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COVID-19 in haematology patients: a multicentre West Midlands clinical outcomes analysis on behalf of the West Midlands Research Consortium.
No full textAntibodies to gp210 and understanding risk in patients with primary biliary cholangitis.
No full textBACKGROUND AND AIMS
A variety of auto-antibody assays are available as part of the clinical care of patients with liver disease. We sought to better understand the clinical utility of immune-serological testing in patients with primary biliary cholangitis (PBC).
METHODS
We retrospectively analyzed data from 2846 patients investigated for liver disease at a UK liver transplant center between 2001 and 2017. 499 patients with PBC were identified. Immune serology results were examined for their diagnostic utility and prognostic significance to predict transplant-free survival.
RESULTS
Anti-mitochondrial antibodies (AMA) were specific (94.5%) and sensitive (85.6%) for PBC; anti-nuclear antibodies (ANA) against glycoprotein-210 (gp210) and sp100 were specific (>98%) but not sensitive (<25%). The disease-specific ANAs were detectable in 29.6% of AMA-negative patients. Anti-gp210 auto-antibodies were significantly associated with elevated hepatic aminotransferases, bilirubin, and liver stiffness at presentation (P<0.010). Anti-gp210 auto-antibodies predicted non-response to ursodeoxycholic acid (UDCA) by GLOBE criteria (39.3% vs. 16.7%, P=0.005). Moreover, anti-gp210 was independently associated with death or liver transplantation (HR 3.22, 95% CI 1.49-6.96; P=0.003), after accounting for other significant baseline determinants of outcome. Moreover, the expression of anti-gp210 antibodies conferred an independent risk of death or transplantation (HR 4.13, 95% CI 1.85-9.22; P=0.001) after accounting for treatment response.
CONCLUSION
In our single centre cohort of patients with PBC the presence of anti-gp210 was associated with an adverse presenting phenotype, predicted treatment non-response and independently predicted reduced transplant-free survival
Noninvasive Instrument-based Tests for Detecting and Measuring Vitreous Inflammation in Uveitis: A Systematic Review.
No full textPURPOSE
This systematic review aims to identify instrument-based tests for quantifying vitreous inflammation in uveitis, report the test reliability and the level of correlation with clinician grading.
METHODS
Studies describing instrument-based tests for detecting vitreous inflammation were identified by searching bibliographic databases and trials registers. Test reliability measures and level of correlation with clinician vitreous haze grading are extracted.
RESULTS
Twelve studies describing ultrasound, optical coherence tomography (OCT), and retinal photography for detecting vitreous inflammation were included: Ultrasound was used for detection of disease features, whereas OCT and retinal photography provided quantifiable measurements. Correlation with clinician grading for OCT was 0.53-0.60 (three studies) and for retinal photography was 0.51 (1 study). Both instruments showed high inter- and intra-observer reliability (>0.70 intraclass correlation and Cohen's kappa), where reported in four studies.
CONCLUSION
Retinal photography and OCT are able to detect and measure vitreous inflammation. Both techniques are reliable, automatable, and warrant further evaluation
Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014.
No full textOBJECTIVE
To describe the population of patients who attend emergency departments (ED) in England for mental health reasons.
METHODS
Cross-sectional observational study of 6 262 602 ED attendances at NHS (National Health Service) hospitals in England between 1 April 2013 and 31 March 2014. We assessed the proportion of attendances due to psychiatric conditions. We compared patient sociodemographic and attendance characteristics for mental health and non-mental health attendances using logistic regression.
RESULTS
4.2% of ED attendances were attributable to mental health conditions (median 3.2%, IQR 2.6% to 4.1%). Those attending for mental health reasons were typically younger (76.3% were aged less than 50 years), of White British ethnicity (73.2% White British), and resident in more deprived areas (59.9% from the two most deprived Index of Multiple Deprivation quintiles (4 and 5)). Mental health attendances were more likely to occur 'out of hours' (68.0%) and at the weekend (31.3%). Almost two-thirds were brought in by ambulance. A third required admission, but around a half were discharged home.
CONCLUSIONS
This is the first national study of mental health attendances at EDs in England. We provide information for those planning and providing care, to ensure that clinical resources meet the needs of this patient group, who comprise 4.2% of attendances. In particular, we highlight the need to strengthen the availability of hospital and community care 'out of hours.
Pathological features of 11,337 patients with primary ductal carcinoma in situ (DCIS) and subsequent events: results from the UK Sloane Project.
No full textBACKGROUND
The Sloane audit compares screen-detected ductal carcinoma in situ (DCIS) pathology with subsequent management and outcomes.
METHODS
This was a national, prospective cohort study of DCIS diagnosed during 2003-2012.
RESULTS
Among 11,337 patients, 7204 (64%) had high-grade DCIS. Over time, the proportion of high-grade disease increased (from 60 to 65%), low-grade DCIS decreased (from 10 to 6%) and mean size increased (from 21.4 to 24.1 mm). Mastectomy was more common for high-grade (36%) than for low-grade DCIS (15%). Few (6%) patients treated with breast-conserving surgery (BCS) had a surgical margin <1 mm. Of the 9191 women diagnosed in England (median follow-up 9.4 years), 7% developed DCIS or invasive malignancy in the ipsilateral and 5% in the contralateral breast. The commonest ipsilateral event was invasive carcinoma (n = 413), median time 62 months, followed by DCIS (n = 225), at median 37 months. Radiotherapy (RT) was most protective against recurrence for high-grade DCIS (3.2% for high-grade DCIS with RT compared to 6.9% without, compared with 2.3 and 3.0%, respectively, for low/intermediate-grade DCIS). Ipsilateral DCIS events lessened after 5 years, while the risk of ipsilateral invasive cancer remained consistent to beyond 10 years.
CONCLUSION
DCIS pathology informs patient management and highlights the need for prolonged follow-up of screen-detected DCIS
Safety and efficacy of transurethral resection of bladder tumour comparing spinal anaesthesia to spinal anaesthesia with an obturator nerve block: a systematic review and meta-analysis.
No full textAims To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for TURBT during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosol-generating procedures. We aimed to compare outcomes of transurethral resection of bladder tumours (TURBT) using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity. Methods We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar and Web of Science), identifying studies comparing the outcomes of TURBT using spinal anaesthesia versus spinal with an obturator nerve block. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data. Results Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of spinal anaesthesia with an obturator nerve block was associated with a significantly reduced risk of obturator reflex (P<0.00001), bladder perforation (P=0.02), incomplete resection (P<0.0001) and 12-month tumour recurrence (P=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity (0/159). Conclusion Our meta-analysis suggests that TURBT employing spinal anaesthesia with an obturator nerve block is superior to the use of spinal anaesthesia alone. During the COVID-19 pandemic, where avoidance of aerosol-generating procedures (AGPs) such as a general anaesthesia is paramount, the use of an obturator nerve block with spinal anaesthesia is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade
Infection Prevention and Control Lead Link Practitioner: a new deployed role piloted on Exercise SAIF SAREEA 3.
No full textDisease non-battle injury has plagued British expeditionary forces through the ages. While in recent years significant mortality has reduced, it has had a large impact on operational effectiveness, at times leading to closure of major medical treatment facilities (MTFs).Infection Prevention and Control (IPC) benefits from a subject matter expert and champion to ensure it remains at the front of people's minds and to be on hand to manage acute and dynamic situations. To mitigate the lack of an IPC Nursing Officer, we piloted a deployed military IPC Lead Link Practitioner (IPC-LL) for the first time on a large-scale overseas exercise (SAIF SAREEA 3). An experienced generalist nurse deploying as the IPC-LL (after specific training) provided pre-deployment IPC education and preparation, deployed IPC advice, undertook mandatory audits and monitored IPC compliance throughout the MTFs on the exercise. Data from 22 IPC audits conducted on the exercise showed that the presence of the IPC-LL improved IPC compliance and standards overall in the MTF where based, compared with others. In addition, a gastroenteritis outbreak occurred and was successfully managed with significant input from the IPC-LL. The IPC-LL was also able to add value by pre-empting potential IPC problems from occurring.There is a small pool of deployable Infection Prevention and Control Nursing Officers, so this new IPC-LL role could help to fill the capability gap. The IPC-LL could be the dedicated person focusing on IPC elements, reducing the IPC risk within the deployed field hospital setting where deployed experts are not available
'Our COVID-19 cloud silver lining': the initiation and progress of postnatal contraception services during the COVID-19 pandemic in a UK maternity hospital.
No full textValidation of the Neuropsychological Assessment Battery Screening Module (NAB-SM) in patients with traumatic brain injury.
No full textThis study cross-validates the screening module of the Neuropsychological Assessment Battery (NAB-SM) with a battery of well validated neuropsychological tests (Convergent Validity Test Battery: CVTB) in a Traumatic Brain Injury (TBI) population. Forty-four participants with "mild-complicated" to "severe" TBI were recruited from a cohort of patients attending an outpatient clinic at a UK major trauma center. The NAB-SM Total Index score and an abbreviated short-form, from which a TBI Index was derived, both showed good classification accuracy in predicting impairment as measured by the CVTB mean score. These indices also accurately identified impairment as defined by the base rate of low scores across individual CVTB indices measuring mental processing speed, working memory, memory and executive functioning. The NAB-SM and its derived TBI index therefore have significant utility as a cognitive screening tool for use in either inpatient (acute) or outpatient TBI populations