Staff Publication

Best practice for embryology staffing in HFEA licensed assisted conception centres-guidance from Association of Reproductive & Clinical Scientists (2024)

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Type of publication:
Journal article

Author(s):
*Kasraie, Jason; Kennedy, Hannah

Citation:
Human Fertility. 27(1):2322729, 2024 Dec.

Abstract:
The Association of Reproductive and Clinical Scientists (ARCS) has long promoted the importance of externally accredited training and assessment of scientific staff within assisted conception centres to ensure professional registration and relevant training at all levels. This not only gives scientific staff the opportunity to empower themselves but also acts to ensure assisted conception centres maintain the highest standards of care and quality for patients whilst meeting HFEA requirements for staffing and training. It also provides assurance to patients that treatment is being delivered by highly trained and competent staff. Clinical embryology practice requires intense concentration, with increasingly complex treatment plans and options coupled with the ever-present consequences of clinical error at the forefront of practitioners' minds, exhaustion and burn out are very real risks. Overloading embryology teams is likely to lead to increased error rates and serious incidents. This guideline aims to bring the sector in line with other Clinical Science specialities to optimise patient care, increase safety, reduce risk (including the risk of legal action against centres and individuals), ensure the use of recognised job titles with appropriate levels of remuneration, and provide centres with a template to work towards for appropriate levels of scientific staffing.

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A genome-wide meta-analysis of palmoplantar pustulosis implicates Th2 responses and cigarette smoking in disease pathogenesis (2024)

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Type of publication:
Journal article

Author(s):
Hernandez-Cordero A.; Thomas L.; Smail A.; Lim Z.Q.; Saklatvala J.R.; Chung R.; Curtis C.J.; Baum P.; Visvanathan S.; Burden A.D.; Cooper H.L.; Dunnill G.; Griffiths C.E.M.; Levell N.J.; Parslew R.; Reynolds N.J.; Wahie S.; Warren R.B.; Wright A.; Simpson M.; Hveem K.; Barker J.N.; Dand N.; Loset M.; Smith C.H.; Capon F.; Abraham T.; Ali M.; August S.; Baudry D.; Becher G.; Bewley A.; Brown V.; Cornelius V.; Ghaffar S.; Ingram J.; Kavakleiva S.; *Kelly S.; Khorshid M.; Lachmann H.; Ladoyanni E.; McAteer H.; McKenna J.; Meynell F.; Patel P.; Pink A.; Powell K.; Pushparajah A.; Sinclair C.; Wachsmuth R.;

Citation:
Journal of Allergy and Clinical Immunology. 2024 May 28:S0091-6749(24)00553-0 [epub ahead of print]

Abstract:
Background: Palmoplantar pustulosis (PPP) is an inflammatory skin disorder that mostly affects smokers and manifests with painful pustular eruptions on the palms and soles. While the disease can present with concurrent plaque psoriasis, TNF and IL-17/IL-23 inhibitors show limited efficacy. There is therefore a pressing need to uncover PPP disease drivers and therapeutic targets. Objective(s): To identify genetic determinants of PPP and investigate whether cigarette smoking contributes to disease pathogenesis. Method(s): We performed a genome-wide association meta-analysis of three North-European cohorts (n=1,456 PPP cases and 402,050 controls). We then used the scGWAS program to investigate the cell-type specificity of the resulting association signals. We undertook genetic correlation analyses to examine the similarities between PPP and other immune-mediated diseases. Finally, we applied Mendelian randomization to analyze the causal relationship between cigarette smoking and PPP. Result(s): We found that PPP is not associated with the main genetic determinants of plaque psoriasis. Conversely, we identified genome-wide significant associations with the FCGR3A/FCGR3B and CCHCR1 loci. We also observed 13 suggestive (P<5X10-6) susceptibility regions, including the IL4/IL13 interval. Accordingly, we demonstrated a significant genetic correlation between PPP and Th2-mediated diseases like atopic dermatitis and ulcerative colitis. We also found that genes mapping to PPP-associated intervals were preferentially expressed in dendritic cells and enriched for T-cell activation pathways. Finally, we undertook a Mendelian randomization analysis, which supported a causal role of cigarette smoking in PPP. Conclusion(s): The first genome-wide association study of PPP points to a pathogenic role for deregulated Th2 responses and cigarette smoking.

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The characteristics and predictors of mortality in periprosthetic fractures around the knee (2024)

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Type of publication:
Journal article

Author(s):
Nasser, Ahmed A H H; Sidhu, Manpreet; Prakash, Rohan; Mahmood, Ansar; Osman, Khabab; Chauhan, Govind S; Nandra, Rajpal; Dewan, Varun; Davidson, Jerome; Al-Azzawi, Mohammed; Smith, Christian; Gawad, Mothana; Palaiologos, Ioannis; Cuthbert, Rory; Wignadasan, Warran; Banks, Daniel; Archer, James; Odeh, Abdulrahman; Moores, Thomas; Tahir, Muaaz; Brooks, Margaret; Biring, Gurdeep; Jordan, Stevan; Elahi, Zain; Shaath, Mohammed; Veettil, Manoj; De, Chiranjit; Handford, Charles; Bansal, Mohit; Bawa, Akshdeep; Mattar, Ahmed; Tandra, Varun; Daadipour, Audrina; Taha, Ahmed; Gangoo, Shafat; Srinivasan, Sriram; Tarisai, Mandishona; Budair, Basil; Subbaraman, Krishna; Khan, Farrukh; Gomindes, Austin; Samuel, Arjun; Kang, Niel; Kapur, Karan; Mainwaring, Elizabeth; Bridgwater, Hannah; Lo, Andre; *Ahmed, Usman; *Khaleeq, Tahir; El-Bakoury, Ahmed; Rashed, Ramy; Hosny, Hazem; Yarlagadda, Rathan; Keenan, Jonathan; Hamed, Ahmed; Riemer, Bryan; Qureshi, Arham; Gupta, Vatsal; Waites, Matthew; Bleibleh, Sabri; Westacott, David; Phillips, Jonathan; East, Jamie; Huntley, Daniel; Masud, Saqib; Mirza, Yusuf; Mishra, Sandeep; Dunlop, David; Khalefa, Mohamed; Balakumar, Balasubramanian; Thibbaiah, Mahesh; Payton, Olivia; Berstock, James; Deano, Krisna; Sarraf, Khaled M; Logishetty, Kartik; Lee, George; Subbiah-Ponniah, Hariharan; Shah, Nirav; Venkatesan, Aakaash; Cheseldene-Culley, James; Ayathamattam, Joseph; Tross, Samantha; Randhawa, Sukhwinder; Mohammed, Faisal; Ali, Ramla; Bird, Jonathan; Khan, Kursheed; Akhtar, Muhammad A; Brunt, Andrew; Roupakiotis, Panagiotis; Subramanian, Padmanabhan; Bua, Nelson; Hakimi, Mounir; Bitar, Samer; Al Najjar, Majed; Radhakrishnan, Ajay; Gamble, Charlie; James, Andrew; Gilmore, Catherine; Dawson, Dan; Sofat, Rajesh; Antar, Mohamed; Raghu, Aashish; Heaton, Sam; Tawfeek, Waleed; Charles, Christerlyn; Burnand, Henry; Duffy, Sean; Taylor, Luke; Magill, Laura; Perry, Rita; Pettitt, Michala; Okoth, Kelvin; Pinkney, Thomas

Citation:
Bone & Joint Journal. 106-B(2):158-165, 2024 Feb 01

Abstract:
Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality. Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation. Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.

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Cardiac rehabilitation for children and young people (CardioActive): protocol for a single-blind randomised feasibility and acceptability study of a centre-based cardiac rehabilitation programme versus usual care in 11-16 years with heart conditions (2024)

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Type of publication:
Journal article

Author(s):
Capobianco, Lora; Hann, Mark; McManus, Emma; Peters, Sarah; Doherty, Patrick Joseph; Ciotti, Giovanna; *Murray, Joanne; Wells, Adrian.

Citation:
BMJ Open. 14(2):e077958, 2024 Feb 24.

Abstract:
BACKGROUND: Congenital heart conditions are among the most common non-communicable diseases in children and young people (CYP), affecting 13.9 million CYP globally. While survival rates are increasing, support for young people adjusting to life with a heart condition is lacking. Furthermore, one in three CYP with heart conditions also experiences anxiety, depression or adjustment disorder, for which little support is offered. While adults are offered cardiac rehabilitation (CR) to support their mental and physical health, this is not offered for CYP.One way to overcome this is to evaluate a CR programme comprising exercise with
mental health support (CardioActive; CA) for CYP with heart conditions. The exercise and mental health components are informed by the metacognitive model, which has been shown to be effective in treating anxiety and depression in CYP and associated with improving psychological outcomes in adult CR. METHOD AND ANALYSIS: The study is a single-blind parallel randomised feasibility trial comparing a CR programme (CA) plus usual care against usual care alone with 100 CYP (50 per arm) aged 11-16 diagnosed with a heart condition. CA will include six group exercise, lifestyle and mental health modules. Usual care consists of routine outpatient management. Participants will be assessed at three time points: baseline, 3-month (post-treatment) and 6-month follow-up. Primary outcomes are feasibility and acceptability (ie, referral rates, recruitment and retention rates, attendance at the intervention, rate of return and level of completion of follow-up data). Coprimary symptom outcomes (Strength and Difficulties Questionnaire and Paediatric Quality of Life) and a range of secondary outcomes will be administered at each time point. A nested qualitative study will investigate CYP, parents and healthcare staff views of CR and its components, and staff's experience of delivering CA. Preliminary health economic data will be collected to inform future cost-effectiveness analyses. Descriptive data on study processes and clinical outcomes will be reported. Data analysis will follow intention to treat. Qualitative data will be analysed using thematic analysis and the theoretical framework of acceptability. ETHICS AND DISSEMINATION: Ethical approval was granted on 14 February 2023 by the Greater Manchester East Research Ethics Committee (22/NW/0367). The results will be disseminated through peer-reviewed journals, conference presentations and local dissemination. TRIAL REGISTRATION NUMBER: ISRCTN50031147; NCT05968521.

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The improvement and retention of skills in shoulder dystocia management with the use of high-fidelity simulation: the SAFE (SimulAtion high-FidElity) study (2024)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios; Klazoglou, Paraskevi; Valasoulis, George; Tzavara, Chara.

Citation:
Women & Birth: Journal of the Australian College of Midwives. 101590, 2024 Feb 16.

Abstract:
BACKGROUND: Shoulder dystocia is a relatively uncommon but serious childbirth-related emergency. AIM: To explore the improvement and retention of skills in shoulder dystocia management through high-fidelity simulation training. METHODS: The SAFE (SimulAtion high-FidElity) study was a prospective cohort study that utilised a high-fidelity birth simulator. Registered midwives and final year midwifery students were invited to participate in a one-day workshop at 6-monthly intervals. There was a 30-minute initial assessment, a 30-minute theoretical and hands-on training, and a 30-minute post-training assessment on shoulder dystocia management. Pre-training and post-training values for the predetermined outcomes were compared. In each workshop we assessed the proportion of successful simulated births, the performance of manoeuvres to manage shoulder dystocia, the head-to-body birth time, the fetal head traction force, the quality of communication, the perception of time-to-birth, and the self-reported confidence levels. FINDINGS: The baseline workshop recruited 101 participants that demonstrated a significant increase in the proportion of successful simulated births (8.9% vs 93.1%), and a two-fold to three-fold increase in the score of manoeuvres, communication, and confidence after training. Those with low pre-training levels of competency and confidence improved the most post-training at baseline. There was a retention of manoeuvres, communication skills and confidence at 6 months. There was no reduction in fetal head traction force over time. Those being proficient before initial training retained and performed best at the 6-month follow-up. CONCLUSION: The SAFE study found a significant improvement in skills and confidence after the initial high-fidelity simulation training that were retained after 6 months.

A hypoxia biomarker does not predict benefit from giving chemotherapy with radiotherapy in the BC2001 randomised controlled trial (2024)

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Type of publication:
Randomised controlled trial

Author(s):
Smith, Tim A D; West, Catharine M L; Joseph, Nuradh; Lane, Brian; Irlam-Jones, Joely; More, Elisabet; Mistry, Hitesh; Reeves, Kimberley J; Song, Yee Pei; Reardon, Mark; Hoskin, Peter J; Hussain, Syed A; *Denley, Helen; Hall, Emma; Porta, Nuria; Huddart, Robert A; James, Nick D; Choudhury, Ananya.

Citation:
EBioMedicine. 101:105032, 2024 Feb 21.

Abstract:
BACKGROUND: BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. METHODS: RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). PRIMARY ENDPOINT: invasive loco-regional control (ILRC); secondary overall survival. FINDINGS: Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99-1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82-2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99-2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28-1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7-119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07-15.5, p = 0.978) radiotherapy. INTERPRETATION: Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial.

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Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data (2024)

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Type of publication:
Journal article

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

Citation:
Hernia. 2024 Feb 12.

Abstract:
PURPOSE: Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery. METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >= 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS: A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%. CONCLUSIONS: There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.

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Rhabdomyolysis Following Prolonged Entrapment on a Fence: A Case Report (2024)

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Type of publication:
Journal article

Author(s):
*Nwaneri, Chukwuemeka; *Aboshehata, Ahmed M; *Marsh, Adrian R.

Citation:
Cureus. 16(1):e51954, 2024 Jan.

Abstract:
It is well documented that prolonged immobilization and heavy alcohol consumption can independently cause rhabdomyolysis; however, entrapment on a fence following alcohol consumption resulting in rhabdomyolysis without prolonged coma or seizures has not been reported. We report a case of a 25-year-old man who, following alcohol consumption, whilst attempting to climb a fence, became entrapped and desperately had to clinch on the fence with both forearms for over three hours, resulting in rhabdomyolysis. This case report highlights the importance of recognizing the potential complications associated with prolonged immobilization and the subsequent management of rhabdomyolysis.

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