2019

Failure of drip and suck in postoperative ileus: A faulty non-perforated NG tube (2019)

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Type of publication:
Journal article

Author(s):
*Bristow D.; *Shaw J.

Citation:
BMJ Case Reports; Jun 2019; vol. 12 (no. 6)

Abstract:
A 55-year-old woman developed a postoperative ileus with associated nausea and vomiting following an
elective laparotomy. A wide bore nasogastric (NG) tube was inserted for gastric decompression and symptom
relief. Aspiration of the tube was unsuccessful and the patient continued to vomit. Imaging to investigate the
acute abdomen demonstrated the nasogastric tube to be correctly sited and within pooled gastric contents.
Gentle initial attempts were made to unblock the NG but to no avail and therefore it was removed. On
inspection it was discovered that the NG tube had no distal perforations to allow drainage, causing failure and
increasing the patient's risk of aspiration. The aim of this report is draw attention to the importance of
scrutinising all medical equipment prior to use to prevent avoidable and potentially serious patient harm.

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Respiratory workload and medical staffing in uk local neonatal units (LNUS) and special care units (SCUS)-time for a rethink (2019)

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Type of publication:
Conference abstract

Author(s):
*Tyler W.; Fox G.F.; Fenton A.C.

Citation:
Archives of Disease in Childhood; May 2019; vol. 104

Abstract:
Introduction: The majority of UK neonatal care occurs in SCUs and LNUs with a smaller volume of highly complex care delivered by NICUs. Whilst the significant shortfall in nursing numbers nationally has been highlighted, medical staffing has received little attention. Aim To determine levels of medical staffing in UK LNUs/ SCUs, days of respiratory support provided and admissions weighing <1.5 kg. Methods Questionnaire sent to every LNU and SCU requesting details of medical tier staffing. ODNs provided the number of
respiratory care days (RCD – invasive and non-invasive mechanical respiratory support) delivered 2013-15 and numbers of admissions weighing <1.5 kg. Results 78 (86.7%) LNUs and 38 (95%) SCUs responded. 11/ 90 LNUs delivered <365 RCDs annually. Of these 9 admitted <25 infants weighing <1.5 kg. 6/40 SCUs delivered >365 RCDs annually. Significant numbers of LNUs and SCUs employed nontraining grade medical staff and ANNPs to cover rotas; neonatal CST holders or equivalent support many units (Tables 1 & 2). The 8/11 low-activity LNUs who responded provided partially separate Tier 1 staffing from paediatrics, consistent with SCU staffing recommendations only. Half of the high activity LNUs and all high activity SCUs did not achieve staffing standards for NICUs or LNUs respectively. Conclusions A wide range of activity is undertaken by UK LNUs and SCUs, with moderate overlap of workload between unit types. These data should inform potential unit redesignation as part of the current national reviews. Current medical and ANNP staffing is a major barrier to implementing change. (Table Presented).

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1200-P: Diabetes. Predictors of glycaemic and weight gain response to empagliflozin treatment: The ABCD Nationwide Empagliflozin Audit. (2019)

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Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:
Introduction: We investigated clinical parameters that are potentially associated with improved empagliflozin treatment response.

Methods: We obtained data from a large-scale audit of empagliflozin use in the UK. We analyzed the association between patients’ baseline age, HbA1c, weight, diabetes duration, alanine aminotransferase (ALT), sex, chronic kidney disease (CKD) stage, empagliflozin dose (25 vs. 10mg), use of GLP-1RAs and use of insulin with HbA1c and weight changes at 26 weeks of treatment.

Results: Among 1436 patients, HbA1c reduced by, mean[95% CI], 1.35%[1.27,1.42] (p<0.0001) from a baseline of, mean±SD, 9.41±1.41%. Among 1381 patients, weight reduced by 3.6 kg[3.3,3.9] (p<0.0001) from a baseline of 100.2±20.7 kg. Results of univariate analyses are shown in Table 1. In multivariate analysis, higher baseline HbA1c (p<0.0001), lower CKD stage (p=0.002) and higher ALT (log transformed)(p=0.02) were associated with greater HbA1c reduction. Higher baseline weight (p<0.001) and non-insulin use (p<0.0001) were associated with greater weight reduction.

Conclusion: As expected, HbA1c reduction was associated with baseline HbA1c and background renal function, while weight reduction was associated with baseline weight. The interactions between HbA1c reduction and ALT levels, and weight reduction with insulin treatment status warrant further investigations.

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1201-P: Characteristics and Treatment Outcomes of Patients Treated with Empagliflozin in the ABCD Nationwide Empagliflozin Audit (2019)

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Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:

Introduction: We investigated characteristics and treatment outcomes of patients treated with empagliflozin in a large-scale audit of routine clinical practice in the UK.

Methods: Data was obtained from the Association of British Clinical Diabetologists Nationwide Empagliflozin Audit. Between December 2014 to September 2018, multiple sites submitted data through 10 major centers on 1947 patients with at least one follow-up visit after empagliflozin initiation.

Results: Baseline characteristics of patients were, mean±SD, age 59.9±9.9 years, diabetes duration 6.4±5.4 years, HbA1c 9.41±1.43%, weight 99.6±20.8 years, BMI 33.6±9.1 kg/m2and 62.1% were male. Proportion of use of empagliflozin 25mg (vs. 10mg), GLP-1 receptor agonist, and insulin were 63.7%, 13.7% and 20.1%, respectively. There were 44.9%, 49.9%, 5.1% and 0.1% of patients with eGFR>90, 60-89, 45-59 and <45 ml/min/1.73m2, respectively. By 26 weeks, treatment with empagliflozin was associated with, mean±SD, HbA1c reduction of 1.35±1.49% (p<0.0001), weight reduction of 3.6±5.1 kg (p<0.0001) and systolic blood pressure reduction of 5±14 mmHg (p<0.0001).

Conclusions: An audit of empagliflozin use in the UK revealed poorly controlled diabetes being frequently encountered in practice in contrast to randomized clinical trials. There was a preponderance of empagliflozin 25mg dose use, disproportionate prescribing to men rather than women, and frequent co-prescription with GLP-1 receptor agonists and insulin. The audit showed excellent adherence to prescribing guidelines in relation to avoiding empagliflozin use in patients with eGFR<45 ml/min/1.73m2. There was similar treatment efficacy with empaglilfozin as was seen in clinical trials.

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Breast Reconstruction Affects Coping Mechanisms in Breast Cancer Survivors (2019)

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Type of publication:
Journal article

Author(s):
*Lake, Blossom; Fuller, Heidi R; *Rastall, Sarah; *Usman, Tamoor

Citation:
Indian Journal of Surgery; Feb 2019; vol. 81 (no. 1); p. 43-50

Abstract:
Coping strategies used by women with breast cancer are vital for adjustment to their disease. Whilst it is clear that factors such as age at diagnosis, social support and ethnicity can influence coping mechanisms, there is currently no information about whether breast reconstruction changes mechanisms of coping for such patients. The aims of this study, therefore, were to determine how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. This was a retrospective cohort study, using a standardised questionnaire called the Brief Cope Scale. Inclusion criteria was the following: all women
who had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for ductal carcinoma in situ or node-negative invasive breast cancer. Each patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone. Two hundred thirty-four questionnaires were sent with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04) compared to those in the mastectomy alone cohort. In contrast, significantly more patients in the mastectomy alone cohort coped by active venting compared to the reconstruction cohort (T value 1.71, P value 0.04). This study indicates for the first time that breast reconstruction may alter coping mechanisms in breast cancer survivors. Awareness of these coping mechanisms will enable clinicians to provide appropriate, individualised support.

Community-acquired pneumonia: what community nurses should know. (2019)

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Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Apr 2019; vol. 33 (no. 2); p. 50-54

Abstract:
Pneumonia has a huge impact upon the healthcare system in the UK and is not only associated with higher rates of hospital admissions than any other respiratory disease, but also carries a high risk of mortality. This article offers an overview of community-acquired pneumonia in adult patients, including the pathophysiology, common aetiologies, at-risk groups and pharmacological management. There is also a brief discussion on differential diagnoses and potential strategies to support clinical decision-making in the community.

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