Tracking

Thursday 27 December 2018

WUTH publication: Preoperative Mechanical and Oral Antibiotic Bowel Preparation to Reduce Infectious Complications of Colorectal Surgery - The Need for Updated Guidelines

Citation: The Journal of Hospital Infection. 2019, 101(3), 295-299. Epub 2018 Dec 21
Author: Battersby CLF, Battersby NJ, Slade DAJ, Soop M, Walsh CJ
Abstract: Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided; colorectal resection: an international, multi-centre, prospective audit.
BACKGROUND: Increasing evidence indicates that combined mechanical and oral antibiotic bowel preparation reduces the infectious complications of colorectal surgery. Anecdotal evidence suggests the combination is rarely used in the UK & Europe.
AIM: To establish colorectal surgeons' current use, and awareness of the benefits of such bowel preparation amongst, and to identify decision-making influences surrounding preoperative bowel preparation.
METHOD: An electronic survey was emailed to all members of the Association of Coloproctology of Great Britain and Ireland, and promoted via Twitter.
FINDINGS: 495 respondents completed the survey: 413 (83.2%) UK, 39 (7.9%) other European, 43 (8.7%) non-European. Respondents used oral antibiotics for 12%-20% of cases. Mechanical bowel preparation (MBP), phosphate enema, and no preparation respectively ranged between 9%-80%. Combined MBP and oral antibiotic bowel preparation ranged between 5.5%-18.6%. 53% (260/495) agreed that combined mechanical and oral antibiotic bowel preparation reduces surgical site infection. 32% (157/495) agreed that the combination reduces risk of anastomotic leak. Kappa statistics between 0.06-0.27 indicate considerable incongruity between surgeons' awareness of the literature, and day-to-day practice. 24% (96/495) believed MBP to be incompatible with ERAS. 41% (204/495) believe that MBP delays return to normal intestinal function.
CONCLUSIONS: Few UK and European colorectal surgeons use mechanical and oral antibiotic bowel preparation, despite evidence of its efficacy in reducing infectious complications. The influence of ERAS pathways and UK and European guidelines may explain this. In contradiction to the UK and Europe, North American guidelines recommend incorporating MBP/OAB, into ERAS programmes. We suggest future UK and European guidelines incorporate MBP/OABP into the ERAS pathway.
Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Link to PubMed record

Monday 10 December 2018

WUTH publication: The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

Citation: Colorectal Disease. 2018, 20(Sup 8), 3-117
Author: Brown SR, Fearnhead NS, Faiz OD, Abercrombie JF, Acheson AG, Arnott RG, Clark SK, Clifford S, Davies RJ, Davies MM, Douie WJP, Dunlop MG, Epstein JC, Evans MD, George BD, Guy RJ, Hargest R, Hawthorne AB, Hill J, Hughes GW, Limdi JK, Maxwell-Armstrong CA, O'Connell PR, Pinkney TD, Pipe J, Sagar PM, Singh B, Soop M, Terry H, Torkington J, Verjee A, Walsh CJ, Warusavitarne JH, Williams AB, Williams GL, Wilson RG, ACPGBI IBD Surgery Consensus Collaboration
Abstract: AIM: There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
METHODS: Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
RESULTS: All aspects of surgical care for IBD have been included along with 157 recommendations for management.
CONCLUSION: These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
© 2018 Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
KEYWORDS: Crohn's disease; Inflammatory bowel disease; clinical guideline; consensus; surgery; ulcerative colitis

Link to PubMed record

Friday 16 November 2018

WUTH publication: Non-invasive ventilation for the management of children with bronchiolitis (NOVEMBR): a feasibility study and core outcome set development protocol

Citation: Trials. 2018, 19(1), 627
Author: van Miert C, Fernandes RM, Eccleson H, Bedson E, Lane S, Peak M, Thorburn K, Compton V, Woolfall K, Lacy D, Williamson P, McNamara PS
Abstract: BACKGROUND: Bronchiolitis is an acute lower respiratory infection which predominantly affects young children. Treatment for bronchiolitis is limited to supportive therapy. Nasal oxygen therapy is part of routine care, and delivery now incorporates varying levels of non-invasive continuous positive airway pressure and/or high-flow nasal cannula oxygen therapy. Despite wide clinical use, there remains a lack of evidence on the comparative effectiveness and safety of these interventions. Furthermore, research in this field is hampered by the use of multiple outcome measures in current clinical trials.
METHODS/DESIGN: This mixed methods study includes a systematic review of outcome measures, telephone interviews with parents, focus group workshops and a Delphi survey with healthcare professionals and parents. These methods will be used to identify and prioritise outcomes for inclusion in a core outcome set and to explore issues pertinent to the design of a future randomised controlled trial comparing different modes of oxygen therapy for bronchiolitis. UK hospitals will also be contacted and asked to complete a survey to provide an overview of current practice to enable assessment of capability and capacity to run a future clinical trial.
DISCUSSION: This study will facilitate the design of a future clinical trial of non-invasive ventilation in children with bronchiolitis which is acceptable to important stakeholders. Furthermore, core outcome set development will improve standardisation, measurement and reporting of clinically important outcomes in bronchiolitis.
TRIAL REGISTRATION: ISRCTN Registry, ISRCTN75766048. Registered on 18 December 2017. This study was retrospectively registered in the ISRCTN Registry and on the Core Outcome Measures in Effectiveness Trials (COMET) Initiative database (15 September 2017).
KEYWORDS: Bronchiolitis; Core outcome sets; High-flow nasal cannula; Nasal continuous positive airway pressure; Oxygen inhalation therapy

Link to PubMed record

Tuesday 13 November 2018

WUTH publication: Concerns over Efficacy and Safety of 0.1% Cyclosporine a Cationic Emulsion in the Treatment of Severe Dry Eye Disease

Citation: European Journal of Ophthalmology. 2017, 27(6), e193
Author: Clearkin L
Abstract: Comment in: Author's Reply to: "Concerns Over: Efficacy and Safety of 0.1% Cyclosporine a Cationic Emulsion in the Treatment of Severe Dry Eye Disease". [Eur J Ophthalmol. 2017]
Comment on: Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. [Eur J Ophthalmol. 2016]

Link to PubMed record

Wednesday 7 November 2018

WUTH publication: Legal, Regulatory and Ethical Frameworks or Standards for AI and Autonomous Robotic Surgery

Citation: The international journal of medical robotics and computer assisted surgery. 2018 Nov 5, e1968.  [Epub ahead of print]
Author: O'Sullivan S, Nevejans N, Allen C, Blyth A, Leonard S, Pagallo U, Holzinger K, Holzinger A, Sajid MI, Ashrafian H
Abstract: BACKGROUND: This paper aims to move the debate forward regarding the potential of AI and autonomous robotic surgery with a particular focus on ethical and legal aspects.
METHODS: We conducted a literature search on current and emerging surgical robot technologies, relevant standards and legal systems worldwide. We provide a discussion of unique challenges for robotic surgery faced by proposals made for AI more generally (e.g. Explainable AI) as well as recommendations for developing/improving relevant standards or legal and regulatory frameworks.
CONCLUSION: We distinguished three types of robot responsibility by classifying responsibility into: I. Accountability; II. Liability and III. Culpability. The component which produces the least clarity is Culpability, since it is unthinkable in the current state of technology. We envision in the nearer future that, as with autonomous driving, a robot can learn routine tasks which can then be supervised by the surgeon (a doctor-in-the-loop) being in the driving seat.

Link to PubMed record

Friday 2 November 2018

WUTH publication: Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia: the ARREST RCT

Citation: Health Technology Assessment. 2018, 22(59), 1-148
Author: Thwaites GE, Scarborough M, Szubert A, Saramago Goncalves P, Soares M, Bostock J, Nsutebu E, Tilley R, Cunningham R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS
Abstract: BACKGROUND: Staphylococcus aureus bacteraemia is a common and frequently fatal infection. Adjunctive rifampicin may enhance early S. aureus killing, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death.
OBJECTIVES: To determine whether or not adjunctive rifampicin reduces bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. Secondary objectives included evaluating the impact of rifampicin on all-cause mortality, clinically defined failure/recurrence or death, toxicity, resistance emergence, and duration of bacteraemia; and assessing the cost-effectiveness of rifampicin.
DESIGN: Parallel-group, randomised (1 : 1), blinded, placebo-controlled multicentre trial.
SETTING: UK NHS trust hospitals.
PARTICIPANTS: Adult inpatients (≥ 18 years) with meticillin-resistant or susceptible S. aureus grown from one or more blood cultures, who had received < 96 hours of antibiotic therapy for the current infection, and without contraindications to rifampicin.
INTERVENTIONS: Adjunctive rifampicin (600-900 mg/day, oral or intravenous) or placebo for 14 days in addition to standard antibiotic therapy. Investigators and patients were blinded to trial treatment. Follow-up was for 12 weeks (assessments at 3, 7, 10 and 14 days, weekly until discharge and final assessment at 12 weeks post randomisation).
MAIN OUTCOME MEASURES: The primary outcome was all-cause bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation.
RESULTS: Between December 2012 and October 2016, 758 eligible participants from 29 UK hospitals were randomised: 370 to rifampicin and 388 to placebo. The median age was 65 years [interquartile range (IQR) 50-76 years]. A total of 485 (64.0%) infections were community acquired and 132 (17.4%) were nosocomial; 47 (6.2%) were caused by meticillin-resistant S. aureus. A total of 301 (39.7%) participants had an initial deep infection focus. Standard antibiotics were given for a median of 29 days (IQR 18-45 days) and 619 (81.7%) participants received flucloxacillin. By 12 weeks, 62 out of 370 (16.8%) patients taking rifampicin versus 71 out of 388 (18.3%) participants taking the placebo experienced bacteriological (microbiologically confirmed) failure/recurrence or died [absolute risk difference -1.4%, 95% confidence interval (CI) -7.0% to 4.3%; hazard ratio 0.96, 95% CI 0.68 to 1.35; p = 0.81]. There were 4 (1.1%) and 5 (1.3%) bacteriological failures (p = 0.82) in the rifampicin and placebo groups, respectively. There were 3 (0.8%) versus 16 (4.1%) bacteriological recurrences (p = 0.01), and 55 (14.9%) versus 50 (12.9%) deaths without bacteriological failure/recurrence (p = 0.30) in the rifampicin and placebo groups, respectively. Over 12 weeks, there was no evidence of differences in clinically defined failure/recurrence/death (p = 0.84), all-cause mortality (p = 0.60), serious (p = 0.17) or grade 3/4 (p = 0.36) adverse events (AEs). However, 63 (17.0%) participants in the rifampicin group versus 39 (10.1%) participants in the placebo group experienced antibiotic or trial drug-modifying AEs (p = 0.004), and 24 (6.5%) participants in the rifampicin group versus 6 (1.5%) participants in the placebo group experienced drug-interactions (p = 0.0005). Evaluation of the costs and health-related quality-of-life impacts revealed that an episode of S. aureus bacteraemia costs an average of £12,197 over 12 weeks. Rifampicin was estimated to save 10% of episode costs (p = 0.14). After adjustment, the effect of rifampicin on total quality-adjusted life-years (QALYs) was positive (0.004 QALYs), but not statistically significant (standard error 0.004 QALYs).
CONCLUSIONS: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S. aureus bacteraemia.
FUTURE WORK: Given the substantial mortality, other antibiotic combinations or improved source management should be investigated.
TRIAL REGISTRATIONS: Current Controlled Trials ISRCTN37666216, EudraCT 2012-000344-10 and Clinical Trials Authorisation 00316/0243/001.
FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 59. See the NIHR Journals Library website for further project information.

Link to PubMed record

Thursday 18 October 2018

Sign up to KnowledgeShare : the latest evidence sent to your inbox


What is KnowledgeShare?
KnowledgeShare is a new resource which delivers the latest evidence of your chosen subject (or subjects) to your inbox.

What will I receive?
The emails you will receive contain links to high level evidence from a wide range of sources including journal articles, national reports and local professional development events.
“KnowledgeShare keeps you up-to-date without overwhelming you with information”.

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You can choose whether you receive them on a daily, weekly or monthly basis. If there are new items, these are sent out to you.

How do I sign up?
Complete the registration form, telling us which areas of health care you are interested in and we will set up an account for you on KnowledgeShare.
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To find out more ask a member of LKS staff for details or visit the KnowledgeShare website.

Wednesday 17 October 2018

WUTH publication: A literature review of the complications following anterior and posterior ankle arthroscopy

Citation: Foot and ankle surgery. 2019, 25(5), 553-58. Epub 2018 Jul 18
Author: Zekry M, Shahban SA, El Gamal T, Platt S
Abstract: INTRODUCTION: There is a wealth of studies reporting the complications of anterior and posterior ankle arthroscopy. The aim of this study is to summarise and review the complication rate(s) associated with both anterior and posterior ankle arthroscopy, as described in the literature.
MATERIAL AND METHODS: The authors carried out a comprehensive review of the literature up until March 2018. An extensive search of the MEDLINE, Cochrane library and EMBASE databases was undertaken using the following keywords: complications of ankle arthroscopy, anterior ankle arthroscopy, and posterior ankle arthroscopy.
RESULTS: A total of 107 papers were identified and 55 were deemed appropriate for analysis. The overall complication rate of ankle arthroscopy was found to be between 3.4- 9%.
CONCLUSIONS: No life threatening complications were identified in the literature with both anterior and posterior ankle arthroscopy. The commonest complication after anterior and posterior ankle arthroscopy is superficial peroneal nerve injury and temporary Achilles tendon tightness, respectively.
Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.
KEYWORDS: Anterior ankle arthroscopy; Complications; Posterior ankle arthroscopy

Link to PubMed record

WUTH publication: The effect of ultrasound-guided percutaneous ozone injection around cervical dorsal root ganglion in zoster-associated pain: a retrospective study

Citation: Journal of Pain Research. 2018, 11, 2179-88
Author: Lin SY, Zhang SZ, An JX, Qian XY, Gao XY, Wang Y, Zhao WX, Eastwood D, Cope DK, Williams JP
Abstract: OBJECTIVE: This study was to evaluate the effectiveness of ultrasound-guided percutaneous ozone injections around the cervical dorsal root ganglions of zoster-associated pain (ZAP) patients.
STUDY DESIGN: Retrospective comparative study.
SETTINGS: The study was conducted at a pain center of a university hospital.
PATIENTS AND METHODS: From June 2016 to July 2017, a total number of 30 patients with ZAP were treated with ultrasound-guided percutaneous ozone injection around the cervical dorsal root ganglion (DRG) at the injured nerve level (C2-C8). A volume of 3 mL ozone-oxygen mixture at a concentration of 30 µg/mL was injected into the area around the DRG. Patients were divided into two groups according to their disease duration: group A (at or <3 months) and group B (>3 months). The pain severity was assessed according to a visual analog scale, and imaging changes were evaluated by ultrasound. Patient improvements in pain and neurologic function were evaluated during a follow-up period from 1 to 3 months.
RESULTS: The data showed that ozone injections reduced pain in patients with ZAP. However, the success rate of group A was higher than group B. After the injection, the von Frey data demonstrated decreases in both groups, but, there were no significant differences between the groups. Moreover, univariate logistic regression analysis and multivariate regression analysis showed a history of diabetes mellitus had a significant effect on the treatment results.
CONCLUSIONS: Percutaneous ozone injection around the DRG might be a useful method for treatment-resistant cases of ZAP at the cervical level. Institutional Review Board (IRB) approval number: HK2017-1130.
KEYWORDS: herpes zoster; neuropathic pain; ozone injection; post-herpetic neuralgia

Link to PubMed record

Tuesday 16 October 2018

WUTH publication: Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy

Citation: European Journal of Trauma and Emergency Surgery. 2020, 46(1), 215-220. Epub 2018 Oct 13
Author: Simpson G, Parker A, Hopley P, Wilson J, Magee C
Abstract: INTRODUCTION: Emergency laparotomy in patients over the age of 80 is associated with high morbidity and mortality. Accurate risk prediction in this patient population is desirable. Sarcopenia has been shown to be associated with outcome in multiple clinical settings and the psoas major muscle as measured on computed tomography (CT) imaging has been demonstrated as a marker of sarcopenia. We aim to assess the use of psoas major measurement on pre-operative CT as a prognostic indicator in over-80s undergoing emergency laparotomy and compare this measurement to P-POSSUM.
METHODS: A retrospective interrogation of the prospectively collected National Emergency Laparotomy Database including all over-80s undergoing emergency laparotomy between January 2014 and September 2016 was conducted. Demographic, operative data and P-POSSUM data were collected and analysed. Computed tomography (CT) images were accessed and analysed, and cross-sectional areas of psoas major and the corresponding lumbar vertebral body at the level of the L3 inferior end plate were calculated. The ratio of psoas major-to-L3 cross-sectional area (PM:L3) was calculated for each patient. Mann-Whitney U test and receiver-operating characteristics (ROC) curves were used for statistical analysis.
RESULTS: One hundred and three over-80s underwent emergency laparotomy. Male:female ratio was 60:43. Median age was 84 years (range 80-98 years). 30-day mortality was 19.4%.90-day mortality was 25.2%. Median PM:L3 ratio in patients who died as an inpatient was 0.3 and PM:L3 ratio in patients who survived to discharge was 0.52 (p < 0.0001). Median PM:L3 ratio in patient who died within 30 days post-op was 0.28 and 0.48 in those patients who survived to 30 days (p < 0.0001). Median PM:L3 ratio in patient who died within 90 days post-op was 0.28 and 0.51 in those patients who survived to 90 days (p < 0.0001). ROC analysis gave an area under the curve (AUC) of 0.85 for in-patient mortality, 0.86 for 30-day mortality, and 0.88 for 90-day mortality. ROC analysis for P-POSSUM in this data set demonstrated an AUC of 0.51 for in-patient mortality and 0.75 for 30- and 90-day mortality.
CONCLUSION: CT imaging of the abdomen and pelvis is routinely used in over-80s prior to emergency laparotomy making PM:L3 calculation feasible for the majority of patients in this group. PM:L3 ratio is a useful prognostic indicator for prediction of mortality in patients over the age of 80. PM:L3 is superior to the P-POSSUM score in this series.
KEYWORDS: Emergency laparotomy; Frailty; Psoas major dimensions; Sarcopenia

Link to PubMed record

Friday 12 October 2018

Research / Library Drop-in Support session

Friday 19 October any time between 12-2pm
Library, Education Centre, APH​

Are you:
  • interested in understanding/getting involved in research?
  • undertaking Masters/PhD study?
  • or just have questions about research that need answering? 
If so, we are here to help with any questions you may have, including: 
·         Where do I start?
·         How should I undertake a literature search?
·         What is a critical appraisal and how can I access tools to assist me to be more critical? 
·         What is the difference between research, audit and service evaluation?
·         What approvals do I need?

Bespoke support and advice will be given.

If you are unable to attend on the day please email either the Library on WUTH.LKS@NHS.NET or the Research Department wih-tr.ResearchDepartment@nhs.net who will be happy to help.​

Thursday 4 October 2018

WUTH publication: Saccular internal carotid artery aneurysm masquerading as a pituitary macroadenoma

Citation: BMJ Case Reports. 2018 Oct 2
Author: Goldsmith L, Williams S, Mohsin N, Srinivas-Shankar U
Abstract: KEYWORDS: neuroendocrinology; neuroimaging; pituitary disorders

Link to PubMed record

Monday 1 October 2018

WUTH publication: United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

Citation: The British Journal of Ophthalmology. 2019, 103(6), 837-43
Author: Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip PL, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA
Abstract: AIM: To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.
METHODS: This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main  outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.
RESULTS: 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).
CONCLUSIONS: This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
KEYWORDS: diabetes; electronic medical record

Link to PubMed record

Tuesday 11 September 2018

WUTH publication: Indexing dialysis dose for gender, body size and physical activity: Impact on survival

Citation: PLoS one. PLoS one. 2018, 13(9), e0203075
Author: Sridharan S, Vilar E, Davenport A, Ashman N, Almond M, Banerjee A, Roberts J, Farrington K
Abstract: Current practice basing dialysis dose on urea distribution volume (V) has been questioned. We explored the impact on survival of scaling dialysis dose (Kt) to parameters reflective of metabolic activity. In a multicentre prospective cohort study of 1500 patients on thrice-weekly haemodialysis, body surface area (BSA) and resting energy expenditure (REE) were estimated using validated equations and physical activity by the Recent Physical Activity Questionnaire. Total energy expenditure (TEE) was estimated from REE and physical activity data. Kt was calculated from delivered (single-pool Kt/V)*Watson V. Kt/BSA, Kt/REE and Kt/TEE were then calculated at baseline and 6 monthly during follow-up for 2 years. In adjusted Cox models Kt/TEE, Kt/BSA, Kt/REE, in that order, had lower hazard ratios for death than single-pool Kt/V. On the basis of adjusted survival differences, putative minimum target doses were estimated for Kt/BSA as 27119 ml/m2 and Kt/TEE as 25.79 ml/kcal. We identified spKt/V values equivalent to these estimated targets, ranging from 1.4 to 1.8 in patient groups based on gender, body size and physical activity. For sedentary patients, the minimum target dose was 1.4 for large males, 1.5 for small males and 1.7 for women. For active patients the target was 1.8 irrespective of gender and body-weight. Patients achieving these individualised minimum targets had greater adjusted two-year survival compared to those achieving conventional minimum targets. Metabolic activity related parameters, such as Kt/TEE and Kt/BSA, may have a clinically important role in scaling haemodialysis dose. Using such parameters or their spKt/V equivalents to adjust minimum target doses based on gender, body size and habitual physical activity may have a positive impact on survival.

Link to PubMed record

Thursday 23 August 2018

WUTH publication: Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS)

Citation: Acute Medicine. 2018, 17(3), 168
Author: Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A
Abstract: Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.

Link to PubMed record

WUTH publication: Focused Acute Medicine Ultrasound (FAMUS)

Citation: Acute Medicine. 2018, 17(3), 164-7
Author: Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A
Abstract: Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.

Link to PubMed record

Thursday 9 August 2018

WUTH publication: Advancing quality in sepsis management: a large-scale programme for improving sepsis recognition and management in the North West region of England

Citation: Postgraduate Medical Journal. 2018, 94(1114), 463-468
Author: Nsutebu EF, Ibarz-Pavón AB, Kanwar E, Prospero N, French N, McGrath C
Abstract: OBJECTIVE: To evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England.
SETTING: 14 hospitals in the northwest of England.
INTERVENTION: A quality improvement programme (Advancing Quality (AQ) Sepsis) that promoted a sepsis care bundle including time-based recording of early warning scores, documenting systemic inflammatory response syndrome criteria and suspected source of infection, taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, administration of oxygen, fluid resuscitation, measurement of fluid balance and senior review.
MAIN OUTCOME MEASURES: Inpatient mortality, 30-day readmission rates and duration of hospital ≥10 days.
RESULTS: Data for 7776 patients were included in this study between 1 July 2014 and 29 December 2015. Participation in the AQ Sepsis programme was associated with a reduction in readmissions within 30 days (OR 0.81 (0.69-0.95)) and hospital stays over 10 days (OR 0.69 (0.60-0.78)). However, there was no reduction in mortality. Administration of a second litre of intravenous fluid within 2 hours, oxygen therapy and review by a senior clinician were associated with increased mortality. Starting a fluid balance chart within 4 hours was the only clinical process measure that did not affect mortality. Taking a blood culture sample, administering antibiotic therapy and measuring serum lactate within 3 hours of hospital arrival were all associated with reduced mortality (OR 0.69 (0.59-0.81), OR 0.77 (0.67-0.89) and OR 0.64 (0.54-0.77), respectively) and shorter hospitalisations (OR 0.58 (0.49-0.69), OR0.81 (0.70-0.94) and OR 0.54 (0.45-0.66), respectively). However, none of these measures had an impact on the risk of readmission to hospital within 30 days.
CONCLUSIONS: The AQ Sepsis collaborative in northwest of England improved readmission and length of stay for patients admitted with sepsis but did not affect mortality. Further cost-effectiveness evaluation of the programme is needed.
© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: infectious diseases

Link to PubMed record

Patient Risk and Safety


Relevant articles from MA Healthcare journals to support your staff’s education and practice

August 2018

As the NHS aims to become one of the safest healthcare systems in the world, the issue of patient safety is taking on a larger focus in the work of healthcare professionals. So that both NHS staff and patients can be treated in a safe environment and be protected from avoidable risks, it is vital for everyone working within the NHS to minimise patient safety incidents and drive improvements in compliance and quality of care.

We have provided a list of relevant articles from MA Healthcare journals dealing with this area, thereby providing your NHS staff with research, information and tips that will support both their work and the care of their patients

(Access to links via OpenAthens authentication currently only work on the desktop version of the MAG Online Library platform)
African Journal of Midwifery and Women’s Health

·         Bugs, babies and birthing: midwifery management of sepsis

Published Online: February 07, 2017

British Journal of Community Nursing:
·         ENFit: a major patient safety breakthrough http://www.magonlinelibrary.com/doi/10.12968/bjcn.2016.21.Sup7.S7
Published Online: February 10, 2017
·         Implications of case managers' perceptions and attitude on safety of home-delivered care http://www.magonlinelibrary.com/doi/10.12968/bjcn.2015.20.12.602
Published Online: December 04, 2015

British Journal of Healthcare Assistants

·         Septic shock — and the role the HCA and AP can play

Published Online: February 18, 2014

·         Care Certificate Standard 15: infection prevention and control

Published Online: June 10, 2016

·         Hazards and risk: the support worker's role

Published Online: October 18, 2016

·         Hand hygiene 2017—it's up to you

Published Online: May 11, 2017

·         Falls: reducing risks and improving quality of life

Published Online: October 16, 2017

British Journal of Healthcare Management

·         Maintaining hand hygiene to prevent the transmission of infection

Published Online: May 09, 2017

·         Supporting infection control and patient safety

Published Online: May 16, 2016

·         Essential practice for infection prevention and control: RCN guidance for nursing staff

Published Online: December 09, 2017
·         Patient safety: reducing harm and saving lives http://www.magonlinelibrary.com/doi/10.12968/bjhc.2014.20.5.220
Published Online: June 24, 2014
·         Ensuring patient safety during the development of ambulatory emergency care http://www.magonlinelibrary.com/doi/10.12968/bjhc.2014.20.7.324
Published Online: July 10, 2014

British Journal of Midwifery:
·         Better Births: A platform for innovation and transformation http://www.magonlinelibrary.com/doi/10.12968/bjom.2016.24.5.310 
Published Online: May 02, 2016

·         More rigorous investigating needed to improve maternity safety

Published Online: January 31, 2018

British Journal of Neuroscience Nursing

·         Neutropenic sepsis: assessment, pathophysiology and nursing care

Published Online: April 27, 2015

·         Preconception to postpartum care: the need to maximise the safety of women with epilepsy

Published Online: June 27, 2016

British Journal of Nursing:
·         Patient safety: the next 15 years http://www.magonlinelibrary.com/doi/10.12968/bjon.2016.25.9.518
Published Online: May 12, 2016
·         Medication governance: preventing errors and promoting patient safety http://www.magonlinelibrary.com/doi/10.12968/bjon.2017.26.3.159
Published Online: February 10, 2017

·         Ensuring the safe discharge of older patients from hospital

Published Online: July 28, 2016

·         Reducing harm to patients caused by avoidable adverse drug reactions

Published Online: April 23, 2018

·         Guidelines not tramlines: the WHO safe childbirth checklist

Published Online: March 28, 2016

·         Improving the National Reporting and Learning System and responses to it

Published Online: March 08, 2018

·         A collaborative approach to reduce healthcare-associated infections

Published Online: June 09, 2016

·         Does a checklist reduce the number of errors made in nurse-assembled discharge prescriptions?

Published Online: April 28, 2017

·         Patient safety perspectives from other countries: reflecting on reporting

Published Online: April 29, 2016

·         Barriers to implementing the Sepsis Six guidelines in an acute hospital setting

Published Online: May 11, 2018

·         Assessment and management of the septic patient: part 1

Published Online: September 24, 2016

·         Assessment and management of the septic patient: part 2

Published Online: November 24, 2016

·         Children's nursing: patient safety and clinical risk in neonatal care

Published Online: September 24, 2016

·         Written communication: from staff nurse to nurse consultant; Part 7: Incident Reports

Published Online: November 26, 2014

British Journal of Hospital Medicine:
·         Supporting the engagement of doctors in training in quality improvement and patient safety http://www.magonlinelibrary.com/doi/10.12968/hmed.2015.76.3.166
Published Online: March 11, 2015
·         Improving communication with primary care to ensure patient safety post-hospital discharge http://www.magonlinelibrary.com/doi/10.12968/hmed.2015.76.1.46
Published Online: January 13, 2015

·         The risk of surgical never events

Published Online: February 13, 2016

·         Understanding safe discharge of patients with dementia from the acute hospital

Published Online: March 10, 2016

·         Improving safety of care for older people

Published Online: February 12, 2018

Journal of Aesthetic Nursing
·         Key pointers on patient safety and prescribing practice http://www.magonlinelibrary.com/doi/10.12968/joan.2017.6.1.42
Published Online: February 07, 2017

·         Infection control and environmental cleanliness in aesthetic practice

Published Online: June 07, 2016

Journal of Kidney Care

·         Improving patient safety and avoiding incidents in renal units

Published Online: February 18, 2014
·         Improving patient safety and avoiding incidents in renal units http://www.magonlinelibrary.com/doi/10.12968/jorn.2014.6.1.24
Published Online: February 18, 2014
·         ANSA conference: patient safety in anaemia management http://www.magonlinelibrary.com/doi/10.12968/jorn.2014.6.2.102
Published Online: March 30, 2014

Journal of Paramedic Practice
·         Patient confidentiality and safety: a classic conundrum http://www.magonlinelibrary.com/doi/10.12968/jpar.2017.9.5.214
Published Online: May 13, 2017
·         Can multi-disciplinary simulation-based training improve patient safety? http://www.magonlinelibrary.com/doi/10.12968/jpar.2014.6.2.98
Published Online: March 05, 2014

Journal of Wound Care

·         An assessment of key risk factors for surgical site infection in patients undergoing surgery for spinal metastases

Published Online: September 09, 2016

Nurse Prescribing
·         Patient safety comes first
Published Online: August 13, 2015
·         Effective safety-netting in prescribing practice http://www.magonlinelibrary.com/doi/10.12968/npre.2014.12.7.349
Published Online: July 08, 2014

·         Prescribing safely: Top 10 tips for non-medical prescribers

Published Online: August 13, 2016

Practice Management:
·         Managing health and safety in practice http://www.magonlinelibrary.com/doi/10.12968/prma.2016.26.9.12
Published Online: January 17, 2017
·         Legal aspects of patient data-sharing http://www.magonlinelibrary.com/doi/10.12968/prma.2017.27.7.42
Published Online: July 27, 2017

·         Getting to the point of infection control

Published Online: January 16, 2017

Nursing and Residential Care:
·         Preserving safety within the care home environment http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.10.594
Published Online: September 18, 2017
·         The growing importance of health and safety for care homes http://www.magonlinelibrary.com/doi/10.12968/nrec.2015.17.6.352
Published Online: May 19, 2015

·         Reporting medication errors: residents with diabetes

Published Online: October 16, 2014

·         Infection prevention and control: steps to take in your home 

Published Online: August 17, 2016

·         Making a difference: optimising medication management

Published Online: July 18, 2016