change in optimising educational events in theatre. The Operating Room Educational Environment Measure (OREEM) evaluates each component of the learning environment to enable optimisation of these educational events. However, the OREEM has not yet been assessed for reliability in higher surgical trainees in England. The aim of the current study was to explore areas of strength and weakness in the educational environment in the operating room as perceived by surgical trainees' in one English region. The secondary aim was to assess the reliability of the OREEM.Methods: Using a quantitative approach, data was collected over one month from surgical trainees in England using the OREEM.Results: Fifty-four surgical trainees completed the questionnaire. The OREEM had good internal consistency (α = 0.906, variables = 40). The mean OREEM score was 79.16%. Areas for improvement included better learning opportunities (average subscale score = 72.9%) and conducting pre- and post-operative teaching (average score = 70.4%). Trainees were most satisfied with the level of supervision and workload (average subscale score = 82.87%). The learning environment favoured senior trainees (p = 0.017). There was a strong correlation between OREEM and the global satisfaction score (p < 0.001).Conclusions: The OREEM was shown to be a reliable measure of the educational environment. It can be used to identify areas of improvement and as an audit tool. The current perception of the education environment is satisfactory, however, areas of improvement include reducing service provision, empowering trainees to plan lists, improving teamwork and using tools to optimise the educational value of each operation. There is a favourable attitude regarding the use of improvement tools, especially for dissatisfied trainees.

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Induction of labour for predicted macrosomia: study protocol for the 'Big Baby' randomised controlled trial (2022)

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Type of publication:Journal article

Author(s):Ewington LJ; Gardosi J; Lall R; Underwood M; Fisher JD; Wood S; Griffin R; Harris K; Bick D; Booth K; Brown J; Butler E; Fowler K; Williams M; *Deshpande S; *Gornall A; Dewdney J; Hillyer K; Gates S; Jones C; Mistry H; Petrou S; Slowther AM; Willis A; Quenby S

Citation:BMJ Open, 2022 Nov 11; Vol. 12 (11), pp. e058176. Date of Electronic Publication: 2022 Nov 11.

Abstract:Introduction: Large-for-gestational age (LGA) fetuses have an increased risk of shoulder dystocia. This can lead to adverse neonatal outcomes and death. Early induction of labour in women with a fetus suspected to be macrosomic may mitigate the risk of shoulder dystocia. The Big Baby Trial aims to find if induction of labour at 38+0-38+4 weeks' gestation, in pregnancies with suspected LGA fetuses, reduces the incidence of shoulder dystocia.Methods and Analysis: The Big Baby Trial is a multicentre, prospective, individually randomised controlled trial of induction of labour at 38+0 to 38+4 weeks' gestation vs standard care as per each hospital trust (median gestation of delivery 39+4) among women whose fetuses have an estimated fetal weight >90th customised centile according to ultrasound scan at 35+0 to 38+0 weeks' gestation. There is a parallel cohort study for women who decline randomisation because they opt for induction, expectant management or caesarean section. Up to 4000 women will be recruited and randomised to induction of labour or to standard care. The primary outcome is the incidence of shoulder dystocia; assessed by an independent expert group, blind to treatment allocation, from delivery records. Secondary outcomes include birth trauma, fractures, haemorrhage, caesarean section rate and length of inpatient stay. The main trial is ongoing, following an internal pilot study. A qualitative reporting, health economic evaluation and parallel process evaluation are included.

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Cost Analysis of Thoracic Endovascular Aortic Repair in Type B Aortic Dissection: How Much Does Quality Cost? (2023)

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Type of publication:Journal article

Author(s):Bashir M; Jubouri M; *Patel R; Geragotellis A; Tan SZ; Bailey DM; Mohammed I; Velayudhan B; Williams IM

Citation:
Annals of Vascular Surgery. 94 (pp 38-44), 2023. Date of Publication: August 2023.

Abstract:Introduction: Aortic dissection (AD) is a life-threatening medical emergency that affects an estimated 3-4 people per 100,000 annually, with 40% of cases classified as type B AD (TBAD). TBAD can be further classified as being complicated (co-TBAD) or uncomplicated (un-TBAD) based on the presence or absence of certain features such as malperfusion and rupture. TBAD can be managed conservatively with optimal medical therapy (OMT), or invasively with open surgical repair (OSR) or thoracic endovascular aortic repair (TEVAR), depending on several factors such as type of TBAD and its clinical acuity. The cost-effectiveness, or cost-benefit profile, of these strategies must be given equal consideration. However, TBAD studies featuring cost analyses are limited within the literature. Aims: This narrative review aims to address the gap in the literature on cost effectiveness of TBAD treatments by providing an overview of cost-analyses comparing OMT with TEVAR in un-TBAD and TEVAR with OSR in co-TBAD. Another aim is to provide a market analysis of the commercially available TEVAR devices. Methods: A comprehensive literature search was performed using several search engines including PubMed, Ovid, Google Scholar, Scopus and EMBASE to identify and extract relevant studies. Results: Several TEVAR devices are available commercially on the global market costing $12,000-19,495. Nevertheless, the Terumo Aortic RELAY® stent-graft seems to be the most cost-effective, yielding highly favourable clinical outcomes. Despite the higher initial cost of TEVAR, evidence in the literature strongly suggest that it is superior to OMT for un-TBAD on the long-term. In addition, TEVAR is well established in the literature as being gold-standard repair technique for co-TBAD, replacing OSR by offering a more optimal cost-benefit profile through lower costs and improved results. Conclusion: The introduction of TEVAR has revolutionised the field of aortovascular surgery by offering a highly efficacious and long-term cost effective treatment for TBAD.

Fate and Consequences of the False Lumen After Thoracic Endovascular Aortic Repair in Type B Aortic Dissection (2023)

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Type of publication:Journal article

Author(s):Jubouri M; *Patel R; Tan SZ; Al-Tawil M; Bashir M; Bailey DM; Williams IM

Citation:Annals of Vascular Surgery. 94:32-37, 2023 Aug.

Abstract:Background: Type B aortic dissection (TBAD) occurs due to an entry tear in the intimal layer of the aorta distal to the origin of the left subclavian artery where blood enters the newly formed false lumen (FL) and extends distally or proximally to form a dissection over an indeterminate length of the aorta which, over time, may eventually rupture. Thoracic endovascular aortic repair (TEVAR) aims to seal off the entry tear proximally with the stent-graft, occluding the origin of the dissection and excluding the FL. Nevertheless, in some cases, the perfusion to the FL is maintained, hindering the aortic remodelling process and increasing the risk of aneurysmal degeneration and rupture, particularly in the abdominal aorta where evidence suggest that remodelling is slower. This review examines the long-term effects of a patent or partially thrombosed FL on clinical outcomes following TEVAR in TBAD, also highlighting the pathological processes behind negative aortic remodelling. Another aim of this review is to provide an overview and appraisal of the currently available techniques for managing a patent or partially thrombosed FL to prevent long-term morbidity occurring. Methods: A comprehensive literature search was performed using several search engines including PubMed, Ovid, Google Scholar, Scopus, and Embase to identify and extract relevant studies. Results: Evidence in the literature show that a partially thrombosed FL is more dangerous than a patent FL due to the occlusion of the distal re-entry tears, impeding outflow and increasing mean arterial and diastolic pressures, whereas the latter is decompressed via distal re-entry sites. FL thrombosis and satisfactory remodelling is sometimes achieved in as few as 40% of patients after TEVAR due to the maintained perfusion of the FL either at the level of the thoracic or abdominal aorta. However, although the thoracic aorta is predominantly covered by the TEVAR stent-graft, poorer remodelling and more dilation is seen in the abdominal aorta. Several techniques are available to embolize the FL, including the Provisional Extension to Induce Complete Attachment, Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair, candy-plug, and Knickerbocker techniques. Conclusions: The management of TBAD is invariably TEVAR to seal off the proximal entry tear while extending the repair distally to completely exclude the FL. A risk of aortic wall dilatation distal to TEVAR stent-graft remains; hence, regular monitoring and accurate imaging are essential. At present, a patent FL can be treated using a range of different endovascular techniques.

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Thyrotoxic Periodic Paralysis: Case Presentation With Tetraparesis and Cardiac Dysrhythmia (2022)

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Type of publication:Journal article

Author(s):*Dosu A; *Gupta M; *Walsh O; *Makan J

Citation:Cureus, 2022 Sep 29; Vol. 14 (9), pp. e29759

Abstract:Thyrotoxic hypokalaemic periodic paralysis (THPP) is a rare complication of hyperthyroidism that is potentially life-threatening if not treated promptly. It is more common in Asian and Polynesian populations and very few cases have been reported to date in people of White ethnicity. We present a case report of a young male patient of White ethnicity, who was initially brought in as a stroke alert with tetraparesis which was ruled out on initial assessment, but then had a syncopal episode and was noted to be initially bradycardic and subsequently tachycardic. Blood tests showed hypokalaemia and hypophosphataemia and he was treated as a hypokalaemic periodic paralysis patient. Intravenous potassium replacement was commenced. Symptoms and ECG changes resolved with correction of potassium levels. Thyroid function tests requested later were suggestive of hyperthyroidism and the diagnosis of thyrotoxic hypokalaemic periodic paralysis was made. This is an interesting case given its rarity, and this case report highlights the importance of early diagnosis and prompt treatment.

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All sleep and no play? An audit and service evaluation of children undergoing radiological imaging (2022)

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Type of publication:
Conference abstract

Author(s):
*Muneer K.

Citation:
Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2022. Liverpool United Kingdom. 107(Supplement 2) (pp A120-A121), 2022. Date of Publication: August 2022.

Abstract:
Aims The use of sedation in children for radiological imaging is common practice in Paediatrics. However, the risks need to be weighed against the benefits of imaging under sedation. Play therapy has been considered as an alternative to sedation in a cooperative child. This study explored the safety, efficacy and adherence of practice to local trust guidelines for sedation of children (derived from the NICE Sedation under 19s guidelines) and highlighted play therapy as a potential alternative for selected children requiring radiological imaging. Methods Data was gathered retrospectively from a 6 month period with the help of the Trust's medical records department. There were 36 children who underwent sedation for various imaging modalities and 19 children who had imaging done utilising play therapy over the same period. The information gathered from the resources used was collated in an excel database for the purpose of comparative analysis. Results 1. The assignment of patients was based on their clinical presentation, urgency and medical background 2. Children receiving sedation were predominantly below the age of 3 years while those in the play group were between 6-9 years 3. The youngest child to receive sedation was 3 months old and the youngest to have successful MRI using play therapy was 3 years 5 months 4. The success rate of Sedation was 92% vs. 86% for play therapy 5. 83% underwent MRI, 11% DMSA and 6% MAG3 under sedation. 95% had MRI and 5% CT in the play group 6. 14% required a repeat dose of medication for sedation 7. None had complications secondary to sedation 8. One had MRI Head done under sedation and later MRI Spine successfully under play therapy at 3 years 5 months 9. Where all documents were available for analysis, the adherence to local guidelines for sedation was 100% Conclusion 1. Sedation is a safe and effective option available in a DGH setting for young children needing relatively urgent radiological imaging to establish diagnosis where the benefits generally outweigh the risks. 2. Play therapy is a suitable alternative for cooperative children who can be adequately prepared. 3.Healthcare teams and parents need to be made more aware of these options in the future.

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