2017

Adding Celecoxib With or Without Zoledronic Acid for Hormone-Naïve Prostate Cancer: Long-Term Survival Results From an Adaptive, Multiarm, Multistage, Platform, Randomized Controlled Trial (2017)

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Type of publication:
Randomised controlled trial

Author(s):
Mason, Malcolm D; Clarke, Noel W; James, Nicholas D; Dearnaley, David P; Spears, Melissa R; Ritchie, Alastair W S; Attard, Gerhardt; Cross, William; Jones, Rob J; Parker, Christopher C; Russell, J Martin; Thalmann, George N; Schiavone, Francesca; Cassoly, Estelle; Matheson, David; Millman, Robin; Rentsch, Cyrill A; Barber, Jim; Gilson, Clare; Ibrahim, Azman; Logue, John; Lydon, Anna; Nikapota, Ashok D; O'Sullivan, Joe M; Porfiri, Emilio; Protheroe, Andrew; *Srihari, Narayanan Nair; Tsang, David; Wagstaff, John; Wallace, Jan; Walmsley, Catherine; Parmar, Mahesh K B; Sydes, Matthew R; STAMPEDE Investigators

Citation:
Journal of clinical oncology : official journal of the American Society of Clinical Oncology; 35, no. 14 (May 2017) p. 1530-1541.

Abstract:
Purpose Systemic Therapy for Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy is a randomized controlled trial using a multiarm, multistage, platform design. It recruits men with high-risk, locally advanced or metastatic prostate cancer who were initiating long-term hormone therapy. We report survival data for two celecoxib (Cel)-containing comparisons, which stopped accrual early at interim analysis on the basis of failure-free survival. Patients and Methods Standard of care (SOC) was hormone therapy continuously (metastatic) or for ≥ 2 years (nonmetastatic); prostate (± pelvic node) radiotherapy was encouraged for men without metastases. Cel 400 mg was administered twice a day for 1 year. Zoledronic acid (ZA) 4 mg was administered for six 3-weekly cycles, then 4-weekly for 2 years. Stratified random assignment allocated patients 2:1:1 to SOC (control), SOC + Cel, or SOC + ZA + Cel. The primary outcome measure was all-cause mortality. Results were analyzed with Cox proportional hazards and flexible parametric models adjusted for stratification factors. Results A total of 1,245 men were randomly assigned (Oct 2005 to April 2011). Groups were balanced: median age, 65 years; 61% metastatic, 14% N+/X M0, 25% N0M0; 94% newly diagnosed; median prostate-specific antigen, 66 ng/mL. Median follow-up was 69 months. Grade 3 to 5 adverse events were seen in 36% SOC-only, 33% SOC + Cel, and 32% SOC + ZA + Cel patients. There were 303 control arm deaths (83% prostate cancer), and median survival was 66 months. Compared with SOC, the adjusted hazard ratio was 0.98 (95% CI, 0.80 to 1.20; P = .847; median survival, 70 months) for SOC + Cel and 0.86 (95% CI, 0.70 to 1.05; P =.130; median survival, 76 months) for SOC + ZA + Cel. Preplanned subgroup analyses in men with metastatic disease showed a hazard ratio of 0.78 (95% CI, 0.62 to 0.98; P = .033) for SOC + ZA + Cel. Conclusion These data show no overall evidence of improved survival with Cel. Preplanned subgroup analyses provide hypotheses for future studies.

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Anatomical siting of the splenic flexure using computed tomography (2017)

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Type of publication:
Journal article

Author(s):
*Meecham, L; *Brookes, A; *Macano, Caw; *Stone, T; *Cheetham, M

Citation:
Annals of the Royal College of Surgeons of England; Mar 2017; vol. 99 (no. 3); p. 207-209

Abstract:
INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

An unusual cause of tonsillar asymmetry (2017)

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Type of publication:
Journal article

Author(s):
*Karamchandani, D; *El-Shunnar, S K; *Fussey, J M; *Ahsan, S F; *Bhatia, S

Citation:
Annals of the Royal College of Surgeons of England; Mar 2017; vol. 99 (no. 3); p. e112

Abstract:
We present the first reported case of tonsillar asymmetry secondary to a mandibular osteoma. Computed tomography rather than tonsillectomy for histology prevented the distress and risk of unnecessary surgery, and the patient was managed conservatively.

The incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS: a hospital-based cohort study (2017)

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Type of publication:
Journal article

Author(s):
*Antonakou, Angeliki; *Papoutsis, Dimitrios; *Henderson, Karen; *Qadri, Zahid; *Tapp, Andrew

Citation:
Archives of gynecology and obstetrics. Vol 295(5):1201-1209

Abstract:
PURPOSETo identify the incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in women who sustained an OASIS in their first vaginal delivery and have a subsequent vaginal birth.METHODS Data were collected retrospectively for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Women with breech deliveries, stillbirths, foetal congenital abnormalities and multiple pregnancies were excluded.RESULTSOver the study period, we identified 11,191 women who had a first vaginal birth, of which 603 (5.4%) sustained a first episode of OASIS. Of these women, 243 (40.2%) had a subsequent pregnancy with 190 (78.1%) having a second vaginal birth, 13 (5.4%) an emergency caesarean section (CS) delivery while in labour and 40 (16.5%) an elective CS delivery. In those who delivered vaginally, 16 (8.4%) women had a repeat OASIS. After adjusting for several confounding factors, it was found that the risk of a repeat OASIS was associated with the use of epidural analgesia (OR = 3.66; 95% CI:1.14-11.71) and an episiotomy in the first delivery (OR = 3.93; 95% CI:1. 03-15.02) and a short labour (<2.8 h) in the second delivery (OR = 14.55; 95% CI: 1.83-115.75). The time interval between the two vaginal births was not associated with any increased risk of a repeat OASIS.CONCLUSION We found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

Human factors: role of cognitive and social skills in clinical practice (2017)

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Type of publication:
Journal article

Author(s):
*Thomas Wood

Citation:
Emergency Nurse; Mar 2017; vol. 24 (no. 10); p. 18-19

Abstract:
Last September, a team from our trust was chosen by the Resuscitation Council UK (RCUK) to represent the UK in a simulation-based cardiopulmonary resuscitation (CPR) competition at the annual European Resuscitation Congress, in Iceland.

Mortality and burden of cervical spine fractures in the elderly: can we do more? (2017)

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Type of publication:
Conference abstract

Author(s):
*Matthew Chan, *Benjamin Chatterton, *David Ford

Citation:
Spine Journal; Mar 2017; vol. 17 (no. 3), S20

Abstract:
BACKGROUND CONTEXT: Cervical spine fractures in the elderly are a significant injury that poses difficult treatment dilemmas. Despite this little has been done to evaluate the mortality and hospital burden. PURPOSE: Evaluate the mortality and hospital burden associated with cervical spine fractures in elderly patients at district general hospitals. STUDY DESIGN/SETTING: 10-year retrospective analysis of patients over the age of 70 presenting with a cervical spine fracture to two district general hospitals. METHODS: The data was collected from documentation on online hospital database systems. Data recorded included patient demographics, injuries sustained including level and mechanism of cervical injury, length of stay and details on inpatient complications, inpatient mortality and one-year mortality. RESULTS: 153 patients were identified with a mean age of 83, and slight female predominance (55%). Mechanical falls (90%) leading to isolated fractures of upper cervical spine, particularly C2 (52%), were the most common site and mechanism of injury. Inpatient mortality was 22.9%, and 1-year mortality was calculated at 35.3%. Inpatient medical complications, particularly chest infections, were common and occurred in 35.9% of patients. Total average length of stay was 18 days, and critical care input was required in 10.5% of patients. CONCLUSIONS: Cervical spine fractures in the elderly cause significant mortality and hospital burden. Medical complications are common, leading to increased morbidity and length of stay. Consideration should be made to develop national guidance akin to hip fractures. This would encourage a multidisciplinary team approach, including early input from medical and physiotherapy teams to ensure more effective treatment and prevention of complications.

Etest versus broth microdilution for ceftaroline MIC determination with Staphylococcus aureus: Results from PREMIUM, a European multicentre study (2017)

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Type of publication:
Journal article

Author(s):
Canton R.; Morosini M.I.; Livermore D.M.; Diaz-Reganon J.; Rossolini G.M.; Verhaegen J.; Cartuyvels R.; Claeys G.; De Beenhouwer H.; Delmee M.; Denis O.; Glupczynski Y.; Leven G.; Melin P.; Pierard D.; Pagani L.; Arena F.; Luzzaro F.; Gesu G.P.; Serra R.; D'Argenio A.; Sarti M.; Pecile P.; Mazzariol A.; Biscaro V.; Manso E.; Catania M.R.; Giraldi C.; Stefani S.; Labonia M.; Aschbacher R.; Giammanco A.; Cristino M.; Sancho L.; Diogo J.M.; Ramalheira E.; Ramos H.; Pinheiro D.; Garcia-Castillo M.; Calvo J.; Oliver A.; Gimeno C.; Pascual A.; Quintano F.T.; Bartolome R.; Cisterna R.; Cercenado E.; Merino P.; Marco F.; Bou G.; Sanchez J.E.G.; Cilla G.; Iglesias M.R.; Droz S.; Frei R.; James D.; Mushtaq S.; Howe R.; Paton R.; Gould K.; Eyre A.; Jepson A.; Swann A.; Weston D.; *Harvey G.; Humphrey H.

Citation:
Journal of Antimicrobial Chemotherapy; 2017; vol. 72 (no. 2); p. 431-436

Abstract:
Objectives: To compare the concordance of ceftaroline MIC values by reference broth microdilution (BMD) and Etest (bioMerieux, France) for MSSA and MRSA isolates obtained from PREMIUM (D372SL00001), a European multicentre study. Methods: Ceftaroline MICs were determined by reference BMD and by Etest for 1242 MSSA and MRSA isolates collected between February and May 2012 from adult patients with community-acquired pneumonia or complicated skin and soft tissue infections; tests were performed across six European laboratories. Selected isolates with ceftaroline resistance in broth (MIC >1 mg/L) were retested in three central laboratories to confirm their behaviour. Results: Overall concordance between BMD and Etest was good, with >97% essential agreement and >95% categorical agreement. Nevertheless, 12 of the 26 MRSA isolates found resistant by BMD scored as susceptible by Etest, with MICs <1 mg/L, thus counting as very major errors, whereas only 5 of 380 MRSA isolates found ceftaroline susceptible in BMD were miscategorized as resistant by Etest. Twenty-one of the 26 isolates with MICs of 2 mg/L by BMD were then retested twice by each of three central laboratories: BMD MICs of 2 mg/L were consistently found for 19 of the 21 isolates. Among 147 Etest results for these 21 isolates (original plus six repeats per isolate) 112 were >1 mg/L. Conclusions: BMD and Etest have good overall agreement for ceftaroline against Staphylococcus aureus; nevertheless, reliable Etest based discrimination of the minority of ceftaroline-resistant (MIC 2 mg/L) MRSA is extremely challenging, requiring careful reading of strips, ideally with duplicate testing.

Link to full-text: jac.oxfordjournals.org/content/early/2016/10/19/jac.dkw442.full.pdf

End of Life Care Marriages in a Hospital setting (2017)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
Jules Lewis

Abstract:
Shrewsbury and Telford Hospital NHS Trust Staff have been working hard to have a clear process for when an End of Life Care Patient wishes to get married in Hospital.

Flowcharts have been designed for both Ward Staff and the Chaplaincy service to follow to ensure the process is done without confusion and nothing is forgotten at this special and emotional time, this includes required documentation for special licence and contact details of people who will be able to assist in and out of hours.

Both religious and civil services can be offered depending on the couples preference.

The end of life care team have created a wedding bag to assist the ward staff in making this day as special as possible, this includes bunting, a ring box, a wedding card, champagne glasses and fizz, confetti, pen, paper, a keepsake gift and the flow charts on the process.

The Ward staff together with the End of Life Care Team get flowers and cake on the big day.

Ward Staff even managed to get a photographer to capture the special day for the wedding earlier this year with our hospital photographer printing the photos for the couple next working day, the wedding even took place in our swan room which made it extra special.

Thank you to everyone involved in making this happen from the Registrar services, Hospital Chaplaincy Team, End of Life Care Team, Communications Team, Photographer, Ward Staff and to the Director of Corporate Governance.

Together we made it happen because it’s the right thing to do as we have one chance to get it right.

Link to more details

End of Life Care Swan Rooms making a real difference (2017)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
Jules Lewis

Abstract:
The staff at Shrewsbury and Telford Hospital NHS Trust have been working hard to provide Swan Rooms in three areas.

This important work was facilitated by Jules Lewis End of Life Care Facilitator and Jules Lock End of Life Care Volunteer.

However, there was a real team approach in making it happen.

Thank you to all staff involved from staff & public who donatated pictures & CD players, to the painters, carpenter, communications team and ward staff including some fabulous End of Life Care Champions.

The Swan Rooms are side rooms that are used for people who are at end of life, they allow families to spend quality and special time with their loved one in a calming environment.

The side room is freshly painted, beautiful pictures are placed on the wall, a CD player and mood light are available when wanted and a swan recliner chair for relatives to rest when spending long periods of time with their loved one.

Jules Lock also donated lovely mugs / glasses and biscuits in a clear tub to encourage / support staff to make relatives drinks.

It’s the little things that make the biggest difference.

This work is part of the swan scheme for End of Life & Bereavement care which was adopted by the Trust in November 2015.

The end of life care team are planning more swan rooms for 2017 they are making a real difference to the care / support staff give to end of life patients and their family/friends and carers at the most difficult time.

It’s a privilege to care for people at end of life & support the family, we have one chance to get it right for every person every time.

Thank you everyone who was involved, together we achieve wonderful things #onechance #TeamSaTH Jules Lewis and Jules Lock from SaTH Proud to care, together we achieve, make it happen, some of our trust values

Link to full-text

Improving Oxygen Delivery on Wards (2017)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
*Nawaid Ahmad

Full text:
Oxygen (O2) is a drug and should be prescribed if administered to a patient. The British Thoracic Society has published guidelines on emergency oxygen delivery and a recent audit showed that out of 100 patients on O2, 42 did not have a written order.

Cycle 1: 2 FY1s collected data on O2 prescription and delivery on the respiratory ward at the Princess Royal Hospital, a part of the Shrewsbury and Telford Hospital NHS trust. At our trust, O2 is prescribed on the patient’s drug chart and saturation targets are mentioned on the prescription. 61% patients on O2 had a written order and 58% had the target mentioned along with the prescription.

 

Cycle 2: After the data collection, we started doing face to face education about O2 prescription in the acute medical unit and the respiratory ward. We targeted the Drs, nurses and the health care assistants. This was done for a week. A prompt card was developed (Pic 1) which was attached next to the O2 delivery system on the wall to prompt nurses to get the O2 prescribed. A card mentioning O2 targets was attached to the board above the patients bed. Another data collection was done a month later which showed that O2 prescription rates had gone up to 79% and 77% had a target mentioned.

Cycle 3: This involved forming an O2 team comprising the 2FY1s, one staff nurse and one healthcare assistant from the ward. They are called ‘O2 Ninjas’ and wear a badge (Pic 2). Their main role now will be to continue the education of all staff, each at their own level. We plan to roll out an educational programme through the trust staff education department and teach using scenarios. The idea is to spread this process to other specialties within the trust. Work is on going.

Our Motto: “ An idea needs to become a movement, for change to happen”

Link to more details or full-text: http://fabnhsstuff.net/2017/05/27/improving-oxygen-delivery-wards/