2023

Fast Track Discharge (2023)

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Type of publication:
Service improvement case study

Author(s):
*Rebecca Martin (Therapy Operational Manager for Inpatient Therapies PRH, ESD and Head of Occupational Therapy), *Dr Emma Corbett (Consultant in Palliative Medicine)/ *Ruth Walker (Macmillan Palliative Care Cancer Nurse Specialist)/ *Rachael Roebuck and *Jennifer Russell (Discharge Liaison Nurse)/ *Kate Robinson and *Jane Carter (Occupational Therapist)/ *Alison Jones (Nurse Specialist Palliative Care)

Citation:
SaTH Improvement Hub, January 2023

Abstract:
Opportunities for improvement were identified in the Fast Track patient pathway (patients with a life expectancy of 3 months or less). A pilot was carried out to understand if the availability of a dedicated EoLC Occupational Therapist improved patient discharge.

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Improve completion of Fluid and Solid balance charts in Paediatrics PRH (2023)

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Type of publication:
Service improvement case study

Author(s):
*Aisha Noor (FY1) *Farhah Anuar (FY1)

Citation:
SaTH Improvement Hub, March 2023

Abstract:
To improve completion of Fluid balance charts for Paediatric patients at PRH by 30% by 06th May 2023.

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The rise in trauma & orthopaedic trainee-led research and audit collaborative projects in the United Kingdom since the start of the COVID-19 pandemic (2023)

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Type of publication:
Journal article

Author(s):
*Khaleeq T.; *Kabariti R.; *Ahmed U.

Citation:
Pakistan Journal of Medical Sciences. 39(3) (pp 769-774), 2023. Date of Publication: May – June 2023.

Abstract:
Background and Objective: A significant increase has been observed globally in multi-centre trainee-led trauma & orthopaedic (T&O) research collaborative projects with more emphasis have been on tackling important research questions since the start of the COCID-19 pandemic. The objective of our analysis was to determine the number of trainee-led research collaborative projects in T&O in the United Kingdom that were started during the COVID-19 pandemic. Method(s): A retrospective analysis was conducted to determine how many trainee-led national collaborative projects in T&O were conducted since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021) and the number of projects identified were compared to the previous year (2019). Any regional collaborative projects, projects that were started before the onset of COVID and projects of other surgical specialities were not included in the study. Result(s): There were no projects identified in 2019 while in the Covid pandemic lockdown we identified 10 trainee-led collaborative trauma & orthopaedic projects with six of them being published with level of evidence from three to four. Conclusion(s): Covid was unprecedented and has placed considerable trials across healthcare. Our study highlights an increase in multi-centre trainee-led collaborative projects within the UK and it underlines the feasibility of such projects especially with the advent of social media and Redcap which facilitate recruitment of new studies and data.

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Primary acinic cell carcinoma in an adolescent female (2023)

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Type of publication:
Journal article

Author(s):
Venkatasami M.; Harrison K.

Citation:
Advances in Oral and Maxillofacial Surgery. 10 (no pagination), 2023. Article Number: 100419. Date of Publication: June 2023. [epub ahead of print]

Abstract:
Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 17% of all primary salivary gland malignancies in adults. ACC most commonly affects the parotid gland, predominating fifth and sixth decades of life and a female predilection. In the paediatric population, mucoepidermoid carcinoma is the most common parotid malignancy, followed by ACC. We report a case of a 16-year-old female, presenting with a slow-growing right parotid lump. Clinical examination revealed a small right parotid nodule, grade I House-Brackmann score and cervical lymphadenopathy. Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland and reactive lymph nodes. Surgical management included a right partial parotidectomy. Immunohistochemistry was negative for S100, positive with DOG-1 and widespread PAS-D-resistant granules throughout the tumour cells, confirming a diagnosis of ACC. ACC is an important differential diagnosis to consider in salivary gland pathology in the female adolescent patient.

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The analysis of gut microbiota in patients with bile acid diarrhoea treated with colesevelam (2023)

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Type of publication:
Journal article

Author(s):
Kumar A; Quraishi MN; Al-Hassi HO; El-Asrag ME; Segal JP; Jain M; Steed H; Butterworth J; Farmer A; Mclaughlin J; Beggs A; Brookes MJ Authors Full Name Kumar, Aditi; Quraishi, Mohammed Nabil; Al-Hassi, Hafid O; El-Asrag, Mohammed E; Segal, Jonathan P; Jain, Manushri; Steed, Helen; *Butterworth, Jeffrey; Farmer, Adam; Mclaughlin, John; Beggs, Andrew; Brookes, Matthew

Citation:
Frontiers in Microbiology. 14:1134105, 2023. [epub ahead of print]

Abstract:
Introduction: Bile acid diarrhoea (BAD) is a common disorder that results from an increased loss of primary bile acids and can result in a change in microbiome. The aims of this study were to characterise the microbiome in different cohorts of patients with BAD and to determine if treatment with a bile acid sequestrant, colesevelam, can alter the microbiome and improve microbial diversity. Materials and methods: Patients with symptoms of diarrhoea underwent 75-selenium homocholic acid (75SeHCAT) testing and were categorised into four cohorts: idiopathic BAD, post-cholecystectomy BAD, post-operative Crohn's disease BAD and 75SeHCAT negative control group. Patients with a positive 75SeHCAT (<15%) were given a trial of treatment with colesevelam. Stool samples were collected pre-treatment, 4-weeks, 8-weeks and 6-12 months post-treatment. Faecal 16S ribosomal RNA gene analysis was undertaken. Results: A total of 257 samples were analysed from 134 patients. alpha-diversity was significantly reduced in patients with BAD and more specifically, in the idiopathic BAD cohort and in patients with severe disease (SeHCAT <5%); p < 0.05. Colesevelam did not alter bacterial alpha/beta-diversity but patients who clinically responded to treatment had a significantly greater abundance of Fusobacteria and Ruminococcus, both of which aid in the conversion of primary to secondary bile acids. Conclusion: This is the first study to examine treatment effects on the microbiome in BAD, which demonstrated a possible association with colesevelam on the microbiome through bile acid modulation in clinical responders. Larger studies are now needed to establish a causal relationship with colesevelam and the inter-crosstalk between bile acids and the microbiome.

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Detailed Sub-study Analysis of the SECRAB Trial: Quality of Life, Cosmesis and Chemotherapy Dose Intensity (2023)

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Type of publication:
Journal article

Author(s):
Fernando IN; Lax S; Bowden SJ; Ahmed I; Steven JH; Churn M; Brunt AM; *Agrawal RK; Canney P; Stevens A; Rea DW Authors Full Name Fernando, I N; Lax, S; Bowden, S J; Ahmed, I; Steven, J H; Churn, M; Brunt, A M; Agrawal, R K; Canney, P; Stevens, A; Rea, D W.

Citation:
Clinical Oncology (Royal College of Radiologists). Volume 35, pages 397-407, 2023 Mar 20.

Abstract:
AIMS: SECRAB was a prospective, open-label, multicentre, randomised phase III trial comparing synchronous to sequential chemoradiotherapy (CRT). Conducted in 48 UK centres, it recruited 2297 patients (1150 synchronous and 1146 sequential) between 2 July 1998 and 25 March 2004. SECRAB reported a positive therapeutic benefit of using adjuvant synchronous CRT in the management of breast cancer; 10-year local recurrence rates reduced from 7.1% to 4.6% (P = 0.012). The greatest benefit was seen in patients treated with anthracycline-cyclophosphamide, methotrexate, 5-fluorouracil (CMF) rather than CMF. The aim of its sub-studies reported here was to assess whether quality of life (QoL), cosmesis or chemotherapy dose intensity differed between the two CRT regimens. MATERIALS AND METHODS: The QoL sub-study used EORTC QLQ-C30, EORTC QLQ-BR23 and the Women's Health Questionnaire. Cosmesis was assessed: (i) by the treating clinician, (ii) by a validated independent consensus scoring method and (iii) from the patients' perspective by analysing four cosmesis-related QoL questions within the QLQ-BR23. Chemotherapy doses were captured from pharmacy records. The sub-studies were not formally powered; rather, the aim was that at least 300 patients (150 in each arm) were recruited and differences in QoL, cosmesis and dose intensity of chemotherapy assessed. The analysis, therefore, is exploratory in nature. RESULTS: No differences were observed in the change from baseline in QoL between the two arms assessed up to 2 years post-surgery (Global Health Status: -0.05; 95% confidence interval -2.16, 2.06; P = 0.963). No differences in cosmesis were observed (via independent and patient assessment) up to 5 years post-surgery. The percentage of patients receiving the optimal course-delivered dose intensity (>=85%) was not significantly different between the arms (synchronous 88% versus sequential 90%; P = 0.503). CONCLUSIONS: Synchronous CRT is tolerable, deliverable and significantly more effective than sequential, with no serious disadvantages identified when assessing 2-year QoL or 5-year cosmetic differences.

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Global impact of COVID-19 pandemic on gastric cancer patients (2023)

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Type of publication:
Journal article

Author(s):
Herrera-Kok J.H.; Parmar C.; Bangash A.H.; Samadov E.; Demirli Atici S.; Cheruvu C.V.; Abouelazayem M.; Yang W.; Galanis M.; Di Maggio F.; Isik A.; *Bandopyadaya S.; Viswanath Y.K.

Citation:
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. (no pagination), 2023. Date of Publication: 02 Mar 2023.[epub ahead of print]

Abstract:

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Intussusception of the appendix in a young adult: an important differential diagnosis of abdominal pain in cystic fibrosis patients? (2023)

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Type of publication:
Journal article

Author(s):
*Venkatasami, Meena; *Cobby, Ellen.

Citation:
Journal of Surgical Case Reports. 2023(3):117, 2023 Mar.

Abstract:
Cystic fibrosis (CF) is commonly associated with gastrointestinal manifestations from infancy to adulthood. Distal intestinal obstruction syndrome (DIOS) affects 20% of CF patients, where intussusception can be a rare complication. A 20-year-old CF male was diagnosed with a 3-day history of right iliac fossa pain and diarrhoea. Clinical examination revealed a tender palpable mass in the right iliac fossa and raised serum inflammatory markers. Contrast computerized-tomography of the abdomen-pelvis suggested intussusception of the appendix and further confirmed on histological analyses. The patient underwent an open appendicectomy where the intussusception had self-resolved. The literature review indicated a scarcity of data with 10 cases reported of intussusception in adult CF patients. Our case was in line with previous research of transient intussusception. This rare case highlights an importance to carry a higher index of suspicion for gastrointestinal manifestations in CF patients where differential diagnoses of DIOS and intussusception should be considered in the acute presentation.

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