2021

Postpartum haemorrhage and risk of long-term hypertension and cardiovascular disease: an English population-based longitudinal study using linked primary and secondary care databases (2021)

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Type of publication:
Journal article

Author(s):
*Parry-Smith, William; Šumilo, Dana; Subramanian, Anuradhaa; Gokhale, Krishna; Okoth, Kelvin; Gallos, Ioannis; Coomarasamy, Arri; Nirantharakumar, Krishnarajah

Citation:
BMJ Open; May 2021; vol. 11 (no. 5); p. e041566

Abstract:
OBJECTIVE To investigate the long-term risk of developing hypertension and cardiovascular disease (CVD) among those women who suffered a postpartum haemorrhage (PPH) compared with those women who did not. DESIGN Population-based longitudinal open cohort study. SETTING English primary care (The Health Improvement Network (THIN)) and secondary care (Hospital Episode Statistics (HES)) databases. POPULATION Women exposed to PPH during the study period matched for age and date of delivery, and unexposed. METHODS We conducted an open cohort study using linked primary care THIN and HES Databases, from 1 January 1997 to 31 January 2018. A total of 42 327 women were included: 14 109 of them exposed to PPH during the study period and 28 218 matched for age and date of delivery, and unexposed to PPH. HRs for cardiovascular outcomes among women who had and did not have PPH were estimated after controlling for covariates using multivariate Cox regression models. OUTCOME MEASURES Risk of hypertensive disease, ischaemic heart disease, heart failure, stroke or transient ischaemic attack. RESULTS During a median follow-up of over 4 years, there was no significant difference in the risk of hypertensive disease after adjustment for covariates (adjusted HR (aHR): 1.03 (95% CI: 0.87 to 1.22); p=0.71). We also did not observe a statistically significant difference in the risk of composite CVD (ischaemic heart disease, heart failure, stroke or transient ischaemic attack) between the exposed and the unexposed cohort (aHR: 0.86 (95% CI: 0.52 to 1.43; p=0.57). CONCLUSION Over a median follow-up of 4 years, we did not observe an association between PPH and hypertension or CVD.

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Modification of hospital discharge summary software to improve Covid-19 documentation and safeguard community infection prevention (2021)

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Type of publication:
Conference abstract

Author(s):
*Lo N.

Citation:
European Journal of Case Reports in Internal Medicine. Conference: 19th European Congress in Internal Medicine Internal Medicine, ECIM 2021. Virtual. 8(Supplement 1) (pp 108), 2021. Date of Publication: 2021.

Abstract:
Background and Aims: Initial review of 50 discharge summaries at Royal Shrewsbury Hospital in April 2020 revealed only 27% included the patient's COVID-19 test result and 2% outlined any recommended self-isolation advice. This had potential adverse implications for infection control as well as medicolegal sequalae for the Trust if exposed patients were discharged without self-isolation advice and subsequently spread COVID-19 in the community. The medical team worked with hospital IT to amend the existing discharge summary software, such that two tabs were added to make COVID-19 test result and self isolation documentation mandatory prior to sign off, in an early pilot version. We aimed to evaluate the impact of this software modification on COVID-19 discharge summary documentation. Method(s): Following the implementation of the modified software, 50 consecutive discharge summaries were retrospectively reviewed for: Documentation of COVID-19 result. Documentation of self-isolation advice for patient. Result(s): Following the software amendment, 91% of discharge summaries included COVID-19 test result (up from 27%) and 100% included documented self-isolation advice for the patient (up from 2%). Conclusion(s): Simple modification of the existing IT system greatly improved compliance with COVID-19 test result and self-isolation advice documentation on discharge summaries. A further software update since the study has added a tab awaiting results, to cater for patients discharged prior to COVID-19 test result becoming available. We propose all hospitals consider adopting similar measures in the interest of infection prevention, public safety and potential medico-legal sequalae.

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A different perspective: using interactive virtual reality (IVR) for psychiatry training (2021)

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Type of publication:
Conference abstract

Author(s):
Evans H.; Young S.; Whitehurst J.; *Madadi A.; Barton J.

Citation:
BJPsych Open. Conference: Royal College of Psychiatrists International Congress, RCPsych 2021. Virtual. 7(Supplement 1) (pp S22-S23), 2021. Date of Publication: June 2021.

Abstract:
Aims. To evaluate the potential of interactive virtual reality in teaching and training Postgraduate Psychiatry Trainees in the Keele Cluster Background. Face to face supervised clinical experience will always be the best way to train and learn, followed by using simulated patients in practice scenarios allowing a safe environment in which to practice and train without risk. However, the practicalities of a busy NHS often mean that the expense and time required for both of these are not possible and often PowerPoints and handouts in induction are used to prepare new starters in Psychiatry, which is clearly suboptimal. Interactive Virtual Reality (IVR) allows trainees to not only be immersed in a simulation but take control, choosing the direction of questioning for example. It also allows the training to be easily repeated and scaled to any number of students, anytime and anywhere there is an internet connection. Method. Following successful funding from the RCPsych General Adult Faculty we chose three common scenarios that a new started in Psychiatry would face. These included acute agitation/ rapid tranquilisation, a patient wishing to leave/section 5(2) and a patient with tachycardia following clozapine initiation. Using established guidelines and literature, in conjunction with feedback from subject matter experts and practicing clinicians, scenarios were written. We then researched the best hardware and software to make this possible, ensuring that the resources required were realistic to allow accessibility to as many trainees as possible. Result. Creating IVR is challenging but an engaging medium. Achieving consensus on the training material is time consuming yet paramount to a good training session. Producing high quality videos is extremely resource intensive requiring large amounts of computing power and storage. However, the outcome is an engaging and practical alternative to face to face training. Conclusion. The possibilities for IVR for are vast. For example, trainees can practice different methods of asking questions (e.g. open vs closed) and how this affects the outcome. Training could be produced centrally and then shared, allowing best practice to be disseminated. It could improve and standardise induction, especially considering the expanding workforce. It could also improve recruitment, allowing an immersive experience of Psychiatry to those who would otherwise be unable to obtain shadowing. It also has a role in patient safety – demonstrating common scenarios that the trainee may face allowing them to practice in a safe environment.

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MRI of the Achilles tendon - a comprehensive pictorial review. Part two (2021)

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Type of publication:
Journal article

Author(s):
Szaro P.; Nilsson-Helander K.; *Carmont M.

Citation:
European Journal of Radiology Open; Jan 2021; vol. 8

Abstract:
The most common disorder affecting the Achilles tendon is midportion tendinopathy. A focal fluid signal indicates microtears, which may progress to partial and complete rupture. Assessment of Achilles tendon healing should be based on tendon morphology and tension rather than structural signal. After nonoperative management or surgical repair of the Achilles tendon, areas of fluid signal is pathologic because it indicates re-rupture. A higher signal in the postoperative Achilles tendon is a common finding and is present for a prolonged period following surgical intervention and needs to be interpreted alongside the clinical appearance.

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Randomised controlled trial of antibiotic/ hydroxychloroquine combination versus standard budesonide in active Crohn's disease (Apricot) (2021)

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Type of publication:
Conference abstract

Author(s):
Rhodes J.; Subramanian S.; Martin K.; Probert C.; Flanagan P.; Horgan G.; Mansfield J.; Parkes M.; Hart A.; Dallal H.; Iqbal T.; *Butterworth J.; Culshaw K.

Citation:
Gut; Jan 2021; vol. 70

Abstract:
Introduction Mucosal E. coli are increased in Crohn's disease (CD). They replicate within macrophages and are then inaccessible to penicillins and gentamicin. Hydroxychloroquine is used with doxycycline to treat Whipple's disease. It raises macrophage intra-vesicular pH and inhibits replication of bacteria that require acidic pH. Ciprofloxacin and doxycycline are also effective against E. coli within macrophages. Methods Adult patients with active CD (CDAI>220 plus CRP>=5 mg/l and/or faecal calprotectin >250 ugram/g) were randomised to receive (open label) either oral budesonide (Entocort CR 9 mg/day 8 weeks, then 6 mg/day 2 weeks and 3 mg/day 2 weeks) or antibiotics/hydroxychloroquine (AB/ HCQ) – oral ciprofloxacin 500 mg bd, doxycycline 100 mg bd, hydroxychloroquine 200 mgs tds for 4 weeks, followed by doxycycline 100 mg bd and hydroxychloroquine 200 mgs tds for 20 weeks. Use of anti-TNF in the previous 3 months was an exclusion. Primary endpoints were remission (CDAI

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Evaluation of the Head and Neck Cancer Patient Concerns Inventory in routine multidisciplinary Speech and Language Therapy/Dietetics follow up clinics (2021)

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Type of publication:
Poster presentation

Author(s):
*Zuydam AC , *Lowe D, *Rogers SN, *McLaughlin K, *Glaister C, *Burch L

Citation:
Preseted at BAHNO 2021 Annual Scientific Meeting Friday 14th May 2021

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Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab (2021)

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Type of publication:
Journal article

Author(s):
Kennedy N.A.; Goodhand J.R.; Chee D.; Lin S.; Chanchlani N.; Ahmad T.; Bewshea C.; Nice R.; McDonald T.J.; *Butterworth J.; Cooney R.; Croft N.M.; Kok K.B.; Hart A.L.; Irving P.M.; Lamb C.A.; Limdi J.K.; Macdonald J.; McGovern D.P.; Mehta S.J.; Murray C.D.; Patel K.V.; Pollok R.C.; Raine T.; Russell R.K.; Selinger C.P.; Smith P.J.; Bowden J.; Lees C.W.; Sebastian S.; Powell N.

Collaborators at Shrewsbury and Telford Hospital NHS Trust: *Jeff Butterworth, *Colene Adams, *Elizabeth Buckingham, *Danielle Childs, *Alison Magness, *Jo Stickley.

Citation:
Gut; May 2021; vol. 70 (no. 5); p. 865-875

Abstract:
OBJECTIVE: Antitumour necrosis factor (anti-TNF) drugs impair protective immunity following pneumococcal, influenza and viral hepatitis vaccination and increase the risk of serious respiratory infections. We sought to determine whether infliximab-treated patients with IBD have attenuated serological responses to SARS-CoV-2 infections. DESIGN: Antibody responses in participants treated with infliximab were compared with a reference cohort treated with vedolizumab, a gut-selective anti-integrin alpha4beta7 monoclonal antibody that is not associated with impaired vaccine responses or increased susceptibility to systemic infections. 6935 patients were recruited from 92 UK hospitals between 22 September and 23 December 2020. RESULT(S): Rates of symptomatic and proven SARS-CoV-2 infection were similar between groups. Seroprevalence was lower in infliximab-treated than vedolizumab-treated patients (3.4% (161/4685) vs 6.0% (134/2250), p<0.0001). Multivariable logistic regression analyses confirmed that infliximab (vs vedolizumab; OR 0.66 (95% CI 0.51 to 0.87), p=0.0027) and immunomodulator use (OR 0.70 (95% CI 0.53 to 0.92), p=0.012) were independently associated with lower seropositivity. In patients with confirmed SARS-CoV-2 infection, seroconversion was observed in fewer infliximab-treated than vedolizumab-treated patients (48% (39/81) vs 83% (30/36), p=0.00044) and the magnitude of anti-SARS-CoV-2 reactivity was lower (median 0.8 cut-off index (0.2-5.6) vs 37.0 (15.2-76.1), p<0.0001). CONCLUSION(S): Infliximab is associated with attenuated serological responses to SARS-CoV-2 that were further blunted by immunomodulators used as concomitant therapy. Impaired serological responses to SARS-CoV-2 infection might have important implications for global public health policy and individual anti-TNF-treated patients. Serological testing and virus surveillance should be considered to detect suboptimal vaccine responses, persistent infection and viral evolution to inform public health policy. TRIAL REGISTRATION NUMBER: ISRCTN45176516.

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Service redesign: how a tissue viability specialist lead nurse developed and improved acute wound care through real-world evidence and partnership working (2021)

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Type of publication:
Journal article

Author(s):
*Clare Checketts, Jacqui Hughes, Helen Horton, Tim Styche

Citation:
British Journal of Healthcare Management, May 2021; vol. 27 (no. 5); p. 116-125

Abstract:
The importance of leadership in service redesign should not be underestimated. Increasing demand for services and cost-effective approaches makes the drive and dedication of a leader towards quality improvement crucial. The lead tissue viability nurse at the Shrewsbury and Telford Hospital NHS Trust worked in partnership with the wound care industry to redesign the trust’s acute wound care service. An audit was carried out and an opportunity to reduce variations in care was identified. To achieve this, the service reduced the number of foam dressings on the formulary, listing only the ALLEVYN (Smith+Nephew, UK) family of wound dressings. As a result, the volume of dressings used reduced by 4.8%, meaning that the service produced less waste and saw a cost reduction of approximately £14066 over a 6-month period. This article highlights the positive outcomes that can be achieved through streamlining formularies, reducing variations in care and delivering robust care pathways. It also describes the collaborative working approach taken by this service, spearheaded by the lead tissue viability nurse, as an example of innovative practice for other NHS trusts.

Description of a novel technique for creation of a custom-made prosthesis to aid vocalisation following laryngectomy (2021)

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Type of publication:
Journal article

Author(s):
*Halliday, E; *Beswick, H; *Bunn, S; *Ahsan, S F

Citation:
European Annals of Otorhinolaryngology, Head and Neck Diseases; Dec 2021; vol. 138 (no. 6); p. 475-477

Abstract:
There are various options to restore phonation after laryngectomy; one option involves using tracheo-oesophageal voice by placing a speaking valve through the tracheo-oesophageal wall. Some patients struggle to obtain good fixation of an adhesive base plate to the skin; this can result in air leakage and poor voice. We describe a technique using a custom-made prosthesis to provide a better base plate for fixation of the heat and moisture exchange cassette. This technique involves making an impression of the anterior neck around the laryngectomy stoma to create an anatomically fitted prosthesis, which accurately fills the void around the stoma. The custom-made prosthesis provides a more individualised fit compared to a standard base plate, helping improve vocalisation and communication.