WUTH publication: Neonatal Drug Formularies-A Global Scope

Citation: Children. 2023, 10(5)
Author: Shaniv D; Bolisetty S; Young TE; Mangum B; Ainsworth S; Elbers L; Schultz P; Cucchi M; de Wildt SN; van der Zanden TM; Caldwell N; Smits A; Allegaert K; 

Abstract: Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician's toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients.

WUTH publication: Efficacy of preoperative axillary ultrasound in excluding nodal disease in early breast cancer

Citation: European Journal of Surgical Oncology. 2023, 49(5), e250
Author: Javed, Nida; Iqbal, Ejaz; Afzal, Sidra; Parvaiz, Muhammad Asad; Rehman, Bushra 

WUTh publication: Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses

Citation: Annals of African medicine. 2023, 22(2), 189-203
Author: Adeleye QA; Ahmed PA; Babaniyi IB; Oniyangi O; Mukhtar-Yola M; Adelayo AY; Wey YO; Ononiwu UN; Sanni UA; Adeleye BB; Audu LI; 
Abstract: Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm.

Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses.

Materials and Methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds.

Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000).

Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial.

Competing Interests: None

WUTH publication: Bell's palsy

Citation: BMJ Publishing Group. 2023
Author: Matthew Q. Miller MD; Liliana Ein MD

WUTH publication: Patient preference for commonly-used, head and neck cancer-specific quality of life questionnaires in the follow-up setting (Determin): A multi-centre randomised controlled trial and mixed methods study

Citation: Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2023 Apr 04.
Author: Mehanna H; Carter B; Hartley A; Abou-Foul AK; Brooks J; Jones J; Fresco L; Moss L; Jones TM; Rogers SN; Morton RP; 
Abstract: Background: Quality of life (QoL) assessment forms an integral part of modern cancer care and research. The aim of this study is to determine patients' preferences and willingness to complete commonly used head-and-neck cancer (HNC) QoL questionnaires (QLQs) in routine follow-up clinics.
Methods: This is a randomised control trial of 583 subjects from 17 centres during follow-up after treatment for oral, oropharyngeal or laryngeal cancer. Subjects completed three structured validated questionnaires: EORTC QLQ-HN35; FACT-HN and UW-QOL, and an unstructured patient-generated list. The order of questionnaire presentation was randomised, and subjects were stratified by disease site and stage. Patients self-rated the questionnaires they found most helpful to communicate their health concerns to their clinicians.
Results: Of the 558 respondents, 82% (457) found QLQs useful to communicate their health concerns to their clinician (OR = 15.76; 95% CI 10.83-22.94). Patients preferred the structured disease-specific instruments (OR 8.79; 95% CI 5.99-12.91), while the open list was the most disliked (OR = 4.25; 95% CI 3.04-5.94). There was no difference in preference by treatment modality. More women preferred the FACT-HN (OR = 3.01, 95% CI 1.05-8.62), and patients under 70 preferred EORTC QLQ-HN35 (OR = 3.14, 95% CI 1.3-7.59). However, only 55% of patients expressed preference to complete questionnaires routinely at the clinic.
Conclusions: Most patients found QLQs helpful during their follow-up and 55% supported routine questionnaires in follow-up clinics. Males and people over 70 years old were the least willing to complete the routine questionnaires and preferred shorter questionnaires (e.g., UW-QOL). Women preferred FACT-HN, and younger patients preferred EORTC QLQ-HN35. Reasons for the reluctance to complete questionnaires require elucidation.

WUTH publication: The Scare 2023 guideline: Updating consensus surgical case report (SCARE) guidelines

Citation: International journal of surgery. 2023 Apr 05
Author: Sohrabi C; Mathew G; Maria N; Kerwan A; Franchi T; Agha RA; 
Abstract: Background: The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons. This paper presents an update to these guidelines.
Materials and Methods: The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by email. An online survey was completed to indicate their agreement with the proposed changes to the guideline items.
Results: A total of 54 participants were invited to participate and 45 (83.3%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion within the updated guidelines.
Conclusion: Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centered care.

WUTH publication: Safety and feasibility of cardiopulmonary exercise testing in head and neck cancer survivors

Citation: Clinical physiology and functional imaging. 2023, 43(3), 170-80
Author: Cunha FA; Key A; Patterson JM; Rogers SN; 
Abstract: Purpose: Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels.
Methods: Fifty HaNC survivors [29 male; mean (SD) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire.
Results: Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (SD) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (p < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active.
Conclusion: These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.

WUTH publication: Intraoperative and early postoperative complications of reverse shoulder arthroplasty: A current concepts review

Citation: Journal of Orthopaedics. 2022, 35, 120-5
Author: David Hawkes, Steven Brookes-Fazakerley, Simon Robinson, Vijay Bhalaik

WUTH publication: Coronavirus in hip fractures (CHIP) 4 : has vaccination improved mortality outcomes in hip fracture patients?

Citation: Bone Joint Journal. 2022, 104-B(12), 1362-8
Author: Fatima Rashid, Aatif Mahmood, David H. Hawkes, William J. Harrison

WUTH publication: The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation

Citation: Diabetes therapy: research, treatment and education of diabetes and related disorders. 2023, 14(4), 691-707
Author: Holland D; Heald AH; Hanna FFW; Wu P; Sim J; Duff CJ; Duce H; Green L; Scargill J; Howe JD; Robinson S; Halsall I; Gaskell N; Davison A; Simms M; Denny A; Langan M; Fryer AA; 
Abstract: Introduction: Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics.

Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics.

Results: In April 2020, monthly requests dropped to 7.9-18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7-86.9% of 2019 levels. During April-June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4-63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April-June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April-June 2020; trend test p < 0.001) and two subsequent periods (July-September and October-December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group.

Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59-86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality.