Staff Publication

An evaluation of the current assessment methods used within a district general NHS trust spasticity service (2021)

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Type of publication:Journal article

Author(s):*Fitzgerald, A. ; Pandyan, P.A.

Citation:Physiotherapy, December 2021. Vol 113, Supplement 1, p. E21-E22

Abstract:The management of spasticity in specialist clinic has not been evaluated objectively. One of the barriers to conducting an audit is the lack of a robust patient-centred assessment framework. The aim of this study was to audit the existing patient notes and from this develop a patient-centred assessment framework that provides objective data that can be used to audit the service.

Cerebrospinal fluid leak following a COVID-19 nasopharyngeal swab (2021)

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Type of publication:Journal article

Author(s):*Hill, Thomas ; *Sivapatham, Stefan; *Metcalfe, Christopher; *Tzortzis, Sevina

Citation:British Journal of Hospital Medicine (17508460); Nov 2022; vol. 82 (no. 11); p. 398-400

Abstract:The article describes the case of an adult who developed cerebrospinal fluid leak after taking a COVID-19 nasopharyngeal swab.

The release of adhesions improves outcome following minimally invasive repair of Achilles tendon rupture (2022)

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Type of publication:Journal article

Author(s):*Carmont, Michael R; Knutsson, Sara Brandt; Brorsson, Annelie; Karlsson, Jón; Nilsson-Helander, Katarina

Citation:Knee Surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA; Mar 2022; vol. 30 (no. 3); p. 1109-1117

Abstract:PURPOSE Operative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions. METHODS From February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have been prospectively evaluated using the Achilles tendon Total Rupture Score (ATRS) and Heel-Rise Height Index (HRHI), following acute Achilles tendon rupture. RESULTS Fourteen (5.6%) patients were identified as having adhesions. Four patients reported superficial adhesions and ten patients reported a deeper tightness of the tendon. At a mean (SD) of 10.5 (2.3) months following repair, the overall ATRS was at a median (IQR) 65 (44.5-78) points and (HRHI) was mean (SD) 81.5 (13.5)%. Of those deemed to have deep adhesions the antero-posterior diameter of the tendon was at mean (SD) 15.6 (4.6) mm. Open release of superficial adhesions resulted in improved ATRS in all patients. Endoscopic debridement anterior to the Achilles tendon led to alleviation of symptoms of tightness and discomfort from deep adhesions and improved outcome in terms of the ATRS score. At a mean (SD) of 15.9 (3.3)-month follow-up from initial rupture and repair, the patients reported at median (IQR) ATRS scores of 85 (64.8-92.8) points, Tegner level 5 (3-9) and mean (SD) HRHI 86.2 (9.5)%. Patients significantly improved both ATRS and HRHI following release at median (IQR) of 16.5 (- 1.8-29.3) points (p = 0.041) and mean (SD) 5.6 (8.3)% (p = 0.043). CONCLUSIONS The incidence of patient-reported adhesions following minimally invasive repair of Achilles tendon rupture was estimated to be 5.6%. The occurrence of superficial adhesions was associated with a lower outcome scores as well as symptoms of anterior tendon tightness and stiffness were associated with a lower score in most patients. Surgical release of adhesions led to a significant improvement in outcome.

Evaluating the quality and readability of online information on keratoconus treatment (2023)

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Type of publication:Journal article

Author(s):Panthagani, Jesse; Hamze, Hisham; *Riaz, Afrah; Moussa, George

Citation:Canadian Journal of Ophthalmology. 58(2):150-155, 2023

Abstract:OBJECTIVE This study aims to evaluate the quality and readability of online resources on keratoconus treatment. METHODS A Google.com search was conducted on August 9, 2020; 32 web sites were selected for analysis. Popularity was assessed by Google and Alexa rank. The quality of web sites was analyzed using the quality criteria for consumer health information (DISCERN) tool, the Journal of the American Medical Association (JAMA) benchmark, and the Health On the Net Code of Conduct Certification (HONcode). The readability of the web sites was assessed using the Fleschwebr hea Reading Ease, the Automated Readability Index, and the Fleschted Readability RESULTS: The JAMA benchmark scores, unlike the DISCERN scores, were correlated with the Google and Alexa rank. One web site (3.1%) met all the JAMA benchmark criteria, and 3 (9.3%) others had HON code certification. The median DISCERN score was 33 (range, 29.6-43.1; maximum possible, 80). Rnib.org.uk scored the highest at 57 (71.0%). The mean Flesch-Kincaid Reading Ease score (52.9 ± 7.1) corresponded to uk" n DIdifficult to read." Thirty-one web sites (96.8%) had a Flesch-Kincaid Grade higher than the American Medical Association recommendation of sixth grade level. The median Automated Readability Index score was 7 (range, 6.2-7.3). CONCLUSION The majority of online information currently available on keratoconus treatment is complex and highly variable. Rnib.org.uk is the best currently available source. Clinicians should inform patients on how to assess the credibility of online information and recommend suitable information sources

Successful diagnosis of gout with use of dual energy CT in a patient presenting with atypical symptoms and negative aspiration (2021)

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Type of publication:Conference abstract

Author(s):*Goel N.; *Amarasena R.

Citation:International Journal of Rheumatic Diseases; Sep 2021; vol. 24 ; p. 177

Abstract:A 42 year old Caucasian gentleman presents with acute left knee swelling, developed over 3 days without preceding trauma. He was referred to Trauma and Orthopaedics who aspirated the knee, finding no organisms or crystals. Following readmission 4 days later with the same complaint, re-aspiration again showed no crystals or organisms. MRI of the left knee showed femoral condyle oedema, initially suggesting Osteomyelitis, but on re-discussion with the radiologist seemed unlikely. The patient was started on Indomethacin and referred to Rheumatology. Despite having some symptomatic relief, he developed progressive swelling in the left calf, ankle and foot. Blood tests confirmed raised D-Dimer and rising CRP: 142 (ref range 0-5). Ultrasound Doppler of the left leg revealed no evidence of DVT, but did show pockets of fluid in the lower thigh, which were noted on previous MRI. X-rays of the knee and ankle did not show any pathological changes. Following Rheumatology review, it was postulated that he could have myofasciitis or infection. RF and CCP were found to be negative with normal complement levels and CK. Further MRI of the left leg showed progressive persistent oedema in the lateral femur. He was commenced on Intravenous flucloxacillin and diclofenac for suspected infection. Following 10 weeks of investigations and management, an MDT discussion opted for Dual Energy CT scan to look for evidence of gout. The Dual Energy CT scan showed extensive gout crystal deposition in the left knee, as well as affecting the popliteus tendon. He was commenced on Prednisolone, counselled on lifestyle factors and later started on Allopurinol that was up-titrated with bridging Colchicine, with excellent response. This case highlights the advances in Dual Energy CT scanning in helping to diagnose gout in those patients with atypical presentation and negative results on needle aspiration.

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The largest transcriptomic resource for radiotherapy-treated high-risk prostate cancer: paving the way for companion diagnostic biomarkers (2021)

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Type of publication:Conference abstract

Author(s):Thiruthaneeswaran N.; Bibby B.; Pereira R.; More E.; Hoskin P.; Bristow R.; Choudhury A.; West C.; Wylie J.; *Denley H.; Henry A.

Citation:Journal of Medical Imaging and Radiation Oncology; Sep 2021; vol. 65 ; p. 252

Abstract:Purpose: The Cancer Genome Atlas (TCGA) is a valuable resource for developing and validating gene signatures for personalising treatments. TCGA samples came from patients who received heterogeneous treatments-dominated by surgery. Improving the biological precision of radiotherapy is hampered by the lack of well annotated cohorts that reflect patient populations relevant for radiation oncologists. We aimed to generate transcriptomic data from needle core biopsies for a large multicentre cohort of high-risk prostate cancer patients and use the data to validate published gene signatures. Methods and materials: A total of 478 NCCN classified high-risk patients treated from 2008-2016 were identified: 244 patients received intensity modulated radiotherapy (IMRT) to the prostate only (BEDalpha/beta 1.5-3Gy of 120-180 Gy) and 234 patients received IMRT to the prostate and a high dose rate (HDR) brachytherapy boost (BEDalpha/beta 1.5-3Gy 159-265 Gy). Androgen deprivation was given to all patients for 3-36 months. Biochemical failure was defined as prostate-specific antigen (PSA) rise of >=2 ng/ml above nadir post-radiotherapy. The primary clinical end-point was 7-year biochemical relapse-free survival (bRFS). Gene expression data were generated from diagnostic needle core biopsies using Affymetrix Clariom S arrays. Two (28-gene and 32 gene) published hypoxia gene signatures and a tumour radiosensitivity index (RSI) were tested for prognostic significance [1-3]. Result(s): The median follow-up for the entire cohort was 6.3 years. Both the 28 gene (p = 0.021) and 32-gene (p = 0.033) hypoxia signatures were prognostic for 7-year bRFS. Non-prostate hypoxia signatures were not prognostic. The bRFS for radioresistant (RSI-R) vs radiosensitive (RSI-S) was prognostic in the IMRT EBRT only cohort (p = 0.01) and not in the HDR boost cohort (p = 0.8). Conclusion(s): We generated the largest high-risk prostate radiotherapy cohort with full gene expression data and showed its value in validating published gene signatures. The RSI signature should be explored further to select patients with high-risk prostate cancer who should benefit from dose escalation with a HDR brachytherapy boost. This resource will be a valuable asset for future research generating and validating signatures for personalising radiotherapy in men with prostate cancer.

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Onyx embolisation of a small bowel arteriovenous malformation prior to resection (2021)

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Type of publication:Conference abstract

Author(s):*Jones G.A.R.; *Hinwood D.; *McCloud J.; McCafferty I.

Citation:Colorectal Disease; Sep 2021; vol. 23 ; p. 126

Abstract:Small bowel arteriovenous malformation (AVM) is uncommon with an incidence of approximately 1:100,000. Nevertheless cases causing severe anaemia may necessitate surgery posing the dilemma for the surgeon at operation of exactly which portion of small bowel to resect. We present a case of a rare mid small bowel AVM definitively managed with highly selective mesenteric angiography and embolisation with Onyx immediately prior to surgical resection. Onyx is an injectable embolic fluid for which the main application is in the treatment of brain AVMs. To the authors' knowledge this is the first reported case of its use in small bowel AVM. Being black in colour Onyx demonstrates the location and extent of the abnormal bowel segment allowing preservation of normal small bowel. Secondly it reduces the blood flow in the abnormal segment reducing bleeding. A 24 year old man was referred with severe recurrent iron deficiency anaemia since childhood having required multiple blood transfusions and iron infusions. His diagnosis of mid small bowel AVM was made by capsule endoscopy showing small bowel varices and confirmed with CT angiography. On the day of the procedure at angiography the SMA was catheterised and selective injections confirmed the mid small bowel AVM. Micro catheters were then used to selectively enter jejunal branches and embolisation was performed with Onyx and micro-coils. The patient was transferred to theatre for laparotomy. Small bowel resection was performed transfixing all pedicles and stapled anastamosis. Four months post-operatively the patient has had no further problems with anaemia.

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Soft tissue extensor mechanism tendon ruptures of the knee (2021)

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Type of publication:Journal article

Author(s):Rhind J.-H.; *Lancaster P.; *Ahmed U.; *Carmont M.

Citation:British Journal of Hospital Medicine; Sep 2021; vol. 82 (no. 9); p. 1-9

Abstract:Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.