Staff Publication

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England (2024)

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Type of publication:
Journal article

Author(s):
Ayyaz, F M; Joyner, J; *Cheetham, M; Briggs, Twr; Gray, W K.

Citation:
Annals of the Royal College of Surgeons of England. 2024 Apr 02.

Abstract:
INTRODUCTION: The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS: This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic
cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS: Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December
2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of
prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS: Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

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British Oncology Pharmacy Association Delphi Consensus Guidelines: co-infusion of trometamol-containing calcium folinate (Leucovorin) with Systemic Anti-Cancer Treatments (2024)

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Type of publication:
Journal article

Author(s):
Polwart C.; Root T.; Tezcan S.; Meehan S.; Wetherill B.; Waterson C.; *Burnett B.; Chauhan R.; Al-Modaris I.; Walters-Davies R.

Citation:
medRxiv. (no pagination), 2024. Date of Publication: 11 Feb 2024.

Abstract:
Drug stability and compatibility are critical factors influencing cost and logistics of treatment delivery, therapeutic effectiveness, and patient safety. This is particularly significant in the realm of cancer chemotherapeutics, where stability and compatibility studies play a vital role in ensuring rational and safe medicine administration. Oxaliplatin, fluorouracil, and irinotecan, commonly used in various combination for gastrointestinal cancers, are complemented by co-administration of folinic acid in certain protocols. Notably, some folinic acid preparations include trometamol as an excipient, potentially impacting the stability of the chemotherapeutic agents if infused concomitantly. This study seeks to establish guidelines for oncology multidisciplinary teams, addressing potential risks associated with the combination of trometamol-containing folinic acid and chemotherapeutics. To achieve this, a quantitative questionnaire was distributed to members of the British Oncology Pharmacy Association (BOPA) and non-BOPA members through an online survey. Nineteen healthcare professionals with oncology experience, comprising 18 pharmacists and 1 nurse, completed the questionnaires. Each participant rated the validity and clarity of statements on a 5-point scale. The Delphi process concluded after the fourth round, consolidating the findings and recommendations from the multidisciplinary team. Twelve recommendations for safe practice have been made.

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Coeliac disease (2024)

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Type of publication:
Journal article

Author(s):
*Butterworth J.; Los L.

Citation:
Medicine (United Kingdom). 52(3) (pp 174-180), 2024. Date of Publication: March 2024.

Abstract:
Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocyte concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal- and non-gastrointestinal-related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with symptoms suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.

Diagnostic imaging of the diabetic foot: an EANM evidence-based guidance (2024)

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Type of publication:
Journal article

Author(s):
Lauri, Chiara; Noriega-Alvarez, Edel; *Chakravartty, Riddhika M; Gheysens, Olivier; Glaudemans, Andor W J M; Slart, Riemer H J A; Kwee, Thomas C; Lecouvet, Frederic; Panagiotidis, Emmanouil; Zhang-Yin, Jules; Martinez, Jose Luis Lazaro; Lipsky, Benjamin A; Uccioli, Luigi; Signore, Alberto.

Citation:
European Journal of Nuclear Medicine & Molecular Imaging. 2024 Mar 27.

Abstract:
PURPOSE: Consensus on the choice of the most accurate imaging strategy in diabetic foot infective and non-infective complications is still lacking. This document provides evidence-based recommendations, aiming at defining which imaging modality should be preferred in different clinical settings. METHODS: This working group includes 8 nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), 3 radiologists and 3 clinicians (one diabetologist, one podiatrist and one infectious diseases specialist) selected for their expertise in diabetic foot. The latter members formulated some clinical questions that are not completely covered by current guidelines. These questions were converted into statements and addressed through a systematic analysis of available literature by using the PICO (Population/Problem-Intervention/Indicator-Comparator-Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria. RESULTS: Nine clinical questions were formulated by clinicians and used to provide 7 evidence-based recommendations: (1) A patient with a positive probe-to-bone test, positive plain X-rays and elevated ESR should be treated for presumptive osteomyelitis (OM). (2) Advanced imaging with MRI and WBC scintigraphy, or [18F]FDG PET/CT, should be considered when it is needed to better evaluate the location, extent or severity of the infection, in order to plan more tailored treatment. (3) In a patient with suspected OM, positive PTB test but negative plain X-rays, advanced imaging with MRI or WBC scintigraphy + SPECT/CT, or with [18F]FDG PET/CT, is needed to accurately assess the extent of the infection. (4) There are no evidence-based data to definitively prefer one imaging modality over the others for detecting OM or STI in fore- mid- and hind-foot. MRI is generally the first advanced imaging modality to be performed. In case of equivocal results, radiolabelled WBC imaging or [18F]FDG PET/CT should be used to detect OM or STI. (5) MRI is the method of choice for diagnosing or excluding Charcot neuro-osteoarthropathy; [18F]FDG PET/CT can be used as an alternative. (6) If assessing whether a patient with a Charcot foot has a superimposed infection, however, WBC scintigraphy may be more accurate than [18F]FDG PET/CT in differentiating OM from Charcot arthropathy. (7) Whenever possible, microbiological or histological assessment should be performed to confirm the diagnosis. (8) Consider appealing to an additional imaging modality in a patient with persisting clinical suspicion of infection, but negative imaging. CONCLUSION: These practical recommendations highlight, and should assist clinicians in understanding, the role of imaging in the diagnostic workup of diabetic foot complications.

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Are term breech babies who undergo successful external cephalic version still at increased risk of developmental dysplasia of the hip? (2024)

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Type of publication:
Journal article

Author(s):
*Stock, Joanne; *Deshpande, Sanjeev A.

Citation:
Archives of Disease in Childhood. 109(4):351-353, 2024 Mar 19.

Abstract:

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200.03 Is Rivaroxaban Safe and Effective in Preventing Venous Thromboembolism in COVID-19 Patients: A Systematic Review and Meta-Analysis (2024)

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Type of publication:
Conference abstract

Author(s):
Abdelkhalek M.; Elshahat A.; *Aboshehata A.; Baidoun H.; Turk S.; Rashed M.A.; Rzk F.M.; Ellabban M.H.; Elneny M.

Citation:
JACC: Cardiovascular Interventions. Conference: CRT 2024, Cardiovascular Research Technologies. Washington Hilton, Washington, DC United States. 17(4 Supplement) (pp S31-S32), 2024. Date of Publication: 26 Feb 2024.

Abstract:
Background: Rivaroxaban, a novel oral anticoagulant, inhibits factor Xa and has gained significant usage in clinical settings since the onset of the COVID-19 pandemic. It is widely believed that Rivaroxaban effectively reduces the occurrence of thromboembolic events in individuals who have contracted COVID-19. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Rivaroxaban in preventing thromboembolic events in patients with COVID-19 infection. Method(s): A comprehensive literature search was conducted, and randomized controlled trials (RCTs) and observational studies comparing Rivaroxaban with control groups were included. The primary outcomes assessed were venous thromboembolism, mortality. Safety outcomes, specifically bleeding events. Result(s): A total of 9 studies involving 5484 patients were included in the final analysis. The meta-analysis showed that Rivaroxaban has a significant advantage in preventing venous thromboembolism (RR=0.17, 95% CI [0.06 to 0.54], P=0.002). Regarding mortality, Rivaroxaban was associated with a lower risk compared to the control group (RR=0.55, 95% CI [0.31 to 0.96], P=0.04), particularly in the cardiovascular mortality subgroup (RR=0.14, 95% CI [0.05 to 0.45], P=0.0008). The Rivaroxaban had a higher risk of bleeding events (RR=3.28, 95%CI [1.54 to 6.97], P=0.002). Conclusion(s): This systematic review and meta-analysis suggest that Rivaroxaban effectively reduces mortality and prevents venous thromboembolism. However, it was associated with a higher risk of bleeding events compared to the control group. These findings provide valuable insights into using Rivaroxaban to prevent thromboembolic events. [Formula presented]

The magnetic effect: sustainability of patient centric outcomes, time and cost saving following 5 years of Magseed experience (2024)

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Type of publication:
Conference abstract

Author(s):
*Lake B.; *Wilson M.; *Deane L.; *Cielecki L.; *Thomas G.; *Usman T.

Citation:
European Journal of Surgical Oncology. Conference: ESSO 42 2023. Florence Italy. 50(2) (no pagination), 2024. Article Number: 107333. Date of Publication: February 2024.

Abstract:
Background: Magseed has transformed the conventional guided procedures for impalpable breast cancer. In an initial service evaluation, we described "the triple effect of Magseed": reducing re-excision rates, reducing costs, and providing high patient satisfaction, with our cost saving analysis described in NICE guidance MIB236. Our change of practice service evaluation demonstrated that Magseed localisation for breast cancer promotes a patient-centric approach by reducing need for further surgery and ensuring high patient satisfaction. Other advantages are improved patient flow, as placement can occur prior to surgery, and cost saving in theatre and radiology. The aim of this study was to see if this described triple effect is sustainable in terms of patient outcomes and cost saving after 500 Magseeds and following 5 years of experience. Material(s) and Method(s): A 5-year service evaluation was conducted at Shrewsbury and Telford Hospital of all patients who had image-guided wide local excision for impalpable breast cancer from July 2017 to June 2022. Outcomes recorded included re-excision rate, theatre cost-saving analysis, radiology time and patient satisfaction. Result(s): 907 cases were performed, 501 Magseed guided procedures, and 406 coventional guided procedures. Significantly lower re-excision rates were maintained post-Magseed compared to pre-Magseed of 12.9% v 22.4% (chi2=11.1377 P<0.000846). Cost was saved in terms of surgery and radiology time. 94,321 was saved per year, with 58.6% fewer further operations, with an overall saving of 471,605. Significantly less radiology time with Magseed insertion average of 36 minutes, compared to wire insertion of 52 min (t-value =-2.24215, p-value<0.01854.) High patient satisfaction was maintained with the Magseed service described as "completely comfortable" and "quick and straightforward". Conclusion(s): Magseed continues to be the technique of choice for the detection of impalpable breast cancer, and its benefits of reducing re-excision rates, cost saving in surgery and radiology and high patient satisfaction are sustainable: the magnetic effect.

The additive effect of Magtrace: improved theatre efficiency, operative capacity and patient experience (2024)

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Type of publication:
Conference abstract

Author(s):
Lake B.; Wilson M.; Appleton D.

Citation:
European Journal of Surgical Oncology. Conference: ESSO 42 2023. Florence Italy. 50(2) (no pagination), 2024. Article Number: 107518. Date of Publication: February 2024.

Abstract:
Background: Magtrace is a non-radioactive magnetic tracer designed specifically for Sentinel Lymph Node biopsy, with multiple benefits including a flexible injection window up to 30 days prior to surgery, no requirement for nuclear medicine and has been statistically proven non-inferior to Technetium and Blue Dye, the current gold standard. The "conventional" patient pathway at the Shrewsbury and Telford Hospital involved the patient travelling to the Nuclear Medicine Department at the Royal Shrewsbury Hospital the day before or morning of surgery for Technetium injection. Surgery takes place at Princess Royal Hospital, necessitating two journeys for the patient. NICE Guidance GID-MT568 recommends Magtrace as an option to locate sentinel lymph nodes for breast cancer in hospitals with limited or no access to radio-pharmacy and thus eliminates patient travel and nuclear medicine resources. Magtrace can be injected either in outpatients or on the day of surgery. Magtrace also has the potential to reduce cost as described by NICE MTG72, with an expectation that its usage would lead to an additional sentinel node biopsy per week due to improved theatre utilisation. The aim of this study was to evaluate the use of Magtrace and its impact on theatre efficiency and patient experience. Material(s) and Method(s): A 4-month trial of Magtrace for sentinel node biopsy was conducted at the Shrewsbury & Telford NHS Trust from November 2022 to March 2023. Outcomes recorded were theatre utilisation, numbers of sentinel node biopsies performed per week and patient satisfaction. Result(s): 62 patients had Magtrace as the technique for SLNB combined either wide local excision or mastectomy during the trial period. Theatre utilisation improved from 77% to 85%, due to reduction in theatre delays due to waiting for patients to have radioisotope and improved theatre flow. Significantly more sentinel node biopsies were performed per week, increasing from 6.48 per week (Pre Magtrace 2022) to 8.52 per week (Post Magtrace November 22 to March 23) (t-value = -3.03541 p-value <0.00208), with a resultant net increase of 2 patients per week. High patient satisfaction was found with 100% finding injection more convenient on day of surgery and 100% would recommend technique if needed to friend or relative. Conclusion(s): Magtrace for sentinel node biopsy gives an "additive effect" by improving theatre utilisation, increasing the number of sentinel node biopsies per week and improving patient experience.

A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes (2024)

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Type of publication:
Journal article

Author(s):
Graham-Brown M.P.M.; Casula A.; Savino M.; Humphrey T.; Pyart R.; Amaran M.; Williams J.; Crowe K.; Medcalf J.F.; Lee D.K.; Dan Cooper; Carr D.E.; Marthi D.A.; Swift D.O.; Hull D.K.; Nimmo D.A.; Liewm D.H.; Tariq D.B.; Whitehead D.J.; Edney D.N.; Whitbread D.D.; Mohamed D.M.; Duffy D.S.; Edwards D.G.; Czajka D.R.; Ahmad D.S.H.; Joslin D.J.; Yong D.E.S.T.; Chaudry D.S.; McGuinness D.D.; Defreitas D.S.; Nosseir D.H.; Seal D.K.; Amaran D.M.; Gulati D.K.; Azam D.M.J.; Williams D.J.; Smith-Jackson; Yin D.B.-S.; Shuaib D.R.; Akter D.M.; Arimoto D.R.; Oluyombo D.R.; Davies D.M.; Patel D.P.; Best-Trent T.; Handra D.H.; Mackie S.; Wright K.; Rahman D.M.; Cheema D.H.; Sardar D.A.; Harvard D.L.; Brook D.M.; *Elphic D.E.; Ahmed D.M.; Ammar D.K.; Harbe D.M.; Corke D.E.; Stacey D.H.; Yousif D.M.; Mohamed D.D.; Soe D.L.T.; Sherna D.A.; Soutter D.L.; Davari D.M.; Abburu D.S.; Wells D.J.; Winterbottom D.C.; Bottomley D.M.; Morris D.H.; Sadiq D.A.; Youssouf D.S.

Citation:
Clinical Medicine, Journal of the Royal College of Physicians of London. 24(2) (no pagination), 2024. Article Number: 100028. Date of Publication: March 2024.

Abstract:
Background: Acute kidney injury (AKI) is a common complication of hospitalisations. This national audit assessed the care received by patients with AKI in hospital Trusts in England and Wales. Method(s): Twenty four hospital Trusts across England and Wales took part. Patients with AKI stage2/3 were identified using the UK Renal Registry AKI master patient index. Data was returned through a secure portal with linkage to hospital episode statistic mortality and hospitalisation data. Completion rates of AKI care standards and regional variations in care were established. Result(s): 989 AKI episodes were included in the analyses. In-hospital 30-day mortality was 31-33.1% (AKI 2/3). Standard AKI interventions were completed in >80% of episodes. Significant inter-hospital variation remained in attainment of AKI care standards after adjustment for age and sex. Recording of urinalysis (41.9%) and timely imaging (37.2%) were low. Information on discharge summaries relating to medication changes/re-commencement and follow-up blood tests associated with reduced mortality. No quality indicators relating to clinical management associated with mortality. Better communication on discharge summaries associated with reduced mortality. Conclusion(s): Outcomes for patients with AKI in hospital remain poor. Regional variation in care exists. Work is needed to assess whether improving and standardising care improves patient outcomes.

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Baseline Expression of Immune Gene Modules in Blood is Associated With Primary Response to Anti-TNF Therapy in Crohn's Disease Patients (2024)

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Type of publication:
Journal article

Author(s):
Journal of Crohn's and Colitis. 18(3) (pp 431-445), 2024. Date of Publication: 01 Mar 2024

Citation:
Reppell M.; Smaoui N.; Waring J.F.; Pivorunas V.; Guay H.; Lin S.; Chanchlani N.; Bewshea C.; Goodhand J.R.; Kennedy N.A.; Anderson C.A.; Patel V.; Mazhar Z.; Saich R.; Colleypriest B.; Tham T.C.; Iqbal T.H.; Kaushik V.; Murugesan S.; Singhi S.; Weaver S.; Preston C.; Butt A.; Smith M.; Basude D.; Beale A.; Langlands S.; Direkze N.; Parkes M.; Torrente F.; De La Revella Negro J.; MacDonald C.E.; Evans S.M.; Gunasekera A.V.J.; Thakur A.; Elphick D.; Shenoy A.; Nwokolo C.U.; Dhar A.; Cole A.T.; Agrawal A.; Bridger S.; Doherty J.; Cooper S.C.; de Silva S.; Mowat C.; Mayhead P.; Lees C.; Jones G.; Hart J.W.; Gaya D.R.; Russell R.K.; Gervais L.; Dunckley P.; Mahmood T.; Banim P.J.R.; Sonwalkar S.; Ghosh D.; Phillips R.H.; Azaz A.; Sebastian S.; Shenderey R.; Armstrong L.; Bell C.; Hariraj R.; Matthews H.; Jafferbhoy H.; Selinger C.P.; Zamvar V.; De Caestecker J.S.; Willmott A.; Miller R.; Babu P.S.; Tzivinikos C.; Bloom S.L.; Chung-Faye G.; Croft N.M.; Fell J.M.E.; Harbord M.; Hart A.; Hope B.; Irving P.M.; Lindsay J.O.; Mawdsley J.E.; McNair A.; Monahan K.J.; Murray C.D.; Orchard T.; Paul T.; Pollok R.; Shah N.; Bouri S.; Johnson M.W.; Modi A.; Kabiru K.D.; Baburajan B.K.; Bhaduri B.; Fagbemi A.A.; Levison S.; Limdi J.K.; Watts G.; Foley S.; Ramadas A.; MacFaul G.; Mansfield J.; Grellier L.; Morris M.-A.; Tremelling M.; Hawkey C.; Kirkham S.; Charlton C.P.J.; Rodrigues A.; Simmons A.; Lewis S.J.; Snook J.; Tighe M.; Goggin P.M.; De Silva A.N.; Lal S.; Smith M.S.; Panter S.; Cummings F.; Dharmisari S.; Carter M.; Watts D.; Mahmood Z.; McLain B.; Sen S.; Pigott A.J.; Hobday D.; Wesley E.; Johnston R.; Edwards C.; Beckly J.; Vani D.; Ramakrishnan S.; Chaudhary R.; Trudgill N.J.; Cooney R.; Bell A.; Prasad N.; Gordon J.N.; Brookes M.J.; Li A.; Gore S.; Bai B.Y.H.; Ahmad T.;

Abstract:
Background and Aims: Anti-tumour necrosis factor [anti-TNF] therapy is widely used for the treatment of inflammatory bowel disease, yet many patients are primary non-responders, failing to respond to induction therapy. We aimed to identify blood gene expression differences between primary responders and primary non-responders to anti-TNF monoclonal antibodies [infliximab and adalimumab], and to predict response status from blood gene expression and clinical data. Method(s): The Personalised Anti-TNF Therapy in Crohn's Disease [PANTS] study is a UK-wide prospective observational cohort study of anti-TNF therapy outcome in anti-TNF-naive Crohn's disease patients [ClinicalTrials.gov identifier: NCT03088449]. Blood gene expression in 324 unique patients was measured by RNA-sequencing at baseline [week 0], and at weeks 14, 30, and 54 after treatment initiation [total sample size = 814]. Result(s): After adjusting for clinical covariates and estimated blood cell composition, baseline expression of major histocompatibility complex, antigen presentation, myeloid cell enriched receptor, and other innate immune gene modules was significantly higher in anti-TNF responders vs non-responders. Expression changes from baseline to week 14 were generally of consistent direction but greater magnitude [i.e. amplified] in responders, but interferon-related genes were upregulated uniquely in non-responders. Expression differences between responders and non-responders observed at week 14 were maintained at weeks 30 and 54. Prediction of response status from baseline clinical data, cell composition, and module expression was poor. Conclusion(s): Baseline gene module expression was associated with primary response to anti-TNF therapy in PANTS patients. However, these baseline expression differences did not predict response with sufficient sensitivity for clinical use.

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