Charcot Marie Tooth disease type 2S with late onset diaphragmatic weakness: An atypical case (2018)

Type of publication:
Journal article

Author(s):
Kulshrestha, Richa; Forrester, Natalie; Antoniadi, Thalia; Willis, Tracey; *Sethuraman, Sethil Kumar; Samuels, Martin

Citation:
Neuromuscular disorders : NMD; Dec 2018; vol. 28 (no. 12); p. 1016-1021

Abstract:
Immunoglobulin-helicase-μ-binding protein 2 (IGHMBP2) mutations are associated with partial continuum between two extremes of rapidly lethal disorder of spinal muscular atrophy with respiratory distress type 1 (SMARD1), with infantile axonal neuropathy, diaphragmatic weakness and commonly death before 1 year of age, and Charcot-Marie-Tooth disease (CMT) type 2S with slowly progressive weakness and sensory loss but no significant respiratory compromise. We present an atypical case of CMT2S. A 9 month old boy presented with bilateral feet deformities and axonal neuropathy. Genetic testing revealed two heterozygous variants in the IGHMBP2 gene: c.1156 T>C p.(Trp386Arg) in exon 8 and c.2747G>A p.(Cys916Tyr) in exon 14, that were inherited from his father and mother respectively. At 9 years, he developed diaphragmatic weakness, following which he was established on non-invasive ventilation. Our case emphasizes the importance of life long respiratory surveillance for patients with CMT2S and expands the phenotype of this condition.

A patient-centred model to quality assure outputs from an echocardiography department: consensus guidance from the British Society of Echocardiography (2018)

Type of publication:
Journal article

Author(s):
*Ingram, Thomas E; Baker, Steph; Allen, Jane; Ritzmann, Sarah; Bual, Nina; Duffy, Laura; Ellis, Chris; Bunting, Karina; Black, Noel; Peck, Marcus; Hothi, Sandeep S; Sharma, Vishal; Pearce, Keith; Steeds, Richard P; Masani, Navroz

Citation:
Echo research and practice; Dec 2018; vol. 5 (no. 4); p. G25

Abstract:
Background Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met. In addition, a process is detailed for departments that are seeking to demonstrate to external bodies adherence to a robust QA process. Methods The EQF consists of four domains. These include assessment of Echo Quality (including study acquisition and report generation); Reproducibility & Consistency (including analysis of individual variability when compared to the group and focused clinical audit), Education & Training (for all providers and service users) and Customer & Staff Satisfaction (of both service users and patients/their carers). Examples of what could be done in each of these areas are presented. Furthermore, evidence of participation in each domain is categorised against a red, amber or green rating: with an amber or green rating signifying that a quantifiable level of engagement in that aspect of QA has been achieved. Conclusion The proposed EQF is a powerful tool that focuses the limited time available for departmental QA on areas of practice where a change in patient experience or outcome is most likely to occur.

Link to full-text [NHS OpenAthens account required]

Screening for colorectal cancer in defunctioned colons (2018)

Type of publication:
Journal article

Author(s):
*Akbar, Fayyaz; Quyn, Aaron; Steele, Robert

Citation:
Journal of medical screening; Dec 2018; vol. 25 (no. 4); p. 178-182

Abstract:
OBJECTIVES Population-based colorectal (bowel) cancer screening using faecal occult blood tests leads to a reduction in cause-specific mortality. However, in people where the colon is defunctioned, the use of standard faecal occult blood test is not appropriate. The aim of this study was to examine the current trends of clinical practice for colorectal cancer screening in people with defunctioned colons.METHODS An online survey was performed using SurveyMonkey. All members of the Association of Coloproctology of Great Britain and Ireland were invited by email to participate. Reminders were sent to non-responders and partial responders till six weeks. All responses were included in our analysis. RESULTS Of the 206 (34.59%) questionnaires completed, all questions were answered in 110 (55.8%). Among responders, 94 (85.4%) were colorectal consultant surgeons, 72% had worked in their current capacity for more than five years, and 105 (50.9%) had encountered colorectal cancer in defunctioned colons during their career. Some 72.2% of responders stated that a screening test for colorectal cancer in patients with defunctioned colons was currently not offered, or that they did not know whether or not it was offered in their area.CONCLUSIONS Bowel screening in the United Kingdom is currently not offered to 72.2% of the age appropriate population with defunctioned colons. Among responding colorectal surgeons, 50% had encountered colorectal cancer in such patients. There is considerable variability in clinical practice regarding the optimal age for onset of screening, time interval, and the optimal modality to offer for screening in such cases.

Link to full-text [no password required]

Self-inflicted bilateral ocular and eyelid injuries in an unsuspected individual (2019)

Type of publication:
Journal article

Author(s):
*Samia-Aly, Emma; *Ha, Jerome; *Sagili, Suresh

Citation:
Scottish medical journal; May 2019; vol. 64 (no. 2); p. 78-82

Abstract:
BACKGROUND AND AIMS This report aims to illustrate a case of self-inflicted ocular and orbital injury, resulting in severe tissue loss and ophthalmoplegia in a patient with no known history of mental illness.METHODS AND RESULTS A 71-year-old male initially presented to the emergency department with significant tissue loss from his left upper and lower lids, orbital tissue loss and complete ophthalmoplegia, after reportedly tripping and falling onto his desk. He subsequently attended the emergency department on two further occasions with similar injuries, affecting the same and contralateral eye, whilst maintaining a traumatic cause for his injuries. He was eventually admitted to a psychiatric ward for mental health assessment. This report covers his progress as well as illustrating his injuries with images. CONCLUSION Self-harm is an important differential diagnosis in cases where the mechanism of injury does not correspond to the extent of injury or tissue loss. It can, however, be difficult to differentiate from accidental injury and even with repeated assessments, a formal psychiatric diagnosis may not be possible.

Longer duration of operative time enhances healing metabolites and improves patient outcome after Achilles tendon rupture surgery (2018)

Type of publication:
Journal article

Author(s):
Svedman S.; Aufwerber S.; Ackermann P.W.; Westin O.; Nilsson-Helander K.; *Carmont M.R.; Karlsson J.; Edman G.

Citation:
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA; Jul 2018; vol. 26 (no. 7); p. 2011-2020

Abstract:
PURPOSE: The relationship between the duration of operative time (DOT), healing response and patient outcome has not been previously investigated. An enhanced healing response related to DOT may potentiate repair processes, especially in hypovascular and sparsely metabolized musculoskeletal tissues such as tendons. This study aimed to investigate the association between DOT and the metabolic healing response, patient reported outcome and the rate of post-operative complications after acute Achilles tendon injury.METHODS: Observational cohort, cross-sectional study with observers blinded to patient grouping. A total of two-hundred and fifty-six prospectively randomized patients (210 men, 46 women; mean age 41 years) with an acute total Achilles tendon rupture all operated on with uniform anaesthetic and surgical technique were retrospectively assessed. At 2 weeks post-operatively, six metabolites were quantified using microdialysis. At 3, 6 and 12 months, patient-reported pain, walking ability and physical activity were examined using self-reported questionnaires, Achilles tendon total rupture score, foot and ankle outcome score and physical activity scale. At 12 months, functional outcome was assessed using the heel-rise test. Complications, such as deep venous thrombosis, infections and re-operations, were recorded throughout the study.RESULTS: Patients who underwent longer DOT exhibited higher levels of glutamate (p = 0.026) and glycerol (p = 0.023) at 2 weeks. At the 1-year follow-up, longer DOT was associated with significantly less loss in physical activity (p = 0.003), less pain (p = 0.009), less walking limitations (p = 0.022) and better functional outcome (p = 0.014). DOT did not significantly correlate with the rate of adverse events, such as deep venous thrombosis, infections or reruptures. Higher glutamate levels were associated with less loss in physical activity (p = 0.017). All correlations were confirmed by multiple linear regressions taking confounding factors into consideration.CONCLUSION: The results from this study suggest a previously unknown mechanism, increased metabolic response associated with longer DOT, which may improve patient outcome after Achilles tendon rupture surgery. Allowing for a higher amount of traumatized tissue, as reflected by up-regulation of glycerol in patients with longer DOT, may prove to be an important surgical tip for stimulation of repair of hypometabolic soft tissue injuries, such as Achilles tendon ruptures.II.

Link to full-text [no password required]

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study (2019)

Type of publication:
Journal article

Author(s):
Claireaux H.A.; Antoniou I.; Dean R.; Davies N.; Trecarten S.; Henderson I.; Holmes C.; Wylie J.; Shuttleworth R.H.; Jindal A.; Hughes F.; Gouda P.; McNamee L.; Fleck R.; Hanrahan M.; Karunakaran P.; Chen J.H.; Sykes M.C.; Sethi R.K.; Suresh S.; Patel P.; Patel M.; Varma R.K.; Mushtaq J.; Gundogan B.; Bolton W.; Mohan M.; Khan T.; Burke J.; Morley R.; Favero N.; Adams R.; Thirumal V.; Kennedy E.D.; Ong K.K.; Tan Y.H.; Gabriel J.; Bakhsh A.; Low J.Y.L.; Yener A.; Paraoan V.; Preece R.; Tilston T.W.; Cumber E.; Dean S.; Ross T.; McCance E.; Amin H.; Satterthwaite L.; Clement K.D.; Gratton R.; Mills E.D.; Chiu S.M.; Hung G.; Rafiq N.M.; Hayes J.D.B.; Robertson K.L.; Dynes K.; Huang H.C.; Assadullah S.; Duncumb J.W.; Moon R.D.C.; Poo S.X.; Mehta J.K.; Joshi K.R.; Callan R.; Norris J.M.; Chilvers N.J.; Keevil H.; Jull P.; Mallick S.; Elf D.; Carr L.; Player C.; Barton E.C.; Martin A.L.; Ratu S.G.; Roberts E.J.; Phan P.N.; Dyal A.R.; Rogers J.E.; Henson A.D.; Reid N.B.; Burke D.; Culleton G.; Lynne S.; Mansoor S.; Brennan C.; Blessed R.; Holloway C.; Hill A.; Goldsmith T.; Mackin S.; Kim S.; Woin E.; Brent G.; Coffin J.; Ziff O.; Momoh Z.; Debenham R.; Ahmed M.; Yong C.S.; Wan J.C.; Copley H.C.; Raut P.; Chaudhry F.I.; Nixon G.; Dorman C.; Tan R.; Kanabar S.; Canning N.; Dolaghan M.; Bell N.; McMenamin M.; Chhabra A.; Duke K.; Turner L.; Patel T.; Chew L.S.; Mirza M.; Lunawat S.; Oremule B.; Ward N.; Khan M.; Tan E.T.; Maclennan D.; McGregor R.J.; Chisholm E.G.; Griffin E.J.; Bell L.; Hughes B.A.; Davies J.; Haq H.; Ahmed H.; Ungcharoen N.; Whacha C.; Thethi R.; Markham R.M.; Lee A.H.Y.; Batt E.; Bullock N.P.; Francescon C.T.; Davies J.E.; Shafiq N.M.; Zhao J.; Vivekanantham S.; Barai I.; Allen J.L.Y.; Marshall D.C.; McIntyre C.J.; Wilson H.C.P.; Ashton A.J.; Lek C.; Behar N.; Davis-Hall M.; Seneviratne N.; Esteve L.; Sirakaya M.; Ali S.; Pope S.; Ahn J.S.; Craig-McQuaide A.; Gatfield W.A.; Leong S.; Demetri A.M.; Kerr A.L.; Rees C.; Loveday J.; Liu S.; Wijesekera M.; Maru D.; Attalla M.; Smith N.; Brown D.; Sritharan P.; Shah A.; Charavanamuttu V.; Heppenstall-Harris G.; Ng K.; Raghvani T.; Rajan N.; Hulley K.; Moody N.; Williams M.; Cotton A.; Sharifpour M.; Lwin K.N.; Bright M.; Chitnis A.R.; Abdelhadi M.; Semana A.D.; Morgan F.; Reid R.; Dickson J.; Anderson L.; McMullan R.; Ahern N.; Asmadi A.; Anderson L.B.; Boon Xuan J.L.; Crozier L.; McAleer S.; Lees D.M.; Adebayo A.A.; Das M.; Amphlett A.H.; Al-Robeye A.; Valli A.; Khangura J.; Winarski A.; Ali A.; Woodward H.; Gouldthrope C.; Turner M.; Sasapu K.; Tonkins M.; Wild J.R.L.; Robinson M.; Hardie J.; Heminway R.; Narramore R.; Ramjeeawon N.; Hibberd A.; Winslow F.; Ho W.; Chong B.F.; Lim K.; Ho S.; Crewdson J.A.; Singagireson S.; Kalra N.; Koumpa F.; Jhala H.; Soon W.C.; Karia M.; Rasiah M.G.; Xylas D.; Gilbert H.; Sundar-Singh M.; Wills J.; Akhtar S.; Patel S.; Hu L.; Brathwaite-Shirley C.; Nayee H.; Amin O.; Rangan T.; Turner E.J.H.; McCrann C.; Shepherd R.; Patel N.; Prest-Smith J.; Auyoung E.; Murtaza A.; Coates A.; Prys-Jones O.; King M.; Gaffney S.; Dewdney C.J.; Nehikhare I.; Lavery J.; Bassett J.; Davies K.; Ahmad K.; Collins A.; Acres M.; Egerton C.; Cheng K.; Chen X.; Chan N.; Sheldon A.; Khan S.; Empey J.; Ingram E.; Malik A.; Johnstone M.; Goodier R.; Shah J.P.; Giles J.E.; Sanders J.A.; McLure S.W.; Pal S.; Rangedara A.; Baker A.N.; Asbjoernsen C.A.; Girling C.; Gray L.; Gauntlett L.; Joyner C.; Qureshi S.; Mogan Y.P.; Ng J.C.K.; Kumar A.N.; Park J.H.; Tan D.; Choo K.P.; Raman K.P.; Buakuma P.; Xiao C.; Govinden S.; Thompson O.D.; Charalambos M.A.; Brown E.; Karsan R.B.; Dogra T.; Bullman L.M.; Dawson P.M.; Frank A.L.; Abid H.; Tung L.; Qureshi U.; Tahmina A.; Matthews B.W.; Harris R.T.; O'Connor A.; Mazan K.; Iqbal S.; Stanger S.A.; Thompson J.D.; Sullivan J.A.L.; Uppal E.; MacAskill A.; Bamgbose F.A.; Neophytou C.; Carroll A.F.; Rookes C.W.; Datta U.; Dhutia A.J.; Rashid S.; Ahmed N.; Lo T.; Bhanderi S.; Blore C.D.; Ahmed S.; Shaheen H.; Abburu S.; Majid S.; Abbas Z.; Talukdar S.S.; Burney L.J.; Patel J.B.; Al-Obaedi O.; Roberts A.W.; Mahboob S.; Singh B.; Sheth S.; Karia P.; Prabhudesai A.; Kow K.; Koysombat K.; Wang S.; Morrison P.; Maheswaran Y.; Keane P.; Copley P.C.; Brewster O.; Xu G.X.; Harries P.; Wall C.; AlMousawi A.; Bonsu S.; Cunha P.; Ward T.; Paul J.; Nadanakumaran K.; Tayeh S.; Holyoak H.; Remedios J.; Theodoropoulou K.; Luhishi A.; Jacob L.; Long F.; Atayi A.; Sarwar S.; Parker O.; Harvey J.; Ross H.; Rampal R.; Thomas G.; Vanmali P.; McGowan C.; Stein J.; Robertson V.; Carthew L.; Teng V.; Fong J.; Street A.N.; Thakker C.E.; O'Reilly D.; Bravo M.; Pizzolato A.; Khokhar H.A.; Ryan M.; Cheskes L.; Carr R.; Salih A.E.; Bassiony S.; Yuen R.; Chrastek D.; Rosen O'Sullivan H.; Amajuoyi A.; Wang A.; Sitta O.; Wye J.; Qamar M.A.; Major C.; Kaushal A.; Morgan C.; Petrarca M.; Allot R.; Verma K.; Dutt S.; Chilima C.P.; Peroos S.; Kosasih S.R.; Chin H.; Ashken L.; Pearse R.J.; O'Loughlin R.A.; Menon A.; Singh K.; Norton J.; Sagar R.; Jathanna N.; Rothwell L.; Watson N.; Harding F.; Dube P.; Khalid H.; Punjabi N.; Sagmeister M.; Gill P.; Shahid S.; Hudson-Phillips S.; George D.; Ashwood J.; Lewis T.; Dhar M.; Sangal P.; Rhema I.A.; Kotecha D.; Afzal Z.; Syeed J.A.; Prakash E.; Jalota P.; Herron J.; Kimani L.; Delport A.; Shukla A.; Agarwal V.; Parthiban S.; Thakur H.; Cymes W.; Rinkoff S.; Turnbull J.A.; Hayat M.; Darr S.; Khan U.; Lim J.; Higgins A.; Lakshmipathy G.; Forte B.; Canning E.; Jaitley A.; Lamont J.; Toner E.; Ghaffar A.; McDowell M.; Salmon D.; O'Carroll O.; Khan A.; Kelly M.E.; Clesham K.; Palmer C.; Lyons R.; Bell A.; Chin R.; Waldron R.M.; Trimble A.; Cox S.E.; Ashfaq U.; Campbell J.; Holliday R.B.S.; McCabe G.; Morris F.; Priestland R.; Vernon O.K.; Ledsam A.; Vaughan R.; Lim D.; Bakewell Z.R.; Hughes R.K.; Koshy R.M.; Jackson H.R.; Narayan P.; Cardwell A.E.; Jubainville C.L.; Arif T.; Elliott L.E.; Gupta V.; Bhaskaran G.; Odeleye A.; Ahmed F.; Shah R.; Pickard J.; Suleman Y.N.; North A.S.; McClymont L.F.; Hussain N.; Ibrahim I.; Ng G.S.; Wong V.; Lim A.E.; Harris L.N.; Tharmachandirar T.; Mittapalli D.; Patel V.; Lakhani M.; Bazeer H.Z.; Narwani V.; Sandhu K.K.; Wingfield L.R.; Gentry S.; Adjei H.; Bhatti M.; Braganza L.; Barnes J.; Mistry S.; Chillarge G.; Stokes S.; Cleere J.; Wadanamby S.; Bucko A.M.; Meek J.; Boxall N.; Heywood E.G.; Wiltshire J.J.; Toh C.; Ward A.E.; Shurovi B.N.; Horth D.; Patel B.Y.; Ali B.; Spencer T.; Axelson T.; Kretzmer L.; Chhina C.; Anandarajah C.; Fautz T.; Horst C.; Thevathasan A.A.; Ng J.Q.; Hirst F.; Brewer C.F.; Logan A.E.; Lockey J.W.; Forrest P.R.; Keelty N.; Wood A.D.; Springford L.R.; Avery P.; Schulz T.M.; Bemand T.P.; Howells L.; Collier H.; Khajuria A.; Tharakan R.G.; Parsons S.; Buchan A.M.; McGalliard R.J.; Mason J.D.; Cundy O.J.; Li N.; Redgrave N.A.; Watson R.P.; Pezas T.P.; Dennis Y.F.; Segall E.; Hameed M.; Lynch A.S.; Chamberlain M.; Peck F.S.; Neo Y.N.; Russell G.; Elseedawy M.; Lee S.; Foster N.L.; Soo Y.H.; Puan L.; Dennis R.; Goradia H.; Qureshi A.; Osman S.; Reeves T.; Dinsmore L.; Marsden M.; Lu Q.; Pitts-Tucker T.; Dunn C.E.; Walford R.A.; Heathcote E.; Martin R.; Pericleous A.; Brzyska K.; Reid K.G.; Williams M.R.; Wetherall N.; McAleer E.; Thomas D.; Kiff R.; Milne S.; Holmes M.J.V.; Bartlett J.; Lucas de Carvalho J.; Bloomfield T.; Tongo F.; Bremner R.H.; Yong N.; Atraszkiewicz B.A.; Mehdi A.; Tahir M.; Sherliker G.X.J.; Tear A.K.; Pandey A.; Broyd A.; Omer H.M.; Raphael M.; Chaudhry W.W.; Shahidi S.; Jawad A.S.; Gill C.K.; Fisher I.H.; Adeleja I.; Clark I.J.; Aidoo-Micah G.E.; Stather P.W.; Salam G.J.; Glover T.E.; Deas G.; Sim N.K.; Obute R.D.; Wynell-Mayow W.M.; Sait M.S.; Mitha N.; de Bernier G.L.; Siddiqui M.; Shaunak R.; Wali A.; Cuthbert G.; Bhudia R.; Webb E.; Shah S.; Ansari N.; Perera M.; Kelly N.; McAllister R.; Stanley G.H.; Keane C.P.; Shatkar V.; MaxwellArmstrong C.; Henderson L.A.; Maple N.; Manson R.; Adams R.D.; Semple E.; Mills M.; Daoub A.; Marsh A.; Ramnarine A.; Hartley J.; Malaj M.; Jewell P.D.; Whatling E.A.; Hitchen N.; Chen M.; Goh B.; Fern J.; Rogers S.; Derbyshire L.; Robertson D.T.; Abuhussein N.; Deekonda P.; Abid A.; Harrison P.L.M.; Aildasani L.; Turley H.; Sherif M.A.; Pandey G.; Filby J.J.; Johnston A.; Burke E.; Mohamud M.; Gohil K.; Tsui A.Y.; Singh R.; Lim S.J.; O'Sullivan K.; McKelvey L.L.; O'Neill S.; Roberts H.F.; Brown F.S.; Cao Y.; Buckle R.T.; Liew Y.; Sii S.; Ventre C.M.; Graham C.J.; Filipescu T.; Yousif A.; Dawar R.; Wright A.; Peters M.; Varley R.; Owczarek S.; Hartley S.; Khattak M.; Iqbal A.; Ali M.; Durrani B.; Narang Y.; Bethell G.S.; Horne L.; Pinto R.; Nicholls K.; Kisyov I.; Torrance H.D.; English W.; Lakhani S.M.; Ashraf S.F.; Venn M.; Elangovan V.; Kazmi Z.; Brecher J.; Sukumar S.; Mastan A.; Mortimer A.; Parker J.; Boyle J.; Elkawafi M.; *Beckett J.; *Mohite A.; *Narain A.; *Mazumdar E.; *Sreh A.; *Hague A.; *Weinberg D.; *Fletcher L.; *Steel M.; Shufflebotham H.; Masood M.; Sinha Y.; Jenvey C.; Kitt H.; Slade R.; Craig A.R.; Deall C.; Reakes T.; Chervenkoff J.; Strange E.; O'Bryan M.; Murkin C.; Joshi D.; Bergara T.; Naqib S.; Wylam D.; Scotcher S.E.; Hewitt C.M.; Stoddart M.T.; Kerai A.; Trist A.J.; Cole S.J.; Knight C.L.; Stevens S.; Cooper G.E.; Ingham R.; Dobson J.; O'Kane A.; Moradzadeh J.; Duffy A.; Henderson C.; Ashraf S.; McLaughin C.; Hoskins T.C.; Reehal R.S.; Bookless L.R.; McLean R.C.; Stone E.J.; Wright E.V.; Abdikadir H.R.; Roberts C.; Spence O.; Srikantharajah M.; Ruiz E.M.; Matthews J.H.; Gardner E.; Hester E.; Naran P.; Simpson R.; Minhas M.; Cornish E.; Semnani S.A.; Rojoa D.; Radotra A.; Eraifej J.; Eparh K.; Smith D.N.E.; Mistry B.D.; Hickling S.L.; Din W.; Liu C.; Mithrakumar P.; Mirdavoudi V.; Rashid M.; Mcgenity C.; Hussain O.; Kadicheeni M.; Gardner H.; Anim-Addo N.; Pearce J.; Aslanyan A.; Ntala C.; Sorah T.; Parkin J.; Alizadeh M.; White A.; Edozie F.; Johnston J.; Kahar A.; Navayogaarajah V.; Patel B.; Carter D.; Khonsari P.; Burgess A.; Kong C.; Ponweera A.; Cody A.; Tan Y.; Ng A.Y.L.; Croall A.; Allan C.; Ng S.; Raghuvir V.; Telfer R.; Greenhalgh A.D.; McKerr C.N.; Edison M.A.; Patel B.A.; Dear K.; Hardy M.R.; Williams P.; Hassan S.; Sajjad U.; O'Neill E.M.; Lopes S.; Healy L.; Jamal N.; Tan S.; Lazenby D.; Husnoo S.B.; Beecroft S.; Sarvanandan T.; Weston C.; Bassam N.; Rabinthiran S.; Hayat U.; Ng L.; Varma D.; Sukkari M.; Mian A.; Omar A.; Kim J.W.; Sellathurai J.; Mahmood J.; O'Connell C.; Bose R.; Heneghan H.; Lalor P.; Matheson J.; Doherty C.; Cullen C.; Cooper D.; Angelov S.; Drislane C.; Smith A.C.D.; Kreibich A.; Palkhi E.; Durr A.; Lotfallah A.; Gold D.; Mckean E.; Dhanji A.; Anilkumar A.; Thacoor A.; Siddiqui Z.H.; Lim S.; Piquet A.; Anderson S.M.; McCormack D.R.; Gulati J.; Ibrahim A.; Murray S.E.; Walsh S.L.; McGrath A.; Ziprin P.; Chua E.Y.; Lou C.N.; Bloomer J.; Paine H.R.; Osei-Kuffour D.; White C.J.; Szczap A.; Gokani S.; Patel K.; Malys M.K.; Reed A.; Torlot G.E.; Cumber E.M.; Charania A.; Ahmad S.; Varma N.; Cheema H.; Austreng L.; Petra H.; Chaudhary M.; Zegeye M.I.; Cheung F.; Coffey D.; Heer R.S.; Singh S.; Seager E.; Cumming S.; Suresh R.S.; Verma S.; Ptacek I.B.; Gwozdz A.M.; Yang T.; Khetarpal A.A.; Shumon S.; Fung T.M.P.; Leung W.; Kwang P.; Chew L.; Loke W.; Curran A.; Chan C.; McGarrigle C.; Mohan K.; Cullen S.; Wong E.; Toale C.; Collins D.; Keane N.; Traynor B.P.; Shanahan D.; Yan A.; Jafree D.J.; Topham C.; Mitrasinovic S.; Omara S.; Bingham G.; Lykoudis P.M.; Miranda B.H.; Whitehurst K.; Kumaran G.; Devabalan Y.; Aziz H.; Shoa M.; Dindyal S.; Yates J.A.; Bernstein I.; Rattan G.; Coulson R.; Stezaker S.; Isaac A.; Salem M.; McBride A.; McFarlane H.; Yow L.; MacDonald J.; Bartlett R.D.; Turaga S.; White U.; Liew W.; Yim N.; Ang A.; Simpson A.; McAuley D.; Craig E.; Murphy L.; Shepherd P.; Kee J.Y.; Abdulmajid A.; Chung A.; Warwick H.L.; Livesey A.; Holton P.; Theodoreson M.D.; Jenkin S.L.; Turner J.; Entwisle J.H.; Marchal S.T.; O'Connor S.; Blege H.K.; Aithie J.M.; Sabine L.M.; Stewart G.E.; Jackson S.; Kishore A.; Lankage C.M.; Acquaah F.; Joyce H.L.; McKevitt K.L.; Coffey C.J.; Fawaz A.S.; Dolbec K.S.; O'Sullivan D.A.; Geraghty J.M.; Lim E.; Bolton L.; FitzPatrick D.; Robinson C.; Ramtoola T.; Collinson S.; Grundy L.; McEnhill P.M.; Harbhajan Singh G.S.; Loughran D.; Golding D.M.; Keeling R.E.; Williams R.P.; Whitham R.D.J.; Yoganathan S.; Nachiappan R.; Egan R.J.; Owasil R.; Kwan M.L.; He A.; Goh R.W.; Bhome R.; Wilson H.; Teoh P.J.; Raji K.; Jayakody N.; Matthams J.; Chong J.; Luk C.Y.; Greig R.J.; Trail M.; Charalambous G.; Rocke A.S.; Gardiner N.; Bulley F.; Warren N.; Brennan E.; Fergurson P.; Wilson R.; Whittingham H.; Brown E.J.; Khanijau R.; Gandhi K.; Morris S.; Boulton A.J.; Chandan N.; Barthorpe A.E.; Maamari R.; Sandhu S.; McCann M.; Higgs L.; Balian V.; Reeder C.; Diaper C.; Sale T.; Ali H.; Archer C.H.; Clarke A.K.; Heskin J.; Hurst P.C.; Farmer J.D.; O'Flynn L.D.; Doan L.; Shuker B.A.; Stott G.D.; Vithanage N.A.; Hoban K.A.; Nesargikar P.N.; Kennedy H.R.; Grossart C.M.; Tan E.S.M.; Roy C.S.D.; Sim P.; Leslie K.E.; Sim D.; Abul M.H.; Cody N.; Tay A.Y.; Woon E.; Sng S.; Mah J.; Robson J.; Shakweh E.; Wing V.C.; Mills H.; Li M.M.; Barrow T.R.; Balaji S.; Jordan H.E.M.; Phillips C.; Naveed H.; Hirani S.; Tai A.; Ratnakumaran R.; Sahathevan A.; Shafi A.M.A.; Seedat M.; Weaver R.; Batho A.; Punj R.; Selvachandran H.; Bhatt N.; Botchey S.; Khonat Z.; Brennan K.; Morrison C.J.; Devlin E.; Linton A.; Galloway E.; McGarvie S.; Ramsay N.; McRobbie H.D.; Whewell H.; Dean W.; Nelaj S.; Eragat M.; Mishra A.; Kane T.; Zuhair M.; Wells M.; Wilkinson D.; Woodcock N.; Sun E.; Aziz N.; Ghaffar M.K.A.; McLean K.A.; Glasbey J.C.; Borakati A.; Brooks T.M.; Chang H.M.; Choi S.M.; Goodson R.; Nielsen M.; Pronin S.; Salloum N.L.; Sewart E.; Vanniasegaram D.; Drake T.M.; Gillies M.A.; Harrison E.M.; Chapman S.J.; Khatri C.; Kong C.Y.; Bath M.F.; Kelly M.; Mitchell H.; Fitzgerald J.E.; Bhangu A.; Nepogodiev D

Citation:
British Journal of Anaesthesia; Jan 2019; vol. 122 (no. 1); p. 42-50

Abstract:
Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Method(s): This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Result(s): Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusion(s): After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Altmetrics

Identifying demographics and co-morbidities among hospitalised adults infected with acute respiratory syncytial virus (RSV) (2017)

Type of publication:
Conference abstract

Author(s):
*Huntley C.; *Ahmad N.; *Makan A.; *Srinivasan K.; *Moudgil H.

Citation:
European Respiratory Journal; Sep 2017; vol. 50

Abstract:
Background/Objectives: The importance of RSV infection among adults admitted to secondary care is not well defined. Objectives were to identify patient demographics and co-morbidities and relate findings to length of hospital stay (LOS). Method(s): A retrospective review of adults admitted to one NHS trust with confirmed RSV (PCR respiratory swabs), identified during 3 months until 31st January 2017, coinciding with the UK winter. Result(s): Peak incidence was the 3rd week of December 2016 whilst later with Influenza (n=145) and earlier with paediatric admissions with RSV (n=3) throughout the study. Mean (SD, range) age of admitted adult patients (n=50) was 68.9 (19.5, 23-96) years with 27 (54%) female and LOS 8.8 (9.6, 0-41) days. 3 (6%) had concurrent RSV/Influenza A infection. 46 (92%) were admitted from home mainly via A&E (60%), General Practitioner (28%), and ambulatory care (8%). 73.5% had at least four co-morbidities, predominantly cardiorespiratory (50%) with a longer LOS (10.7 days), but also diabetes (20%), dementia (10%), malignancy (20%), and immunosuppression (10%). LOS correlated (Spearman rho) positively with both age (r =0.481, p<0.001) and number of co-morbidities (r< =0.486, p<0.0001). LOS was shorter where RSV was a primary as opposed to concurrent diagnosis (6.13, 0-21 vs 13.8, 1-41) days. Conclusion(s): RSV was detected at greater numbers during different times of the three month period among hospital admissions compared with paediatric RSV and influenza admissions, suggesting a staggered temporal relationship. Increasing age and the number of co-morbidities, predominantly cardio-respiratory, correlated positively with longer LOS.