WUTH publication: Spontaneous pneumomediastinum and pneumopericardium in a young healthy adult with plans for air travel

Citation: Clinical Case Reports. 2020, 8(12), 3075-78
Author: Joseph Winterton, Simon Biart 

Abstract: Although rare, pneumomediastinum and pneumopericardium should be considered in patients presenting with sudden onset post-tussive chest discomfort.

Keywords: acute medicine; cardiothoracic surgery; respiratory medicine.

Link to PubMed record

WUTH publication: Antibiotic prophylaxis during dental implant placement in the UK

Citation: British Dental Journal. 2020, 229(12), 787-92. Epub 2020 Dec 18

Author: Robert G M Williams
Abstract: Background Antimicrobial resistance is a growing concern globally. It has previously been demonstrated that antibiotic prescribing for dental implants within the UK is varied with an apparent lack of guidance. This study aimed to establish current use of antibiotic prophylaxis during dental implant placements in the UK.Method An anonymous validated online questionnaire was distributed to members of the BAOS, BSSPD, BSP, ADI and ITI. Data were then collated and analysed.Results Two hundred and twenty-nine responses were received during April-July 2018. Fifty-five percent of dentists routinely prescribed antibiotics during implant placements. One-third did sometimes, but not routinely. Thirteen percent never prescribed. Reported protocols contained 61 different drug/dose combinations given over 124 different regimens. Those who prescribed routinely had significantly higher levels of training/qualification (P = 0.008), placed more implants (P = 0.014) and undertook more complex placements (P = 0.002) than non-prescribers. Seventy-three percent believed antibiotics decrease post-operative infection. One in ten felt they gave no benefit. Half believed they decrease implant failure. Over 90% would like national guidelines.Conclusion Significant variance in practice is clear. Almost half of practitioners did not routinely prescribe. Those who did were significantly more experienced, highly trained and did more complex placements. There was a difference between practitioners' perceived benefits of antibiotic prophylaxis and the evidence in the literature. There was a great desire for clearer guidance.

Link to PubMed record

CCC publication: ESTRO ACROP guideline for target volume delineation of skull base tumors

Citation: Radiotherapy and Oncology. 2021, 156, 80-94. (2020, S0167-8140(20), 31179-8)

Author: Stephanie E Combs, Brigitta G Baumert, Martin Bendszus, Alessandro Bozzao, Michael Brada, Laura Fariselli, Alba Fiorentino, Ute Ganswindt, Anca L Grosu, Frank L Lagerwaard, Maximilian Niyazi, Tufve Nyholm, Ian Paddick, Damien Charles Weber, Claus Belka, Giuseppe Minniti 

Abstract: Background and purpose: For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors.

Material and methods: A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation.

Results: All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented.

Conclusions: This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.

Keywords: EORTC; RTOG; chondrosarcoma; chordoma; consensus; craniopharyngioma; meningioma; pituitary adenoma; radiotherapy; skull base target volume; target delineation; vestibular schwannoma.

Link to PubMed record

CCC publication: A phase (ph) II, multi-center study of the safety and efficacy of tebentafusp (tebe) (IMCgp100) in patients (pts) with metastatic uveal melanoma (mUM)

Citation: Annals of Oncology. 2020, 31(Sup7), S1442-3

Author: J.J. Sacco, R. Carvajal, M.O. Butler, A.N. Shoushtari, J.C. Hassel, A. Ikeguchi, L. Hernandez-Aya, P. Nathan, O. Hamid, J.M. Piulats Rodriguez, M. Rioth, D.B. Johnson, J.J. Luke, E. Espinosa, S. Leyvraz, H.M. Goodall, C. Holland, S. Abdullah, T. Sato,

CCC publication: Management of Newly-diagnosed Metastatic Hormone-sensitive Prostate Cancer: a Survey of UK Uro-oncologists

Citation: International Journal of Clinical Practice. 2020 Nov 30; e13874. Online ahead of print.

Author: Amit Bahl, Simon Crabb, Dan Ford, Rob Jones, Zaf Malik, Danish Mazhar, Joe O'Sullivan, Heather Payne

Abstract: Aim: To explore the practice and views of uro-oncologists in the UK regarding their use of chemotherapy and androgen receptor-targeted agents (ARTAs) in patients with newly-diagnosed metastatic hormone-sensitive prostate cancer (mHSPC).

Methods: An expert-devised paper or online questionnaire was completed by members of the British Uro-oncology Group.

Results: All respondents stated that they would offer patients with newly-diagnosed mHSPC docetaxel and androgen deprivation therapy (ADT) if they were sufficiently fit to receive chemotherapy (this was the only option available at the time of the survey); 64% would strongly recommend docetaxel for those with high-volume metastatic disease and 31% for those with low-volume disease. Hypothetically, if both docetaxel and ARTAs were available in the UK for mHSPC, almost 65% of respondents would recommend an ARTA with ADT to these patients in at least one-half of all cases, with the strongest recommendations to patients with high-risk disease. Imaging for response was conducted according to suspicion of disease progression, regardless of treatment, with the minority of clinicians recommending routine imaging. If a choice of therapy was available, docetaxel would be more likely to be offered to patients with liver or lung metastases, and ARTAs to patients with bone or lymph node only metastases. Almost all respondents would offer local radiotherapy to the primary tumour in patients with low-volume disease.

Conclusion: All the UK uro-oncologists those surveyed stated that they would offer docetaxel in combination with ADT to all newly-diagnosed patients with mHSPC if fit enough for chemotherapy. ARTAs would be offered to many patients if available, especially those with high-risk disease or those unfit to receive chemotherapy. Scanning was typically conducted following treatment only at suspicion of disease progression.

Keywords: abiraterone; apalutamide; docetaxel; enzalutamide; metastatic hormone-sensitive prostate cancer.

Link to PubMed record

CCC publication: The E3 Ubiquitin Ligase NEDD4L Targets OGG1 for Ubiquitylation and Modulates the Cellular DNA Damage Response

Citation: Frontiers in cell and developmental biology. 2020, eCollection 2020

Author: Jonathan R Hughes, Jason L Parsons 

Abstract: 8-Oxoguanine DNA glycosylase (OGG1) is the major cellular enzyme required for the excision of 8-oxoguanine DNA base lesions in DNA through the base excision repair (BER) pathway, and therefore plays a major role in suppressing mutagenesis and in controlling genome stability. However, the mechanism of regulation of cellular OGG1 protein, particularly in response to oxidative stress, is unclear. We have purified the major E3 ubiquitin ligase responsible for OGG1 ubiquitylation from human cell extracts, and identify this as E3 ubiquitin-protein ligase NEDD4-like (NEDD4L). We demonstrate that recombinant NEDD4L stimulates ubiquitylation of OGG1 in vitro, particularly on lysine 341, and that NEDD4L and OGG1 interact in U2OS cells. Depletion of NEDD4L in U2OS cells has no impact on the stability and steady-state protein levels of OGG1, however, OGG1 stability is enhanced in response to oxidative stress induced by ionizing radiation. Furthermore, ubiquitylation of OGG1 by NEDD4L in vitro inhibits its DNA glycosylase/lyase activity. As a consequence of prolonged OGG1 stability and increased excision activity in the absence of NEDD4L, cells display increased DNA repair capacity but conversely that this decreases cell survival post-irradiation. This effect can be reproduced following OGG1 overexpression, suggesting that dysregulation of OGG1 increases the formation of lethal intermediate DNA lesions. Our study therefore highlights the importance of balancing OGG1 protein levels and BER capacity in maintaining genome stability.

Keywords: DNA damage; DNA repair; NEDD4L; OGG1; ubiquitin.

 

Link to PubMed record

CCC publication: Optimisation of Urine Sample Preparation for Headspace-Solid Phase Microextraction Gas Chromatography-Mass Spectrometry: Altering Sample pH, Sulphuric Acid Concentration and Phase Ratio

Citation: Metabolites. 2020, 10(12), 1-17. [2020, 10(12), E482]

Author: Prashant Aggarwal, James Baker, Mark T Boyd, Séamus Coyle, Chris Probert, Elinor A Chapman

Abstract: Headspace-solid phase microextraction gas chromatography-mass spectrometry (HS-SPME-GC-MS) can be used to measure volatile organic compounds (VOCs) in human urine. However, there is no widely adopted standardised protocol for the preparation of urine samples for analysis resulting in an inability to compare studies reliably between laboratories. This paper investigated the effect of altering urine sample pH, volume, and vial size for optimising detection of VOCs when using HS-SPME-GC-MS. This is the first, direct comparison of H2SO4, HCl, and NaOH as treatment techniques prior to HS-SPME-GC-MS analysis. Altering urine sample pH indicates that H2SO4 is more effective at optimising detection of VOCs than HCl or NaOH. H2SO4 resulted in a significantly larger mean number of VOCs being identified per sample (on average, 33.5 VOCs to 24.3 in HCl or 12.2 in NaOH treated urine) and more unique VOCs, produced a more diverse range of classes of VOCs, and led to less HS-SPME-GC-MS degradation. We propose that adding 0.2 mL of 2.5 M H2SO4 to 1 mL of urine within a 10 mL headspace vial is the optimal sample preparation prior to HS-SPME-GC-MS analysis. We hope the use of our optimised method for urinary HS-SPME-GC-MS analysis will enhance our understanding of human disease and bolster metabolic biomarker identification.

Keywords: H2SO4; HCl; HS-SPME-GC-MS; NaOH; VOCs; hydrochloric acid; sodium hydroxide; vials; volatile organic compounds.

Link to PubMed record

CCC publication: A phase Ib study of NUC-1031 in combination with cisplatin for the first-line treatment of patients with advanced biliary tract cancer (ABC-08)

Citation: The oncologist. 2021, 26(4)
Author: McNamara M.G.; Valle J.W.; Bridgewater J.; Palmer D.H.; Faluyi O.; Wasan H.; Patel A.; Ryder W.D.; Barber S.; Gnanaranjan C.; Ghazaly E.; Evans T

CCC publication: Practice Considerations for Proton Beam Radiation Therapy of Uveal Melanoma During the Coronavirus Disease Pandemic: Particle Therapy Co-Operative Group Ocular Experience

Citation: Adv Radiat Oncol. 2020, 5(4), 682-86

Author: Kavita K. Mishra, MD, MPH,,∗ Armin Afshar, MD MBA, Juliette Thariat, MD, PhD, Helen A. Shih, MD, MS, MPH, Jessica E. Scholey, MA, Inder K. Daftari, PhD,a Andrzej Kacperek, PhD, Alessia Pica, MD, Jan Hrbacek, PhD, Remi Dendale, MD, Alejandro Mazal, PhD, Jens Heufelder, PhD, Devron H. Char, MD, Wolfgang A.G. Sauerwein, MD, PhD, Damien C. Weber, MD, and Bertil E. Damato, MD, PhDl

Abstract: Uveal melanoma (UM) is a rare but life-threatening cancer of the eye. In light of the coronavirus disease (COVID-19) pandemic, hospitals and proton eye therapy facilities must analyze several factors to ensure appropriate treatment protocols for patients and provider teams. Practice considerations to limit COVID-19 transmission in the proton ocular treatment setting for UM are necessary. The Particle Therapy Co-Operative Group is the largest international community of particle/proton therapy providers. Participating experts have current or former affiliation with the member institutions of the Particle Therapy Co-Operative Group Ocular subcommittee with long-standing high-volume proton ocular programs. The practices reviewed in this document must be taken in conjunction with local hospital procedures, multidisciplinary recommendations, and regional/national guidelines, as each community may have its unique needs, supplies, and protocols. Importantly, as the pandemic evolves, so will the strategies and recommendations. Given the unique circumstances for UM patients, along with indications of potential ophthalmologic transmission as a result of health care providers working in close proximity to patients and intrinsic infectious risk from eyelashes, tears, and hair, practice strategies may be adapted to reduce the risk of viral transmission. Certainly, providers and health care systems will continue to examine and provide as safe and effective care as possible for patients in the current environment.

Link to PubMed record

CCC publication: Reply to Comment on "The UK consensus position on the treatment of pancreatic cancer during the COVID-19 pandemic"

Citation: British Journal of Cancer. 2021, 124(3), 679-80. epub 2020

Author: Jones C.M.; Goody R.; Radhakrishna G.; Valle J.W.; Aitken K.; Hunt A.; Bridgewater J.; Corrie P.; Eatock M.; Ghaneh P.; Good J.; Grose D.; Holyoake D.; Jamieson N.B.; Palmer D.H.; Soonawalla Z.; Hawkins M.A.; Mukherjee S. (somnath.mukherjee@oncology.ox.ac.uk)

CCC publication: Real-World Evidence of Caplacizumab Use in the Management of Acute TTP

Citation: Blood 2020
Author: Dutt T.; Shaw R.J.; Lane S.; Toh C.-H.; Stubbs M.J.; Tomkins O.; Yong J.; Bailiff B.; Cranfield T.; Crowley M.P.; Desborough M.J.R.; Eyre T.A.; Gooding R.; Grainger J.; Hanley J.P.; Haughton J.; Hermans J.; Hill Q.A.; Humphrey L.; Lowe G.C.; Lyall H.; Mohsin M.; Nicolson P.L.R.; Priddee N.; Rampotas A.; Rayment R.; Rhodes S.; Taylor A.; Thomas W.; van Veen J.J.; Scully M

CCC publication: Effect of ramucirumab on ALBI grade in patients with advanced HCC : Results from REACH and REACH-2

Citation: JHEP Reports. 2021, 3(2). 2020

Author: Masatoshi Kudo, Peter R. Galle, Giovanni Brandi, Yoon-Koo Kang, Chia-Jui Yen, Richard S. Finn, Josep M. Llovet, Eric Assenat, Philippe Merle, Stephen L. Chan, Daniel H. Palmer, Masafumi Ikeda, Tatsuya Yamashita, Arndt Vogel, Yi-Hsiang Huang, Paolo B. Abada, Reigetsu Yoshikawa, Kenta Shinozaki, Chunxiao Wang, Ryan C. Widau, Andrew X. Zhu

Abstract: Abstract: Background & Aims. The albumin-bilirubin (ALBI) grade/score is derived from a validated nomogram to objectively assess prognosis and liver function in patients with hepatocellular carcinoma (HCC). This post-hoc analysis assessed prognosis in terms of survival by baseline ALBI grade and monitored liver function during treatment with ramucirumab or placebo using ALBI score in patients with advanced HCC. Methods. Patients with advanced HCC, Child-Pugh class A with prior sorafenib treatment were randomized in REACH trials to receive ramucirumab 8 mg/kg or placebo every 2 weeks. Data were analyzed by trial and as a meta-analysis of individual patient-level data (pooled population) from REACH (alpha-fetoprotein ≥400 ng/mL) and REACH-2. Patients from REACH with Child-Pugh class B were analyzed as a separate cohort. ALBI grade and score were calculated at baseline and before each treatment cycle. Results. Baseline characteristics by ALBI grade were balanced between treatment arms among patients in the pooled population (ALBI-1, n = 231; ALBI-2, n = 296; ALBI-3, n = 7). Baseline ALBI grade was prognostic for overall survival (OS; ALBI grade 2 vs. 1; Hazard ratio: 1.38 [1.13-1.69]), after adjusting for other significant prognostic factors. Mean ALBI scores remained stable in both treatment arms compared to baseline and were unaffected by baseline ALBI grade, macrovascular invasion, tumor response, geographical region, or prior locoregional therapy. Baseline ALBI grades 2 and 3 were associated with increased incidence of liver-specific adverse events and discontinuation rates in both treatments. Ramucirumab improved OS in patients with baseline ALBI grade 1 (HR 0.605 [0.445-0.824]) and ALBI grade 2 (HR 0.814 [0.630-1.051]). Conclusions. Compared with placebo, ramucirumab did not negatively impact liver function and improved survival irrespective of baseline ALBI grade. Keywords: ALBI; Liver function; Prognosis; Safety; Survival; Tumor response

CCC publication: Prostate Cancer Radiation Therapy Recommendations in Response to COVID-19

Citation: Adv Radiat Oncol. 2020, 5, 26-32

Author: Nicholas G. Zaorsky, MD, James B. Yu, MD, Sean M. McBride, MD, Robert T. Dess, MD, William C. Jackson, MD, Brandon A. Mahal, MD, Ronald Chen, MD, Ananya Choudhury, MD, Ann Henry, MD, Isabel Syndikus, MD, Timur Mitin, MD, Alison Tree, MD, Amar U. Kishan, MD, and Daniel E. Spratt, MDd,∗

Abstract: Purpose

During a global pandemic, the benefit of routine visits and treatment of patients with cancer must be weighed against the risks to patients, staff, and society. Prostate cancer is one of the most common cancers radiation oncology departments treat, and efficient resource utilization is essential in the setting of a pandemic. Herein, we aim to establish recommendations and a framework by which to evaluate prostate radiation therapy management decisions.

Methods and Materials

Radiation oncologists from the United States and the United Kingdom rapidly conducted a systematic review and agreed upon recommendations to safely manage patients with prostate cancer during the COVID-19 pandemic. A RADS framework was created: remote visits, and avoidance, deferment, and shortening of radiation therapy was applied to determine appropriate approaches.

Results

Recommendations were provided by the National Comprehensive Cancer Network risk group regarding clinical node-positive, postprostatectomy, oligometastatic, and low-volume M1 disease. Across all prostate cancer stages, telemedicine consultations and return visits were recommended when resources/staff available. Delays in consultations and return visits of between 1 and 6 months were deemed safe based on stage of disease. Treatment can be avoided or delayed until safe for very low, low, and favorable intermediate-risk disease. Unfavorable intermediate-risk, high-risk, clinical node-positive, recurrence postsurgery, oligometastatic, and low-volume M1 disease can receive neoadjuvant hormone therapy for 4 to 6 months as necessary. Ultrahypofractionation is preferred for localized, oligometastatic, and low-volume M1, and moderate hypofractionation is preferred for postprostatectomy and clinical node positive disease. Salvage is preferred to adjuvant radiation.

Conclusions

Resources can be reduced for all identified stages of prostate cancer. The RADS (remote visits, and avoidance, deferment, and shortening of radiation therapy) framework can be applied to other disease sites to help with decision making in a global pandemic.

Link to PubMed record

CCC publication: Activating transcription factor-2 (ATF2) is a key determinant of resistance to endocrine treatment in an in vitro model of breast cancer

Citation: Breast Cancer Research. 2020, 22, 126

Author: Athina Giannoudis, Mohammed Imad Malki, Bharath Rudraraju, Hisham Mohhamed, Suraj Menon, Triantafillos Liloglou, Simak Ali, Jason S. Carroll, and Carlo Palmiericorresponding author

Abstract: Background

Activating transcription factor-2 (ATF2), a member of the leucine zipper family of DNA binding proteins, has been implicated as a tumour suppressor in breast cancer. However, its exact role in breast cancer endocrine resistance is still unclear. We have previously shown that silencing of ATF2 leads to a loss in the growth-inhibitory effects of tamoxifen in the oestrogen receptor (ER)-positive, tamoxifen-sensitive MCF7 cell line and highlighted that this multi-faceted transcription factor is key to the effects of tamoxifen in an endocrine sensitive model. In this work, we explored further the in vitro role of ATF2 in defining the resistance to endocrine treatment.

Materials and methods

We knocked down ATF2 in TAMR, LCC2 and LCC9 tamoxifen-resistant breast cancer cell lines as well as the parental tamoxifen sensitive MCF7 cell line and investigated the effects on growth, colony formation and cell migration. We also performed a microarray gene expression profiling (Illumina Human HT12_v4) to explore alterations in gene expression between MCF7 and TAMRs after ATF2 silencing and confirmed gene expression changes by quantitative RT-PCR.

Results

By silencing ATF2, we observed a significant growth reduction of TAMR, LCC2 and LCC9 with no such effect observed with the parental MCF7 cells. ATF2 silencing was also associated with a significant inhibition of TAMR, LCC2 and LCC9 cell migration and colony formation. Interestingly, knockdown of ATF2 enhanced the levels of ER and ER-regulated genes, TFF1, GREB1, NCOA3 and PGR, in TAMR cells both at RNA and protein levels. Microarray gene expression identified a number of genes known to mediate tamoxifen resistance, to be differentially regulated by ATF2 in TAMR in relation to the parental MCF7 cells. Moreover, differential pathway analysis confirmed enhanced ER activity after ATF2 knockdown in TAMR cells.

Conclusion

These data demonstrate that ATF2 silencing may overcome endocrine resistance and highlights further the dual role of this transcription factor that can mediate endocrine sensitivity and resistance by modulating ER expression and activity.

Keywords: ATF2, Tamoxifen, Endocrine resistance, Breast cancer

Link to PubMed record

WUTH publication: The COVID-19 Pandemic as a Catalyst for a National Cancer Imaging Repository: Answering the Topol Review

Citation: Clinical Oncology. 2021, 33(3), e194.  Epub 2020 Nov 12.

Author: Boon IS, Yap MH, Au Yong TPT, Boon CS

Link to PubMed record

WUTH publication: Oral and maxillofacial dental care professionals in critical care during the COVID-19 pandemic

Citation: The British Journal of Oral and Maxillofacial Surgery. 2021, 59(1), 117-20. [Epub 2020 Aug 25]
Author: Forrester S, Fisher G, Chieng CY, Rogers SN
Abstract: At the peak of the COVID-19 pandemic there was a 'call to arms' across the oral and maxillofacial staff. This article reports on the extended role of the department's dental care professionals (DCPs) and the tremendous opportunity and value that temporary redeployment presented.

Keywords: COVID-19; Critical care; Dental care professionals.

Link to PubMed record

Trans Awareness Week 2020

The Library and Knowledge Service have put together a collection of resources relating to Trans Awareness Week, 13-19 November 2020. This marks the week before Transgender Day of Remembrance on 20 November.

If you are interested in receiving more information on this topic, or wish to access anything listed, please email us at wuth.lks@nhs.net

Advice and support

Stonewall

https://www.stonewall.org.uk/help-and-advice

Information and support for LGBT communities and their allies. Contact Stonewall's Information Service FREEPHONE 0800 0502020 Lines are open 9:30 - 4:30 Monday to Friday.

 

Trans Awareness Week

https://www.glaad.org/transweek

Each year between November 13 – 19, people and organizations around the country participate in Transgender Awareness Week to help raise the visibility about transgender people and address issues members of the community face.

Transgender Day of Remembrance (TDOR), is an annual observance on November 20 that honors the memory of the transgender people whose lives were lost in acts of anti-transgender violence that year.

 

Mermaids

https://mermaidsuk.org.uk/

Helping gender-diverse kids, young people and their families since 1995

 

TransUnite

https://www.transunite.co.uk/

Access over 100 verified UK Trans support groups and locate one close to you. Detailed profiles offer specific information on the scope of support provided, meeting schedules and contact information.

 

Recent Reports

New research provides insights into the distress experienced by transgender adults

Published on 22 September 2020

https://doi.org/10.3310/alert_41281

The findings provide further evidence that transgender people need better support within the healthcare system and in society more broadly […]

 

The care and management of individuals who are transgender

HM Prisons and Probations service: Gov.uk

Last updated: 2020

https://www.gov.uk/government/publications/the-care-and-management-of-individuals-who-are-transgender

This Policy Framework ensures that transgender individuals are treated with respect and sensitivity while they are in custody, and that the safety of anyone in our care, transgender or not, is prioritised.

 

Attitudes to transgender people

Equality and Human Rights Commission

Date: August 2020

https://www.evidence.nhs.uk/document?id=2272408

We commissioned research in 2019 about the British public's attitudes to transgender people.

Data from NatCen's British Social Attitudes (BSA) survey suggests that public attitudes to transgender people are broadly positive. However, people's attitudes are more nuanced in specific situations and according to demographic characteristics.

The research covers:

• personal feelings and prejudice towards transgender people
• attitudes to transgender people in gender-specific situations
• attitudes about transgender people's right to change the sex on their birth certificate
• variation by geography and changes over time

This report presents an analysis of the findings of the BSA survey.

LGBTQ+ people’s experience of using health and social care services in North Yorkshire: a focus on mental health

Author(s):

Publication Date: 2020

Abstract:Research has shown that significant health disparities exist for individuals identifying as LGBTQ+. North Yorkshire Healthwatch wanted to find out what these inequalities look like for North Yorkshire's LGBTQ+ community. They asked what works well and what can be improved, with a particular focus on mental health care. More than 200 people shared their views through this survey using questionnaires, interviews and outreach activities.

Database: HMIC

 

Health and Care LGBTQ+ Leaders Network launched

Author(s):

Source: National Health Executive; 2020

Publication Date: 2020

Abstract:NHS Confederation has launched the Health and Care LGBTQ+ Leaders Network to transform the NHS so that members of the LGBTQ+ community can be assured of equal treatment, receive the best care and work in an inclusive environment across the healthcare service. [Introduction]

Database: HMIC

 

The health status of transgender and gender non-binary adults in the United States

Author(s): Cicero, Ethan C; Reisner, Sari L; Merwin, Elizabeth I; Humphreys, Janice C; Silvia, Susan G

Source: PLoS ONE; 2020; vol. 15 (no. 2)

Publication Date: 2020

Available  at PLoS ONE -  from Europe PubMed Central - Open Access

Abstract:The goal of this exploratory study was to delineate health differences among transgender subpopulations (transgender women/TW, transgender men/TM, gender nonbinary/GNB adults). 2015 Behavioral Risk Factor Surveillance System data were analyzed to compare the health of three groups (TW:N = 369; TM:N = 239; GNB:N = 156). Logistic regression and adjusted odds ratios were used to determine whether health outcomes (fair/poor health, frequent physical and mental unhealthy days, chronic health conditions, and health problems/impairments) are related to group and its interaction with personal characteristics and socioeconomic position. Group was a significant predictor of fair/poor health and frequent mental unhealthy days, revealing significant health differences between the transgender groups. The odds of poor/fair health were approximately 2.5 times higher in TM and GNB adults relative to TW. The odds of frequent mental unhealthy days for TM were approximately 1.5-2 times greater than TW and GNB adults. Among those with health insurance, the odds of fair/poor health for GNB adults was more than 1.5-2 times higher that of TM and TW. Among those without health insurance, TM had over seven times greater odds of fair/poor health than TW. This study underscores the importance of classifying and examining the health of the transgender population as unique subpopulations, as notable health differences were discovered. TM and GNB adults have significant health concerns, requiring the attention of clinical interventions aimed at promoting health and preventing illness. [Abstract]

Database: HMIC

 

Advancing LGBTQ health equity via human-centered design

Author(s): Coulter, Robert W. S.; Siconolfi, Daniel E.; Egan, James E.; Chugani, Carla D.

Source: Psychiatric Services; Feb 2020; vol. 71 (no. 2); p. 109

Publication Date: Feb 2020

Publication Type(s): Journal Peer Reviewed Journal Comment/Reply

PubMedID: 32008475

Available  at Psychiatric services (Washington, D.C.) -  from Unpaywall

Abstract:Comments on an article by J. K. Felner et al. (see record 2020-11846-003). Felner et al. conducted a to explore how lesbian, gay, bisexual, transgender, and queer (LGBTQ) people’s lived experiences as sexual and gender minorities influenced their substance use in adolescence and young adulthood. Numerous factors at the individual, interpersonal, and structural levels of the socioecological model influenced LGBTQ people’s substance use, including using substances to cope with internalized stigma, familial rejection, and structural stigma. Their findings also underscore how social influence and community norms facilitated substance use for LGBTQ young adults. An important finding is that people who identified both as a gender minority (e.g., transgender) and a sexual minority (e.g., LGBTQ) had to cope with twofold minority stressors and socioecological influences that affected their substance use in intersecting ways. This qualitative study supports the mounting quantitative evidence, that substance use by LGBTQ youths and young adults is influenced by complex, multilevel interacting factors. Human-centered design (HCD; also known as user centered design) is well suited to advance the field of substance use prevention interventions for LGBTQ youths by designing interventions that simultaneously target several of the complex, multilevel factors identified by Felner et al. HCD can broadly be defined as a set of approaches that engage multiple stakeholder groups, including end users, in developing innovative solutions to problems. Overall, HCD approaches can help researchers and stakeholders create meaningful, acceptable, and novel interventions that target the complex, multilevel factors influencing LGBTQ youths’ substance use. Although there is a long way to go in eliminating inequities in substance use and disorders among LGBTQ youths and young adults, we believe that HCD methods are an untapped resource that can help realize the goal of health equity for the LGBTQ population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Database: PsycINFO

 

A national survey of u.S. Psychiatry residents’ lgbt cultural competency: The importance of lgbt patient exposure and formal education

Author(s): Nowaskie, Dustin

Source: Journal of Gay & Lesbian Mental Health; Jun 2020

Publication Date: Jun 2020

Publication Type(s): Journal Peer Reviewed Journal

Abstract:The prevalence of many mental health disorders is substantially higher in the lesbian, gay, bisexual, and transgender (LGBT) population compared to the cisgender, heterosexual population. While psychiatry residents are in crucial roles as learners and providers, there is a paucity of data regarding U.S. psychiatry residents’ experiences and education with LGBT healthcare. A 29-item self-reporting, anonymous, cross-sectional survey was distributed to U.S. psychiatry residents across the country between July and October 2019. Survey items included demographics, experiential variables, and the 7-point Likert LGBT-Development of Clinical Skills Scale. Psychiatry residents (N = 304) reported caring for many LGBT patients (M = 23.56, SD = 40.43) and receiving a low number of annual LGBT curricular hours (M = 1.21, SD = 1.58) and a moderate number of LGBT extracurricular hours (M = 10.79, SD = 20.54). They also reported very high affirming attitudinal awareness (M = 6.58, SD = 0.72), moderate knowledge (M = 5.42, SD = 1.28), and low clinical preparedness (M = 4.68, SD = 1.23). Approximations of 40 LGBT patients and 20 LGBT total hours were determined to offer significant preparedness and knowledge. Psychiatry residents embody many strengths, namely their diversity and affirming attitudes, but also have shortcomings such as clinical skills and preparedness. During this current state of national psychiatry training, there is a lack of standardized education and exposure to LGBT care. Future efforts should heavily consider increasing both LGBT patient contact hours and formal education hours. (PsycInfo Database Record (c) 2020 APA, all rights reserved)  (Source: journal abstract)

Database: PsycINFO

 

LGBTQ mental health: International perspectives and experiences

Author(s):

Source: LGBTQ mental health: International perspectives and experiences; 2020

Publication Date: 2020

Publication Type(s): Book Edited Book

Abstract:This book expands the understanding of lesbian, gay, bisexual, transgender, or queer (LGBTQ) people's lives beyond the dominant narrative of the West to include the experiences of LGBTQ people from around the world. In the United States, Canada, and Western Europe, much has been written about LGBTQ health and mental health. Chapters in this book cover LGBTQ populations that are largely invisible in the psychological literature by focusing on the Majority World to expand our understanding of what it means to be LGBTQ and how mental health needs and priorities contextually vary. The book chapters address the concerns of LGBTQ people of various regions of the world, including South Asia, Southeast Asia, Northern Asia, Eastern Europe, Latin America, the Caribbean, and sub-Saharan Africa. These chapters provide some historical perspective, as well as cultural factors and values, conceptualizations of gender and sexuality, perspectives and concerns of LGBTQ people, and relevant clinical issues and recommendations for mental health practitioners to consider. Authors address how being a sexual and/or gender diverse person may impact mental health and highlight challenges faced by LGBTQ populations as they relate to laws, policies, and cultural beliefs. Chapters include one or more vignettes based either on one or more authors' experiences or on a fictionalized or deidentified case in order to give readers a sense of what concerns are relevant to the LGBTQ population from that particular country or region. Book chapters are organized to allow readers to compare and contrast LGBTQ experiences within and between regions. (PsycINFO Database Record (c) 2019 APA, all rights reserved)  (Source: create)

Database: PsycINFO

 

Systematic review of the content and methods of empirical psychological research on LGBTQ and SGM populations in the new millennium

Author(s): Walch, Susan E.; Bernal, Darren R.; Gibson, Laynie; Murray, Linda; Thien, Samantha; Steinnecker, Kyra

Source: Psychology of Sexual Orientation and Gender Diversity; Feb 2020

Publication Date: Feb 2020

Publication Type(s): Journal Peer Reviewed Journal Journal Article

Abstract:Over the past century, the content and methods of empirical research on lesbian, gay, bisexual, transgender, and queer (LGBTQ) or sexual and gender minority (SGM) populations have evolved. The present study aimed to describe and quantify broad content themes, methodological and design features, and trends over time in the empirical psychological literature base on LGBTQ and SGM populations since the start of the new millennium. A systematic review of 650 study samples with LGBTQ or SGM participants from 632 empirical research articles with LGBTQ or SGM terms in the article title, published in English in peer-reviewed journals indexed in PsycINFO in selected years (2000, 2005, 2010, and 2015), is reported in this article. Findings suggest substantial increases in the number, but not the percentage, of studies with LGBTQ or SGM participants since the start of the new millennium. Even with this increase in volume, the literature remains characterized almost exclusively by nonexperimental, descriptive, or observational research relying primarily on cross-sectional, retrospective, correlational designs and nonprobability, self-selected, or convenience sampling methods. Despite an increase in use of online recruitment and data collection, the majority of sample sizes remain small to moderate in size. Most samples were composed of adults and an increase in racial/ethnic diversity of study samples was observed over time. Reporting of important sample characteristics, particularly socioeconomic status, was frequently inadequate. Findings indicate that research sampling has evolved substantially from its historic roots; however, there is much room for greater methodological diversity and rigor in this area of research. (PsycINFO Database Record (c) 2020 APA, all rights reserved)  (Source: journal abstract)                                                                                         Impact statementPublic Significance Statement—This review article describes and quantifies the topics, scientific methods, and trends over time in psychological research on lesbian, gay, bisexual, transgender, and queer (LGBTQ) or sexual and gender minority (SGM) populations since the start of the new millennium. A systematic review of 650 study samples from 632 research articles shows substantial increases in the number, but not the percentage, of studies with LGBTQ or SGM participants since the start of the new millennium and describes ways in which research methods have remained stable or changed since the year 2000. Findings indicate that research sampling has evolved from early historical methods; however, there is much room for greater methodological variety and rigor. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

Database: PsycINFO

 

Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: Education for nursing students.

Author(s): McEwing, Evan

Source: Nurse education today; Nov 2020; vol. 94 ; p. 104573

Publication Date: Nov 2020

Publication Type(s): Journal Article

PubMedID: 32927395

Abstract:PURPOSEDespite well-documented healthcare disparities in the lesbian, gay, bisexual, and transgender (LGBT) community, nursing education has lagged other health professions in promoting culturally competent care to members of this minority group.METHODSUsing national guidelines, the author developed an educational program for BSN students to improve competency in providing care for LGBT individuals. One hundred twenty-four students completed online modules and a simulation exercise, which explored LGBT healthcare topics. One hundred eight participants completed surveys pre-, post-, and 1 month after the intervention.RESULTSOverall LGB competence scores improved from pre- (M = 4.42) to post-test (M = 5.20) and did not significantly decrease at one-month (M = 5.03, p < .001). Similar findings were observed in the transgender cultural competence scores (pre- (M = 4.02); post- (M = 5.08); one-month (M = 4.92, p < .001)).CONCLUSIONEducational content focused on cultural competency for nurses may lead to improved health outcomes among the LGBT community.

Database: Medline

 

Provider and LGBT Individuals' Perspectives on LGBT Issues in Long-Term Care: A Systematic Review.

Author(s): Caceres, Billy A; Travers, Jasmine; Primiano, Jillian E; Luscombe, Rachel E; Dorsen, Caroline

Source: The Gerontologist; Apr 2020; vol. 60 (no. 3); p. e169

Publication Date: Apr 2020

Publication Type(s): Research Support, N.i.h., Extramural Journal Article Systematic Review

PubMedID: 30726910

Abstract:BACKGROUND AND OBJECTIVESDiscrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, we sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals' perspectives of LGBT issues in LTSS in the United States.RESEARCH DESIGN AND METHODSFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies.RESULTSNineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS.DISCUSSION AND IMPLICATIONSThis systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS.

Database: Medline

 

Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association.

Author(s): Caceres, Billy A; Streed, Carl G; Corliss, Heather L; Lloyd-Jones, Donald M; Matthews, Phoenix A; Mukherjee, Monica; Poteat, Tonia; Rosendale, Nicole; Ross, Leanna M; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council

Source: Circulation; Nov 2020; vol. 142 (no. 19); p. e321

Publication Date: Nov 2020

Publication Type(s): Journal Article

PubMedID: 33028085

Abstract:There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This American Heart Association scientific statement reviews the extant literature on the cardiovascular health of LGBTQ adults. Informed by the minority stress and social ecological models, the objectives of this statement were (1) to present a conceptual model to elucidate potential mechanisms underlying cardiovascular health disparities in LGBTQ adults, (2) to identify research gaps, and (3) to provide suggestions for improving cardiovascular research and care of LGBTQ people. Despite the identified methodological limitations, there is evidence that LGBTQ adults (particularly lesbian, bisexual, and transgender women) experience disparities across several cardiovascular health metrics. These disparities vary by race, sex, sexual orientation, and gender identity. Future research in this area should incorporate longitudinal designs, elucidate physiological mechanisms, assess social and clinical determinants of cardiovascular health, and identify potential targets for behavioral interventions. There is a need to develop and test interventions that address multilevel stressors that affect the cardiovascular health of LGBTQ adults. Content on LGBTQ health should be integrated into health professions curricula and continuing education for practicing clinicians. Advancing the cardiovascular health of LGBTQ adults requires a multifaceted approach that includes stakeholders from multiple sectors to integrate best practices into health promotion and cardiovascular care of this population.

Database: Medline

 

Medical students' knowledge of and attitudes towards LGBT people and their health care needs: Impact of a lecture on LGBT health.

Author(s): Wahlen, Raphaël; Bize, Raphaël; Wang, Jen; Merglen, Arnaud; Ambresin, Anne-Emmanuelle

Source: PloS one; 2020; vol. 15 (no. 7); p. e0234743

Publication Date: 2020

Publication Type(s): Journal Article

PubMedID: 32609754

Available  at PloS one -  from Europe PubMed Central - Open Access

Abstract:OBJECTIVESLesbian, gay, bisexual, and transgender (LGBT) adolescents have specific health care needs and are susceptible to health care disparities. Lack of skills and knowledge on the part of health care providers have a negative effect on their access to care and health outcomes. This study 1) explores the knowledge and attitudes of medical students regarding LGBT people, and 2) assesses the impact of a one-hour lecture targeting adolescent LGBT health needs.METHODSFourth-year medical students attended a compulsory one-hour lecture on sexual orientation and gender identity development in adolescence, highlighting health issues. We created a questionnaire with items to elicit students' knowledge and attitudes about LGBT health issues. Students were invited to complete this questionnaire online anonymously one week before the lecture and one month after the lecture.RESULTSOut of a total of 157 students, 107 (68.2%) responded to the pre-intervention questionnaire and 96 (61.1%) to the post-intervention questionnaire. A significant proportion-13.7% of all respondents-identified as LGBT or questioning. Our results show that most medical students already show favorable attitudes towards LGBT people and a certain degree of knowledge of LGBT health needs. They demonstrated a large and significant increase in knowledge of LGBT health issues one month after the lecture.DISCUSSIONA single one-hour lecture on sexual orientation and LGBT health issues may increase knowledge among medical students. Medical students and professionals should receive such training to increase their knowledge about LGBT patients as it, together with favorable attitudes, has the potential to improve health outcomes among this vulnerable population.

Database: Medline

 

Experiences of Palliative and End-of-Life Care among Older LGBTQ Women: A Review of Current Literature.

Author(s): Valenti, Korijna G; Jen, Sarah; Parajuli, Jyotsana; Arbogast, Annabelle; Jacobsen, Anna Liss; Kunkel, Suzanne

Source: Journal of palliative medicine; Nov 2020; vol. 23 (no. 11); p. 1532-1539

Publication Date: Nov 2020

Publication Type(s): Journal Article

PubMedID: 32835594

Abstract:Background: Understanding end-of-life (EOL) and palliative care continues to grow. However, little attention has been paid to the experiences, preferences, and needs of older lesbian, gay, bisexual, transgender, and queer (LGBTQ) women. While some universal expectations or preferences at EOL exist, this population may not receive adequate or appropriate attention or reporting of unique EOL issues and experiences. Objective: Systematically search for and narratively review existing evidence concerning the expectations, preferences, and needs for palliative and EOL care of LGBTQ older women. Design: A comprehensive literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles reporting needs, experiences, and perspectives of palliative care and EOL care among LGBTQ older women were evaluated. Measurements: Articles published between 1996 and 2019 were retrieved from PsycINFO, MEDLINE, Cochrane Library, Academic Search Complete, AgeLine, CINHAL, PubMed, LGBT Life, SocINDEX, Women's Studies International, Joanna Briggs Institute, and Open Grey. Results: A total of 16 articles were included. Articles described several concerns for the overall LGBTQ population; however, additional issues and experiences specific to older LGBTQ women were also identified, including vulnerability associated with isolation and poverty, women's social needs and support networks, and preferences for complementary care. Conclusion: There remains a need for further research with older LGBTQ women concerning palliative and EOL care, particularly around preparation for EOL and preferences for support. Inclusion of diverse populations in terms of sexual and gender identification are needed to fully understand how to provide appropriate and preferred support.

Database: Medline

 

A multicenter, multidisciplinary evaluation of 1701 healthcare professional students' LGBT cultural competency: Comparisons between dental, medical, occupational therapy, pharmacy, physical therapy, physician assistant, and social work students.

Author(s): Nowaskie, Dustin Z; Patel, Anuj U; Fang, Ryan C

Source: PloS one; 2020; vol. 15 (no. 8); p. e0237670

Publication Date: 2020

Publication Type(s): Comparative Study Multicenter Study Journal Article

PubMedID: 32790797

Available  at PloS one -  from Europe PubMed Central - Open Access

Abstract:BACKGROUNDEfforts to characterize healthcare professional students' lesbian, gay, bisexual, and transgender (LGBT) cultural competency are necessary to recommend educational initiatives. Very few studies have evaluated LGBT cultural competency across multiple healthcare disciplines, and no known studies have included students of other healthcare disciplines such as occupational therapy, pharmacy, physical therapy, and physician assistant.METHODSHealthcare professional students (N = 1701) at three universities across the United States completed a survey consisting of demographics, experiential variables (i.e., LGBT patients and LGBT curricular hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores, annual LGBT patients, and annual LGBT curricular hours were compared across healthcare disciplines.RESULTSWhile students reported very high Attitudinal Awareness (M = 6.48, SD = 0.92), they endorsed moderate Basic Knowledge (M = 5.54, SD = 1.16) and low Clinical Preparedness (M = 3.78, SD = 1.28). After controlling for several demographic and experiential variables, there were significant differences among healthcare disciplines on LGBT-DOCSS scores, with social work students reporting the highest on all scores, and dental students reporting the lowest on all scores except Clinical Preparedness. There were also significant differences among healthcare disciplines on annual LGBT patients [mean range: 0.57 (dental) to 7.59 (physician assistant)] and annual LGBT curricular hours [mean range: 0.51 (occupational therapy) to 5.64 (social work)]. Experiential variables were significant predictors for Overall LGBT-DOCSS, Clinical Preparedness, and Basic Knowledge (all p < 0.001); LGBT patients was also a significant predictor for Attitudinal Awareness (p < 0.05).CONCLUSIONSTaken together, significant differences in LGBT cultural competency exist across healthcare disciplines, which may result from inadequate experiences with LGBT patients and LGBT curricular education. Future efforts should consider increasing LGBT patient contact hours and LGBT formal education hours to enhance healthcare students' LGBT cultural competency.

Database: Medline

 

The Aging Experiences of LGBTQ Ethnic Minority Elders: A Systematic Review.

Author(s): Chen, Jinwen; McLaren, Helen; Jones, Michelle; Shams, Lida

Source: The Gerontologist; Sep 2020

Publication Date: Sep 2020

Publication Type(s): Journal Article

PubMedID: 32941597

Abstract:BACKGROUND AND OBJECTIVESIn gerontological research and practice, an increasing amount of attention is being paid to lesbian, gay, bisexual, transgender and queer (LGBTQ) older people and how their experiences differ from their heterosexual and cisgender counterparts. However, LGBTQ elders themselves are not a homogenous group. Moreover, as the immigrant populations in industrialized nations age, the number of LGBTQ elders from ethnic minority backgrounds will only grow. This systematic review hence investigates the experiences of LGBTQ ethnic minority elders.RESEARCH DESIGN AND METHODSFollowing the PRISMA guidelines, we conducted a systematic search in five databases for English peer-reviewed studies. The retrieved articles were coded and analyzed inductively using an intersectional framework to tease out the varying influences of ethnicity, age, gender and sexual identity on the LGBTQ ethnic minority elders' experiences.RESULTSA total of 30 articles across 17 studies (13 qualitative, seven quantitative and one mixed methods) were identified. Six key themes emerged from the studies: stigma and discrimination; isolation, support and belonging, interactions with services and institutions, self-acceptance, resilience and agency; mental health and wellbeing; and uncertain futures.DISCUSSION AND IMPLICATIONSThe experiences of LGBTQ ethnic minority elders echo those of LGBTQ ethnic majority elders when they are shaped by gender and sexual identity factors. Nevertheless, significant differences in experiences -both positive and negative-emerge when cultural and ethnicity-related factors come to the fore. These findings emphasize the need for intersectional aging policies and services that go beyond catering for LGBTQ elders to include the diversity within this sub-population.

Database: Medline

 

How can we meet the support needs of LGBT cancer patients in oncology? A systematic review.

Author(s): Webster, R; Drury-Smith, H

Source: Radiography (London, England : 1995); Aug 2020

Publication Date: Aug 2020

Publication Type(s): Journal Article Review

PubMedID: 32800429

Abstract:OBJECTIVESApproximately 3.6 million people in the UK identify as lesbian, gay, bisexual and transgender (LGBT). Fear of discrimination and lack of sexual orientation and gender identity recording suggests LGBT people are invisible to health services. A systematic review was conducted to critically analyse primary research investigating psychosocial support needs for LGBT cancer patients during and after treatment.KEY FINDINGSTwenty studies were included in the review; of which ten were qualitative, seven quantitative and three mixed methods. The main themes highlighted include health care professional knowledge and education, negative impact on mental health, lack of inclusive support groups, prevalence of discrimination within healthcare services and the disclosure or non-disclosure of sexual orientation and gender identity.CONCLUSIONThe review highlights how healthcare providers are failing LGBT cancer patients in psychosocial support resulting in unmet needs. Recommendations have been made to ensure an LGBT inclusive environment within cancer services, as well as the need to develop support services for LGBT cancer patients.IMPLICATIONS FOR PRACTICETraining should be provided for HCP staff in LGBT health and awareness. Sexual orientation and gender identity recording and monitoring is important to ensure LGBT people are not 'invisible' in oncology, radiotherapy and in future research. LGBT cancer support groups and resources should be created, as the review evidence suggests LGBT patients are actively looking for these resources.

Database: Medline

WUTH publicaton: A clinical librarian in a hospital critical care unit may generate a positive return on investment

Citation: Health information and Libraries Journal. 2020 Nov 16. Online ahead of print.
Author: Hartfiel N, Sadera G, Treadway V, Lawrence C, Tudor Edwards R
Abstract: Background: Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit.

Objective: The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital.

Methods: Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention. Total costs included salary and equipment costs. Total monetised benefits included time saving for hospital staff, support for professional development and improved patient care.

Results: When total monetised benefits were compared with total costs, the 15-month clinical librarian intervention generated a positive ROI of £1.18-£3.03 for every £1 invested.

Discussion: Using outcome measures derived from previous research, this novel study generated promising results indicative for commissioners seeking to improve patient care and deliver value for money. To improve generalisability, multisite studies using standardised ROI tools are recommended.

Conclusion: Employing a clinical librarian in a critical care unit can generate a positive ROI.

Keywords: National Health Service(NHS); consultants; costs and cost analysis; evidence-based practice; information services; knowledge transfer; knowledge translation; librarians, clinical; library and information professionals; nurses.

Link to PubMed record

WUTH publication: 'Ball valve' small bowel obstruction caused by a large caecal faecolith

Citation: Annals of the Royal College of Surgeons of England. 2020 Nov 13. Online ahead of print
Author: Sharma S, Majeed T, Solomon J, Guy R
Abstract: Small bowel obstruction is a common surgical presentation, but intestinal faecoliths are rarely reported as a cause. A 75-year-old woman presented with small bowel obstruction from a large faecolith lodged in the caecum. This required removal at laparoscopy-assisted surgery. This case highlights the need to deal promptly with symptomatic intestinal faecoliths as they are unlikely to pass spontaneously and are prone to cause acute obstruction.
Keywords: Faecolith; Intestinal obstruction.

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WUTH publication: A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside

Citation: The Journal of Laryngology and Otology. 2020, 1-6. Online ahead of print

Author: Hampton T, Allan J, Pearson D, Emerson H, Jones GH, Junaid M, Kanzara T, Lau AS, Siau R, Williams SP, Wilkie MD

Abstract: Background: There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks.

Methods: A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites.

Results: A total of 225 procedures were performed (range of 1.2-9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres.

Conclusion: Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.

Keywords: Benchmarking; Endoscopy; Pharynx; Retrospective Studies; Zenker Diverticulum.

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WUTH publication: National survey of feasibility of NIV trials for management of children with bronchiolitis

Citation: BMJ paediatrics open. 2020, 4(1), e000780

Author: Rosala-Hallas A, Jones AP, Bedson E, Compton V, Fernandes RM, Lacy D, Lyttle MD, Peak M, Thorburn K, van Miert C, Woolfall K, McNamara PS

Abstract: Background: Bronchiolitis is a major cause of admission to hospital in children. Non-invasive ventilation (NIV) support with continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) oxygen is routinely used for infants in the UK with bronchiolitis.

Objective: To establish UK paediatric practice regarding management of bronchiolitis, and to explore issues pertinent to the design of a potential future randomised controlled trial of NIV.

Design: Screening logs were completed in hospitals in England capturing information on paediatric bronchiolitis admissions. An online national survey of clinical practice was disseminated to healthcare professionals (HCPs) across the UK to ascertain current management strategies.

Results: Screening logs captured data on 393 infants from 8 hospitals. Reasons for admission were most commonly respiratory distress and/or poor fluid intake. Oxygen was administered for 54% of admissions. Respiratory (CPAP and HFNC) and non-respiratory support administered varied considerably. The national survey was completed by 111 HCPs from 76 hospitals. Data were obtained on criteria used to commence and wean NIV, responsibilities for altering NIV settings, minimum training requirements for staff managing a child on NIV, and numbers of trained staff. Most centres were interested in and capable of running a trial of NIV, even out of normal office hours.

Conclusions: Respiratory and non-respiratory management of bronchiolitis in UK centres varies widely. A trial of HFNC oxygen therapy in this group of patients is feasible and HCPs would be willing to randomise patients into such a trial. Future work should focus on defining trial eligibility criteria.

Keywords: neonatology; therapeutics.

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CCC publication: CTEN Induces Tumour Cell Invasion and Survival and Is Prognostic in Radiotherapy-Treated Head and Neck Cancer

Citation: Cancers. 2020, 12(10), E2963

Author: Fleming JC(1)(2)(3), Woo J(4), Moutasim K(1), Hanley CJ(1), Frampton SJ(1), Wood O(1), Ward M(1), Woelk CH(4)(5), Ottensmeier CH(1)(2)(3)(6), Hafizi S(7), Kim D(8), Thomas GJ(1)

Abstract: Head and neck squamous cell carcinoma (HNSCC) is a heterogenous disease treated with surgery and/or (chemo) radiotherapy, but up to 50% of patients with late-stage disease develop locoregional recurrence. Determining the mechanisms underpinning treatment resistance could identify new therapeutic targets and aid treatment selection. C-terminal tensin-like (CTEN) is a member of the tensin family, upregulated in several cancers, although its expression and function in HNSCC are unknown. We found that CTEN is commonly upregulated in HNSCC, particularly HPV-ve tumours. In vitro CTEN was upregulated in HPV-ve (n = 5) and HPV+ve (n = 2) HNSCC cell lines. Stable shRNA knockdown of CTEN in vivo significantly reduced tumour growth (SCC-25), and functional analyses in vitro showed that CTEN promoted tumour cell invasion, colony formation and growth in 3D-culture (SCC-25, Detroit 562). RNA sequencing of SCC-25 cells following CTEN siRNA knockdown identified 349 differentially expressed genes (logFC > 1, p < 0.05). Gene ontology analysis highlighted terms relating to cell locomotion and apoptosis, consistent with in vitro findings. A membrane-based antibody array confirmed that CTEN regulated multiple apoptosis-associated proteins, including HSP60 and cleaved caspase-3. Notably, in a mixed cohort of HPV+ve and HPV-ve HNSCC patients (n = 259), we found a significant, independent negative association of CTEN with prognosis, limited to those patients treated with (chemo)radiotherapy, not surgery, irrespective of human papillomavirus (HPV) status. These data show that CTEN is commonly upregulated in HNSCC and exerts several functional effects. Its potential role in modulating apoptotic response to therapy suggests utility as a predictive biomarker or radio-sensitising target.

Keywords: CTEN; apoptosis; biomarker; head and neck cancer; human papillomavirus; invasion; radiotherapy; tensin.

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CCC publication: A phase II randomised, placebo-controlled trial of low dose (metronomic) cyclophosphamide and nintedanib (BIBF1120) in advanced ovarian, fallopian tube or primary peritoneal cancer

Citation: Gynecologic Oncology. 2020, 159(3), 692-698. 2020, S0090-8258(20), 33958-5. Online ahead of print

Author: Hall MR(1), Dehbi HM(2), Banerjee S(3), Lord R(4), Clamp A(5), Ledermann JA(6), Nicum S(7), Lilleywhite R(8), Bowen R(9), Michael A(10), Feeney A(11), Glasspool R(12), Hackshaw A(13), Rustin G(14).

Abstract: Background: We investigated the safety and efficacy of a combination of the oral tyrosine kinase inhibitor, nintedanib (BIBF 1120) with oral cyclophosphamide in patients with relapsed ovarian cancer.

Patients and methods: Patients with relapsed ovarian, fallopian tube or primary peritoneal cancer received oral cyclophosphamide (100 mg o.d.) and were randomised (1,1) to also have either oral nintedanib or placebo. The primary endpoint was overall survival (OS). Secondary endpoints included progression free survival (PFS), response rate, toxicity, and quality of life.

Results: 117 patients were randomised, 3 did not start trial treatment, median age 64 years. Forty-five (39%) had received ≥5 lines chemotherapy. 30% had received prior bevacizumab. The median OS was 6.8 (nintedanib) versus 6.4 (placebo) months (hazard ratio 1.08; 95% confidence interval 0.72-1.62; P = 0.72). The 6-month PFS rate was 29.6% versus 22.8% (P = 0.57). Grade 3/4 adverse events occurred in 64% (nintedanib) versus 54% (placebo) of patients (P = 0.28); the most frequent G3/4 toxicities were lymphopenia (18.6% nintedanib versus 16.4% placebo), diarrhoea (13.6% versus 0%), neutropenia (11.9% versus 0%), fatigue (10.2% versus 9.1%), and vomiting (10.2% versus 7.3%). Patients who had received prior bevacizumab treatment had 52 days less time on treatment (P < 0.01). 26 patients (23%) took oral cyclophosphamide for ≥6 months. There were no differences in quality of life between treatment arms.

Conclusions: This is the largest reported cohort of patients with relapsed ovarian cancer treated with oral cyclophosphamide. Nintedanib did not improve outcomes when added to oral cyclophosphamide. Although not significant, more patients than expected remained on treatment for ≥6 months. This may reflect a higher proportion of patients with more indolent disease or the higher dose of cyclophosphamide used.

Clinical trial registration: Clinicaltrials.govNCT01610869.

Keywords: Late stage relapsed ovarian cancer; Nintedanib; Oral cyclophosphamide; Prior bevacizumab.

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CCC publication: Genomic profiles of de novo high and low-volume metastatic prostate cancer: Results from a 2-stage feasibility and prevalence study in the STAMPEDE trial

Citation: JCO Precision Oncology. 2020, 4, 882-897 

Author: Gilson C.; Ingleby F.; Gilbert D.C.; Atako N.B.; Gannon M.; Wanstall C.; Brawley C.; Amos C.; Parmar M.K.B.; Langley R.E.; Sydes M.R.; Parry M.A.; Attard G. (g.attard@ucl.ac.uk); Ali A.; Hoyle A.; Clarke N.W.; Mason M.D.; Parry-Jones A.; Malik Z.; Simmons A.; Loehr A.; Eeles R.; Kote-Jarai Z.; James N.D.; Chowdhury S.

WUTH publication: Prevalence and risk factors of depressive symptoms among dialysis patients with end-stage renal disease (ESRD) in Khartoum, Sudan: A cross-sectional study

Citation: Journal of Family Medicine and Primary Care. 2020, 9(7), 3639-3643
Author: Elkheir HK, Wagaella AS, Badi S, Khalil A, Elzubair TH, Khalil A, Ahmed MH

Abstract: Background: Depression is the most common prevalent psychiatric condition among patients with chronic kidney disease (CKD), and especially during dialysis. This study aimed to evaluate depression symptoms in Sudanese patients with end-stage renal diseases (ESRD) who undergo hemodialysis.

Methods: This is a case finding, hospital-based study recruited 75 patients on dialysis in Khartoum, Sudan. Data were analyzed by statistical package for social science (SPSS, version 23).

Results: The percentage of depression symptoms that satisfies the criteria for the diagnosis of major depression disorders in patients with ESRD undergoes dialysis was 68%. The new patients who undergo dialysis for less than 1 year had more depression symptoms (66.7%) than those on dialysis for 2-3 years (21.6%) or more than 3 years with a percentage of11.8%. Chi-square test showed significant associations between depression and age, the duration of dialysis, signs of significant weight loss when no dieting, and when the clinical symptoms related to distress or social or functional impairment (P = 0.016, 0.000, 0.004, and 0.000, respectively). Logistic regression test showed that age and duration of dialysis were significantly associated with depression with (odds ratios [OR]: 0.724, 0.211).

Conclusion: More than two-thirds of patients on dialysis have depressive symptoms. Risk factors associated with depression in Sudanese patients on dialysis were age, duration of dialysis, weight loss, and social and functional impairment. Future research is needed in order to assess the benefit of antidepressants in patients on dialysis. Family physicians should be aware of the association between depression and dialysis, in order to provide early treatment and prevent suicide.

Keywords: Depressive symptoms; Khartoum; Sudan; dialysis patients; end-stage renal disease (ESRD).

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WUTH publication: The Role of the Computed Tomography (CT) Thorax in the Diagnosis of COVID-19 for Patients Presenting with Acute Surgical Emergencies. A Single Institute Experience

Citation: The Indian Journal of Surgery. 2020 Oct 20, 1-6. Online ahead of print
Author: Majeed T, Ali RS, Solomon J, Mesri M, Sharma S, Shamim S, Aiynattu S, Ishak R, Wilson J, Magee C
Abstract: The current Coronavirus disease 2019 (COVID-19) pandemic has had a huge impact on emergency surgical services in the UK. The Royal College of Surgeons (RCS) published guidelines about COVID-19 pandemic in March, 2020 to aid decision making for the surgeons. These guidelines recommended that all patients requiring urgent surgery should have reverse transcriptase polymerase chain reaction (RT-PCR) and/or computed tomography (CT) thorax pre-operatively. However, it is currently unclear whether the use of CT thorax is a sensitive and specific diagnostic test. The objective of this study was to find out whether CT thorax is a reliable and accurate test in the diagnosis of COVID-19 compared to RT-PCR. This is particularly important in surgical patients where there is no time to wait for RT-PCR results. A prospective cohort study of patients presented with acute surgical emergencies at a University Teaching Hospital was conducted. Data was collected from March 23, to May 15, 2020, during the peak of the crisis in the UK. All adult patients presented with operable general surgical emergencies were considered eligible. Another group of patients, admitted with acute medical emergencies but with suspected COVID-19 infection, was used for comparison. Data was manually collected, and sensitivity, specificity and predictive value were calculated using the MedCalc statistical software version 19.2.6. Standard reporting for COVID-19 infection for CT chest based on guidelines from British Society of Thoracic Imaging (BSTI) and Radiological Society of North America (RSNA) was used. Patients who had their CT thorax reported as typical or classic of COVID 19 (high probability) were treated as infected cases with extra precautions in the wards and surgical theatres as suggested by health and safety executive (HSE). These patients had serial RT-PCR during their admissions or in the post-operative phase, if the first swab was negative. For the study, 259 patients were considered eligible for inclusion from both groups. Patients admitted for acute surgical emergencies were treated according to RCS guidelines and subjected to RT-PCR test and/or CT scan of the thorax. There were 207 patients with high clinical suspicion of COVID-19. Of those 207 patients, 77 patients had CT thorax with radiographic features consistent with COVID-19 pneumonia. However, only 40 patients had a positive RT-PCR result. CT thorax was normal in 130 patients, out of which 29 patients were found to have COVID-19 diagnosis after swab test. Sensitivity of CT scan to diagnose COVID-19 infection was found to be 58% (95% CI; 45.48% to 69.76%) whilst specificity was 73% (95% CI; 64.99% to 80.37%) with a negative predictive value of 77.69% (95% CI; 72.17% to 82.39%). CT scan was found to be a reliable tool in the diagnosis of COVID-19. With a negative predictive value of up to 82.4%, CT thorax can play an important role to help surgeons in their decision making for asymptomatic suspected cases of COVID-19. However, over-reliance on CT scan which also has a high false positive rate for diagnosis of COVID-19 infections can lead to overtreatment, overuse of resources and delays in decision-making process. Hence, results should be interpreted with caution and correlated with clinical presentation and swab test results.

Keywords: COVID-19; CT chest; Pandemic; RT-PCR; SARS-CoV-2; Surgery; Viral pneumonia.

Link to PubMed record

WUTH publication: Digital healthcare and shifting equipoise in radiation oncology: The butterfly effect of the COVID-19 pandemic

Citation: Journal of Medical Imaging and Radiation Sciences. 2021, 52(1), 11-13

Author: Boon IS, Lim JS, Au Yong TPT, Boon CS

Link to PubMed record

COVID-19 Information

The World Health Organization have written a very useful post on navigating the continuous stream of information regarding COVID-19.

https://www.who.int/news-room/spotlight/let-s-flatten-the-infodemic-curve

 

We are receive this information through multiple channels every day, and not all of it is reliable.

 

Includes info on the following:

 

·       Assessing the source

·       Going beyond the headlines

·       Identifying the author

·       Checking the date

·       Examining supporting evidence

·       Checking your biases

·       Consult a fact-checker

 

Our training sessions on ‘Finding the Evidence’ and ‘Critical Appraisal’ also give you the skills to quickly find and assess the evidence that you are reading.

 

If you are interested in booking a virtual training session, either 1:1 or for your team, please email us at wuth.lks@nhs.net