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European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit
No full textThe European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
Lifting limitations following elbow arthroplasty: A survey of British Elbow and Shoulder Society members
No full textThe primary aim of this survey was to capture current practice with regard to lifting limitations following elbow arthroplasty. An online survey was emailed to all members of the British Elbow and Shoulder Society. All consultant respondents who reported performing elbow arthroplasty were asked about their advice for post-operative lifting limitations. In total, 115 surveys were completed: 55 consultants reported performing linked total elbow arthroplasty, 18 reported performing unlinked total elbow arthroplasty and 44 reported performing distal humeral hemiarthroplasty. The majority of elbow consultants advise a lifelong lifting limitation following linked and unlinked total elbow arthroplasty (78% and 61% respectively). There was variation in the weight specified for lifelong lifting limitations, the median weight restriction in linked total elbow arthroplasty was 5 lb, and in unlinked total elbow arthroplasty was 10 lb (range 1-20 lb). In total, 13% of consultants performing linked total elbow arthroplasty and 33% of consultants performing unlinked total elbow arthroplasty do not advise any lifelong lifting limitations post-operatively. In a perceived attempt to prolong implant longevity, most surgeons recommend lifelong lifting limitations following total elbow arthroplasty. There is variation in the weight restriction advised by consultant elbow surgeons. Currently the optimal weight restriction to maximise implant longevity is not known and further work needs to be done to understand the true relationship between activity, loading and implant failure.Full Text unavailable for 1 year from time of publication
A comparison of general surgery training programmes across 11 countries: improving understanding of the experience level of international medical graduates in the UK
No full textINTRODUCTION: Within the past five years there has been a significant increase in the number of international medical graduates (IMGs) joining the United Kingdom's (UK) workforce. Having mentors and supervisors who understand the needs of IMGs and clinical and cultural differences in the workplace can benefit in the transition to working in a new country. Improving knowledge of and understanding differences between general surgical training programmes and grades across different countries could therefore aid in the support of IMGs within the UK. METHODS: Data on general surgical training programmes of the top ten countries for the primary medical qualifications of IMGs in the UK were collected to provide comparison with the UK training programme. RESULTS: The following countries were included: UK, India, Pakistan, Nigeria, Egypt, Ireland, Sudan, Sri Lanka, Romania, Iraq and South Africa. Training programme lengths ranged from 3 to 10 years. Only some training programmes provide additional training and qualification in sub-specialisation in general surgery. Other differences included a requirement for internship/non specialist training prior to training, differences in lengths of time spent in other surgical specialties and a requirement for research. CONCLUSION: Understanding the training programmes of other countries may help UK surgeons to understand the prior experience of IMGs and enable them to provide better training and support.Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
Role of tenecteplase in ischemic stroke after 4.5 hours: an evaluation of the TRACE-III trial
No full textTenecteplase (TNK), as a thrombolytic treatment for acute ischemic stroke (AIS), has been found to be effective when used within 4.5 hours of symptom onset. However, the efficacy of TNK after 4.5 hours is not well established, especially in patients with large vessel occlusion and with no access to thrombectomy. In this article, we will discuss the results of the recently published TRACE-III trial. The study involved 516 patients with large vessel occlusion, either proximal middle cerebral artery or internal carotid artery, with salvageable brain tissue and no endovascular thrombectomy access. Key safety outcomes included symptomatic intracranial hemorrhage and death. TNK treatment resulted in a higher percentage of patients with a modified Rankin scale score of 0 or 1 at 90 days than standard medical treatment. Mortality at 90 days was 13.3% with TNK and 13.1% with standard medical treatment. The trial found that TNK treatment for Chinese patients with ischemic stroke resulted in less disability and similar survival compared to standard medical treatment. However, there was a higher incidence of symptomatic intracranial hemorrhage within 36 hours.Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
Is it safe for neonates with probable bacterial infection to be treated with oral antibiotics in high-income countries?
No full textPublished version, accepted version, submitted versionRD&E staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted
Parental experience of neonatal pain research while participating in the Parental touch trial (Petal)
No full textParental involvement in neonatal comfort care is a core component of family-centred care. Yet, parents experience a range of positive and negative feelings when providing pain-relieving interventions for their infants. Parents of infants who participated in the Parental touch trial (Petal), a multicentre randomised controlled trial investigating the impact of gentle parental touch on neonatal pain, were asked to complete an anonymous survey. This survey aimed to (1) explore parent-reported motivations in deciding to participate in the Petal trial; (2) understand parent-reported experiences related to trial participation; (3) understand parents' willingness to participate in future studies; and (4) evaluate parent-reported feelings while they were delivering a gentle touch intervention either before or after a clinically necessary blood test. One hundred six parents (1 parent per infant) took part in the survey. Primary motivators for participation were altruistic. Parents most frequently reported that they wanted their child to take part in the research because it has a potential benefit to babies in the future and because they wanted to improve scientific understanding. Parents reported that providing gentle touch to their children during painful procedures was associated with positive emotions, such as feeling useful" (64%) and "reassured" (53%). Furthermore, nearly all parents (98%) were pleased to have participated in the Petal trial and would consider, or maybe consider, participating in further research studies. These results underscore the importance of structuring trials around parental involvement and providing opportunities for parents to be involved in providing comfort to their infants during necessary painful clinical procedures."Published version, accepted version (12 month embargo), submitted versionThe article is available via Open Access. Click on the 'Additional link' above to access the full-text
Maternal plasma cortisol's effect on offspring birth weight: a Mendelian Randomisation study
No full textBACKGROUND: Observational studies and randomized controlled trials have found evidence that higher maternal circulating cortisol levels in pregnancy are associated with lower offspring birth weight. However, it is possible that the observational associations are due to residual confounding. METHODS: We performed two-sample Mendelian Randomisation (MR) using a single genetic variant (rs9989237) associated with morning plasma cortisol (GWAS; sample 1; N = 25,314). The association between this maternal genetic variant and offspring birth weight, adjusted for fetal genotype, was obtained from the published EGG Consortium and UK Biobank meta-analysis (GWAS; sample 2; N = up to 406,063) and a Wald ratio was used to estimate the causal effect. We also performed an alternative analysis using all GWAS reported cortisol variants that takes account of linkage disequilibrium. We also tested the genetic variant's effect on pregnancy cortisol and performed PheWas to search for potential pleiotropic effects. RESULTS: The estimated effect of maternal circulating cortisol on birth weight was a 50 gram (95% CI, -109 to 10) lower birth weight per 1 SD higher log-transformed maternal circulating cortisol levels, using a single variant. The alternative analysis gave similar results (-33 grams (95% CI, -77 to 11)). The effect of the cortisol variant on pregnancy cortisol was 2-fold weaker than in the original GWAS, and evidence was found of pleiotropy. CONCLUSIONS: Our findings provide some evidence that higher maternal morning plasma cortisol causes lower birth weight. Identification of more independent genetic instruments for morning plasma cortisol are necessary to explore the potential bias identified.published versionThe article is available via Open Access. Click on the 'Additional link' above to access the full-text
Complications of fibrotic interstitial lung disease for the general radiologist
No full textInterstitial lung diseases (ILDs) are a heterogeneous group of conditions characterised by non-infective inflammation and scarring of the lung parenchyma. They are not infrequently encountered by the general radiologist in both acute and outpatient reporting settings who may even be the first to make the diagnosis. In the acute setting, patients with ILD can present with respiratory deterioration due to a number of causes and in addition to the common causes of dyspnoea, an acute exacerbation of ILD needs to be considered. An exacerbation can be initiated by common triggers such as infection, pulmonary embolism (PE), and heart failure, and it can also be initiated by an insult to the lung or occur due to an unknown cause. Particular care needs to be taken when interpreting computed tomography (CT) examinations in these patients as the findings of an acute exacerbation are non-specific and patient and technical factors can cause spurious appearances including dependent changes, breathing artefact and contrast medium opacification. In the non-acute setting, patients with ILD are at increased risk of lung cancer and pulmonary hypertension (PH), with lung cancer being a particularly important consideration as treatments carry the risk of triggering an acute exacerbation or deterioration in lung function. Overall, this review aims to provide an overview for the general radiologist of additional factors to consider when interpreting scans in patients with ILD and how the presence of ILD impacts the differential diagnoses and complications that can occur in these patients in both acute and non-acute settings.Published version, accepted version (12 month embargo)Supports Open Acces
Digital tools in cardiac reperfusion pathways: A systematic review
No full textWith health and surgery increasingly aided by digital technologies, there exists a growing impetus to understand how such tools must integrate into existing clinical pathways to ensure a positive impact on patient and organisational outcomes. Consequently, this study sought to collate evidence on the use of digital technology in cardiac reperfusion surgeries. We systematically searched three scientific databases for relevant articles. In total, 1,092 articles were retrieved, with 126 screened using inclusion/exclusion criteria, and 21 selected for analysis. Articles reported on the use of virtual reality, mHealth and telehealth in cardiovascular reperfusion procedures, ranging from surgical training regimens to postoperative rehabilitation. Here, despite clinical advantages, limitations were highlighted, including cost, ineffective interfaces and extensive training needed to operate novel digital tools. Nevertheless with further development and input from patient stakeholders, many limitations look set to dematerialise and provide tangible improvements to the benefit of patients and hard-pressed health institutions.Published version (12 month embargo), accepted version (12 month embargo)Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
Implementing a strategic plan for research
No full textEffective integration of research within healthcare organisations is recognised to improve outcomes. A research strategy within a hospital Trust in South West England was revised, following the launch of a national Chief Nursing Officer (CNO) strategy that promotes research engagement and activity. The aim was to develop, implement and evaluate this revised strategic plan for research. High-level engagement within the organisation was established and previous initiatives evaluated. A 6-year plan with 2-year targets was defined and evaluated at year end. The four pillars of the CNO strategy were central to the revised strategy, underpinned by digital innovation. Evaluation of the earlier strategy indicated excellent engagement with the Chief Nurse Research Fellow initiative and the Clinical Academic Network. The 'Embedding Research In Care' (ERIC) unit was reconfigured to an ERIC model, which aided question generation and project development. Year one objectives were achieved within the revised plan. Implementing a research strategy within an organisation requires a cultural shift and a long-term vision is required with measurable objectives. The team demonstrated significant progress through high-level leadership, mentoring and cross-professional collaboration.Published version, accepted version (6 months embrago), submitted versionRDUH staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted