2017

Normal acutely performed CT scan of the brain may give a false sense of safety prior to use of antiplatelets in transient focal (2017)

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Type of publication:
Conference abstract

Author(s):
*McNeela N.; *Srinivasan M.

Citation:
Cerebrovascular Diseases; Jul 2017; vol. 43 ; p. 116

Abstract:
Transient focal neurological episodes (TFNE) are frequently assumed to be transient ischaemic attacks (TIAs) in older patients who are then started on antiplatelets for stroke prevention. Imaging with a CT scan of the brain reported as normal or not suggesting haemorrhage can give a false sense of security with regard to therapeutic decision making. Current UK stroke guidelines do not emphasise the need for imaging (either CT or MRI) in transient ischaemic attacks with NICE guidance recommending treat with aspirin immediately and then refer to stroke services for further management. Imaging is then only recommended for patients where the vascular territory or pathology is uncertain with diffusion weighted MRI scans. In cases where MRI is contraindicated second line imaging is a CT head. We present two cases of patients who presented with symptoms of TFNEs treated as TIAs who then subsequently developed haemorrhagic strokes. The first case is of an 80 year old lady with new onset atrial fibrillation who presented with transient face and arm paraesthesia and dysarthria. Following a normal CT head she was started on anticoagulation and discharged home. She subsequently represented with a further two episodes and each time underwent a repeat imaging which again showed no abnormalities until she eventually succumbed to a massive right cortical intracranial haemorrhage. The second case involves a 68 year old gentleman with no significant past medical history other than a recent headache who presented with recurrent symptoms of left face and arm paraesthesia and dysarthria. A CT scan of the brain was normal and so he was treated with antiplatelets for a presumed TIA and discharged. However within six hours he deteriorated with dense left hemiplegia and reduced consciousness. A repeat CT showed a large right frontoparietal bleed with midline shift requiring referral to neurosurgeons. These cases highlight how a CT head in an acute presentation with transient symptoms can be misleading. One option would be consideration of blood sensing MRI scans in investigation of TFNE verses TIA diagnoses. As TFNEs often to present as descending paresthesia, we would recommend all patients with this presentation to undergo urgent inpatient MRI scans before being commenced on treatment.

Breathlessness at end of life: what community nurses should know (2017)

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Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Oct 2017; vol. 31 (no. 5); p. 74-77

Abstract:
The provision of end of life care is important core work for community nursing teams. Once end of life has been recognised, a focus on palliation of symptoms and an emphasis upon assisting people to 'live well until they die' becomes paramount. Breathlessness is a common distressing symptom for patients, significantly affecting their quality of life and is sometimes the cause of unnecessary admissions to hospital. This article explores the pathophysiology of breathing and breathlessness and offers some thoughts on history-taking and physical assessment, skills that nurses in advancing practice roles are now undertaking in the community setting to enhance the care they deliver to patients. This article aims to support community nurses to gain knowledge to inform the provision of effective evidence-based care and assist patients and their families to manage breathlessness at end of life.

Interleukin-17-positive mast cells influence outcomes from BCG for patients with CIS: Data from a comprehensive characterisation of the immune microenvironment of urothelial bladder cancer (2017)

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Type of publication:
Journal article

Author(s):
Dowell A.C.; Taylor G.S.; *Cobby E.; Wen K.; During V.; Anderson J.; James N.D.; Devall A.J.; Cheng K.K.; Zeegers M.P.; Bryan R.T.

Citation:
PloS one; 2017; vol. 12 (no. 9)

Abstract:

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Blowing bubbles helps intubation (2017)

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Type of publication:
Journal article

Author(s):
*Howe, D.

Citation:
Indian Journal of Critical Care Medicine; Oct 2017; vol. 21 (no. 10); p. 710-711

Abstract:
Rocuronium is commonly used in preference to suxamethonium for rapid sequence induction in the Intensive Care Unit (ICU). We describe a patient who suffered significant neck trauma following a suicide attempt. On initial presentation to accident and emergency, he was an easy intubation with a Grade 1 view obtained at laryngoscopy. After surgery to repair his neck laceration, he was extubated and discharged from ICU. He later developed a severe aspiration pneumonia and required reintubation. After induction and paralysis with suxamethonium, the best view at laryngoscopy was a Grade 3 despite the use of different laryngoscopes. As the muscle paralysis wore off the patient began breathing. This produced bubbles in the back of the patient's pharynx which directed the clinician to the laryngeal inlet to allow successful intubation. In this case, the short duration of action of suxamethonium significantly aided intubation due to the return of spontaneous breathing by the patient.

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The role of the myosure hysteroscopic tissue removal system in the office setting at detecting abnormal pathology in women with post-menopausal bleeding, who have had blind endometrial sampling reported as inadequate, inactive or benign endometrium (2017)

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Type of publication:
Conference abstract

Author(s):
*Underwood M. ; *Chadha R.; *Hudda A.; *Green J.; *Fry M.; *Barker V.

Citation:
Journal of Minimally Invasive Gynecology; 2017; vol. 24 (no. 7)

Abstract:
Study Objective: Identify any histological discrepancy between blind endometrial sampling (ES) reported as inadequate, inactive or benign endometrium and office based hysteroscopy with the MyoSure tissue removal system in women with post-menopausal bleeding (PMB). Design: retrospective review of cases from our PMB clinic. Setting:Women attending the PMB clinic who's ES is reported as benign, inactive or inadequate. MyoSure Lite or Classic devices were used for the removal of these lesions. Patients:Women with PMB having an endometrial polypectomy using the MyoSure tissue removal system. Intervention: The MyoSure Lite & Classic tissue removal systems were used to remove endometrial polyps in women with PMB who's ES was inactive, inadequate or benign. Histological comparison between the ES and MyoSure histology was made. Measurements and Main Results: 616 women underwent hysteroscopic evaluation for abnormal uterine 2017; 399 were post-menopausal of which 186 women (46.6%) had inactive endometrium, 82 women (20.6%) had inadequate, 109 (27.3%) had benign/polyp and 22 (5.5%) had simple hyperplasia or higher grade disease detected on the blind endometrial sampling prior to polypectomy. The MyoSure polypectomy of those women with "Proliferative/benign endometrium" demonstrated that 19.3% had higher grade disease (Simple, complex, complex with atypia or cancer) than the ES, for the "inactive group 10.8% had high grade disease and those with an inadequate ES 13.4% had higher grade disease. (Table presented) Endometrial thickness in the PMB group ranged from 1.5-45 mm with a mean of 10.6 mm. There were no reported complications in all 616 cases. Conclusion: This retrospective review of patients with inadequate, inactive or benign ES has demonstrated the significant benefit to patient of having the polyp removed simply without complication in the office setting using the MyoSure tissue removal system. Between 10.8-19.3% will have higher grade disease detected using the MyoSure device, which would have an impact on their medical management.

UK Renal Registry 19th Annual Report: Chapter 8 Biochemical Variables amongst UK Adult Dialysis Patients in 2015: National and Centre-specific Analyses (2017)

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Type of publication:
Journal article

Author(s):
Methven S.; Perisanidou L.I.; *Nicholas J. ; Dawnay A.

Citation:
Nephron; Sep 2017; vol. 137 (no. 1); p. 189-234

Abstract:
64.1% of haemodialysis (HD) patients and 60.5% of peritoneal dialysis (PD) patients achieved the Renal Association (RA) audit measure for phosphate (<1.7 mmol/L). . 35.9% of HD and 39.5% of PD patients had a serum phosphate above the RA audit standard (>=1.7 mmol/L). Simultaneous control of all three parameters (calcium, phosphate and parathyroid hormone (PTH)) within current target ranges was achieved by 27.6% of HD and 33.1% of PD patients. 79.3% of HD and 77.8% of PD patients had adjusted calcium in the recommended target range of 2.2-2.5 mmol/L. 57.1% of HD and 61.3% of PD patients had phosphate between 1.1-1.7 mmol/L. 56.8% of HD and 63.6% of PD patients had a serum PTH between 16-72 pmol/L. 18.8% of HD and 13.9% of PD patients had a serum PTH >72 pmol/L. 64.3% of HD and 80.4% of PD patients achieved the audit measure for bicarbonate 18-24 mmol/L for HD patients and 22-30 mmol/L for PD patients).

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UK Renal Registry 19th Annual Report: Chapter 10 Epidemiology of Reported Infections in Patients Receiving Dialysis in England between January 2015 and December 2015: A Joint Report from Public Health England and the UK Renal Registry (2017)

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Type of publication:
Journal article

Author(s):
*Crowley L.; MacNeill S.; Caskey F.J.; Methven S.; Nsonwu O.; Davies J.; Fluck R.; Byrne C.

Citation:
Nephron; Sep 2017; vol. 137 (no. 1); p. 251-257

Abstract:
Between January 2015 and December 2015 there were a total of 31 episodes of Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia in patients receiving dialysis for end stage renal disease. The rate of MRSA episodes per 100 dialysis patient years was 0.13 compared to 0.15 the previous year. Rates of Methicillin Sensitive Staphyloccoccus aureus (MSSA) continued their gradual increase with a rate of 2.35 per 100 patient years compared with 2.26 the year before. This was a result of 560 episodes of bloodstream infection between January and December. Rates of Clostridium difficile infection (CDI) were stable with 245 recorded episodes giving a rate of 1.03 per 100 patient years. Escherichia coli (E.coli) infections occurred at a rate of 1.7 per 100 dialysis patient years, an increase on the previous year's rate of 1.49. As found in previous years, a tunnelled catheter was associated with a higher number of infection episodes than other forms of access in those patients with a staphylococcal bacteraemia.

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The impact of age on the art of mammography and how to adapt accordingly (2017)

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Type of publication:
Journal article

Author(s):
*Lake B.; *Cielecki L. ; *Williams S.; *Worrall C.; *Metelko M.

Citation:
Radiography; Nov 2017; vol. 23 (no. 4)

Abstract:
Introduction Breast cancer is increasingly a disease of the elderly, and combined with the NHS Breast Screening Extension means that more elderly patients are having mammography. Increasing age can make mammography more technically difficult. This is a technical note detailing the results of a local audit which may be of interest due to potential service implications. Method A retrospective audit of the first year of screening extension of The Shropshire Breast Screening Programme. Aims to collect data on patient demographics and describe the technical adaptations developed in Shropshire. Results Breast screening extension has increased by 2.5 times the number of women aged 70-74 screened, and doubled the overall numbers of women over 70 screened. Significantly more older patients are being screened to present technical challenges to a screening programme.  Data was obtained from a month of screening showed that 29% of patients over 70 needed extra time for positioning. Reasons included 22% difficulty in obtaining adequate positioning and 15% needed a relative to aid with consent. Discussion In the Shropshire screening programme different technical adaptations have been developed and are key to ensuring adequate images. These include double appointments, two radiographers, thorough assessment, steeper angles, seated examinations, from-below imaging and pre-planning for  subsequent screen. Conclusion Significantly more older women are having breast screening due to the increasing incidence of breast cancer and the Breast Screening Programme extension. Increasing age can significantly increase time taken for adequate imaging and present technical challenges. Development of technical adaptations to art of mammography is key to achieve adequate images.

Review of trans anal microscopic surgery in a UK district general hospital- a safe practice with excellent patient outcomes (2017)

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Type of publication:
Conference abstract

Author(s):
*V. Vidyaankar, *A. Chakrabarty, *J. McCloud & *R. Clarke

Citation:
Colorectal Disease; Sep 2017; vol. 19 ; Supplement S2 ; p. 123

Abstract:
Aim: Randomised controlled trials have demonstrated advantages of Trans Anal endoscopic microsurgery (TEMS) for the resection of benign and malignant rectal lesions. We assess the safety and outcome of TEMS at a U.K district general hospital. Method: Between July 2011 to January 2017, 122 patients, 54 men and 68 women, Mean age 72 years, underwent TEMS. Patients with Level 4 polyps, large sessile polyps, polyps with invasive features or unsuitable for colonoscopic removal, were selected. Benign follow up with flexible sigmoidoscopy. Cancer follow up with Colonoscopy, MRI, CT, according to protocol. Results: 95 Benign and 27 Cancer lesions. Mean lesion Diameter 46 mm, mean operative time 60 min. Average hospital stay was 1.5 days. Three patients (2.4%) had bleeding, Four (3.2%) perforations, identified and repaired immediately. One (0.8%) surgical emphysema. Four (3.2%) developed pyrexia, two (1.6%) developed minor stricture. One (0.8%) rectovaginal fistula. No recurrence in benign cases. For Early Rectal cancers R0 resection was achieved in 81% and  R1 resection in 19% of cases. One (0.8%) developed local cancer recurrence. No mortality. Conclusion: Our study demonstrates that TEMS can be safely performed at a district general hospital by appropriately trained surgeons, with outcomes comparable with international data.

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