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The option of transosseous distal suture placement during minimally invasive Achilles tendon repair for high-risk patients can improve outcomes, however does not prevent re-rupture (2024)

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Type of publication:
Journal article

Author(s):
*Carmont, Michael R; Nilsson-Helander, Katarina; Carling, Malin.

Citation:
BMC Musculoskeletal Disorders. 25(1):610, 2024 Aug 01.

Abstract:
PURPOSE: Achilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to suture pull-out from the distal tendon stump. The aim of this study was to describe the outcome of ATR patients who received transosseous distal suture placement using a standard technique as a reference. METHODS: Following ATR, patients were evaluated for pre-injury activity level, body weight, location of the tear and size of the distal Achilles tendon stump. Patients considered to be at high-risk of re-rupture: Tegner level >= 8, body weight >= 105Kg and distal ATR, received transosseous (TO) distal suture placement (n = 20) rather than the usual transtendinous (TT) technique (n = 55). Patient reported outcome measures and functional evaluation was performed at 12 months following repair. RESULTS: At 12 months follow up both methods resulted in good median (IQR) Achilles tendon Total Rupture Score TO 83.8 (74-88.3) vs. TT 90 (79-94), low increased relative Achilles Tendon Resting Angle TO -3.5 (3.6) vs. TT -3.5 (3.3) and mean (SD) Single leg Heel-Rise Height Index TO 88.2% (9.9) vs. TT 85.6% (9.9) (n.s.). There were 4 re-ruptures in the high-risk group and 2 in the group receiving TT distal suture placement. All but one of these were traumatic in nature. The mode of failure following TO distal suture placement was proximal suture pull out. CONCLUSIONS: To distal suture placement during minimally-invasive Achilles tendon repair for higher-risk patients can lead to results equivalent to those in lower-risk patients treated with a standard TT MIR technique, except for the re-rupture rate which remained higher. There may be factors that have greater influence on outcome other than suture placement following ATR.

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Stratification to Neoadjuvant Radiotherapy in Rectal Cancer by Regimen and Transcriptional Signatures (2024)

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Type of publication:
Journal article

Author(s):
Mahmood U; Blake A; Rathee S; Samuel L; Murray G; Sebag-Montefiore D; *Gollins S; West NP; Begum R; Bach SP; Richman SD; Quirke P; Redmond KL; Salto-Tellez M; Koelzer VH; Leedham SJ; Tomlinson I; Dunne PD; Buffa FM; Maughan TS; Domingo E

Citation:
Cancer Research Communications. 4(7):1765-1776, 2024 Jul 01.

Abstract:
Response to neoadjuvant radiotherapy (RT) in rectal cancer has been associated with immune and stromal features that are captured by transcriptional signatures. However, how such associations perform across different chemoradiotherapy regimens and within individual consensus molecular subtypes (CMS) and how they affect survival remain unclear. In this study, gene expression and clinical data of pretreatment biopsies from nine cohorts of primary rectal tumors were combined (N = 826). Exploratory analyses were done with transcriptomic signatures for the endpoint of pathologic complete response (pCR), considering treatment regimen or CMS subtype. Relevant findings were tested for overall survival and recurrence-free survival. Immune and stromal signatures were strongly associated with pCR and lack of pCR, respectively, in RT and capecitabine (Cap)/5-fluorouracil (5FU)-treated patients (N = 387), in which the radiosensitivity signature (RSS) showed the strongest association. Upon addition of oxaliplatin (Ox; N = 123), stromal signatures switched direction and showed higher chances to achieve pCR than without Ox (p for interaction 0.02). Among Cap/5FU patients, most signatures performed similarly across CMS subtypes, except cytotoxic lymphocytes that were associated with pCR in CMS1 and CMS4 cases compared with other CMS subtypes (p for interaction 0.04). The only variables associated with survival were pCR and RSS. Although the frequency of pCR across different chemoradiation regimens is relatively similar, our data suggest that response rates may differ depending on the biological landscape of rectal cancer. Response to neoadjuvant RT in stroma-rich tumors may potentially be improved by the addition of Ox. RSS in preoperative biopsies provides predictive information for response specifically to neoadjuvant RT with 5FU. SIGNIFICANCE: Rectal cancers with stromal features may respond better to RT and 5FU/Cap with the addition of Ox. Within patients not treated with Ox, high levels of cytotoxic lymphocytes associate with response only in immune and stromal tumors. Our analyses provide biological insights about the outcome by different radiotherapy regimens in rectal cancer.

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Automating incidence and prevalence analysis in open cohorts (2024)

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Type of publication:
Journal article

Author(s):
Cockburn N.; Hammond B.; Gani I.; Cusworth S.; Acharya A.; Gokhale K.; Thayakaran R.; Crowe F.; Minhas S.; *Smith W.P.; Taylor B.; Nirantharakumar K.; Chandan J.S.;

Citation:
BMC medical research methodology. 24(1) (pp 144), 2024. Date of Publication: 04 Jul 2024.

Abstract:
MOTIVATION: Data is increasingly used for improvement and research in public health, especially administrative data such as that collected in electronic health records. Patients enter and exit these typically open-cohort datasets non-uniformly; this can render simple questions about incidence and prevalence time-consuming and with unnecessary variation between analyses. We therefore developed methods to automate analysis of incidence and prevalence in open cohort datasets, to improve transparency, productivity and reproducibility of analyses. IMPLEMENTATION: We provide both a code-free set of rules for incidence and prevalence that can be applied to any open cohort, and a python Command Line Interface implementation of these rules requiring python 3.9 or later. GENERAL FEATURES: The Command Line Interface is used to calculate incidence and point prevalence time series from open cohort data. The ruleset can be used in developing other implementations or can be rearranged to form other analytical questions such as period prevalence. AVAILABILITY: The command line interface is freely available from https://github.com/THINKINGGroup/analogy_publication .

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Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study (2024)

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Type of publication:
Journal article

Author(s):
Connor M.J.; Genie M.; Dudderidge T.; Wu H.; Sukumar J.; Beresford M.; Bianchini D.; Goh C.; Horan G.; Innominato P.; Khoo V.; Klimowska-Nassar N.; Madaan S.; Mangar S.; McCracken S.; Ostler P.; Paisey S.; Robinson A.; Rai B.; Sarwar N.; *Srihari N.; Jayaprakash K.T.; Varughese M.; Winkler M.; Ahmed H.U.; Watson V.

Citation:
European Urology Oncology. (no pagination), 2024. Date of Publication: 2024.

Abstract:
Background and objective: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. Method(s): A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. Key findings and limitations: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. Conclusions and clinical implications: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. Patient Summary: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.

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Dedicated anticoagulation management protocols in fragility femoral fracture care - a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study

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Type of publication:
Journal article

Author(s):
Farhan-Alanie M.M.; Dixon J.; Irvine S.; Walker R.; Eardley W.G.P.; Smith M.; Yoong A.; Lim J.W.; Yousef O.; McDonald S.; Chileshe C.; Ramus C.; Clements C.; Barrett L.; Rockall O.; Geetala R.; Islam S.U.; Nasar A.; Almond K.; Hassan L.F.Y.; Brand R.B.; Yawar B.; Gilmore C.; McAuley D.; Khan W.; Subramanian P.; Ahluwalia A.; Ozbek L.; Awasthi P.; Sheikh H.; Barkley S.; Ardolino T.; Denning A.; Thiruchandran G.; Fraig H.; Salim O.; Iqbal R.; Guy S.; Hogg J.; Bagshaw O.; Asmar S.; Mitchell S.; Quek F.; Fletcher J.; French J.; Graham S.; Sloper P.; Sadique H.; Matera V.; Sohail Z.; Leong J.W.; Issa F.; Greasley L.; Marsden S.; Parry L.; Mannan S.; Zaheen H.; Moriarty P.; Manning W.; Morris T.; Brockbanks C.; Ward P.; Pearce K.; McMenemy L.; Mahmoud M.; Kieffer W.; Lal A.; Collis J.; Chandrasekaran K.; Foxall-Smith M.; Raad M.; Kempshall P.; Cheuk J.; Leckey S.; Gupta R.; Engelke D.; Kemp M.; Venkatesan A.; Hussain A.; Simons M.; Raghavendra R.M.; Rohra S.; Deo S.; Vasarhelyi F.; Thelwall C.; Cullen K.; Al-Obaidi B.; Fell A.; Thaumeen A.; Dadabhoy M.; Ali M.; Ijaz S.; Lin D.; Khan B.; Alsonbaty M.; Lebe M.; Millan R.K.; Imam S.; Theobald E.; Cormack J.; Sharoff L.; Eardley W.; Jeyapalan R.; Alcock L.; Clayton J.; Bates N.; Mahmoud Y.; Osborne A.; Ralhan S.; Carpenter C.; Ahmad M.; Ravi S.M.; Konbaz T.; Lloyd T.; Sheikh N.; Swealem A.; Soroya E.; Rayan F.; Ward T.; Vasireddy A.; Clarke E.; Sikdar O.; Smart Y.W.; Windley J.; Ilagan B.; Brophy E.; Joseph S.; Lowery K.; Jamjoom A.; Ismayl G.; Aujla R.; Sambhwani S.; Ramasamy A.; Khalaf A.; Ponugoti N.; Teng W.H.; Masud S.; Otoibhili E.; Clarkson M.; Nafea M.; Sarhan M.; Hanna S.; Kelly A.; Curtis A.; Gourbault L.; Tarhini M.; Platt N.; Fleming T.; Pemmaraju G.; Choudri M.J.; Burahee A.; Hassan L.; Hamid L.; Loveday D.; Edres K.; Schankat K.; Granger L.; Goodbun M.; Parikh S.; Johnson-Lynn S.; Griffiths A.; Rai A.; Chandler H.; Guiot L.; Appleyard T.; Robinson K.; Fong A.; Watts A.; Stedman T.; Walton V.; Inman D.; Liaw F.; Hadfield J.; McGovern J.; Baldock T.; White J.; Seah M.; Jacob N.; Ali Z.H.; Goff T.; Sanalla A.; Gomati A.; Nordin L.; Hassan E.; Ramadan O.; Teoh K.H.; Baskaran D.; Ngwayi J.; Abbakr L.; Blackmore N.; Mansukhani S.; Guryel E.; Harper A.; Cashman E.; Brooker J.; Pack L.; Regan N.; *Wagner W.; *Selim A.; *Archer D.; *McConaghie G.; *Patel R.; *Gibson W.; Pasapula C.S.; Youssef H.; Aziz M.A.; Subhash S.; Banaszkiewicz P.; Elzawahry A.; Neo C.; Wei N.; Bhaskaran A.; Sharma A.; Factor D.; Shahin F.; Shields D.; Ferreira C.D.F.; Jeyakumar G.; Liao Q.; Sinnerton R.; Ashwood N.; Sarhan I.; Ker A.; Phelan S.; Paxton J.; McAuley J.; Moulton L.; Mohamed A.; Dias A.; Ho B.; Francis D.; Miller S.; Phillips J.; Jones R.; Arthur C.; Oag E.; Thutoetsile K.; Bell K.; Milne K.; Whitefield R.; Patel K.; Singh A.; Morris G.; Parkinson D.; Patil A.; Hamid H.; Syam K.; *Singh R.; *Menon D.; *Crooks S.; Borland S.; Rohman A.; Nicholson A.; Smith B.; Hafiz N.; Kolhe S.; Waites M.; Piper D.; Westacott D.; Grimshaw J.; Bott A.; Berry A.; Battle J.; Flannery O.; Iyengar K.P.; Thakur A.W.; Yousef M.; Bansod V.; El-nahas W.; Dawe E.; Oladeji E.; Federer S.; Trompeter A.; Pritchard A.; Shurovi B.; Jordan C.; Little M.; Sivaloganathan S.; Shaunak S.; Watters H.; Luck J.; Zbaeda M.; Frasquet-Garcia A.; Warner C.; Telford J.; Rooney J.; Attwood J.; Wilson F.; Panagiotopoulos A.; Keane C.; Scott H.; Mazel R.; Maggs J.; Skinner E.; McMunn F.; Lau J.; Ravikumar K.; Thakker D.; Gill M.; McCarthy P.; Fossey G.; Shah S.; McAlinden G.; McGoldrick P.; O'Brien S.; Patil S.; Millington A.; Umar H.; Sehdev S.; Dyer-Hill T.; Yu Kwan T.; Tanagho A.; Hagnasir A.; White T.; Bano C.; Kissin E.; Ghani R.; Thomas P.S.W.; McMullan M.; Walmsley M.; Elgendy M.; Winstanley R.; Round J.; Baxter M.; Thompson E.; Hogan K.; Youssef K.; Fetouh S.; Hopper G.P.; Simpson C.; Warren C.; Waugh D.; Nair G.; Ballantyne A.; Blacklock C.; O'Connell C.; Toland G.; McIntyre J.; Ross L.; Badge R.; Loganathan D.; Turner I.; Ball M.; Maqsood S.; Deierl K.; Beer A.; Tan A.C.W.; Mackinnon T.; Gade V.; Gill J.; Yu San K.; Archunan M.W.; Shaikh M.; Ugbah O.; Uwaoma S.; Pillai A.; Nath U.; Rohan

Citation:
Injury. 55(8) (no pagination), 2024. Article Number: 111686. Date of Publication: August 2024. [epub ahead of print]

Abstract:
Introduction: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. Method(s): Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged >=60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. Result(s): Dedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54-0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75-3.57, p=0.219). Conclusion(s): Around half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.

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Shropshire's military, NHS, and volunteer community collaborate to provide an innovative training course for medical registrars (2024)

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Type of publication:
Conference abstract

Author(s):
*Eardley K.; *Mackintosh A.; *Wood G.;

Citation:
Future Healthcare Journal. Conference: The future of medicine. RCP annual conference. Regent's Park, London United Kingdom. 11(Supplement) (no pagination), 2024. Article Number: 100046. Date of Publication: April 2024.

Abstract:
Introduction: The position of Medical Registrar is one of the most important for the delivery of safe and effective emergency care in the acute hospital. It is also one of the most challenging physically and mentally. Health Education England West Midland's School of Medicine commissioned Shrewsbury & Telford Hospital NHS Trust (SATH) to deliver a 3-day residential course specifically designed to cover a wide range of competencies and clinical skills, but specifically to help equip the medical registrar with strategies to better manage the complexity, the cognitive load, and psychological stress of the role in a fun and interactive way. Material(s) and Method(s): The course was codesigned by SATH Volunteers, 202 Multi-role Medical Regiment (202MMR), NHS England OP COURAGE, SATH Clinical Simulation team, and RCP Chief Registrar. Feedback during the course meant that delegate's individual learning needs were identified and addressed in Course. Faculty provided feedback in person and a survey monkey was sent to the delegates on completion of the course. Results and discussion: The following course was delivered to 16 Internal Medicine Year 3 doctors. Deteriorating Patient Clinical Simulation Course: Delegates managed simulated clinical scenarios of deteriorating patients. Complexity called upon prioritisation, delegation, escalation, and communication skills. Simulated relatives were used calling on skills of breaking bad news, duty of candour, best interests' decision making, and providing compassionate end of life care. Human Factors Course: 202MMR Army Reservists and permanent staff delivered a course utilising the Centre of Army Leadership training packages. Using several engaging activities, the delegates gained a greater understanding of self and how their emotions, behaviours, and perceptions play an important role in their ability to be a safe and effective clinician, leader, and follower. Hospital Cardiac Arrest Clinical Simulation Course: All scenarios led onto cardiac arrest and included additional complexity requiring discussion with relatives including breaking bad news and making end of life decisions. Mental health session: This session provided a safe space for the delegates to talk about their experiences working in the NHS. Sustaining mental health and coping strategies and concepts were explored. Written feedback from the delegates was very positive and included: 'It was the best simulation course I have ever attended'. 'Role play by volunteers from the community was a unique experience which I have not observed in previous such training. This provided excellent opportunity to receive feedback on various aspects of our performance'. 'Focus on teamwork, leadership and followership is rarely spoken about in other training. Very dynamic and engaging'. 'Training in army barracks with command tasks correlating with leadership, teamwork and human factors. Interactive sessions, everyone was involved, valued, and listened'. 'The arrest scenarios were much truer to life than ALS courses eg relatives, debrief, bleed, thrombolysis'. 'Very useful feedback. Great to have the opportunity to try this before starting on the reg rota. Hugely appreciated thank you'. Conclusion(s): Utilising the skills and experiences of the NHS, military, and wider community significantly enhances the quality of clinical simulation and human factors training for the medical registrar.

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Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study (2024)

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Type of publication:
Journal article

Author(s):
Connor, Martin J; Genie, Mesfin; Dudderidge, Tim; Wu, Hangjian; Sukumar, Johanna; Beresford, Mark; Bianchini, Diletta; Goh, Chee; Horan, Gail; Innominato, Pasquale; Khoo, Vincent; Klimowska-Nassar, Natalia; Madaan, Sanjeev; Mangar, Stephen; McCracken, Stuart; Ostler, Peter; Paisey, Sangeeta; Robinson, Angus; Rai, Bhavan; Sarwar, Naveed; *Srihari, Narayanan; Jayaprakash, Kamal Thippu; Varughese, Mohini; Winkler, Mathias; Ahmed, Hashim U; Watson, Verity.

Citation:
European Urology Oncology. 2024 Jul 06. [epub ahead of print]

Abstract:
BACKGROUND AND OBJECTIVE: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. METHODS: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. KEY FINDINGS AND LIMITATIONS: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. PATIENT SUMMARY: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.

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Automating incidence and prevalence analysis in open cohorts (2024)

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Type of publication:
Journal article

Author(s):
Cockburn, Neil; Hammond, Ben; Gani, Illin; Cusworth, Samuel; Acharya, Aditya; Gokhale, Krishna; Thayakaran, Rasiah; Crowe, Francesca; Minhas, Sonica; *Smith, William Parry; Taylor, Beck; Nirantharakumar, Krishnarajah; Chandan, Joht Singh.

Citation:
BMC Medical Research Methodology. 24(1):144, 2024 Jul 04.

Abstract:
MOTIVATION: Data is increasingly used for improvement and research in public health, especially administrative data such as that collected in electronic health records. Patients enter and exit these typically open-cohort datasets non-uniformly; this can render simple questions about incidence and prevalence time-consuming and with unnecessary variation between analyses. We therefore developed methods to automate analysis of incidence and prevalence in open cohort datasets, to improve transparency, productivity and reproducibility of analyses. IMPLEMENTATION: We provide both a code-free set of rules for incidence and prevalence that can be applied to any open cohort, and a python Command Line Interface implementation of these rules requiring python 3.9 or later. GENERAL FEATURES: The Command Line Interface is used to calculate incidence and point prevalence time series from open cohort data. The ruleset can be used in developing other implementations or can be rearranged to form other analytical questions such as period prevalence. AVAILABILITY: The command line interface is freely available from https://github.com/THINKINGGroup/analogy_publication

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REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use (2024)

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Type of publication:
Journal article

Author(s):
MacLeod C.S.; Nagy J.; Radley A.; Khan F.; Rae N.; Wilson M.S.J.; Suttie S.A.; Munro E.N.; Flett M.M.; Hussey K.; Wolf B.; W R.; Wallace D.; Vesey A.T.; McCaslin J.; Wong P.; Tenna A.; Badger S.; Harrison G.; Ghosh J.; Al-Khaffaf H.; Torella F.; McBride R.; Drinkwater S.; Antoniou G.A.; Bhasin N.; Pradhan A.; Smith G.; Coughlin P.; Brar R.; Peach G.; Kulkarni S.; Brooks M.; Wijesinghe L.; McCune K.; Hopper N.; Cowan A.; Hunter I.; Mittapalli D.; Garnham A.; *Jones S.; Rajagopalan S.; Tiwari A.; Imray C.; Atwal A.; Bahia S.; Jones K.G.; Handa A.; Bowbrick G.; Nordon I.; Button M.; Rudarakanchana N.; D'Souza R.; Tai N.; Moxey P.; Bicknell C.; Gibbs R.; Zayed H.; Saratzis A.; Kannan R.; Batchelder A.; Chong P.L.; Rowlands T.; Hildebrand D.; Thapar A.; Chaudhuri A.; Howard A.; Metcalfe M.; Al-Jundi W.; Sayer G.; Lewis D.; Sohrabi S.; Woolgar J.; Fligelstone L.; Davies H.; Hill S.; Fulton G.; Moneley D.; McDonnell C.; Martin Z.; Dowdall J.; Tierney S.; Walsh S.; Medani M.; Gosi G.

Citation:
European Journal of Vascular and Endovascular Surgery. (no pagination), 2024 [epub ahead of print]

Abstract:
Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Method(s): A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Result(s): Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion(s): This comprehensive consensus statement provides a strong insight into the standard of care for these patients.

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The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope (2024)

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Type of publication:
Journal article

Author(s):
Hannah, Jennifer; Rodziewicz, Mia; Mehta, Puja; Heenan, Kerri-Marie; Ball, Elizabeth; Barratt, Shaney; Carty, Sara; Conway, Richard; Cotton, Caroline V; Cox, Sarah; Crawshaw, Anjali; Dawson, Julie; Desai, Sujal; Fahim, Ahmed; Fielding, Carol; *Garton, Mark; George, Peter; Gunawardena, Harsha; Kelly, Clive; Khan, Fasihul; Koduri, Gouri; Morris, Helen; Naqvi, Marium; Perry, Elizabeth; Riddell, Claire; Sieiro Santos, Cristiana; Spencer, Lisa G; Chaudhuri, Nazia; Nisar, Muhammad K.

Citation:
Rheumatology Advances in Practice. 8(2):rkae056, 2024.

Abstract:
Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies. This article outlines the intended scope for the British Society for Rheumatology guideline on the diagnosis and management of SARD-ILD developed by the guideline working group. It specifically identifies the SARDs for consideration, alongside the overarching principles for which systematic review will be conducted. Expert consensus will be produced based on the most up-to-date available evidence for inclusion within the final guideline. Key issues to be addressed include recommendations for screening of ILD, identifying the methodology and frequency of monitoring and pharmacological and non-pharmacological management. The guideline will be developed according to methods and processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.1.

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