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Predictors of interest in predictive testing for rheumatoid arthritis amongst first degree relatives of rheumatoid arthritis patients.
No full textOBJECTIVES
There is increasing interest in prediction and prevention of rheumatoid arthritis (RA). It is important to understand the views of those at risk to inform the development of effective approaches. First-degree relatives (FDRs) of RA patients are at increased risk of RA. This study assessed predictors of their interest in predictive testing for RA.
METHODS
Questionnaires were completed by RA patients (provided with their questionnaire by a healthcare professional) and their FDRs (provided with their questionnaire by their RA proband). FDR surveys assessed interest in taking a predictive test, demographic variables, perceived RA risk, attitudes about predictive testing, autonomy preferences, illness perceptions, avoidance coping and health anxiety. Patient surveys included demographic variables, disease impact, RA duration and treatment. Ordinal logistic regression examined the association between FDRs' characteristics and their interest in predictive testing. Generalised estimating equations assessed associations between patient characteristics and FDRs' interest in predictive testing.
RESULTS
396 FDRs responded. Paired data from the RA proband were available for 292. 91.3% of FDRs were interested in predictive testing. Information seeking preferences, beliefs that predictive testing can increase empowerment over health and positive attitudes about risk knowledge were associated with increased interest. Beliefs that predictive testing could cause psychological harm predicted lower interest. Patient characteristics of the proband were not associated with FDRs' interest.
CONCLUSIONS
FDRs' interest in predictive testing for RA was high, and factors associated with interest were identified. These findings will inform the development of predictive strategies and informational resources for those at risk
Chemoresection by mitomycin C compared to transurethral resection of bladder tumor in patients with recurrent nonmuscle-invasive bladder cancer: A systematic review and meta-analysis.
No full textSome studies suggest that chemoresection with mitomycin C (MMC) is comparable to transurethral resection of bladder tumor (TURBT) in the management of recurrent nonmuscle-invasive bladder cancer (NMIBC). In this meta-analysis, we compared the efficacy and safety of MMC and TURBT in recurrent NMIBC. A search was conducted for studies published in English in the electronic databases of MEDLINE/PubMed, the Cochrane Library, Scopus, Web of Science, Google Scholar, ProQuest, System for information on Grey Literature, and ClinicalTrials.gov, with no publication date restrictions. Risk of bias was assessed using the Risk of bias 2 tool for randomized controlled trials and Risk of Bias inNon-Randomized Studies of Interventions-I tool for observational studies. Data analysis was performed using the RevMan 5.4 software. Three studies were included in this systematic review(total participants is 291); two studieswere included in themeta-analysis. The rate of complete response was significantly lower in MMC group compared with TURBT (relative risk [RR]: 0.55, 95% confidence interval (CI): 0.45-0.67, P< .001). The rates of local adverse events were lower inMMC, with a statistical significance for dysuria (RR: 0.55, 95% CI: 0.36-0.84, P ¼ .006), urinary frequency (RR: 0.60, 95% CI: 0.43- 0.84, P¼ .003), cystitis (RR: 0.22, 95% CI: 0.06-0.81, P¼ .02), and incontinence (RR: 0.48, 95% CI: 0.24-0.96, P¼ .04). In terms of complete response, TURBT is superior to chemoresection withMMC. Currently, chemoresection withMMC should be restricted to patients unfit for surgery and in clinical trials. Future randomized controlled trials are recommended to confirm or refute the use ofMMC in treating recurrent NMIBC
E-learning communication skills training for physiotherapy students: A two phased sequential mixed methods study.
No full textOBJECTIVE
Test whether a single e-learning session can improve empathy and communication across pre-registration and postgraduate physiotherapy students.
METHODS
Design: Two-phase sequential mixed methods study. Phase 1: Pilot randomised control trial. Phase 2: Qualitative study using interpretive phenomenological analysis.
SAMPLING
A purposive sample for both phases.
OUTCOME MEASURES
Phase 1: At baseline, post and 6-week follow up. Demographics.
PRIMARY OUTCOME
Inter-personal Reactivity Index (IRI). Phase 2: Demographics and interview schedule.
INTERVENTION
An e-learning (E) narrative intervention group or active control condition.
ANALYSIS
Phase 1: Descriptive statistics and confidence intervals. Mann-Whitney U test to compare across group change. Phase 2: Thematic analysis.
RESULTS
Thirty-nine participants took part in the mixed methods study (Phase 1 n = 25; Phase 2 n = 14). Phase 1: No significant differences between groups were identified. Potentially importance changes across time were found for the intervention group and control group. Phase 2 results identified 5 themes and 12 sub-themes.
CONCLUSION
The e-learning groups identified an increase in the perceived ability to handle distressing communication. Other important findings from the e-learning are discussed. Further research is warranted. Practical Implications Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.
PRACTICAL IMPLICATIONS
Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication
Surgical Wound Infection Prevention using Topical Negative Pressure Therapy on Closed Abdominal Incisions - The "SWIPE IT" Randomised Clinical Trial.
No full textBACKGROUND
Surgical site infections (SSIs) are the most common cause of health care-associated infections in surgical patients. It is unclear if incisional negative pressure wound therapy (NPWT) can reduce the risk of SSIs in patients after open abdominal surgery.
METHODS
A prospective, non-blinded multi-centre randomised controlled trial (RCT) was performed to evaluate the incidence of SSI post-laparotomy using incisional NPWT compared to a standard dressing. The primary outcome was the rate of superficial SSI.
RESULTS
There were 124 patients (61 patients in the NPWT arm and 63 patients in the control arm) included. One hundred and nine (87.9%) patients underwent colorectal surgery; 61 patients (49.2%) had emergency surgery. There were more superficial SSIs in the control group than the NPWT group, although not statistically significance (20.6% versus 9.8%, p=0.1). Upon multiple logistic regression analysis, control dressings were associated with increased risk of superficial SSI although again, not statistically significant (OR 2.41, 95%CI 0.81-7.17, p=0.11). There was no superficial non-SSI related wound dehiscence in the NPWT group compared to 9.5% in the control group (p=0.03). There was no difference in post-operative complications (p=0.15), nor other wound complications (p=0.79).
CONCLUSION
NPWT was not associated with decreased superficial SSI in this RCT. However, there was a statistically significant reduction in superficial wound dehiscence with NWPT dressings. The results of this study should be included in meta-analyses for better evaluation of NPWT on closed abdominal incisions
Initial management of acute ischaemic stroke.
No full textThe management of acute ischaemic stroke has been revolutionised by effective reperfusion therapies including thrombolysis and mechanical thrombectomy. In particular, mechanical thrombectomy has heralded a new era in stroke medicine. There have also been developments to improve clinical outcomes for patients who have had an acute ischaemic stroke but are not eligible for this procedure. This article presents an update on the initial management of acute ischaemic stroke, including reperfusion therapies, periprocedural considerations and ongoing research for potential improvements in the care of these patients
A Daily Diagnostic Multidisciplinary Meeting to Reduce Time to Definitive Diagnosis in the Context of Primary Bone and Soft Tissue Sarcoma.
No full textBackground and Objectives
Cancer services are under increasing pressure to deliver waiting time targets. Our service has seen referral numbers increase to over 3000 per annum, with more than 80% coming from secondary care. In order to deliver a responsive service, the department has introduced a daily diagnostic multidisciplinary meeting (DMDT) with the aim being stratification of resources by directing rapid access to clinics and diagnostics to those felt to be at greatest risk of malignancy at the start of the pathway. It also aimed to improve communication with patients and referrers, consistency in decision making and deliver improved diagnostic turn-around times in a sustainable manner. An evaluation was undertaken to assess whether the introduction of the DMDT has improved the pathway, the primary endpoint being a reduction in time to definitive diagnosis (TTDD). Secondary endpoints included measurements of efficiency and whether there has been a reduction in variation in practice.
Methods
Retrospective access to a prospective database over a 1-month period before (2015) and after (2018) the intervention.
Results
The introduction of the DMDT has led to a reduction in TTDD (7 days). The service also has an added benefit in reducing average total patient miles travelled over the course of diagnosis by 22.68 miles.
Conclusion
The introduction of a diagnostic MDT at the start of the pathway does lead to an improvement in service efficiency and a reduction in TTDD
Toxic erythema as the first sign of COVID-19 infection.
No full textDuring the COVID-19 pandemic, dermatologists have sought to identify and categorize skin manifestations associated with COVID-19, in the hope that it will aid early recognition and treatment of the condition, as well as , provide insight into the pathophysiology of the disease. Urticarial, purpuric, maculopapular and acral rashes have been described in the literature to date (1) (2)
Planning for UK terror attacks: Analysis of blast and ballistic injuries.
No full textTerrorist attacks have become more acute, less predictable and frequently involve use of explosives and gunfire to inflict mass casualty to civilians. Resource demand has been reported in Role 3 Medical Facilities but the continued resource required to manage blast and ballistic injuries has not been quantified. This study aimed to assess the resource required for blast and ballistic injuries at the United Kingdom's Role 4 Medical Facility. Military patients admitted to the Queen Elizabeth Hospital (Role 4 Medical Facility) from Afghanistan with blast or ballistic injuries during the 2012 calendar year were retrospectively reviewed. Injury pattern, theatre resource, length of stay and cost analysis were performed. This study included 99 blast and 53 gunshot wound (GSW) patients. Blast patients were more likely to suffer polytrauma than GSW (53% vs 23%), underwent more surgical procedures and utilized double the theatre time. Blast injury patients had a longer length of stay in hospital. The average cost per patient for blast patients was double that of the GSW injury cohort. The Queen Elizabeth experience represents a continuous flow of severely injured military casualties whilst managing concurrent civilian trauma over a long period. This workload has encouraged systematic advancements in managing high numbers of injured patients from point of wounding to rehabilitation. Distribution of resource, theatre planning and multi-disciplinary team working are critical in effectively managing Major Incidents such as terror attacks. Drawing on previous Role 4 Medical Facility experience can aid UK hospitals in terms of strategy and resource distribution
SARS-CoV-2 infection in patients with autoimmune hepatitis.
No full textBACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) continues to have a devastating impact across the globe. However, little is known about the disease course in patients with autoimmune hepatitis (AIH).
METHODS
Data for patients with AIH and SARS-CoV-2 infection were combined from three international reporting registries and outcomes were compared to those with chronic liver disease of other aetiology (non-AIH CLD) and to patients without liver disease (non-CLD).
RESULTS
Between 25 March and 24 October 2020, data were collected for 932 patients with CLD and SARS-CoV-2 infection including 70 with autoimmune hepatitis (AIH). Fifty-eight (83%) of AIH patients were taking one or more immunosuppressive drug. There were no differences in rates of major outcomes between AIH and non-AIH CLD including hospitalization (76% vs 85%; p= 0.06), ICU admission (29% vs. 23%; p=0.240), and death (23% vs. 20%; p=0.643). Factors associated with death within the AIH cohort included age (OR 2.16/10 years; 1.07-3.81), Child-Turcotte-Pugh (CTP) class B (OR 42.48; 4.40-409.53), and CTP-C cirrhosis (OR 69.30; 2.83-1694.50), but not use of immunosuppression. Propensity score matched (PSM) analysis comparing AIH with non-AIH CLD demonstrated no increased risk adverse outcomes including death (+3.2%; -9.2%-15.7%). PSM analysis of AIH versus non-CLD patients (n=769) demonstrated increased risk of hospitalization with AIH (+18.4%; 5.6-31.2%), but equivalent risk of all other outcomes including death (+3.2%; -9.1%-15.6%).
CONCLUSION
AIH patients were not at increased risk of adverse outcomes despite immunosuppressive treatment compared to other causes of CLD and to matched cases without liver disease
The management of patients with functional stroke: speech and language therapists' views and experiences.
No full textPURPOSE
Patients with functional stroke can present with functional speech, language or swallowing symptoms, which are managed by speech and language therapists (SLTs). The aim of this study was to explore SLTs' views and experiences of working with patients with functional stroke.
METHODS
Constructivist grounded theory approach was used. Semi-structured interviews were the method of data collection. Constant comparative analysis was used to analyse data. Participants were eligible if they were SLTs who thought they had experience of working with functional stroke.
RESULTS
12 participants were interviewed. Patients with functional stroke were a common occurrence on participants' caseloads; yet they felt patients do not receive optimum care. All participants wanted to help their patients, yet felt they were working within a multitude of barriers to effective input. These included: stigma about the diagnosis, lack of pre-qualification training, quick discharge from inpatient settings, lack of access to mental health services and lack of clinical guidelines and care pathways.
CONCLUSIONS
As healthcare professionals, participants were keen to help their patients. However, they felt they did not have the skills or knowledge to help which caused professional turmoil. Reducing stigma and increasing awareness and knowledge of functional stroke are required to improve patient outcomes