Wednesday, 28 February 2018
NHS welcomes record high recovery rate for common mental illness
New data published today show that a record number of people made a recovery from mental ill health, due to NHS talking therapies last year. The annual report on NHS England’s Improving Access to Talking Therapies (IAPT) programme, shows that half of people completing a course of treatment for conditions including depression and anxiety, recovered from their condition. Click here for NHS England website
Choice In Mental Health Care
This guidance provides advice for commissioners, GPs and providers on how to implement patients’ legal rights to choose their care provider and the team they see for their mental health care. Click here for Kings Fund blog
Monday, 26 February 2018
Stop vilifying antidepressants – mental health is more complex than the “insteaders” think
Antidepressants work,” blared headlines about a new study published in medical journal The Lancet this week. Hundreds of millions of people live with depression. In a world where vaccines are viewed with suspicion and the internet overflows with dubious health advice “they don't want you to know”, The Lancet paper didn't end debate, it inflamed it. Read new Statesman article here
Hospital Patients with Dementia Twice as Likely to Return Within 30 Days
Older hospital patients with dementia are about twice as likely to return to the hospital within 30 days of discharge, compared to older adults without dementia, according to a new study published in the Journal of the American Geriatrics Society. Click here to read PsychCentral article
Antidepressant response within hours? Experts weigh evidence on ketamine as fast-acting treatment for depression
Recent studies suggest that ketamine, a widely used anesthetic agent, could offer a wholly new approach to treating severe depression -- producing an antidepressant response in hours rather than weeks. Experts weigh recent evidence on ketamine and related drugs for treating depression in two new published reviews. Read ScienceDaily article here
Wednesday, 21 February 2018
Troubled mum took own life after she stopped taking mental health meds due to weight gain
A young mum and much-loved fiancee took her own life after she stopped taking her anti-psychosis medication due to a self-esteem crisis. Click here to read metro article
Largest study of its kind finds alcohol use biggest risk factor for dementia
Alcohol use disorders are the most important preventable risk factors for the onset of all types of dementia, especially early-onset dementia. This according to a nationwide observational study of over one million adults diagnosed with dementia in France. Click here for ScienceDaily article
Tuesday, 20 February 2018
RCOT to host first ‘virtual’ conference
The Royal College of Occupational Therapists (RCOT) is delighted to announce it will be hosting its first ‘virtual’ conference on 27th February 2018. Click here for details
Monday, 19 February 2018
Dementia in Hospital
For a person with dementia a hospital stay is often confusing and frightening. Not knowing where you are, nothing familiar to hold on, lost & alone.
For the nurse, a patient with dementia means extra workload in a schedule that is already packed.
What to do and where to find the time? Click here for tips from FabNHSstuff
For the nurse, a patient with dementia means extra workload in a schedule that is already packed.
What to do and where to find the time? Click here for tips from FabNHSstuff
New Antipsychotic May Relieve Psychosis in Dementia Patients
A new atypical antipsychotic, known as pimavanserin (Nuplazid), has been shown to help relieve the terrifying symptoms of psychosis in Alzheimer’s disease without the devastating side effects often seen with current antipsychotics, according to new findings published in the journal Lancet Neurology. Click here to read PsychCentral article
Latest reports from the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO)
The reports set out the work of the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) during 2014 to 2017 and can be accessed at https://www.gov.uk/government/publications/sabto-annual-reports
A Royal Commission on the NHS: the remit
A Royal Commission on the NHS: the remit
This report sfrom the Centre for Policy Studies ets out how a Royal Commission can ensure the NHS delivers the best outcomes on a sustainable financial basis over the coming decades. It outlines the remit and priorities that such a Commission should adopt, in order to address the NHS's most important problems.
Get the report at http://cps.org.uk/files/reports/original/180112095030-NHSRoyalCommissionRemit.pdf
This report sfrom the Centre for Policy Studies ets out how a Royal Commission can ensure the NHS delivers the best outcomes on a sustainable financial basis over the coming decades. It outlines the remit and priorities that such a Commission should adopt, in order to address the NHS's most important problems.
Get the report at http://cps.org.uk/files/reports/original/180112095030-NHSRoyalCommissionRemit.pdf
Thursday, 15 February 2018
Approved mental health professionals: pressures might never have been greater
Community Care research reveals a continuing decline in AMHP numbers and increasing pressures in the profession including stress, burnout and recruitment problems. Click here to read CommunityCare article
Including Family in Caregiving Can Aid Healing, Reduce Readmissions
A new initiative led by Intermountain Healthcare allows family members of hospitalized patients to participate in their care, resulting in better healing and reduced readmission rates. Click here to read PsychCentral article
Wednesday, 14 February 2018
Uncertain benefits of BNP blood tests to monitor heart failure treatment
In specialist clinics, using B-type natriuretic peptide (BNP) blood levels to guide treatment in people with chronic heart failure shows promise but did not improve survival for all groups. In this review, the benefit was only seen in patients aged less than 75, who survived an extra 1.5 years on average, and possibly those with poor heart function (reduced ejection fraction). However, there was a reduction in hospital admissions for heart failure for everyone.
BNP is a hormone released from the heart muscle, and higher levels may indicate more severe disease. It is currently used for diagnosis, but its use in monitoring treatment has become the subject of recent research interest.
From the NIHR Dissemination Centre
BNP is a hormone released from the heart muscle, and higher levels may indicate more severe disease. It is currently used for diagnosis, but its use in monitoring treatment has become the subject of recent research interest.
From the NIHR Dissemination Centre
NIHR Signal Quality improvement collaboratives can improve clinical processes and patient outcomes
Quality improvement collaboratives (QICs) were largely effective across a wide range of healthcare problems and settings. Of the 64 studies included in this systematic review, 53 showed improvement in some of the healthcare processes and patient outcomes that they investigated. A small number of studies also showed that collaboratives were cost-effective, and the improvements were sustainable for at least six months.
Collaboratives originated in the US in the late 1980s. They provide opportunities for teams from different sites to learn from each other and jointly develop improvement initiatives around specific topics, often using a standard method and framework. They have become increasingly popular without strong evidence to support their use.
From the NIHR Dissemination Centre
Collaboratives originated in the US in the late 1980s. They provide opportunities for teams from different sites to learn from each other and jointly develop improvement initiatives around specific topics, often using a standard method and framework. They have become increasingly popular without strong evidence to support their use.
From the NIHR Dissemination Centre
NIHR Signal Being overweight or having diabetes are both linked to cancer
For western high-income countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a Body Mass Index [BMI] greater than 25). A high BMI was responsible for almost twice as many cancers as diabetes
.
Around 5.6% of cancers globally in 2012 were attributable to diabetes or high BMI. Because obesity is increasing globally, this number may rise by 25% by 2035.
From the NIHR Dissemination Centre
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Around 5.6% of cancers globally in 2012 were attributable to diabetes or high BMI. Because obesity is increasing globally, this number may rise by 25% by 2035.
From the NIHR Dissemination Centre
NIHR Signal Delayed umbilical cord clamping reduces hospital mortality for preterm infants
Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%.
This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.
From the NIHR Dissemination Centre
This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.
From the NIHR Dissemination Centre
NIHR Signal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation
In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
Strimvelis for treating adenosine deaminase deficiency–severe combined immunodeficiency [HST7]
New: Highly specialised technologies guidance
Strimvelis is recommended, within its marketing authorisation, as an option for treating adenosine deaminase deficiency–severe combined immunodeficiency (ADA–SCID) when no suitable human leukocyte antigen-matched related stem cell donor is available.
Strimvelis is recommended, within its marketing authorisation, as an option for treating adenosine deaminase deficiency–severe combined immunodeficiency (ADA–SCID) when no suitable human leukocyte antigen-matched related stem cell donor is available.
Pancreatic cancer in adults: diagnosis and management [NG85]
New: Nice Guideline
This guideline covers diagnosing and managing pancreatic cancer in adults aged 18 and over. It aims to improve care by ensuring quicker and more accurate diagnosis, and by specifying the most effective treatments for people depending on how advanced their cancer is.
1.1 Diagnosis
1.2 Specialist pancreatic multidisciplinary teams
1.3 Staging
1.4 Psychological support
1.5 Pain management
1.6 Nutritional management
1.7 Relieving biliary and duodenal obstruction
1.8 Managing resectable and borderline resectable pancreatic cancer
1.9 Managing unresectable pancreatic cancer
This guideline covers diagnosing and managing pancreatic cancer in adults aged 18 and over. It aims to improve care by ensuring quicker and more accurate diagnosis, and by specifying the most effective treatments for people depending on how advanced their cancer is.
This quality standard covers the management of Parkinson’s disease in adults. It does not include treatment of parkinsonism not caused by Parkinson’s disease. It describes high-quality care in priority areas for improvement.[QS164]
New: Quality standard
This quality standard covers the management of Parkinson’s disease in adults. It does not include treatment of parkinsonism not caused by Parkinson’s disease. It describes high-quality care in priority areas for improvement.
This quality standard covers the management of Parkinson’s disease in adults. It does not include treatment of parkinsonism not caused by Parkinson’s disease. It describes high-quality care in priority areas for improvement.
Lesinurad for treating chronic hyperuricaemia in people with gout [TA506]
New: Technology appraisal guidance
Lesinurad is not recommended within its marketing authorisation, that is, with a xanthine oxidase inhibitor for treating hyperuricaemia in adults with gout whose serum uric acid is above the target level despite an adequate dose of a xanthine oxidase inhibitor alone.
This recommendation is not intended to affect treatment with lesinurad that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Lesinurad is not recommended within its marketing authorisation, that is, with a xanthine oxidase inhibitor for treating hyperuricaemia in adults with gout whose serum uric acid is above the target level despite an adequate dose of a xanthine oxidase inhibitor alone.
This recommendation is not intended to affect treatment with lesinurad that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Promising approaches to living well with dementia
Promising approaches to living well with dementia
Age UK report outlines a number of scalable and cost-effective interventions that can help to support people with dementia. It includes case studies of services and projects that support wellbeing and living well for people with dementia.
Get a PDF of the report at https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health--wellbeing/rb_feb2018_promising_approaches_to_living_well_with_dementia_report.pdf
Age UK report outlines a number of scalable and cost-effective interventions that can help to support people with dementia. It includes case studies of services and projects that support wellbeing and living well for people with dementia.
Get a PDF of the report at https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health--wellbeing/rb_feb2018_promising_approaches_to_living_well_with_dementia_report.pdf
Physios in Valentine's campaign to encourage men and women to ‘pucker up’
Physiotherapists are using Valentine’s Day to highlight that pelvic floor training is not just for bladder problems but also for sexual function.
Read more about the Chartered Society of Physiotherapy campaign at http://www.csp.org.uk/news/2018/02/13/physios-valentines-campaign-encourage-men-women-pucker
Read more about the Chartered Society of Physiotherapy campaign at http://www.csp.org.uk/news/2018/02/13/physios-valentines-campaign-encourage-men-women-pucker
Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma [TA504]
New: Technology appraisal guidance
Ixazomib, with lenalidomide and dexamethasone, is recommended for use within the Cancer Drugs Fund as an option for treating multiple myeloma in adults only if:
Ixazomib, with lenalidomide and dexamethasone, is recommended for use within the Cancer Drugs Fund as an option for treating multiple myeloma in adults only if:
- they have already had 2 or 3 lines of therapy and
- the conditions in the managed access agreement for ixazomib are followed.
This recommendation is not intended to affect treatment with ixazomib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Tuesday, 13 February 2018
NHS England annual accountability statements
NHS England's performance measured against the NHS public health functions agreement. Updated 8 February 2018
Full details available at https://www.gov.uk/government/publications/nhs-england-annual-accountability-statements
Academy of the Medical Royal Colleges / CoPMED statement on reflective practice
The Academy/CoPMED statement on reflective practice is now available to download from http://www.aomrc.org.uk/statements/academycopmed-statement-reflective-practice/
Help available for Worcestershire youngsters during Children's Mental Health Awareness Week
WORCESTERSHIRE Health and Care NHS Trust – the main providers of mental health within the county – is reminding young people who may be living with mental health issues, and their families, of the help that is available to them early, to prevent issues getting worse. Read newspaper article here
Pets Can Help People Manage Mental Health
A new study from the U.K. is one of the first to review evidence on how a companion animal or pet can help a person manage their mental health. Read PsychCentral article here
Sibling bullying makes psychotic disorders three times more likely
People who were bullied by siblings during childhood are up to three times more likely to develop psychotic disorders such as schizophrenia in early adulthood, according to new research. The researchers found that the more frequently children are involved in sibling bullying -- either as bully, victim, or both -- the more likely they are to develop a psychotic disorder. View article from ScienceDaily here
Hand surgery: Applications for Travelling Fellowship now open
Applications for Travelling Fellowship now open!
A new award has been created to facilitate trainee involvement in Global Hand Surgery and the work of the BSSH Overseas Committee. This will allow a trainee to accompany one of many BSSH overseas trips undertaken annually to observe and assist in clinics, theatre, and teaching delivery. Currently, there are ongoing projects in Malawi, Sierra Leone, Ethiopia, Sudan, Cambodia, Nepal, and Myanmar.
Find out more and get the expression of interest form at http://www.bssh.ac.uk/about/news/120/applications_for_travelling_fellowship_now_open
A new award has been created to facilitate trainee involvement in Global Hand Surgery and the work of the BSSH Overseas Committee. This will allow a trainee to accompany one of many BSSH overseas trips undertaken annually to observe and assist in clinics, theatre, and teaching delivery. Currently, there are ongoing projects in Malawi, Sierra Leone, Ethiopia, Sudan, Cambodia, Nepal, and Myanmar.
Find out more and get the expression of interest form at http://www.bssh.ac.uk/about/news/120/applications_for_travelling_fellowship_now_open
Drug company says it will negotiate terms to allow children to access new treatment for rare genetic disorder
Drug company says it will negotiate terms to allow children to access new treatment for rare genetic disorder.
This preliminary decision, which is now the subject of public consultation until 5 March, comes as the company confirmed it is to negotiate with NHS England terms that could allow the drug to be made available while uncertainties in the evidence of its long term benefits are addressed.
Children with CLN2, which is also known as Batten Disease, live to between 8 years and early adolescence; the average life expectancy is 10 years. It is estimated that in the UK there are around 30 to 50 children living with the condition.
CLN2 is a progressive condition caused by the deficiency of the enzyme tripeptidyl peptidase 1. This results in the abnormal storage of proteins and lipids in neurons and other cells, preventing them from functioning normally.
Symptoms in children with CLN2 begin from around the age of 2 and can then progress rapidly with the onset of seizures, decline in speech, loss of mobility, involuntary muscle spasms, progressive dementia and visual impairment leading to blindness.
There is currently no cure or life-extending treatments for CLN2 and clinical management is limited to symptom relief and supportive and palliative care.
Costing over £500,000 for each year’s treatment, cerliponase alfa is an enzyme replacement therapy administered directly into the brain via a surgically implanted permanent access device.
See the full details from NICE at https://www.nice.org.uk/news/article/drug-company-says-it-will-negotiate-terms-to-allow-children-to-access-new-treatment-for-rare-genetic-disorder
This preliminary decision, which is now the subject of public consultation until 5 March, comes as the company confirmed it is to negotiate with NHS England terms that could allow the drug to be made available while uncertainties in the evidence of its long term benefits are addressed.
Children with CLN2, which is also known as Batten Disease, live to between 8 years and early adolescence; the average life expectancy is 10 years. It is estimated that in the UK there are around 30 to 50 children living with the condition.
CLN2 is a progressive condition caused by the deficiency of the enzyme tripeptidyl peptidase 1. This results in the abnormal storage of proteins and lipids in neurons and other cells, preventing them from functioning normally.
Symptoms in children with CLN2 begin from around the age of 2 and can then progress rapidly with the onset of seizures, decline in speech, loss of mobility, involuntary muscle spasms, progressive dementia and visual impairment leading to blindness.
There is currently no cure or life-extending treatments for CLN2 and clinical management is limited to symptom relief and supportive and palliative care.
Costing over £500,000 for each year’s treatment, cerliponase alfa is an enzyme replacement therapy administered directly into the brain via a surgically implanted permanent access device.
See the full details from NICE at https://www.nice.org.uk/news/article/drug-company-says-it-will-negotiate-terms-to-allow-children-to-access-new-treatment-for-rare-genetic-disorder
Health care education funding for postgraduate, dental hygiene and dental therapy students
Department of Health and Social Care (DHSC) -
From August 2018 new postgraduate pre-registration nursing, midwifery, allied health professional, and most new dental hygiene and dental therapy students will access loans from the Student Loans Company. New DHSC guidance explains the changes in further detail.
Access the guidance at https://www.gov.uk/government/publications/healthcare-education-funding-for-postgraduate-and-dental-students/healthcare-education-funding-for-postgraduate-and-dental-students
From August 2018 new postgraduate pre-registration nursing, midwifery, allied health professional, and most new dental hygiene and dental therapy students will access loans from the Student Loans Company. New DHSC guidance explains the changes in further detail.
Access the guidance at https://www.gov.uk/government/publications/healthcare-education-funding-for-postgraduate-and-dental-students/healthcare-education-funding-for-postgraduate-and-dental-students
UHCW publication: Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids
Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids.
Jackisch L, Kumsaiyai W, Moore JD, Al-Daghri N, Kyrou I, Barber TM, Randeva H, Kumar S, Tripathi G, McTernan PG.
Diabetologia 2018 Feb 9. doi: 10.1007/s00125-018-4558-6. [Epub ahead of print]
Abstract
AIMS/HYPOTHESIS: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulatory macrophage-derived factor that increases with obesity and leads to a higher risk of cardiovascular disease (CVD). Despite this, its role in adipose tissue and the adipocyte is unknown. Therefore, the aims of this study were to clarify the expression of Lp-PLA2 in relation to different adipose tissue depots and type 2 diabetes, and ascertain whether markers of obesity and type 2 diabetes correlate with circulating Lp-PLA2. A final aim was to evaluate the effect of cholesterol on cellular Lp-PLA2 in an in vitro adipocyte model.METHODS: Analysis of anthropometric and biochemical variables from a cohort of lean (age 44.4 ± 6.2 years; BMI 22.15 ± 1.8 kg/m2, n = 23), overweight (age 45.4 ± 12.3 years; BMI 26.99 ± 1.5 kg/m2, n = 24), obese (age 49.0 ± 9.1 years; BMI 33.74 ± 3.3 kg/m2, n = 32) and type 2 diabetic women (age 53.0 ± 6.13 years; BMI 35.08 ± 8.6 kg/m2, n = 35), as part of an ethically approved study. Gene and protein expression of PLA2 and its isoforms were assessed in adipose tissue samples, with serum analysis undertaken to assess circulating Lp-PLA2 and its association with cardiometabolic risk markers. A human adipocyte cell model, Chub-S7, was used to address the intracellular change in Lp-PLA2 in adipocytes. RESULTS: Lp-PLA2 and calcium-independent PLA2 (iPLA2) isoforms were altered by adiposity, as shown by microarray analysis (p < 0.05). Type 2 diabetes status was also observed to significantly alter gene and protein levels of Lp-PLA2 in abdominal subcutaneous (AbdSc) (p < 0.01), but not omental, adipose tissue. Furthermore, multivariate stepwise regression analysis of circulating Lp-PLA2 and metabolic markers revealed that the greatest predictor of Lp-PLA2 in non-diabetic individuals was LDL-cholesterol (p = 0.004). Additionally, in people with type 2 diabetes, oxidised LDL (oxLDL), triacylglycerols and HDL-cholesterol appeared important predictors, accounting for 59.7% of the variance (p < 0.001). Subsequent in vitro studies determined human adipocytes to be a source of Lp-PLA2, as confirmed by mRNA expression, protein levels and immunochemistry. Further in vitro experiments revealed that treatment with LDL-cholesterol or oxLDL resulted in significant upregulation of Lp-PLA2, while inhibition of Lp-PLA2 reduced oxLDL production by 19.8% (p < 0.05).CONCLUSIONS/INTERPRETATION: Our study suggests adipose tissue and adipocytes are active sources of Lp-PLA2, with differential regulation by fat depot and metabolic state. Moreover, levels of circulating Lp-PLA2 appear to be influenced by unfavourable lipid profiles in type 2 diabetes, which may occur in part through regulation of LDL-cholesterol and oxLDL metabolism in adipocytes.
View details on PubMed at https://www.ncbi.nlm.nih.gov/pubmed/29427237
Jackisch L, Kumsaiyai W, Moore JD, Al-Daghri N, Kyrou I, Barber TM, Randeva H, Kumar S, Tripathi G, McTernan PG.
Diabetologia 2018 Feb 9. doi: 10.1007/s00125-018-4558-6. [Epub ahead of print]
Abstract
AIMS/HYPOTHESIS: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulatory macrophage-derived factor that increases with obesity and leads to a higher risk of cardiovascular disease (CVD). Despite this, its role in adipose tissue and the adipocyte is unknown. Therefore, the aims of this study were to clarify the expression of Lp-PLA2 in relation to different adipose tissue depots and type 2 diabetes, and ascertain whether markers of obesity and type 2 diabetes correlate with circulating Lp-PLA2. A final aim was to evaluate the effect of cholesterol on cellular Lp-PLA2 in an in vitro adipocyte model.METHODS: Analysis of anthropometric and biochemical variables from a cohort of lean (age 44.4 ± 6.2 years; BMI 22.15 ± 1.8 kg/m2, n = 23), overweight (age 45.4 ± 12.3 years; BMI 26.99 ± 1.5 kg/m2, n = 24), obese (age 49.0 ± 9.1 years; BMI 33.74 ± 3.3 kg/m2, n = 32) and type 2 diabetic women (age 53.0 ± 6.13 years; BMI 35.08 ± 8.6 kg/m2, n = 35), as part of an ethically approved study. Gene and protein expression of PLA2 and its isoforms were assessed in adipose tissue samples, with serum analysis undertaken to assess circulating Lp-PLA2 and its association with cardiometabolic risk markers. A human adipocyte cell model, Chub-S7, was used to address the intracellular change in Lp-PLA2 in adipocytes. RESULTS: Lp-PLA2 and calcium-independent PLA2 (iPLA2) isoforms were altered by adiposity, as shown by microarray analysis (p < 0.05). Type 2 diabetes status was also observed to significantly alter gene and protein levels of Lp-PLA2 in abdominal subcutaneous (AbdSc) (p < 0.01), but not omental, adipose tissue. Furthermore, multivariate stepwise regression analysis of circulating Lp-PLA2 and metabolic markers revealed that the greatest predictor of Lp-PLA2 in non-diabetic individuals was LDL-cholesterol (p = 0.004). Additionally, in people with type 2 diabetes, oxidised LDL (oxLDL), triacylglycerols and HDL-cholesterol appeared important predictors, accounting for 59.7% of the variance (p < 0.001). Subsequent in vitro studies determined human adipocytes to be a source of Lp-PLA2, as confirmed by mRNA expression, protein levels and immunochemistry. Further in vitro experiments revealed that treatment with LDL-cholesterol or oxLDL resulted in significant upregulation of Lp-PLA2, while inhibition of Lp-PLA2 reduced oxLDL production by 19.8% (p < 0.05).CONCLUSIONS/INTERPRETATION: Our study suggests adipose tissue and adipocytes are active sources of Lp-PLA2, with differential regulation by fat depot and metabolic state. Moreover, levels of circulating Lp-PLA2 appear to be influenced by unfavourable lipid profiles in type 2 diabetes, which may occur in part through regulation of LDL-cholesterol and oxLDL metabolism in adipocytes.
View details on PubMed at https://www.ncbi.nlm.nih.gov/pubmed/29427237
Monday, 12 February 2018
The Ageing Process And Health
This briefing summarises the evidence on the biological basis of ageing and outlines the ways in which public health policy can support better health in later life. Click here to view Kings Fund blog
Surviving stigma: an interview with a recovering addict
In this podcast, Diane Goslar, a recovering alcoholic, talks with brutal honesty about the stigma she faced among family, friends and work colleagues as she battled alcohol addiction. To view podcast from RCPsych click here
Friday, 9 February 2018
Birmingham kids with mental health problems face some of longest waits in UK
Children with mental health problems in parts of Birmingham face some of the longest waiting times for treatment in the country - more than five months on average.
There were 6,940 people under 18 in contact with mental health services across West Midlands metropolitan area between January and March last year, figures from NHS Digital reveal.
There were 6,940 people under 18 in contact with mental health services across West Midlands metropolitan area between January and March last year, figures from NHS Digital reveal.
Read newspaper article here
4 in 10 British parents indicate children are anxious about threat of terrorism
A survey of parents with children aged 5 to 18 has revealed that 41% of parents think their children are anxious about the threat of terrorism.
The YouGov survey of over 1,800 parents was commissioned by the Mental Health Foundation to uncover the impact world events could be having on children, and equip parents to respond. Click here for Mental Health Foundation article
The YouGov survey of over 1,800 parents was commissioned by the Mental Health Foundation to uncover the impact world events could be having on children, and equip parents to respond. Click here for Mental Health Foundation article
Thursday, 8 February 2018
PHE publishes independent expert e-cigarettes evidence review
A new Public Health England (PHE) e-cigarette evidence review, undertaken by leading independent tobacco experts, provides an update on PHE’s 2015 review. The main findings of PHE’s evidence review are that:
- vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits
- e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
- e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country
- many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
- there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
- the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
- the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked)
Latest NHS sickness absence statistics - September 2017
The latest figures released by NHS Digital show that for September 2017 NHS staff sickness absence was 3.99 per cent, which is the same as it was in September 2016.
Refreshing NHS plans for 2018/19
This guidance from NHS England, and published jointly with NHS Improvement, sets out the plans for the NHS in light of the November 2017 budget announcements. It outlines how the additional funding will impact on emergency and urgent care, elective surgery and other core frontline services such as mental health and primary care. It is accompanied by revised CCG allocations for the financial year 2018/19.
Investigation into clinical correspondence handling in the NHS
This National Audit Office report outlines the findings of an investigation into the backlog of unprocessed clinical correspondence discovered by NHS England in October 2017.
It sets out the responsibilities for redirecting clinical correspondence; the build-up of the backlog of clinical correspondence within Capita; and discusses the action taken by NHS England and Capita to investigate, understand and rectify the problem.
HPV vaccination programme for men who have sex with men
The government has confirmed that it will introduce a nationwide HPV vaccination programme for men aged 45 or younger who have sex with other men.
NHS England and Public Health England (PHE) will work to start the programme from April 2018, for those attending sexual health (GUM) clinics and HIV clinics in England.
NHS England and Public Health England (PHE) will work to start the programme from April 2018, for those attending sexual health (GUM) clinics and HIV clinics in England.
Guidance on menopause and the workplace
The Faculty of Occupational Medicine (FOM) has produced guidance on menopause and the workplace. It pulls together the latest information on how menopause affects some women at work.
The guidance is aimed at women going through menopause and offers employers practical guidance on how to improve workplace environments for them.
The guidance is aimed at women going through menopause and offers employers practical guidance on how to improve workplace environments for them.
Joint working protocol: when a hospital, services or facility closes at short notice
This document from NHS England provides guidance and direction to any organisation involved in a short notice closure to take appropriate and timely action in supporting patients and making sure they get the care and treatment they deserve.
Series of films to support overseas nurse transition
Health Education England (HEE) has launched a series of films for overseas nurses and their trainers to help support transition and integration into UK practice.
In and out of hospital
This report from the British Red Cross proposes introducing automatic home assessments and other simple interventions for elderly and vulnerable people who are often admitted to hospital to reduce avoidable hospital admissions in vulnerable patients. The report contains analysis of first-hand accounts of frontline health and care workers who argue that there are too many missed opportunities to prevent many of these avoidable admissions.
The risks to care quality and staff wellbeing of an NHS system under pressure
This report, written by the Picker Institute, in conjunction with The King's Fund, considers the relationships between the self-reported experiences and wellbeing of NHS staff, measures of workforce pressures in the health system, and patients’ experiences of their care. It uncovers striking associations between NHS staff and patients’ experiences in hospitals and NHS trusts’ reliance on agency health care workers.
First stroke estimates in England: 2007 to 2016
These reports from Public Health England use general practice data to estimate the incidence of first-ever strokes in England.
While the majority (59%) of strokes occur in the older generation, PHE’s figures also found that over a third (38%) of first time strokes happen in middle-aged adults (between the ages of 40 to 69). More first-time strokes are now occurring at an earlier age compared to a decade ago. The average age for males having a stroke fell from 71 to 68 years and for females, 75 to 73 years between 2007 and 2016.
UK strategy for rare diseases: implementation plan for England
Sets out the actions DHSC and partner organisations will take to implement the commitments under the UK strategy for rare diseases.
UHCW publication: Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma
Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma.
Chahal R, Mohite AA, Heimann H, Bansal A.
Abstract
Purpose: We report a previously unrecognised mechanism of secondary glaucoma due to iridescent crystalline particles released from an irradiated iris melanoma. It masqueraded as refractory hypertensive uveitis following uncomplicated phacoemulsification.
Methods: A 58-year-old gentleman had an iris melanoma that underwent successful regression following irradiation with proton beam radiotherapy (PBRT). Three years later an uncomplicated phacoemulsification with intraocular lens implant was performed and subsequently the patient presented with apparently “refractory hypertensive uveitis”. Closer examination identified unique iridescent crystalline particles originating from a disintegrating tumour and dispersing within the anterior chamber and drainage angle. The patient developed a unilateral secondary open angle glaucoma attributable to these particles. Ultrasound biomicroscopy (UBM) of the anterior segment confirmed absence of tumour recurrence or intra-scleral spread and systemic investigations ruled out distant metastases.
Results: The intra-ocular pressure (IOP) was refractory to maximal medical treatment, but was eventually controlled with trans-scleral diode laser cyclo-photocoagulation.
Conclusions: This is the first report of a secondary glaucoma attributable to trabecular blockage with iridescent crystalline particulate material released from a disintegrating, previously irradiated, iris melanoma. . PBRT and possibly phacoemulsification may have played a role in triggering the release of these previously undescribed particles from the atrophied tumour surface. This unique mechanism of secondary glaucoma needs to be kept in mind in such rare cases. Trans-scleral cyclodiode laser may be used as a good initial option in such cases to minimise potential risk of tumour seeding with incisional glaucoma surgery.
Full text available from Ovid (UHCW Athens login required) at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=ovft&AN=00061198-900000000-98515&PDF=y
Chahal R, Mohite AA, Heimann H, Bansal A.
Journal of Glaucoma: February 01, 2018 Publish Ahead of Print
doi: 10.1097/IJG.0000000000000891
doi: 10.1097/IJG.0000000000000891
Abstract
Purpose: We report a previously unrecognised mechanism of secondary glaucoma due to iridescent crystalline particles released from an irradiated iris melanoma. It masqueraded as refractory hypertensive uveitis following uncomplicated phacoemulsification.
Methods: A 58-year-old gentleman had an iris melanoma that underwent successful regression following irradiation with proton beam radiotherapy (PBRT). Three years later an uncomplicated phacoemulsification with intraocular lens implant was performed and subsequently the patient presented with apparently “refractory hypertensive uveitis”. Closer examination identified unique iridescent crystalline particles originating from a disintegrating tumour and dispersing within the anterior chamber and drainage angle. The patient developed a unilateral secondary open angle glaucoma attributable to these particles. Ultrasound biomicroscopy (UBM) of the anterior segment confirmed absence of tumour recurrence or intra-scleral spread and systemic investigations ruled out distant metastases.
Results: The intra-ocular pressure (IOP) was refractory to maximal medical treatment, but was eventually controlled with trans-scleral diode laser cyclo-photocoagulation.
Conclusions: This is the first report of a secondary glaucoma attributable to trabecular blockage with iridescent crystalline particulate material released from a disintegrating, previously irradiated, iris melanoma. . PBRT and possibly phacoemulsification may have played a role in triggering the release of these previously undescribed particles from the atrophied tumour surface. This unique mechanism of secondary glaucoma needs to be kept in mind in such rare cases. Trans-scleral cyclodiode laser may be used as a good initial option in such cases to minimise potential risk of tumour seeding with incisional glaucoma surgery.
Full text available from Ovid (UHCW Athens login required) at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=ovft&AN=00061198-900000000-98515&PDF=y
UHCW publication: Metabolic phenotype of male obesity-related secondary hypogonadism pre-replacement and post-replacement therapy with intra-muscular testosterone undecanoate therapy
Metabolic phenotype of male obesity-related secondary hypogonadism pre-replacement and post-replacement therapy with intra-muscular testosterone undecanoate therapy.
Endocrine. 2018 Feb 2. doi: 10.1007/s12020-017-1516-x
Abstract
AIM:
To explore the metabolic phenotype of obesity-related secondary hypogonadism (SH) in men pre-replacement and post-replacement therapy with long-acting intramuscular (IM) testosterone undecanoate (TU).
METHODS:
A prospective observational pilot study on metabolic effects of TU IM in male obesity-related SH (hypogonadal [HG] group, n = 13), including baseline comparisons with controls (eugonadal [EG] group, n = 15). Half the subjects (n = 7 in each group) had type 2 diabetes mellitus (T2D). Baseline metabolic assessment on Human Metabolism Research Unit: fasting blood samples; BodPod (body composition), and; whole-body indirect calorimetry. The HG group was treated with TU IM therapy for 6-29 months (mean 14.8-months [SD 8.7]), and assessment at the Human Metabolism Research Unit repeated. T-test comparisons were performed between baseline and follow-up data (HG group), and between baseline data (HG and EG groups). Data reported as mean (SD).
RESULTS:
Overall, TU IM therapy resulted in a statistically significant improvement in HbA1C (9 mmol/mol, P = 0.03), with 52% improvement in HOMA%B. Improvement in glycaemic control was driven by the HG subgroup with T2D, with 18 mmol/mol [P = 0.02] improvement in HbA1C. Following TU IM therapy, there was a statistically significant reduction in fat mass (3.5 Kg, P = 0.03) and increase in lean body mass (2.9 kg, P = 0.03). Lipid profiles and energy expenditure were unchanged following TU IM therapy. Comparisons between baseline data for HG and EG groups were equivalent apart from differences in testosterone, SHBG and basal metabolic rate (BMR).
CONCLUSION:
In men with obesity-related SH (including a subgroup with T2D), TU IM therapy improved glycaemic control, beta cell function, and body composition.
Open access full text available at: https://link.springer.com/article/10.1007/s12020-017-1516-x
Abstract
AIM:
To explore the metabolic phenotype of obesity-related secondary hypogonadism (SH) in men pre-replacement and post-replacement therapy with long-acting intramuscular (IM) testosterone undecanoate (TU).
METHODS:
A prospective observational pilot study on metabolic effects of TU IM in male obesity-related SH (hypogonadal [HG] group, n = 13), including baseline comparisons with controls (eugonadal [EG] group, n = 15). Half the subjects (n = 7 in each group) had type 2 diabetes mellitus (T2D). Baseline metabolic assessment on Human Metabolism Research Unit: fasting blood samples; BodPod (body composition), and; whole-body indirect calorimetry. The HG group was treated with TU IM therapy for 6-29 months (mean 14.8-months [SD 8.7]), and assessment at the Human Metabolism Research Unit repeated. T-test comparisons were performed between baseline and follow-up data (HG group), and between baseline data (HG and EG groups). Data reported as mean (SD).
RESULTS:
Overall, TU IM therapy resulted in a statistically significant improvement in HbA1C (9 mmol/mol, P = 0.03), with 52% improvement in HOMA%B. Improvement in glycaemic control was driven by the HG subgroup with T2D, with 18 mmol/mol [P = 0.02] improvement in HbA1C. Following TU IM therapy, there was a statistically significant reduction in fat mass (3.5 Kg, P = 0.03) and increase in lean body mass (2.9 kg, P = 0.03). Lipid profiles and energy expenditure were unchanged following TU IM therapy. Comparisons between baseline data for HG and EG groups were equivalent apart from differences in testosterone, SHBG and basal metabolic rate (BMR).
CONCLUSION:
In men with obesity-related SH (including a subgroup with T2D), TU IM therapy improved glycaemic control, beta cell function, and body composition.
Open access full text available at: https://link.springer.com/article/10.1007/s12020-017-1516-x
Wednesday, 7 February 2018
Public Health England launches opioid treatment quality improvement programme
PHE will work with drug treatment providers and service users to develop tools to improve the quality of substitution treatment. Click here to go to PHE webpage
Tuesday, 6 February 2018
Crenolanib for advanced or metastatic gastrointestinal stromal tumours (GISTs) with the D842V mutation in the PDGFRA gene
GISTs with D842V mutation in PDGFRA are usually resistant to the currently available targeted cancer drugs. Crenolanib is a medicine that specifically blocks the PDGFRA pathway involved in the production of blood vessels that supply the cancer cells, thereby preventing the cancer cells from growing and multiplying. It is being developed for the treatment of advanced or metastatic GISTs with D842V mutation in the PDGFRA gene. This drug is given by mouth. If licensed, crenolanib will offer an additional treatment option for this patient group, particularly those that do not respond to other treatments.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
NIHR Signal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis
The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less than 60 minutes.
This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins.
From the Dissemination Centre
This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins.
From the Dissemination Centre
Pirfenidone for treating idiopathic pulmonary fibrosis [TA 504]
New: Technology appraisal guidance
https://www.nice.org.uk/guidance/ta504Pirfenidone is recommended as an option for treating idiopathic pulmonary fibrosis in adults only if:
- the person has a forced vital capacity (FVC) between 50% and 80% predicted
- the company provides pirfenidone with the discount agreed in the patient access scheme and
- treatment is stopped if there is evidence of disease progression (an absolute decline of 10% or more in predicted FVC within any 12‑month period).
Pirfenidone (Esbriet, Roche) is an oral immunosuppressant with anti-inflammatory and antifibrotic effects.
Even Meditation Has Limitations
A new review of a variety of meditation studies suggests that while meditation has its benefits, its role in improving compassion may have been overstated. Read PsychCentral article here
Left To Chance: The Health And Care Nursing Workforce Supply In England
Royal College of Nursing report analyses UCAS data and finds that the number of applications for nursing degree courses has fallen by a third since 2016. It calls for a range of incentives to encourage people into nursing, Read King's Fund blog here
Reviewing medical manslaughter laws
GMC welcome the announcement by the Secretary of State to conduct a rapid review into whether gross negligence manslaughter laws are fit for purpose.
Charlie Massey, Chief Executive of the General Medical Council said:
‘We welcome the announcement today from the Secretary of State to conduct a rapid review into whether gross negligence manslaughter laws are fit for purpose in healthcare in England. The issues around GNM within healthcare have been present for a number of years, and we have been engaged in constructive discussions with medical leaders on this issue. Read GMC full response here
Memokath-051 stent for ureteric obstruction [MTG 35]
New: Medical technologies guidance
The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.
The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.
The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.
The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.
Slow growing mycobacteria: procedure for testing heater cooler units
This protocol provides guidance on how best to perform and process environmental water and air sampling, from heater-cooler units and environments where these units are in operation, in order to recover slow growing mycobacterial species.
The environmental samples referred to in this document are:
The environmental samples referred to in this document are:
- water samples from heater-cooler units (used in cardiopulmonary bypass surgery)
- air samples in environments where heater cooler units are in operation (in support of cardiopulmonary bypass surgery)
Monday, 5 February 2018
UHCW publication: Micro-CT for quantitative toolmark analysis of sharp force trauma to bone
The cutting edge - Micro-CT for quantitative toolmark analysis of sharp force trauma to bone.
Norman, D G; Watson, D G; Burnett, B; Fenne, P M; Williams, M A; et al.
Forensic science international 2018 February Vol. 283: 156-172.
Abstract
Toolmark analysis involves examining marks created on an object to identify the likely tool responsible for creating those marks (e.g., a knife). Although a potentially powerful forensic tool, knife mark analysis is still in its infancy and the validation of imaging techniques as well as quantitative approaches is ongoing. This study builds on previous work by simulating real-world stabbings experimentally and statistically exploring quantitative toolmark properties, such as cut mark angle captured by micro-CT imaging, to predict the knife responsible. In Experiment 1 a mechanical stab rig and two knives were used to create 14 knife cut marks on dry pig ribs. The toolmarks were laser and micro-CT scanned to allow for quantitative measurements of numerous toolmark properties. The findings from Experiment 1 demonstrated that both knives produced statistically different cut mark widths, wall angle and shapes. Experiment 2 examined knife marks created on fleshed pig torsos with conditions designed to better simulate real-world stabbings. Eight knives were used to generate 64 incision cut marks that were also micro-CT scanned. Statistical exploration of these cut marks suggested that knife type, serrated or plain, can be predicted from cut mark width and wall angle. Preliminary results suggest that knives type can be predicted from cut mark width, and that knife edge thickness correlates with cut mark width. An additional 16 cut marks walls were imaged for striation marks using scanning electron microscopy with results suggesting that this approach might not be useful for knife mark analysis. Results also indicated that observer judgements of cut mark shape were more consistent when rated from micro-CT images than light microscopy images. The potential to combine micro-CT data, medical grade CT data and photographs to develop highly realistic virtual models for visualisation and 3D printing is also demonstrated. This is the first study to statistically explore simulated real-world knife marks imaged by micro-CT to demonstrate the potential of quantitative approaches in knife mark analysis. Findings and methods presented in this study are relevant to both forensic toolmark researchers as well as practitioners. Limitations of the experimental methodologies and imaging techniques are discussed, and further work is recommended.
Full text available at
Norman, D G; Watson, D G; Burnett, B; Fenne, P M; Williams, M A; et al.
Forensic science international 2018 February Vol. 283: 156-172.
Abstract
Toolmark analysis involves examining marks created on an object to identify the likely tool responsible for creating those marks (e.g., a knife). Although a potentially powerful forensic tool, knife mark analysis is still in its infancy and the validation of imaging techniques as well as quantitative approaches is ongoing. This study builds on previous work by simulating real-world stabbings experimentally and statistically exploring quantitative toolmark properties, such as cut mark angle captured by micro-CT imaging, to predict the knife responsible. In Experiment 1 a mechanical stab rig and two knives were used to create 14 knife cut marks on dry pig ribs. The toolmarks were laser and micro-CT scanned to allow for quantitative measurements of numerous toolmark properties. The findings from Experiment 1 demonstrated that both knives produced statistically different cut mark widths, wall angle and shapes. Experiment 2 examined knife marks created on fleshed pig torsos with conditions designed to better simulate real-world stabbings. Eight knives were used to generate 64 incision cut marks that were also micro-CT scanned. Statistical exploration of these cut marks suggested that knife type, serrated or plain, can be predicted from cut mark width and wall angle. Preliminary results suggest that knives type can be predicted from cut mark width, and that knife edge thickness correlates with cut mark width. An additional 16 cut marks walls were imaged for striation marks using scanning electron microscopy with results suggesting that this approach might not be useful for knife mark analysis. Results also indicated that observer judgements of cut mark shape were more consistent when rated from micro-CT images than light microscopy images. The potential to combine micro-CT data, medical grade CT data and photographs to develop highly realistic virtual models for visualisation and 3D printing is also demonstrated. This is the first study to statistically explore simulated real-world knife marks imaged by micro-CT to demonstrate the potential of quantitative approaches in knife mark analysis. Findings and methods presented in this study are relevant to both forensic toolmark researchers as well as practitioners. Limitations of the experimental methodologies and imaging techniques are discussed, and further work is recommended.
Full text available at
UHCW publication: Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario
Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario.
C. F. Pairaudeau, C. Mendonca, C. Hillermann, I. Qazi, P. A. Baker, R. E. Hodgson, S. Radhakrishna
Anaesthesia 2018 Jan 19. doi: 10.1111/anae.14218
Abstract
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.
Full text PDF available at http://onlinelibrary.wiley.com/doi/10.1111/anae.14218/epdf (UHCW Athens login required)
C. F. Pairaudeau, C. Mendonca, C. Hillermann, I. Qazi, P. A. Baker, R. E. Hodgson, S. Radhakrishna
Anaesthesia 2018 Jan 19. doi: 10.1111/anae.14218
Abstract
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.
Full text PDF available at http://onlinelibrary.wiley.com/doi/10.1111/anae.14218/epdf (UHCW Athens login required)
UHCW publication: Hepatic amyloidosis: a cause of rapidly progressive jaundice
Images in ... Hepatic amyloidosis: a cause of rapidly progressive jaundice.
Mark Ford, Benjamin Disney, Veena Shinde, Sauid Ishaq.
BMJ Case Reports 2018; doi:10.1136/bcr-2017-222942
Full text available at http://casereports.bmj.com/content/2018/bcr-2017-222942.full (UHCW OpenAthens login required)
Mark Ford, Benjamin Disney, Veena Shinde, Sauid Ishaq.
BMJ Case Reports 2018; doi:10.1136/bcr-2017-222942
Full text available at http://casereports.bmj.com/content/2018/bcr-2017-222942.full (UHCW OpenAthens login required)
UHCW publication: pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment
A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1):56–63
Abstract
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1):56–63
Abstract
Aims: Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.
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Patients and Methods: A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions.
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Results: A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups.
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Conclusion: This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further.
Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00010&D=ovft&PDF=y (UHCW Athens login required)
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UHCW publication: Meniscal transplantation is beneficial at one year
Infographic: Meniscal transplantation is beneficial at one year.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1): 64–65
Menisci protect the knee joint from wear by distributing load, providing stability, and improving congruency. Partial and complete meniscectomies are widely performed for patients with meniscal tears that are not repairable, but meniscal loss increases contact pressures and predisposes patients to degenerative change. Meniscal allograft transplantation (MAT) aims to improve symptoms, increase function, and reduce the development of osteoarthritis in patients with a symptomatic, meniscal deficient knee. However, outcomes following MAT have never been definitively tested. We performed a comprehensive cohort study with a pilot randomized controlled trial (RCT) designed to assess the benefits of MAT over a programme of personalised physiotherapy. In this small study, we demonstrate that patients undergoing meniscal allograft transplantation using a ‘soft-tissue’ technique show better patient-reported outcome measures at one year. A long-term multicentre RCT is now required to confirm these promising early findings and to evaluate whether MAT can slow the progression to osteoarthritis and improve function in the long term.
Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00011&D=ovft&PDF=y (UHCW Athens login required)
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1): 64–65
Menisci protect the knee joint from wear by distributing load, providing stability, and improving congruency. Partial and complete meniscectomies are widely performed for patients with meniscal tears that are not repairable, but meniscal loss increases contact pressures and predisposes patients to degenerative change. Meniscal allograft transplantation (MAT) aims to improve symptoms, increase function, and reduce the development of osteoarthritis in patients with a symptomatic, meniscal deficient knee. However, outcomes following MAT have never been definitively tested. We performed a comprehensive cohort study with a pilot randomized controlled trial (RCT) designed to assess the benefits of MAT over a programme of personalised physiotherapy. In this small study, we demonstrate that patients undergoing meniscal allograft transplantation using a ‘soft-tissue’ technique show better patient-reported outcome measures at one year. A long-term multicentre RCT is now required to confirm these promising early findings and to evaluate whether MAT can slow the progression to osteoarthritis and improve function in the long term.
Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00011&D=ovft&PDF=y (UHCW Athens login required)
UHCW publication: Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers
Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers.
Smith, Darren A; Saranga, Jacob; Pritchard, Andrew; Kommatas, Nikolaos A; Punnoose, Shinu Kovelal; et al.
Journal of bodywork and movement therapies Vol. 22, Iss. 1, (January 2018): 13-17.
Abstract
Background
Mulligan's mobilisation-with-movement (MWM) techniques are proposed to achieve their clinical benefit via neurophysiological mechanisms. However, previous research has focussed on responses in the sympathetic nervous system only, and is not conclusive. An alternative measure of neurophysiological response to MWM is required to support or refute this mechanism of action. Recently, vibration threshold (VT) has been used to quantify changes in the sensory nervous system in patients experiencing musculoskeletal pain.
Objective
To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.
Methods
Fifteen asymptomatic volunteers participated in this single-blinded, randomised, within-subject, placebo, control design. Participants received each of three interventions in a randomised order; a lateral glide MWM of the hip joint into flexion, a placebo MWM, and a control intervention. Vibration threshold (VT) measures were taken at baseline and immediately after each intervention. Mean change in VT from baseline was calculated for each intervention and then analysed for between group differences using a one-way analysis of variance (ANOVA).
Results
A one-way ANOVA revealed no statistically significant differences between the three experimental conditions (P = 0.812).
Conclusion
This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.
Smith, Darren A; Saranga, Jacob; Pritchard, Andrew; Kommatas, Nikolaos A; Punnoose, Shinu Kovelal; et al.
Journal of bodywork and movement therapies Vol. 22, Iss. 1, (January 2018): 13-17.
Abstract
Background
Mulligan's mobilisation-with-movement (MWM) techniques are proposed to achieve their clinical benefit via neurophysiological mechanisms. However, previous research has focussed on responses in the sympathetic nervous system only, and is not conclusive. An alternative measure of neurophysiological response to MWM is required to support or refute this mechanism of action. Recently, vibration threshold (VT) has been used to quantify changes in the sensory nervous system in patients experiencing musculoskeletal pain.
Objective
To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.
Methods
Fifteen asymptomatic volunteers participated in this single-blinded, randomised, within-subject, placebo, control design. Participants received each of three interventions in a randomised order; a lateral glide MWM of the hip joint into flexion, a placebo MWM, and a control intervention. Vibration threshold (VT) measures were taken at baseline and immediately after each intervention. Mean change in VT from baseline was calculated for each intervention and then analysed for between group differences using a one-way analysis of variance (ANOVA).
Results
A one-way ANOVA revealed no statistically significant differences between the three experimental conditions (P = 0.812).
Conclusion
This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.
UHCW publication: subtle tardive dyskinesia with paliperidone palmitate
The importance of clinical observation: A case of subtle tardive dyskinesia with paliperidone palmitate.
Omer, Hisham; Thompson, Andrew D
Aust N Z J Psychiatry. 2018 Jan 1:4867417750758. doi: 10.1177/0004867417750758.[letter - no abstract available]
Omer, Hisham; Thompson, Andrew D
Aust N Z J Psychiatry. 2018 Jan 1:4867417750758. doi: 10.1177/0004867417750758.[letter - no abstract available]
Medical Students Who Engage in the Arts Make Better Doctors
A new study finds that students who devoted more time to the arts and humanities during medical school had significantly higher levels of positive physician attributes like empathy, tolerance of ambiguity, wisdom, and emotional intelligence, while at the same time reporting lower levels of adverse traits like burnout. Read PsychCentral article here
Better support needed for thousands of informal dementia carers
Directly involving the thousands of family members and friends who serve as 'informal carers' for people with dementia in the evaluation of patients' symptoms and behavior could offer improved insights for healthcare professionals and help alleviate feelings of stress, guilt and isolation felt by many who fulfill these duties, a new study has found. Click here for ScienceDaily article
UHCW publication: Gin, tonic water and the sun
Image Gallery: Gin, tonic water and the sun.
Chan SA, Shim TN
British journal of dermatology Vol. 177, Iss. 6, (December 2017): e349
Full text available at http://onlinelibrary.wiley.com/doi/10.1111/bjd.15891/epdf (UHCW Athens login required)
Chan SA, Shim TN
British journal of dermatology Vol. 177, Iss. 6, (December 2017): e349
Full text available at http://onlinelibrary.wiley.com/doi/10.1111/bjd.15891/epdf (UHCW Athens login required)
UHCW publication: Hemodynamic instability during dialysis
Hemodynamic instability during dialysis: is intra-dialytic exercise the answer?
Scott McGuire, Elizabeth Horton, Derek Renshaw, Alfonso Jimenez, Nithya S. Krishnan, Gordon McGregor
BioMed Research International 2018 Jan
Abstract
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intra-dialytic hypotension (IDH) can be as high as 20-30%, contributing to sub-clinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodelling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are sub-optimal. Whilst a programme of intra-dialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intra-dialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intra-dialytic exercise with a view to determining the potential for this non-medical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion and reduce cardiovascular morbidity and mortality in ESRD.
Full text PDF available at http://downloads.hindawi.com/journals/bmri/aip/8276912.pdf (free access)
Scott McGuire, Elizabeth Horton, Derek Renshaw, Alfonso Jimenez, Nithya S. Krishnan, Gordon McGregor
BioMed Research International 2018 Jan
Abstract
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intra-dialytic hypotension (IDH) can be as high as 20-30%, contributing to sub-clinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodelling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are sub-optimal. Whilst a programme of intra-dialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intra-dialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intra-dialytic exercise with a view to determining the potential for this non-medical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion and reduce cardiovascular morbidity and mortality in ESRD.
Full text PDF available at http://downloads.hindawi.com/journals/bmri/aip/8276912.pdf (free access)
UHCW publication: distant metastasis in colorectal cancer
Novel digital tissue phenotypic signatures of distant metastasis in colorectal cancer
Korsuk Sirinukunwattana, David Snead, David Epstein, Zia Aftab, Imaad Mujeeb, Yee Wah Tsang, Ian Cree, and Nasir Rajpoot
[no publication details given]
Abstract
Distant metastasis is the major cause of death in colorectal cancer (CRC). Patients at high risk of developing distant metastasis could benefit from appropriate adjuvant and follow-up treatments if stratified accurately at an early stage of the disease. Studies have increasingly recognized the role of diverse cellular components within the tumor microenvironment in the development and progression of CRC tumors. In this paper, we show that a new method of automated analysis of digitized images from colorectal cancer tissue slides can provide important estimates of distant metastasis-free survival (DMFS, the time before metastasis is first observed) on the basis of details of the microenvironment. Specifically, we determine what cell types are found in the vicinity of other cell types, and in what numbers, rather than concentrating exclusively on the cancerous cells. We then extract novel tissue phenotypic signatures using statistical measurements about tissue composition. Such signatures can underpin clinical decisions about the advisability of various types of adjuvant therapy.
PDF full text available at https://arxiv.org/pdf/1801.07451.pdf
Korsuk Sirinukunwattana, David Snead, David Epstein, Zia Aftab, Imaad Mujeeb, Yee Wah Tsang, Ian Cree, and Nasir Rajpoot
[no publication details given]
Abstract
Distant metastasis is the major cause of death in colorectal cancer (CRC). Patients at high risk of developing distant metastasis could benefit from appropriate adjuvant and follow-up treatments if stratified accurately at an early stage of the disease. Studies have increasingly recognized the role of diverse cellular components within the tumor microenvironment in the development and progression of CRC tumors. In this paper, we show that a new method of automated analysis of digitized images from colorectal cancer tissue slides can provide important estimates of distant metastasis-free survival (DMFS, the time before metastasis is first observed) on the basis of details of the microenvironment. Specifically, we determine what cell types are found in the vicinity of other cell types, and in what numbers, rather than concentrating exclusively on the cancerous cells. We then extract novel tissue phenotypic signatures using statistical measurements about tissue composition. Such signatures can underpin clinical decisions about the advisability of various types of adjuvant therapy.
PDF full text available at https://arxiv.org/pdf/1801.07451.pdf
UHCW publication: Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes
Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes
Weickert MO, Pfeiffer, AFH
The Journal of Nutrition, Volume 148, Issue 1, 1 January 2018, Pages 7–12
Abstract
Large prospective cohort studies consistently show associations of a high dietary fiber intake (>25 g/d in women and >38 g/d in men) with a 20–30% reduced risk of developing type 2 diabetes (T2D), after correction for confounders. It is less well recognized that these effects appear to be mainly driven by high intakes of whole grains and insoluble cereal fibers, which typically are nonviscous and do not relevantly influence postprandial glucose responses [i.e., glycemic index (GI)] or are strongly fermented by the gut microbiota in the colon. In contrast, a dietary focus on soluble, viscous, gel-forming, more readily fermentable fiber intakes derived from fruit and certain vegetables yields mixed results and generally does not appear to reduce T2D risk. Although disentangling types of fiber-rich foods and separating these from possible effects related to the GI is an obvious challenge, the common conclusion that key metabolic effects of high-fiber intake are explained by mechanisms that should mainly apply to the soluble, viscous type can be challenged. More recently, studies in humans and animal models focused on gaining mechanistic insights into why especially high-cereal-fiber (HCF) diets appear to improve insulin resistance (IR) and diabetes risk. Although effects of HCF diets on weight loss are only moderate and comparable to other types of dietary fibers, possible novel mechanisms have emerged, which include the prevention of the absorption of dietary protein and modulation of the amino acid metabolic signature. Here we provide an update of our previous review from 2008, with a focus on mechanistic insights of how HCF diets may improve IR and the risk of developing T2D.
Read the full article at https://academic.oup.com/jn/article/148/1/7/4823705 (free access)
Weickert MO, Pfeiffer, AFH
The Journal of Nutrition, Volume 148, Issue 1, 1 January 2018, Pages 7–12
Abstract
Large prospective cohort studies consistently show associations of a high dietary fiber intake (>25 g/d in women and >38 g/d in men) with a 20–30% reduced risk of developing type 2 diabetes (T2D), after correction for confounders. It is less well recognized that these effects appear to be mainly driven by high intakes of whole grains and insoluble cereal fibers, which typically are nonviscous and do not relevantly influence postprandial glucose responses [i.e., glycemic index (GI)] or are strongly fermented by the gut microbiota in the colon. In contrast, a dietary focus on soluble, viscous, gel-forming, more readily fermentable fiber intakes derived from fruit and certain vegetables yields mixed results and generally does not appear to reduce T2D risk. Although disentangling types of fiber-rich foods and separating these from possible effects related to the GI is an obvious challenge, the common conclusion that key metabolic effects of high-fiber intake are explained by mechanisms that should mainly apply to the soluble, viscous type can be challenged. More recently, studies in humans and animal models focused on gaining mechanistic insights into why especially high-cereal-fiber (HCF) diets appear to improve insulin resistance (IR) and diabetes risk. Although effects of HCF diets on weight loss are only moderate and comparable to other types of dietary fibers, possible novel mechanisms have emerged, which include the prevention of the absorption of dietary protein and modulation of the amino acid metabolic signature. Here we provide an update of our previous review from 2008, with a focus on mechanistic insights of how HCF diets may improve IR and the risk of developing T2D.
Read the full article at https://academic.oup.com/jn/article/148/1/7/4823705 (free access)
RSTN launches TRIGGER Trial
The Reconstructive Surgery Trials Network (RSTN) is leading the design of a trial of the treatment of trigger fingers in adults along with Dutch colleagues. We are looking for collaborators around the UK to coordinate a survey of practice as part of this.
We are also hosting a webinar to discuss the trial on 21st February, in conjunction with ICOPLAST.
To learn more, and to sign up for both, please visit: http://reconstructivesurgerytrials.net/trigger/
We are also hosting a webinar to discuss the trial on 21st February, in conjunction with ICOPLAST.
To learn more, and to sign up for both, please visit: http://reconstructivesurgerytrials.net/trigger/
Friday, 2 February 2018
UHCW publication: Clarithromycin as a steroid sparing agent for the management of infantile bullous pemphigoid
Clarithromycin as a steroid sparing agent for the management of infantile bullous pemphigoid Simon Tso, Gabriela Petrof, Simon Unter, Frances Humphreys
BMJ Case Reports 2018; doi:10.1136/bcr-2017-223507
http://casereports.bmj.com/content/2018/bcr-2017-223507.full
You can publish in BMJ Case Reports with the UHCW Fellowship Code. Ask in the CSB Library for more details.
BMJ Case Reports 2018; doi:10.1136/bcr-2017-223507
http://casereports.bmj.com/content/2018/bcr-2017-223507.full
You can publish in BMJ Case Reports with the UHCW Fellowship Code. Ask in the CSB Library for more details.
UHCW publication: gastric acid-reducing drugs following renal transplantation
Do stop me now: gastric acid-reducing drugs following renal transplantation
Full text available with UHCW Openathens login at https://www.magonlinelibrary.com/doi/10.12968/jokc.2018.3.1.6
I Held, R Pyart J Kidney Care 2018 Jan 3(1):6-13
Abstract
Proton pump inhibitors (PPIs) can counteract the risk of gastrointestinal bleeds, but can also be harmful. University Hospitals Coventry and Warwickshire NHS Trust's renal transplant drug protocol recommends that patients take omeprazole if they have a history of peptic ulcers or indigestion. Ines Held and Rhodri Pyart share the findings of two audits on PPIs in renal transplant patients.
Full text available with UHCW Openathens login at https://www.magonlinelibrary.com/doi/10.12968/jokc.2018.3.1.6
UHCW publication: Success rates and complications of eminectomies
Success rates and complications of eminectomies: a retrospective case series
Rahman, Z; Chand, M; Breeze, J; Stocker, J. Oral Surgery; Edinburgh Vol. 11, Iss. 1, (Feb 2018): 28-32.
Introduction
Eminectomy is the physical removal of the articular eminence to enable free movement of the condyle. The primary indication is to treat recurrent dislocation, although in the past it has been used for non-reducing disc displacement without reduction (NDDR). The established contraindication to the procedure is pneumatisation of the articular eminence or tubercle. Determining the success rates of eminectomies from previous papers are hampered by the lack of baseline objective measures needed to improve assessment of treatment outcomes.
Methodology
A retrospective case series was conducted, in which written and computerised hospital records and images were analysed from 2007 to 2014, using a minimum data set developed by our unit to assess outcomes. These included indication for procedure, frequency of dislocation, interincisal distance, pre-operative imaging and objective pain scoring.
Results
Twenty of twenty-eight (71%) patients receiving an eminectomy conformed to the minimum data set. Pain improvement was demonstrated in 60% of patients with both recurrent dislocation and NDDR. Complications occurred in 24% of eminectomies, all of which were temporary.
Conclusions
Eminectomy is a safe and effective procedure for management of chronic temporomandibular joint dislocation in well-selected cases. However, the results were less predictable with NDDR. The recording of specific clinical information is required to improve comparing outcomes and we would recommend the use of a proforma such as one utilised in our study. There was no evidence that pneumatisation of the eminence was related to an adverse clinical outcome but further evidence is required to question this as a contraindication to eminectomy.
Thursday, 1 February 2018
How Have Public Attitudes To The NHS Changed Over The Past Three Decades?
What can data from 23 years of the British Social Attitudes survey tell us about the public's relationship with the NHS and how it is viewed alongside other publicly funded services? We reflect on the top four issues. Click here for Kings Fund
Hunt urges NHS mental health units to prevent inpatient suicides
Health secretary to tell trusts that scores of suicides on NHS wards are due to ‘failure of care’ Click here to read newspaper article
Molecular secrets revealed: Antipsychotic docked in its receptor
Scientists have deciphered the molecular structure of a widely prescribed antipsychotic docked in its key receptor. They are hopeful that this discovery may hold secrets to designing better treatments for schizophrenia, bipolar disorder, and other mental illnesses. Click here to read article from ScienceDaily
Brexit And Mental Health
NHS Confederation -
This briefing outlines the possible implications of Brexit for the mental health sector. It focuses on the analysis relating to future workforce supply and legislation, research, regulation, cross border healthcare and public health. Click here for link to Kings Fund
This briefing outlines the possible implications of Brexit for the mental health sector. It focuses on the analysis relating to future workforce supply and legislation, research, regulation, cross border healthcare and public health. Click here for link to Kings Fund
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