Staff Publication

Hand and Wrist Injuries Related to Motocross Injuries: 5 Year Series (2019)

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Type of publication:
Journal article

Author(s):
*Singh R.; *Hay S.; Chojnowski A.

Citation:
The journal of hand surgery Asian-Pacific volume; Mar 2019; vol. 24 (no. 1); p. 60-64

Abstract:
BACKGROUND: The increasingly fashionable sport of motocross is practiced worldwide by millions of people, but there is very little in the literature regarding its associated injuries and their prevention. We therefore present the first comprehensive, prospective study looking at hand and wrist injuries resulting from motocross injuries in the UK. METHOD(S): Data was prospectively collected over a 5-year period (from 2010 to 2015) at our regional trauma unit. We exclusively looked at motocross riders. Injuries sustained via motorcycle were excluded from our study. RESULT(S): During the period studied (five years), 615 injuries were collected, including 240 patients with 265 hand and wrist injuries. Most of injuries were sustained in male patients. The patient's age range was from 4-78 years with most injuries occurring during the spring and summer months. A total of 96 (40%) patients required operative treatment. The most common injury pattern was distal radius fractures (n = 53, 20%), followed by metacarpal fractures (n = 38, 14%) and phalangeal fractures (n = 36, 13.5%). CONCLUSION(S): This study shows the impact and incidence of related hand and wrist injuries. Motocross is a globally fashionable sport. This study shows that the number of annual tournaments and racers have doubled in last 5 years. The number of hand and wrist related injuries and operative requirements have quadruples over the last five years. It is recognized as a high-risk sport despite the use of protective equipment and course adaptions. These injuries can have implications for nearby treating hospitals.

Prospective, multinational, observational study of real-world treatment outcomes with pazopanib in patients with advanced or metastatic renal cell carcinoma (PRINCIPAL study) (2018)

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Type of publication:
Conference abstract

Author(s):
Schmidinger M.; Procopio G.; Hawkins R.E.; Sanchez A.R.; Vazquez S.; *Srihari N.; Kalofonos H.; Bamias A.; Bono P.; Pisal C.B.; Hirschberg Y.; Dezzani L.; Ahmad Q.I.; Jonasch E.

Citation:
Journal of Clinical Oncology; May 2018; vol. 36 (no. 15)

Abstract:
Background: PRINCIPAL (NCT01649778) was the largest prospective real-world effectiveness and safety study of pazopanib (PAZ) in patients (pts) with renal cell carcinoma (RCC). Method(s): Pts with advanced and/or metastatic clear cell RCC were enrolled within 30 days of initiating firstline PAZ. Follow-up data on progression, survival, and safety was collected approximately every 3 months until death, consent withdrawal, or loss to follow-up, for up to 30 months. Primary efficacy end points were median overall survival (mOS), median progression-free survival (mPFS), and overall response rate (ORR). Safety measures included frequency of adverse events (AEs), serious AEs, and AEs of special interest. Result(s): Among 657 pts who received >=1 dose of PAZ, 76.3% completed the study (33.0% completed 30 months of follow-up and 43.2% died). Median enrollment age was 66 years, with 57.2% aged >=65 years. 4.1%, 62.6%, and 33.3% of pts were grouped as favorable, intermediate, or poor risk by Heng criteria, respectively. Most pts (84%) initiated treatment at 800 mg, and the median treatment time with or without dose interruption was 6.9 and 7.6 months, respectively. mPFS and mOS are shown in the Table. Among the measurable disease population (n = 168), ORR was 30.3%, median duration of response was 11.0 months (95% confidence interval [CI] 8.6-14.6), and time to response, evaluated every 3 months, was 3.0 months (95% CI 2.9-3.1). Most pts had an AE (74.0%) that led to dose  adjustment/interruption in 49.3% and treatment discontinuation in 14.6%. The most frequent ( > 10%) drug-related AEs were hypertension (20.9%), diarrhea (11.3%), and increased alanine aminotransferase (11.0%). Conclusion(s): Realworld effectiveness and safety outcomes in the PRINCIPAL study were consistent with clinical trials and support the first-line use of PAZ across all risk groups of pts with advanced or metastatic RCC.

Comparison of clinical outcomes with firstline pazopanib in clinical trial eligible and non-clinical trial eligible patients with renal cell carcinoma (2018)

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Type of publication:
Conference abstract

Author(s):
Jonasch E.; Procopio G.; Hawkins R.E.; Sanchez A.R.; Vazquez S.; *Srihari N.; Kalofonos H.; Bamias A.; Bono P.; Pisal C.B.; Hirschberg Y.; Dezzani L.; Ahmad Q.I.; Schmidinger M.

Citation:
Journal of Clinical Oncology; May 2018; vol. 36 (no. 15)

Abstract:
Background: Although pazopanib (PAZ) has been evaluated in clinical trials of patients (pts) with renal cell carcinoma (RCC), limited real-world data on the effectiveness and safety of PAZ exist. The PRINCIPAL study (NCT01649778) assessed the effectiveness and safety of first-line PAZ in a real-world setting. Method(s): In this nonrandomized, prospective study, pts with advanced and/or metastatic clear cell RCC were enrolled in PRINCIPAL within 30 days of initiating first-line PAZ. Data on progression, survival, and safety were collected approximately every 3 months (mos) until death, consent withdrawal, or loss to follow-up, for up to 30 mos. Pts in PRINCIPAL were separated into two groups based on key eligibility criteria from the Phase III COMPARZ trial (Motzer et al. NEJM. 2013;369:722). Key clinical trial eligible (CTE) criteria included no prior systemic therapy, presence of measurable disease per RECIST 1.1, Karnofsky performance status >=70, adequate organ system function, no history or clinical evidence of central nervous system metastases, and no coronary or cerebral artery disease at baseline. CTE pts were compared to non-CTE (NCTE) pts. Clinical effectiveness (ie, median overall survival [mOS], median progression-free survival [mPFS], and overall response rate [ORR]), adverse event (AE) measures, and relative dose intensity (RDI) were assessed in both pt populations. Result(s): Of the 657 enrolled pts who received >=1 dose of PAZ, 97 (14.8%) were CTE and 560 (85.2%) were NCTE. RDI >=85% was achieved in 70.1% and 56.6% in the CTE and NCTE populations, respectively. Effectiveness was similar in the CTE and the NCTE populations (mPFS, 9.6 vs 10.7 mos; ORR, 33.0% vs 29.8%; mOS, 26.3 vs 32.9 mos). Serious AEs were reported by 23.7% of CTE and 28.2% of NCTE pts. AEs led to dose adjustment/interruption in 83.5% and 95.2%, respectively, and AEs led to treatment discontinuation in 8.2% of the CTE and 15.5% NCTE pts. Conclusion(s): The results of the PRINCIPAL study suggest that first-line PAZ for pts with advanced or metastatic RCC remains effective and safe in a real-world setting, showing similar outcomes to those reported in large randomized clinical trials.

Parent Experiences with Paediatric Allergy Pathways in the West Midlands: A Qualitative study. (2019)

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Type of publication:
Journal article

Author(s):
Diwakar, Lavanya; Cummins, Carole; Hackett, Scott; *Rees, Martyn; Charles, Lynette; Kerrigan, Caroline; Creed, Helen; Roberts, Tracy

Citation:
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology; Jan 2019 Volume49, Issue3, Pages 357-365

Abstract:
BACKGROUND The prevalence, severity and complexity of allergic diseases has been increasing steadily in the UK over the last few decades. Primary care physicians are often not adequately trained in allergy management whilst specialist services for allergy are scarce and heterogeneous. Services, therefore, have been unable to meet the rising demand. This is particularly true for paediatric allergy services in the UK. OBJECTIVE To understand parent experiences with paediatric allergy pathways in the West Midlands (WM) region of the UK. METHODS Parents of children aged between 0-16 years from the WM region were recruited opportunistically until thematic saturation was achieved. 18 semi-structured interviews were carried out and transcribed verbatim. Data were analysed on NVivo software using the framework method. Themes were identified from the transcripts as well as from existing literature. RESULTS Parents highlighted numerous issues related to allergy services in the region including difficulties with being taken seriously by their physicians, problems with accessing healthcare and issues with information and the need for additional supportive care for allergies. CONCLUSIONS AND CLINICAL RELEVANCE Primary care for children with allergies in the West Midlands is disparate. Parents experience difficulties in accessing primary and secondary care services and also obtaining timely and appropriate information regarding their child's allergies. Most parents were happy to be reviewed by either specialist nurses or by consultants in the hospital. Improving accessibility and availability of reliable information as well as provision of additional services (such as psychologists and dietetics) were highlighted by parents as being important to allergy services in the region. These findings can help inform future planning and commissioning of allergy services

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Coronary heart disease mortality in severe vs. non-severe familial hypercholesterolaemia in the Simon Broome Register (2019)

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Type of publication:
Journal article

Author(s):
Humphries, Steve E; Cooper, Jackie A; *Capps, Nigel; Durrington, Paul N; Jones, Ben; McDowell, Ian F W; Soran, Handrean; Neil, Andrew H W; Simon Broome Familial Hyperlipidaemia Register Group

Citation:
Atherosclerosis. 2019 Feb;281:207-212

Abstract:
BACKGROUND AND AIMS The International Atherosclerosis Society (IAS) has proposed that patients with "severe" FH (SFH) would warrant early and more aggressive cholesterol-lowering treatment such as with PCSK9 inhibitors. SFH is diagnosed if LDL-cholesterol (LDLC)>10mmol/L, or LDLC >8.0mmol/L plus one highrisk feature, or LDLC >5mmol/L plus two high-risk features. Here we compare CHD mortality in SFH and nonSFH (NSFH) patients in the UK prospective Simon Broome Register since 1991, when statin use became routine.METHODS 2929 definite or possible PFH patients (51% women) aged 20-79 years were recruited from 21 UK lipid clinics and followed prospectively between 1992 and 2016. The excess CHD standardised mortality ratio (SMR) compared to the England and Wales population was calculated (with 95% confidence intervals).RESULTS1982 (67.7%) patients met the SFH definition. Compared to the non-SFH, significantly (p < 0.001) more SFH patients had diagnosed CHD at baseline (24.6% vs. 17.5%), were current smokers (21.9% vs 10.2%) and had a BMI>30kg/m2 (14.9% vs. 7.8%). The SMR for CHD mortality was significantly (p=0.007) higher for SFH (220 (184-261) (34,134 person years, 129 deaths observed, vs. 59 expected) compared to NSFH of 144 (98-203) (15,432 person years, 32 observed vs. 22 expected). After adjustment for traditional risk factors, the Hazard Ratio for CHD mortality in SFH vs. NSFH was 1.22 (0.80-1.87) p=0.36, indicating that the excess risk was largely accounted for by these factors.CONCLUSIONS CHD mortality remains elevated in treated FH, especially for SFH, emphasising the importance of optimal lipid-lowering and management of other risk factors.

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Lymphangioma circumscriptum of the vulva clinical picture and surgical management (2018)

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Type of publication:
Journal article

Author(s):
*Papoutsis D.; Haefner H.K

Citation:
Archives of Hellenic Medicine 35(6):809-810 · November 2018

Abstract:
Vulvar lymphangioma circumscriptum is a rare entity that may mimic many other diseases of the vulva. It presents with the non-specific symptoms of persistent vulvar itching and soreness, and the diagnosis is confirmed through vulvar biopsy. Surgical treatment has the lowest recurrence rates compared with other treatment modalities. The case is presented here of a woman diagnosed with lymphangioma circumscriptum of the vulva and its surgical management.

Audit of 2-week wait referrals to the Gynecology Department in District General Hospital and investigating patient awareness of the reasons and importance behind the referral (2018)

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Type of publication:
Conference abstract

Author(s):
Wilkinson M.; *Sahu B

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; Dec 2018; vol. 125 ; p. 48

Abstract:
Introduction Two-week wait referrals to gynecology services are at a premium with pressure on numbers. Referrals can be inappropriate. Patients are often unaware the appointment is for suspected cancer. Methods Two-week wait referrals were examined during a six month period. The gynecologist in clinic collected data. Patients were asked about their 2-week wait referral, gauging awareness around their referral. Clinical symptoms and signs were compared to those in referral. Appropriateness of the referral was assessed by symptoms fitting the 2-week wait criteria or clinical findings on referral not consistent with the presenting symptoms and findings in clinic. Results A total of 172 patients were referred under the 2-week wait criteria; mean age was 58 years, range (17-95). Referrals were from 50 separate primary care practices. Suspected cancer referrals were composed of 111 endometrial, 15 ovarian, 22 cervical, 15 vulva/vaginal and 9 of mixed pathology. There was awareness of referral for cancer in 90 cases (52%), awareness of "2-week wait" in 124 cases (72%) and aware that the appointment could be at either hospital within the trust in 96 cases (56%). The referral was considered appropriate for 2-week wait referral in 123 (72%) of cases. Conclusion The majority of patients were referred correctly. A wide range of pathologies was seen. A significant number could have been referred as routine referrals or advice requested. Patient awareness of it being a referral due to suspected cancer was poor with better appreciation of the urgency of referral.

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Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals (2018)

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Type of publication:
Journal article

Author(s):
Wong, D.J.N.; Harris, S.K.; Moonesinghe, S.R

Collaborators at Shrewsbury and Telford Hospital NHS Trust:
*Jane Wright, *Paul Jones, *Riquella Abbott, *Lisa Bacon, *Christopher Godden, *David Howe, *Angela Loughlin, *Helen Moore, *Samuel Passey, *Rebekah Rodgers

Citation:
BJA: The British Journal of Anaesthesia; Oct 2018; vol. 121 (no. 4); p. 730-738

Abstract:
Background: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity.Results: We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12-4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22-7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22-0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08-0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27-0.56; P<0.001) were less likely to be cancelled.Conclusions: A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.

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The current standard of care and the unmet needs for axial spondyloarthritis (2018)

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Type of publication:
Journal article

Author(s):
*Noureldin, Basil; Barkham, Nick

Citation:
Rheumatology; Volume 57, Issue suppl_6, November 2018, Pages vi10–vi17

Abstract:
The aim of this article is to explore the benefits and limitations of the established treatments for axial SpA (axSpA), including physiotherapy, NSAIDs, conventional synthetic DMARDs and biologic DMARDs such as TNF inhibitors (TNFis). It also briefly discusses the emerging role of anti-IL-17 therapy, which could be used as a valuable alternative to first-line biologic DMARD treatment or as a second-line treatment for patients who are inadequate responders to TNFi therapy, as evidenced by various studies. Exercise programmes improve health related quality of life and hydrotherapy improves disease activity and functional parameters in AS. NSAIDs have been proven to substantially relieve symptoms in 70–80% of patients and enhance physiotherapy by reducing pain and stiffness. The role of NSAIDs in preventing radiographic progression remains unclear. The use of conventional synthetic DMARDs (csDMARDs) is limited to peripheral arthritis; there is insufficient evidence to support the use of csDMARDs for axial disease. TNFi therapy reduces the disease activity of axSpA, however, as not all patients respond to treatment in the same way, it is good to have other therapeutic options available. Finally, this article explores the potential for IL-17 inhibition in AS and introduces clinical data for secukinumab, a fully human monoclonal antibody targeting IL-17A.