WUTH publication: Neonatal IVC thrombosis in a baby born to an aPL positive mother – a case report

Citation: Lupus. 2023, 32(3), 441-43
Author: Ramakrishnan, Smriti; Abbas, Azhar; Jordan, Natasha
Abstract: Neonatal antiphospholipid syndrome (APS) is a rare condition that can occur due to either transplacental transfer of antiphospholipid antibodies (aPL) from the mother, or, more rarely, de novo in the infant.[1] The condition manifests as arterial, venous or mixed thromboses. In the present case, the mother had gestational hypertension, which may have acted as a risk factor for foetal thrombosis.[9] Although maternal hypertension has been found to be independently associated with foetal arterial thrombosis,[10] no such association has been found with venous thrombosis. In the present case, it is possible that gestational hypertension in combination with aPLs resulted in the formation of the IVC thrombosis, but further study is required to determine whether there is a consistent association between maternal hypertension and neonatal venous thrombosis. [Extracted from the article]

WUTH publication: Erratum to ‘Fractured epidural catheter with retained fragment in the epidural space—a case study and proposed management algorithm’ [BJAOpen 4 (2022) 100095]

Citation: BJA Open. 2023 March
Author: Gompels, Ben; Rusby, Tobin; Slater, Neil 

WUTH publication: Removal of breast implants as primary treatment for autoimmune/inflammatory syndrome induced by adjuvants

Citation: Scandinavian journal of rheumatology. 2023, 52(2), 219-20
Author: Ramakrishnan S; Abbas A; Jordan N; 

WUTH publication: Evaluation of Huawei smart wearables for detection of atrial fibrillation in patients following ischemic stroke: The Liverpool-Huawei stroke study

Citation: American heart journal. 2023, 257, 103-10
Author: Harrison SL; Buckley BJR; Zheng Y; Hill A; Hlaing T; Davies R; Guo Y; Lane DA; Lip GYH; 
Abstract: Background: Atrial fibrillation (AF) often remains undetected following stroke. Documenting AF is critical to initiate oral anticoagulation, which has proven benefit in reducing recurrent stroke and mortality in patients with AF. The accuracy and acceptability of using smart wearables to detect AF in patients following stroke is unknown.

Methods: The aims of the Liverpool-Huawei Stroke Study are to determine the effectiveness, cost-effectiveness and patient and staff acceptability of using Huawei smart wearables to detect AF following ischemic stroke. The study plans to recruit 1,000 adults aged ≥18 years following ischemic stroke from participating hospitals over 12 months. All participants will be asked to wear a Huawei smart band for 4 weeks postdischarge. If participants do not have access to a compatible smartphone required for the study, they will be provided with a smartphone for the 4-week AF monitoring period.

Results: Participants with suspected AF detected by the smart wearables, without previous known AF, will be referred for further evaluation. To determine the effectiveness of the Huawei smart wearables to detect AF, the positive predictive value will be determined. Patient acceptability of using this technology will also be examined. Additional follow-up assessments will be conducted at 6 and 12 months, and clinical outcomes recorded in relation to prevalent and incident AF post-stroke. The study opened for recruitment on May 30, 2022, and is currently open at 4 participating hospitals; the first 106 participants have been recruited. One further hospital is preparing to open for recruitment.

Conclusions: This prospective study will examine the effectiveness and acceptability of the use of smart wearables in patients following ischemic stroke. This could have important implications for detection of AF and therefore, earlier prophylaxis for recurrent stroke. The study is registered on https://www.isrctn.com/ (Identifier ISRCTN30693819).

WUTH publication: Addressing patients' concerns in speech and language therapy consultations following the diagnosis and treatment of head and neck cancer

Citation: Current opinion in otolaryngology & head and neck surgery. 2023 Mar 03
Author: Zuydam AC; Rogers SN; Roe JWG; 
Abstract: Purpose of Review: Head and neck cancer (HNC) and its treatment impacts profoundly on patients' functional abilities, emotional well being and social interactions. Communication and swallowing are fundamental to everyday life, and the Speech and Language Therapist (SLT) has a critical role for both patients and their carers. In clinical practice, patient-reported outcome measures (PROMs) are a key part of the armamentarium of the SLT. The purpose of the review is to summarize how these measures can be beneficial in the context of time pressured SLT outpatient consultations.

Recent Findings: Unmet needs in HNC are common and impact negatively on quality of life. There is an ever-increasing number of articles in this area, and it can be a challenge to identify, distil and summarize those specific to SLT.

Summary: In this review, we discuss the scope of holistic evaluation, strengths and limitations of PROMs, the Patient Concerns Inventory-Head and Neck, barriers to the use of outcome measures, the carers perspective and surveillance. SLT are uniquely placed members of the multidisciplinary team and provide expert advice and intervention. The inclusion of PROMs in routine consultations provides a model of follow up, which helps address patients and carers complex and unmet needs, ultimately promoting better outcomes.

WUTH publication: Development of the stroke patient concerns inventory: A modified Delphi study

Citation: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2023, 32(6), 107053. 
Author: Chesworth BM; Patel K; Redfern J; Watkins CL; Rogers SN; Hackett ML; Walker MF; Lightbody CE;
Abstract: Objectives: Stroke survivors often have unmet physical, psychological and/or social concerns. Patient Concerns Inventories (PCIs) have been developed for other health conditions to address concerns. Our objective was to develop a PCI for stroke care.

Methods: This was a development study, including Modified Delphi study design, with academic and healthcare professionals with stroke care expertise. In Stage 1, a draft Stroke PCI (Version 1a) was created through identifying patient-reported concerns post-stroke from three previous studies and through expert panel discussions using Nominal Group Technique. In Stage 2, Version 1a was sent to 92 academic and healthcare professionals with stroke care expertise. Participants ranked their top 20 Stroke PCI items in order of importance and provided feedback. Rankings were converted into scores, and, with the feedback, used to amend the Stroke PCI. Two further rounds of feedback followed until consensus was reached between participants. A final draft of the Stroke PCI was created.

Results: In stage 1, 64 potential Stroke PCI items were generated. In Stage 2, 38 participants (41.3%) responded to the request to rank Stroke PCI items. The three highest ranked items were 'Risk of another stroke', 'Walking', 'Recovery'. After three rounds of feedback and amendments, the final draft of the Stroke PCI consisted of 53 items.

Conclusions: A Stroke PCI has been developed using patient-reported concerns in previous studies and input from academic and healthcare professionals. Future work will involve gathering further feedback on the tool and exploring its acceptability and usability in a pilot study.

(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

WUTH publication: Challenges of Shared Decision-making by Clinicians and Patients With Low-risk Differentiated Thyroid Cancer: A Systematic Review and Meta-Ethnography

Citation: JAMA otolaryngology - head & neck surgery. 2023 Mar 23.
Author: Yang W; Lee YK; Lorgelly P; Rogers SN; Kim D
Abstract: Importance: Several international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient's values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise.

Objectives: To understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC.

Evidence Review: This systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis.

Findings: Of 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked.

Conclusions and Relevance: The findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC.

Trial Registration: PROSPERO Identifier: CRD42022286395.

WUTH publication: Factors that affect quality of life for older people with head and neck cancer: A systematic review

Citation: European Journal of Oncology Nursing April. 2023
Author: Semple, Cherith J. a; McKenna, Gerry b; Parahoo, Roisin a; Rogers, Simon N. c; Tiblom Ehrsson, Ylva d
Abstract: Purpose Quality of life is a critical aspect in the management of older head and neck cancer patients. It needs to be considered alongside survival benefit, treatment burden, and longer-term outcomes. The purpose was to undertake a systematic review of empirical peer-reviewed studies with a primary focus on factors impacting quality of life for older head and neck cancer patients.

Results Only 10 papers fulfilled the inclusion criteria. Two main themes emerged: 1) Impact of head and neck cancer on quality of life domains and 2) quality of life in treatment decision-making.

Conclusions In an era of progressive personalised care, there is an evident need for more qualitative and quantitative studies focusing on quality of life for older head and neck cancer patients. However, older head and neck cancer patients experience notable differences, especially with poorer physical functioning and greater eating and drinking challenges. Quality of life impacts older patients decision-making, treatment planning and intensifies post-treatment support.

@@@@Highlights •Management of older patients with head and neck cancer (HNC) is a source of much debate.•Older HNC patients have greater eating challenges, with higher enteral feeding requirement.•Older HNC patients seem to cope and adjust well to treatment, reflected in HRQoL scores.•Decision-making and treatment priorities often differ for older patients with HNC.•Necessity for future studies to enhance person-centred care for older patients with HNC