2014

The first case of thrombolysis for stroke in pregnancy in the UK (2014)

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Type of publication:
Conference abstract

Author(s):
*Ritchie J., *Lokman M., *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, November 2014, vol./is. 121/(7), 1470-0328 (November 2014)

Abstract:
Case: A healthy 28-year-old Caucasian woman presented to the Royal Shrewsbury Hospital (RSH) in her second pregnancy at 39 weeks of gestation with a sudden onset of dense left hemiparesis. This woman had no preceding risk factors. An urgent CT scan showed no acute changes suggesting a diagnosis of ischaemic stroke. Through discussion between the stroke specialist and consultant obstetrician, it was decided for thrombolysis which was performed in the emergency department prior to transfer to a larger hospital with stroke facilities. We wished to discover how many other women had undergone thrombolysis for stoke in pregnancy and the associated risks. We conducted a literature review concentrating on stroke and pregnancy including known risk factors and thrombolyis in pregnancy. We have found no other documented case of thromboylsis being used for stroke in pregnancy in the UK. Additionally there are many case reports not from the UK that demonstrate good maternal and fetal outcomes after thromobolysis. Conclusion: Our case appears to be the first reported case of thrombolysis for stroke in pregnancy in the UK. All post investigations have so far come back as normal, which is unusual as most other cases have had known risk factors for stroke. Our patient has recovered well post thrombolysis, which demonstrates the importance of dealing with stroke in pregnancy efficiently to allow thrombolysis to be achieved quickly. Although the risks and benefits need to be weighed up on an individual basis, our case and the relevant literature show that thrombolyiss can be safely used in pregnancy with good maternal and fetal outcomes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201411006-00021&LSLINK=80&D=ovft

 

Teenage pregnancy rates and outcomes in a district general hospital NHS Trust in rural Shropshire (2014)

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Type of publication:
Conference abstract

Author(s):
*Ritchie J., *Moores K., *Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, November 2014, vol./is. 121/(19-20), 1470-0328 (November 2014)

Abstract:
Introduction: The UK has the highest rate of teenage pregnancy across Western Europe however; the rate has been reducing, and is currently at its lowest since 1969. Perceptions exist of worse outcomes in teenage pregnancies among healthcare professionals and the public alike. We aim to determine outcomes of teenage pregnancy (2013- 2014) and compare rates of teenage pregnancy (2008-2013) and at Shrewsbury and Telford Hospitals (SaTH) NHS Trust and compare with local population outcomes. Methods: A 12-month retrospective review of teenage pregnancy outcomes and comparison with outcomes of all deliveries at SaTH between April 2013 and March 2014; a total of 4916 deliveries. Data sources included the MEDWAY Hospital Database. Recorded pregnancy outcomes classified into two categories: outcomes in mothers’ aged 19 years or younger at time of delivery and outcomes in all mothers’ in who delivered at SaTH in the study period. Parameters assessed included mode of delivery; blood loss; perineal trauma; birthweight; Apgar scores. Teenage pregnancy rates over the last six years were compared to recorded rates in 1996. Results: The rate of teenage pregnancy has continued to reduce, especially those under 16 years. Over 90% of teenage mothers’ had vaginal delivery; only 3% had elective and 5% had emergency caesarean deliveries. Low rates of instrumental deliveries were seen in each category; however, no failed instrumental deliveries occurred among teenage mothers’. Babies born over 37 weeks of gestation was lower among teenage mothers’ however mean birthweights were similar and mean Apgar scores were the same in both groups. Severe perineal trauma was much lower among teenage mothers’; more than half had no perineal trauma. Furthermore, teenage mothers’ had much lower rates of post-partum haemorrhage. Thus, one may suggest a lower risk of harm to teenage parturients and their babies compared with the general local population.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201411006-00055&LSLINK=80&D=ovft

 

Is the MMR vaccination programme failing to protect women against rubella infection? (2014)

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Type of publication:
Journal article

Author(s):
*Skidmore S., Boxall E., Lord S.

Citation:
Epidemiology and Infection, 2014, vol./is. 142/5(1114-1117), 0950-2688;1469-4409 (2014)

Abstract:
In recent years the number of pregnant women susceptible to rubella has increased markedly. In the West Midlands the proportion has risen from 1.4% in 2004 to 6.9% in 2011. Locally, the proportion of non-immune women ranges from 1.6% in those born prior to 1976 to 17.8% in those born since 1986. The latter group comprises those given MMR in their second year with no further booster doses. The number of non-immune women will continue to rise as a consequence of low MMR uptake in the late 1990s. Repeat testing of samples with values

Link to more details or full-text: http://www.ncbi.nlm.nih.gov/pubmed/23953764

 

Rapid sequence induction in urgent care settings. (2014)

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Type of publication:
Journal article

Author(s):
*Fenwick R

Citation:
Emergency Nurse, 03 2014, vol./is. 21/10(16-24), 1354-5752;1354-5752 (2014 Mar)

Abstract:
In the management of critically ill patients in emergency departments, rapid sequence induction (RSI) of anaesthesia is often required. This article examines the elements of RSI that are necessary before before endotracheal tube placement and reviews the findings of a national audit project, conducted by Royal College of Anaesthetists and Difficult Airway Society. It also considers the role of nurses in RSI procedures.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2012497882&authtype=athens&site=ehost-live

 

Major trauma training for emergency nurses (2014)

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Type of publication:
Journal article

Author(s):
*Fenwick R

Citation:
Emergency Nurse, 04 2014, vol./is. 22/1(12-6), 1354-5752;1354-5752 (2014 Apr)

Abstract:
The Midlands regional trauma network was established in March 2012 to improve and standardise the care offered to patients with major trauma. This article discusses the results of a survey of formal training in, and self-assessed knowledge of, trauma management among emergency department nurses working in the network. Less than one third of the nurses had received formal training against which standards can be benchmarked, and the article recommends that nurse education standards are reinstated as key performance indicators in the region.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2012531636&authtype=athens&site=ehost-live

 

Video Q&A: state-of-the-art therapy for the elite and non-elite athlete: an interview with Mike Carmont (2014)

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Type of publication:
Journal article

Author(s):
*Carmont MR

Citation:
BMC Medicine, 2014, vol./is. 12/(8), 1741-7015;1741-7015 (2014)

Abstract:
In this video Q&A, Mr Mike Carmont answers questions about state-of-the-art treatments for elite athletes, and the progress and challenges behind translating these into successful therapies for the non-elite athlete.

Link to more details or full-text: http://europepmc.org/abstract/PMC/PMC3896799

 

Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial (2014)

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Type of publication:
Randomised Controlled Trial

Author(s):
Dutton SJ,Ferry DR,Blazeby JM,Abbas H,Dahle-Smith A,Mansoor W,Thompson J,Harrison M,*Chatterjee A,Falk S,Garcia-Alonso A,Fyfe DW,Hubner RA,Gamble T,Peachey L,Davoudianfar M,Pearson SR,Julier P,Jankowski J,Kerr R,Petty RD

Citation:
Lancet Oncology, 07 2014, vol./is. 15/8(894-904), 1470-2045;1474-5488 (2014 Jul)

Abstract:
BACKGROUND: Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer.METHODS: For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0-2, and with measurable or evaluable disease on CT scan. Participants were recruited from 48 UK centres and randomly assigned (1:1) to gefitinib (500 mg) or matching placebo by simple randomisation with no stratification factors. Patients, clinicians, and trial office staff were masked to treatment allocation. Treatment continued until disease progression, unacceptable toxicity, or patient choice. The primary outcome was overall survival, analysed by intention to treat. This trial is registered, number ISRCTN29580179.FINDINGS: Between March 30, 2009, and Nov 18, 2011, 450 patients were randomly assigned to treatment groups (one patient withdrew consent; 224 patients allocated gefitinib and 225 allocated placebo included in analyses). Overall survival did not differ between groups (median 373 months, 95% CI 323-450, for gefitinib vs 367 months, 95% CI 297-437, for placebo; hazard ratio 090, 95% CI 074-109, p=029). Among the prespecified patient-reported outcomes (110 patients on gefitinib and 121 on placebo completed both baseline and 4 week questionnaires and were included in analyses), odynophagia was significantly better in the gefitinib group (adjusted mean difference -861, 95% CI -1449 to -273; n=227; p=0004), whereas the other outcomes were not significantly improved compared with placebo: global quality of life (269, 95% CI -233 to 772, n=231, p=0293), dysphagia (-318, 95% CI -836 to 200, n=231, p=0228), and eating (-411, 95% CI -996 to 175, n=229, p=0168). Median progression-free survival was marginally longer with gefitinib than it was with placebo (157 months, 95% CI 123-190 in the gefitinib group vs 117 months, 95% CI 107-137 in the placebo group; HR 080, 95% CI 066-096, p=0020). The most common toxicities were diarrhoea (36 [16%] of 224 patients on gefitinib vs six [3%] of 225 on placebo) and skin toxicity (46 [21%] vs two [1%]), both mostly grade 2. The commonest grade 3-4 toxicities were fatigue (24 [11%] vs 13 [6%] patients) and diarrhoea (13 [6%] vs two [1%]). Serious adverse events were reported in 109 (49%) of 224 patients assigned to gefitinib and 101 (45%) of 225 on placebo. 54 (24%) of patients in the gefitinib group achieved disease control at 8 weeks, as did 35 (16%) of patients on placebo (p=0023).INTERPRETATION: The use of gefitinib as a second-line treatment in oesophageal cancer in unselected patients does not improve overall survival, but has palliative benefits in a subgroup of these difficult-to-treat patients with short life expectancy. Future research should focus on identification of predictive biomarkers to identify this subgroup of benefiting patients.FUNDING: Cancer Research UK. Copyright 2014 Elsevier Ltd. All rights reserved.

Link to more details or full-text: http://www.sciencedirect.com/science/article/pii/S1470204514700245

 

Brachialis muscle tendon insertion avulsion fracture in a 6-year-old child (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Mbah CA, *Hussain A, *Turner R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 6-year-old boy, who fell while playing at school, presented to the fracture clinic with a suspected right distal radius fracture. On examination, the child was tender over the dorsal aspect of the distal radius and also had pain and stiffness around the elbow joint with a lack of the last 25° of elbow flexion. An acute haemarthrosis was also suspected at presentation. Plain anteroposterior (AP) and lateral radiographs of the elbow joint revealed an abnormal calcification superimposed on the anterior aspect of the coronoid process (figure 1A, B), which had not been visualised on plain radiographs in A&E.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202420.extract

 

Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). (2014)

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Type of publication:
Journal article

Author(s):
*Chandra A, *Clarke R, *Shawkat H

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202864.abstract