Health Education England / NIHR BRIDGING SCHEME

Please find below information on the Clinical Research Internship Scheme:

Health Education England / NIHR BRIDGING SCHEME

Are you a Nurse, Midwife, Allied Health Professional, Pharmacist or Healthcare Scientist?

Have you completed or are about to complete a masters level degree or a PhD?

Could you be looking to undertake a PhD or a post-doctoral level fellowship?

Do you want to make a difference through undertaking high quality clinical research?

If so the HEE/NIHR ICA bridging scheme will be of interest to you.

For further details please visit Health Education England / NIHR BRIDGING SCHEME

Please note applications need to be received by 5pm Friday 5^th July 2019

WUTH publication: Acute hot foot: Charcot neuroarthropathy or osteomyelitis? Untangling a diagnostic web

Citation: BMJ Case Reports. 2019, 12(5), e228597
Author: Goldsmith L, Barlow M, Evans PJ, Srinivas-Shankar U
Abstract: A 55-year-old man with poorly controlled type 1 diabetes with microvascular and macrovascular complications presented with a 1-week history of painful erythematous swelling on the dorsum of the left foot with two areas of foot ulceration. Inflammatory markers were raised. MRI of the left foot revealed a soft tissue swelling on the dorsum of the left foot, marrow oedema and destruction of several small joints of the foot, indicating osteomyelitis and Charcot neuroarthropathy (CN). The soft tissue swelling on the dorsum of the left foot was debrided; per-operatively bone destruction of base of the fifth metatarsal was found. The patient received intravenous antibiotics for 6 weeks. The clinical features of CN including erythema, oedema and elevated temperature of the left foot settled with off-loading the foot in an air cast walker after 6 months. Our case highlights the need to recognise CN in an acutely inflamed foot of diabetic patients with neuropathy, even when other conditions like soft tissue infection and osteomyelitis can explain the clinical features.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: bone and joint infections; diabetes; orthopaedics; peripheral nerve disease

Link to PubMed record

WUTH publication: Evaluation of Radiation Exposure During Sentinel Lymph Node Biopsy in Breast Cancer: A Retrospective Study

Citation: World Journal of Surgery. 2019, 43(9), 2250-53
Author: Burrah R, James K, Poonawala S
Abstract: INTRODUCTION: Sentinel node biopsy (SNB) is the standard of care for nodal staging in breast cancer. Currently, radioisotope-guided SNB is the standard technique. We have undertaken this study to analyse radiation exposure during SNB for breast cancer over a significant period of time.
METHODS: The study was conducted over a period of 41 months and included 183 patients. The radioisotope was usually administered the day preceding the surgery at a dose of 40 MBq (±10%), and a lower dose of 20 MBq (±10%) was given if injected on the day of surgery. The radiation exposure was measured by dosimeters worn by the surgeon and surgical assistant.
RESULTS: The surgical procedures performed were mastectomy and SNB (56 patients), wide local excision and SNB (109 patients), and SNB alone (18 patients). The median time interval between the injection and surgery was 19.3 h, and median duration of surgery 93 min. The annual exposure for the surgeon was 0.125 mSv (range 0.01-0.03 mSv) and for the assistant was 0.265 (range 0.01-0.13 mSv).
CONCLUSION: Contrary to other studies, we found the radiation exposure in the assistant was higher than that in the surgeon and we think this is because the assistant is positioned closer to the injection site during the procedure. However, the cumulative levels of radiation with SNB were very low and significantly below the permissible limits. The timing of injection, type of breast surgery and duration of procedure did not affect the levels of radiation exposure.

Link to PubMed record

WUTH publication: Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review

Citation: BMJ Open. 2019, 9(5), e022105
Author: Trubey R, Huang C, Lugg-Widger FV, Hood K, Allen D, Edwards D, Lacy D, Lloyd A, Mann M, Mason B, Oliver A, Roland D, Sefton G, Skone R, Thomas-Jones E, Tume LN, Powell C
Abstract: OBJECTIVE: To assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children.
DESIGN: Systematic review.
DATA SOURCES: British Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018.
ELIGIBILITY CRITERIA: We included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0-18 years), where adverse outcome metrics were reported. Several study designs were considered.
DATA EXTRACTION AND SYNTHESIS: Data extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale.
RESULTS: 36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration.
CONCLUSION: There are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base.
PROSPERO REGISTRATION NUMBER: CRD42015015326.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
KEYWORDS: PEWS; children; clinical deterioration; early warning scores; systematic review; track and trigger scores

Link to PubMed record