2017

Managing glycaemic trends in people with diabetes requiring enteral feeding support: The challenges in primary and secondary care (2017)

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Type of publication:
Journal article

Author(s):
*Richardson, Erica A.; Agbasi, Nneka

Citation:
Journal of Diabetes Nursing; Aug 2017; vol. 21 (no. 7); p. 241-246

Abstract:
Matching therapeutic treatments to manage glycaemic excursions in people with diabetes receiving enteral nutrition (e.g. nasogastric, gastrostomy or jejunostomy) can be difficult. There is evidence to suggest that there is an increased risk of complications and mortality, longer lengths of stay in hospital, higher risk of intensive care input and higher demands for transitional or nursing home care post discharge. Other intrinsic factors, such as illness, timing of medications, poly-pharmacy, types of feeding regimen chosen and history of diabetes, all need to be considered when choosing appropriate treatments. This article describes the challenges of supporting people with diabetes requiring enteral feeding and the implications for diabetes nurses.

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Auditing the complications of LLETZ cervical treatment versus cold-coagulation over a one-year period (2017)

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Type of publication:
Conference abstract

Author(s):
*Ali N.; *Kandareachichi P.; *Blackmore J.; *Papoutsis D.; *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; Nov 2017; vol. 124 ; p. 33

Abstract:
Introduction We aim to audit the complication rates of women treated with either LLETZ cervical treatment or cold-coagulation in our colposcopy unit against the standards set out by the NHSCSP guidelines. It is reported that the proportion of treatment associated with primary haemorrhage that requires a haemostatic technique must be less than 5%, and the proportion of cases admitted as inpatients because of treatment complications must be less than 2%. Methods We retrospectively collected data from our electronic colposcopy database for women treated over the time period of August 2015 – July 2016. Hospital notes were retrieved for those who were identified with complications for further data collection. Results We identified 494 patients with LLETZ and 24 patients with cold-coagulation treatment. There were no complications noted after cold-coagulation. There were 12/494 (2.4%) patients who had post-LLETZ bleeding with one patient being admitted as an inpatient for further management (1/518 or 0.2). The bleeding occurred between 2-28 days after treatment, with 42% of women having had treatment under a general anaesthetic mainly due to a large lesion size. The mean age of women with bleeding was 39 years (range: 27-59) with a mean BMI of 26 kg/m2 (range: 17-34). Only one in three women with bleeding required oral antibiotics, and less than 8% of women had a temporary vaginal pack. All women with bleeding were self-referred directly to the colposcopy service without prior GP consultation/examination. Conclusion We are compliant with the NHS-CSP auditable standards with regards to post-treatment complications and inpatient admissions. As very few women actually necessitated further management this puts into question the appropriateness of the initial referral of these women. Areas for improvement therefore involve educating both staff and patients about the possibility of bleeding after excisional treatment and the role of the GP in reviewing these women before onward referral to the colposcopy service.

Does gestational weight gain of more than 12 kg in women increase the risk of a cesarean section delivery, gestational diabetes and pregnancy induced hypertension? A retrospective case series (2017)

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Type of publication:
Journal article

Author(s):
Antonakou A.; *Papoutsis D.; Kechagia A.

Citation:
Clinical and Experimental Obstetrics and Gynecology; 2017; vol. 44 (no. 4); p. 540-544

Abstract:
Purpose: The purpose of this study was to investigate whether the gestational weight gain of more than 12 kg represented a risk factor for an increased rate of cesarean section (CS) delivery, gestational diabetes, and pregnancy-induced hypertension (PIH). Materials and Methods: This was a retrospective case series study performed in a Greek National Health Service hospital and included women having given birth to singleton pregnancies between 2004-2009. Cases with multiple pregnancies, stillbirths, and congenital fetal abnormalities were excluded. Results: 600 eligible women were included in the study. Gestational weight increase correlated positively and was higher in women with a CS delivery, gestational diabetes, and PIH. The prepregnancy body mass index was identified as a predictor of gestational diabetes. The weight gain of less than 12 kg during pregnancy provided a protective effect against CS delivery by reducing the likelihood of this by 85%. Conclusion: The present authors have shown that the increased body weight gain during pregnancy of more than 12 kg is associated with increased rates of CS delivery, gestational diabetes, and hypertensive disorders in pregnancy.

Motor neuron disease in otolaryngology - A review (2017)

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Type of publication:
Journal article

Author(s):
*Fussey J.M.; *Skinner D.W.

Citation:
Otorhinolaryngologist; 2017; vol. 10 (no. 2); p. 79-81

Abstract:
Motor neuron disease is an incurable neurodegenerative disorder affecting both upper and lower motor neurons, resulting in progressive weakness and inevitable death due to respiratory failure. Up to 30% of patients present with bulbar symptoms and therefore may be seen first by an otolaryngologist. Furthermore, almost all patients experience bulbar symptoms in the late stages of the disease and may require the input of an otolaryngologist as part of their multidisciplinary management.

Effect of latanoprost on thyroid orbitopathy (2017)

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Type of publication:
Journal article

Author(s):
*Ha J.; *Zunz E.; *Sagili S.

Citation:
Expert Review of Ophthalmology; Nov 2017; vol. 12 (no. 6); p. 437-441

Abstract:
Background: Prostaglandin F2alpha analogues are known to reduce human orbital fibroblasts proliferation and adipogenesis and may be used as a potential therapy for treatment of thyroid orbitopathy. The aim of this study was to identify any beneficial effect of latanoprost on thyroid orbitopathy, in the form of reduction in proptosis, secondary to prostaglandin associated periorbitopathy. Methods: A retrospective case review of 11 patients (22 eyes) with thyroid eye disease who were using latanoprost for management of ocular hypertension. Patients receiving systemic immunosuppressants were excluded. Orbital imaging was analysed where available. A change in proptosis was analysed based on Hertel exophthalmometry. Results: Three patients (27%) had >= 2 mm reduction in proptosis and they all had fat predominant thyroid orbitopathy, as evident on orbital imaging. Proptosis remained unchanged or improved by less than 2mm in the rest of the patients (73%). Overall, mean pre treatment exophthalmometry was 22.4 mm (range 15-30 mm) and mean post treatment exophthalmometry was 20.6 mm (range 15-29 mm). Conclusion: Latanoprost was well tolerated in patients with thyroid orbitopathy. Objective reduction in proptosis of 2mm or more was noted in 3 patients (27%) and none of the patients had an increase in proptosis. The improvement in proptosis may be more pronounced in patients with fat predominant orbits.

Group pre-assessment for patients undergoing chemotherapy: Our experience at The Royal Shrewsbury Hospital (2017)

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Type of publication:
Conference abstract

Author(s):
*Allos B.; *Redgrave R.; *Davies W.; *Chatterjee A.

Citation:
Lung Cancer; Jan 2017; vol. 103, Supplement 1, Page S47

Abstract:
Introduction: Waiting time targets in England and Wales state cancer treatment must commence within 31 days of the treatment plan being agreed. Often, pressures on chemotherapy units, such as low staffing levels and capacity, delays starting chemotherapy. This may impact outcomes. To improve capacity and waiting times we have implemented group pre-assessment (GPAC) for all prospective chemotherapy patients at our trust. Methods: Previously each patient received a 1-hour pre-assessment appointment with a dedicated nurse. For non-urgent patients we have established GPAC clinics since January 2014. These are run three times a week by volunteers in conjunction with one chemotherapy nurse and accommodate 6 patients per session. Patients watch a 25-minute DVD providing general information on chemotherapy in addition to introducing the unit, nurses and general treatment procedures. A unit tour follows this. Each patient receives a diagnosis-specific  tumour pack and the session concludes with a 10-minute one-to-one meeting with a nurse to discuss their personal treatment regime. Results: We pre-assess up to 18 patients a week via GPAC. Since implementation we have reduced nursing hours needed for this service to a maximum of 6 hours per week. From September 2015 to August 2016 a total of 667 patients attended GPAC clinic with 312 nursing hours required. Our unit has consequently saved 355 nursing hours over that time period (Figure 1). Patient satisfaction with the service remains high with 24/25 (96%) of patients surveyed rating the service as good to excellent across five categories. With GPAC initiation, our average chemotherapy waiting time has reduced to 13 days from over 20 days. Conclusion: By initiating GPAC our department has significantly saved nursing hours allowing us to reallocate these to chemotherapy delivery and service development. With increased capacity to treat patients waiting times have been significantly reduced. This has not been to the detriment of patient satisfaction. (Table Presented).

Management and outcomes of patients with nonsmall cell lung cancer (NSCLC) and synchronous brain metastases: A multicentre retrospective review (2017)

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Type of publication:
Conference abstract

Author(s):
Cook M.; *Allos B.; O'Beirn M.; Jegannathen A.; Denley S.; Homer K.; Sabel L.; *Chatterjee A.; Koh P.

Citation:
Lung Cancer; Jan 2017; vol. 103, Supplement 1, Page S12

Abstract:
Introduction: 10-20% of patients presenting with NSCLC have synchronous brain metastases, conferring a 4.8 month median survival. Recently published QUARTZ trial data challenges the use of whole brain radiotherapy (WBRT) in older inoperable patients. We present a multicentre retrospective review of the management and survival outcomes of newly diagnosed NSCLC patients with synchronous brain metastases in the Greater Midlands. Methods: Patients diagnosed with NSCLC and synchronous brain metastases January 2014 to June 2015 were identified from five regional hospital lung multidisciplinary meetings. Data collected included patient demographics, performance status (PS), staging, histology, number/volume of brain metastases, initial management, subsequent therapeutic strategy and outcomes. Results: Of 758 newly presenting metastatic lung cancer patients identified, 51(6.7%) had biopsy-proven NSCLC and brain metastases, with demographic, diagnostic and management information presented below (Table 1). 35/51 (69%) patients presented symptomatically as inpatients. Median overall survival (OS) of all patients was 3.4 (range 0.4-41.6) months. In PS 0/1 patients, those age <60 had OS of 7.4 (1.6-32.2) months compared with 13.4 (0.9-30.5) months in patients age >=60. Of those receiving best supportive care (BSC), OS was 1.7 (0.4-3.0) months. Patients receiving initial WBRT had OS of 3.5 (0.8-32.2) months, with those surviving >12 months also receiving  systemic therapy. Patients receiving surgery then WBRT had OS of 6.8 months. Patients with EGFR/ALK sensitising tumours had notably increased median OS of 16.5 months. 83.3% received tyrosine kinase inhibitors after initial WBRT. (Table presented) Conclusion: NSCLC patients presenting with synchronous brain metastases have overall poor prognoses regardless of treatment strategy, in keeping with previously published data. Selected patients, namely those with low volume intracranial disease and good PS suitable for neurosurgery/systemic therapy, or those with sensitising mutations had improved outcomes regardless of age. Our data reiterates that careful and timely patient selection is imperative prior to consideration of aggressive  local and systemic therapy or WBRT as opposed to BSC.

Reduction-fixation of the fractured mandible: Which factors associate with a poor surgical outcome? (2017)

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Type of publication:
Conference abstract

Author(s):
*Mustafa E.; Hanu-Cernat L.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2015; vol. 53 (no. 10)

Abstract:
Introduction: Revision rates following open reduction-fixation of mandibular fractures are not widely reported. This study aims to identify fracture and occlusal patterns asso-ciated with operative difficulties and suboptimal outcomes requiring further surgical correction. Method: All patients who required revision reduction and fixation of mandible fractures at the University Hospital Coventry between November 2008 and December 2013 were identified from the theatre database. Patients treated beyond five weeks, requiring plate removal secondary to infection or those that underwent staged fixation of complex facial trauma were excluded. Radiographs, theatre entries and patient records were examinedtoidentify patient demographics, fracture patterns, operative technique and the grade of the operating surgeon. Results: The return to theatre rate in our series was 2.3% (12 cases out of 524). The need for re-intervention was primarily established on clinical grounds. Revisions were required in: 1. Patients non-compliant with diet modification advice. 2. Pre-existent class III malocclusion. 3. Condylar fractures failing conservative management. 4. Wisdom teeth or a dominant occluding molar left in the line of the fracture. 5. Dentoalveolar injury. 6. Inadequate reduction/fixation on first intervention. No correlation was noted with the timing of treatment or occlusal control. Conclusion: Cases that needed revision surgery were fairly stereotype in our series. Poor outcomes were associated with significant occlusal interferences (pre-existing malocclusions, dentoalveolar fractures or teeth retainedinthe line of fracture) and unstable fracture patterns. Awareness of these risk factors may help with the anticipation of operative difficulties and lead to improved treatment outcomes.