RSS 1.0Dudley Group NHS Foundation Trust
Based in the heart of the Black Country, The Dudley Group NHS Foundation Trust is the main provider of hospital and adult community services to the populations of Dudley. The Trust serves a population of around 450,000 people from three hospital sites at Russells Hall Hospital, Guest Outpatient Centre in Dudley, and Corbett Outpatient Centre in Stourbridge. The Trust provides the full range of secondary care services and some specialist services for the wider populations of the Black Country and West Midlands region. The Trust also provides specialist adult community-based care in patients’ homes and in more than 40 centres in the Dudley Metropolitan Borough Council community. The purpose of our repository collection is to provide an index of Dudley Group staff publications, it will not focus on full text.
Sub-communities within this community
Recent Submissions
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Intracorporeal versus extracorporeal anastomosis in laparoscopic total gastrectomy: a systematic review and meta-analysisBackground: To evaluate outcomes of intracorporeal (IOJ) versus extracorporeal (EOJ) oesophagojejunostomy following laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer. Methods: A comprehensive search of various electronic databases was conducted. Comparative studies of IOJ versus EOJ following LTG in patients with gastric malignancy were included. Primary outcomes were anastomotic leak, anastomotic bleeding, and anastomotic stricture formation. Secondary outcomes included operative time, length of hospital stay (LOS), volume of intra-operative haemorrhage, number of harvested lymph nodes, time to flatus, time to soft diet, intra-abdominal infection, pulmonary infection, surgical site infection (SSI), duodenal stump leak, pancreatic fistula occurrence, postoperative ileus, re-operation, and mortality. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale was used to assess risk of bias. Results: Seventeen non-randomised studies enrolling 2,960 patients divided between an IOJ (n = 1430) and EOJ (n = 1530) group were included. IOJ was associated with significantly lower risk of anastomotic stricture (P = 0.01), volume of intra-operative bleeding (P = < 0.001), and SSI (P = 0.04) compared to EOJ. No difference was found in anastomotic leak (P = 0.93); anastomotic bleeding (P = 0.35); operative time (P = 0.63); LOS (P = 0.30); lymph node yield (P = 0.17); time to first flatus (P = 0.77); time to resumption of soft diet (P = 0.32); intra-abdominal infection (P = 0.22); pulmonary infection (P = 0.45); duodenal stump leak (P = 0.46); pancreatic fistula occurrence (P = 0.16); and paralytic ileus (P = 0.59), re-operation (P = 0.50), and mortality (P = 0.23) between the two groups. Conclusions: LTG for gastric malignancy with IOJ may be associated with lower risk of anastomotic stricture and SSI compared to the extracorporeal approach. However, future adequately powered randomized studies are needed to compare the two techniques.
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Spotlight on hypertension in the African ContinentNo abstract available.
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Disparity in endoscopic localisation of early distal colorectal cancers: a retrospective cohort analysis from a single institutionBackground: Accurate staging of distal colorectal cancers is paramount in guiding neoadjuvant therapy, peri-operative, and ostomy planning. Early colonic lesions can be difficult to visualise on computed tomography (CT) scans, with tumour location solely deduced via endoscopy with the potential for introducing error. We aimed to address the paucity in literature in this area and assessed the accuracy of radiological and endoscopic localisation of distal colorectal cancers. Methods: Retrospective analysis of an electronic database of patients at a large District General Hospital (DGH) diagnosed with distal colorectal cancer between January 2014 to January 2023 was performed. Patient demographics, investigations, endoscopic, and operative findings were analysed. Outcomes were assessed to determine disparities between pre-operative endoscopy and final tumour location. Results: A total of 212 patients were endoscopically diagnosed with distal sigmoid tumour. Of these, 207 (97.6%) had a CT scan performed with 25.1% (52/207) lesions not being identified on this imaging modality with the remainder (74.9%; 155/207) being reported as visible. 38.2% (79/207) of tumours were in the sigmoid colon, 17.4% (36/207) rectosigmoid, and 19.3% (40/207) in the rectum. Pre-operative magnetic resonance imaging (MRI) was performed in 42.5% (90/212) of cases showing 84 tumours: 6.0% (5/84) sigmoid colon, 9.5% (8/84) rectosigmoid and 83.3% (70/84) rectal cancers (upper: 34, mid-rectum: 26, low: 10), with one anal cancer. 42.3% (22/52) of patients with non-visible lesions on CT had MRI scans: 68.2% (15/22) had rectal cancer (upper: 10, mid-rectum: 4, low: 1). Of the 30 where MRI was not performed, 46.7% (14) had sigmoid cancer, 16.7% (5) rectosigmoid, and 33.3% (10) rectal intraoperatively. Overall, 30.7% (65/212) of patients reported as having a distal sigmoid lesion endoscopically in fact had rectal cancer intra-operatively (rectosigmoid lesions excluded). Conclusion: Endoscopic localisation of distal colorectal tumours can be unreliable for accurate staging and operative planning. A pre-operative MRI scan should be considered in such instances, and particularly for non-visible lesions on CT scan. This may improve peri-operative planning, staging accuracy and patient outcomes. Competing Interests: Declarations. Ethical approval: Approval from the local research committee was gained, and ethical approval was waived as the current study did not influence or alter the management course or treatment of any patients analysed. Competing interests: The authors declare no competing interests. � 2025. The Author(s).
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Comparison of a Novel Machine Learning-Based Clinical Query Platform With Traditional Guideline Searches for Hospital Emergencies: Prospective Pilot Study of User Experience and Time EfficiencyBackground: Emergency and acute medicine doctors require easily accessible evidence-based information to safely manage a wide range of clinical presentations. The inability to find evidence-based local guidelines on the trust's intranet leads to information retrieval from the World Wide Web. Artificial intelligence (AI) has the potential to make evidence-based information retrieval faster and easier. Objective: The aim of the study is to conduct a time-motion analysis, comparing cohorts of junior doctors using (1) an AI-supported search engine versus (2) the traditional hospital intranet. The study also aims to examine the impact of the AI-supported search engine on the duration of searches and workflow when seeking answers to clinical queries at the point of care. Methods: This pre- and postobservational study was conducted in 2 phases. In the first phase, clinical information searches by 10 doctors caring for acutely unwell patients in acute medicine were observed during 10 working days. Based on these findings and input from a focus group of 14 clinicians, an AI-supported, context-sensitive search engine was implemented. In the second phase, clinical practice was observed for 10 doctors for an additional 10 working days using the new search engine. Results: The hospital intranet group (n=10) had a median of 23 months of clinical experience, while the AI-supported search engine group (n=10) had a median of 54 months. Participants using the AI-supported engine conducted fewer searches. User satisfaction and query resolution rates were similar between the 2 phases. Searches with the AI-supported engine took 43 seconds longer on average. Clinicians rated the new app with a favorable Net Promoter Score of 20. Conclusions: We report a successful feasibility pilot of an AI-driven search engine for clinical guidelines. Further development of the engine including the incorporation of large language models might improve accuracy and speed. More research is required to establish clinical impact in different user groups. Focusing on new staff at beginning of their post might be the most suitable study design. � Hamza Ejaz, Hon Lung Keith Tsui, Mehul Patel, Luis Rafael Ulloa Paredes, Ellen Knights, Shah Bakht Aftab, Christian Peter Subbe. Originally published in JMIR Human Factors (https://humanfactors.jmir.org).
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Exploring outcomes of percutaneous endoscopic gastrostomy tubes following strokes, when the decision for insertion was made in a patient's best interest.Background: Percutaneous endoscopic gastrostomy (PEG) tube insertion decisions can be complex in incapacitated stroke patients, resulting in poor patient survival rates following the procedure. Aim: The aim of this study was to calculate the average length of survival of stroke patients with a PEG when a best interest decision (BID) was made, compared with when the patient consented (CS). Method: All PEGs inserted between 2020�2022 in an NHS Foundation Trust which serves 45 000 people in the West Midlands were identified through a review of electronic records. Collated data were analysed using SPSS software. Findings: Some 36 PEG procedures were performed in the study period, 16 CS and 20 BID (equalling 55.56% incapacitated stroke patients). CS patients had a mean survival of 271.3 days (P=0.001, standard deviation (SD) 138) and BID patients 245.8 days (P=0.001, SD 141.3), giving a 25.6-day difference. An effect size Cohen's d analysis with Hedges' correction for BID with lower correction was 0.98 (CI 95%), and for CS it was 1.04 (CI 95%). When using the upper interval data it was 2.33 BID (CI 95%) and for CS it was 2.66 (CI 95%). Conclusions: BID PEG tube insertions in incapacitated stroke patents demonstrated shorter survival times than in stroke patients able to consent to their PEG procedure.
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Identifying iNOS and glycogen as biomarkers for degenerated cerebellar purkinje cells in autism spectrum disorder: Protective effects of erythropoietin and zinc sulfateAutism spectrum disorder (ASD) is a collective neurodevelopmental disorder affecting young children and accounting for 1% of the world's population. The cerebellum is the major part of the human brain affected by ASD and is associated with a substantial reduction in the number of Purkinje cells. An association between ASD and the expression of the nitrosative stress biomarker inducible nitric oxide synthase (iNOS), as well as glycogen deposition in damaged Purkinje cells, has not been previously reported in the medical literature. To explore this correlation, young rats were injected with propionic acid (PPA) (500 mg/kg) for 5 days (model group), while the protection groups were treated with either erythropoietin (EPO, 5,000 U/kg) or 2 mg/kg zinc sulfate immediately after the PPA injections. ASD-like features were developed in the model group, as evidenced by cerebellum damage (degeneration of Purkinje cells) and cerebellar dysfunction (behavioral impairment). This study documented the exclusive expression of iNOS in the degenerated Purkinje cells, along with glycogen deposition in these cells. Additionally, PPA significantly (p < 0.001) modulated cerebellar tissue levels of mammalian target of rapamycin (mTOR), gamma-aminobutyric acid (GABA), GABAA receptor, serotonin, the marker of neuronal loss (calbindin D28K), and social interaction deficit. Some of these parameters were differentially protected by EPO and zinc sulfate, with the former providing greater protection than zinc sulfate. Furthermore, a significant correlation between the iNOS score and these parameters associated with ASD was observed. These findings demonstrate the colocalization of iNOS and glycogen in the damaged Purkinje cells induced by ASD, along with the modulation of ASD parameters, which were protected by EPO and zinc sulfate treatments. Thus, these potential novel biomarkers may offer possible therapeutic targets for the treatment of ASD. Competing Interests: The authors have declared that no competing interests exist. Copyright: 2025 Al-Garni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Machine learning for refining interpretation of magnetic resonance imaging scans in the management of multiple sclerosis: a narrative review.Multiple sclerosis (MS) is an autoimmune disease of the brain and spinal cord with both inflammatory and neurodegenerative features. Although advances in imaging techniques, particularly magnetic resonance imaging (MRI), have improved the process of diagnosis, its cause is unknown, a cure remains elusive and the evidence base to guide treatment is lacking. Computational techniques like machine learning (ML) have started to be used to understand MS. Published MS MRI-based computational studies can be divided into five categories: automated diagnosis; differentiation between lesion types and/or MS stages; differential diagnosis; monitoring and predicting disease progression; and synthetic MRI dataset generation. Collectively, these approaches show promise in assisting with MS diagnosis, monitoring of disease activity and prediction of future progression, all potentially contributing to disease management. Analysis quality using ML is highly dependent on the dataset size and variability used for training. Wider public access would mean larger datasets for experimentation, resulting in higher-quality analysis, permitting for more conclusive research. This narrative review provides an outline of the fundamentals of MS pathology and pathogenesis, diagnostic techniques and data types in computational analysis, as well as collating literature pertaining to the application of computational techniques to MRI towards developing a better understanding of MS. Competing Interests: We declare we have no competing interests. � 2025 The Author(s).
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Feasibility of robotic surgery in elderly patients with rectal cancer: a meta-analysis.Rectal cancer's prevalence increases with an aging population, disproportionately affecting the elderly. The suitability of surgical interventions for this demographic is contentious due to underrepresentation during surgery. This study examines the practicality of utilizing Da Vinci surgery for rectal cancer patients who are 70 years and older. Information was gathered from PubMed, Embase, Scopus and the Cochrane Library, with a focus on English-language publications. Statistical analysis was performed using RevMan 5.4, presenting outcomes for categorical variables in risk ratios. Out of 890 patients across 5 studies, 240 were categorized as elderly, while 650 fell into the younger age group. Notable distinctions were noted in harvested lymph nodes, BMI, and postoperative outcomes, whereas factors like the length of hospital stay, Clavien-Dindo classification, and radial resection margin did not display significance. Although age increases postoperative risk, evidence emphasizes frailty, not age alone, as the primary determining factor.Copyright � 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
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Horizontally impacted second and third mandibular molars. A rare case, review of the literature and description of the surgical technique for removal.Horizontally impacted mandibular molars are not uncommon. However, we report a rare case of a horizontally impacted stacked second and third mandibular molar. This paper presents adaption of the principles of surgical exodontia to account for rare variations in abnormal anatomy and a review of the literature, weighing up the balance between orthodontic intervention and surgical removal. Successful removal depends on careful surgical planning and respect for the surrounding anatomical structures whilst following the principles of surgical exodontia.Copyright � 2025
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Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery: a prospective cohort study.Low intraabdominal pressure (IAP) during laparoscopy is associated with improved post-operative outcomes across a variety of surgical specialties. A prospective cohort study was undertaken to assess post-operative outcomes in patients undergoing laparoscopic colorectal surgery (LCRS) with low (8mmHg) versus conventional (15mmHg) IAP. A prospective real-world observational study of patients undergoing LCRS in a single-centre, between June 2020 and June 2023 was performed. Operative procedures for diverse colonic pathology such as diverticular disease, inflammatory bowel disease (IBD), and colorectal cancers (CRC) were included. The evaluated primary outcomes were post-operative pain, return of gastrointestinal motility, and length of hospital stay. Secondary outcomes were the overall safety profile including intra- and post-operative complications and morbidity. Outcomes of interest were investigated using multivariate analysis. Result(s): A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27 kg/m2 (24-32 kg/m2), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6 h (p < 0.001); reduced analgesic requirement (p <= 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381). Low IAP use during LCRS is feasible with a comparable safety profile to conventional laparoscopy. Intra-operative respiratory physiology is improved with reduced postoperative pain and analgesic requirement, and earlier time to pass flatus. Future rationally designed; well-powered, randomised trials are needed to understand the benefits of low intra-peritoneal pressure during laparoscopic colorectal resections.
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Artificial intelligence-based cardiovascular/stroke risk stratification in women affected by autoimmune disorders: a narrative survey.Women are disproportionately affected by chronic autoimmune diseases (AD) like systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis (RA), and Sjgren's syndrome. Traditional evaluations often underestimate the associated cardiovascular disease (CVD) and stroke risk in women having AD. Vitamin D deficiency increases susceptibility to these conditions. CVD risk prediction in AD can benefit from surrogate biomarker for coronary artery disease (CAD), such as carotid ultrasound. Due to non-linearity in the CVD risk stratification, we use artificial intelligence-based system using AD biomarkers and carotid ultrasound. Investigate the relationship between AD and CVD/stroke markers including autoantibody-influenced plaque load. Second, to study the surrogate biomarkers for the CAD and gather radiomics-based features such as carotid intima-media thickness (cIMT), and plaque area (PA). Third and final, explore the automated CVD/stroke risk identification using advanced machine learning (ML) and deep learning (DL) paradigms. Analysed biomarker data from women with AD, including carotid ultrasonography imaging, clinical parameters, autoantibody profiles, and vitamin D levels. Proposed artificial intelligence (AI) models to predict CVD/stroke risk accurately in AD for women. There is a strong association between AD duration and elevated cIMT/PA, with increased CVD risk linked to higher rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPAs) levels. AI models outperformed conventional methods by integrating imaging data and disorder-specific factors. Interdisciplinary collaboration is crucial for managing CVD/stroke in women with chronic autoimmune diseases. AI-based assisted risk stratification methods may improve treatment decision-making and cardiovascular outcomes. Competing Interests: Declarations. Conflict of interest: All authors are full-time employees at their indicated affiliation institutions, which are public universities and hospitals. None of the authors received fees, bonuses or other benefits for the work described in the manuscript. Ethical approval: Ethical clearance was obtained from the ethical committee of the University of Tours. All participants provided written informed consent for data collection and publication prior to data collection. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. We acknowledge that the manuscript was written and edited by authors only. 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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To improve the quality of e-discharge summaries for patients potentially in their last 12 months of life using the G.R.E.A.T toolIntroduction Concise e-discharge summaries undoubtedly support seamless transition to enable clear treatment plans and ensure that patient preferences considered wherever possible. 'Ambitions-for-Palliative-and-End-of-Life-Care' national guidelines emphasise the importance of well-coordinated care; a concise summary will enable this ambition to be fulfilled. Now, discharge summaries fall under the purview of the medical team and serve as primary documents for communicating a patient's care plan between settings. While sifting through patient records, doctors need to know which information to include, to ensure excellent follow-up. Setting Margaret Centre (MC) is an 11-bed specialist inpatient palliative care unit. In its 2021/22 annual report, 1 in 3 of all admissions were discharged to the community. The centre's vision is to provide 'specialist services without walls', achievable through healthy partnerships and collaborations at various levels. Method As part of the Gold standard formwork, we examined e-discharge summaries for all discharges from 1st January to 30th September 2022. We used the G.R.E.A.T tool, adapted from Dudley Group NHS. G.R.E.A.T is an acronym for G- GSF Code; R- resuscitation status; E- End-of-life care (EOLC) medications; AAdvance Care Planning (ACP)including the Urgent Care Plan (previously Coordinate-My-Care; and T - treatment escalation plan (TEP). Results Patients aged 60-102years. 20 males. All potentially within their last 12 months. 9 e-discharges were for Medical Outliers. These were excluded. 32 discharges from MC were to: nursing home (44%), home (38%), acute ward (9%), hospice (6%), and interim placement (3%). 4 discharges had no e-discharge summary. Of 28 patients with summaries: Patient GSF-code was recorded 36% summaries; resuscitation status 43%; present/ absent EOLC medications 61%; inpatient ACP discussions 54%; TEP 50%. All five elements of G.R.E.A.T. present in only 25% of e-discharge summaries. Conclusion A quarter of e-discharge summaries on patients within the last 12 months of life, did not include any information regarding G.R.E.A.T. Junior doctors can be supported in this respect.
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The utility of novel accelerometer metrics for characterising clinical features in patients living with rheumatoid arthritis.Research-grade accelerometers are commonly used to measure physical activity (PA) in rheumatology research, demonstrating superior reliability and validity relative to self-report methods. Several accelerometers offer manufacturer software and embedded proprietary algorithms to reduce the complexities of data processing. However, algorithms vary between device brands, and hinder standardisation of data processing and analysis. Best practice in PA research is now therefore considered to be the collection and analysis of raw accelerometer data, to which transparent and replicable data transformation methods can be carried out post-processing. Novel metrics include average acceleration, intensity gradient, and MX metrics, which represent PA volume, intensity and patterns, and have not been examined in rheumatic diseases. To explore the utility of novel accelerometer metrics for characterising clinical features in Rheumatoid Arthritis (RA), i.e. disease activity and severity, cardiovascular disease (CVD) risk. People living with RA (n = 104) provided demographic data, medical history, a fasted blood sample, and completed the health assessment questionnaire (HAQ, disease severity). Disease activity was measured using the Disease Activity Score 28-CRP (DAS28-CRP), and CVD risk determined using the QRISK3. Participants wore a GT3X Actigraph accelerometer on their right hip for 7-days during waking hours. Accelerometer data were analysed using GGIR (v.2.1-1) to determine average acceleration (AA, mg, proxy for daily volume of PA), intensity gradient (IG = distribution of PA across the day) and MX metrics (acceleration above which a person's most active �X� mins are accumulated e.g., M5 = most active 5 mins). A higher AA and more positive IG indicate a favourable activity profile.�Statistical analyses:�Participants were grouped according to DAS28-CRP (remission = <2.6, low = 2.6 - 3.1, moderate = 3.2 � 5.1, high = >5.1) disease severity (HAQ; low = <1, moderate = 1 � 1.9, high = ?2) and QRISK3 (low = <10%, moderate = 10 - 19%, high = ?20%. Between group differences in AA and IG were analysed using analysis of variance, adjusted for accelerometer wear time. Radar plots were produced in R, to illustrate differences in MX metrics according to clinical features. Valid accelerometer data (?10 hr on ?4 days), were available for n = 102 participants (M �SD, AA = 13.7 �5.2 mg, IG = -2.91�.36). Participants in remission and with low CVD risk, demonstrated a better activity profile (i.e. [M �SE, all�p<.05] significantly higher AA [DAS28-CRP = 17.9 �1.1; QRISK3 = AA = 15.4 �0.6] and more positive IG [DAS28-CRP = -2.62 �0/07, QRISK3 = 2.80 �0.04], compared to patients with moderate or high disease activity and CVD risk (DAS28-CRP [moderate, AA = 12.8 �0.6, IG = -2.99�.04] and [high, AA = 11.2 �1.1, IG = -3.07�.08], QRISK3 [moderate, AA = 12.0 �1.0; IG = -3.0 �0.07] and [high AA = 10.3 �1.1; IG = -3.16 �0.08]). For disease severity IG was significantly more positive in patients with low (-2.78 �0.05) vs. high (-3.10 �0.08) HAQ scores. Radar plots (Figure 1) showed the intensity of the most active accumulated 2-45 mins (M2-M45) was greater (with M10 exceeding 75mg) among participants with better disease profiles (i.e. remission/low DAS28-CRP, HAQ and QRISK3 scores vs. moderate/high). This is the first study to demonstrate the clinical utility of novel accelerometer metrics in RA. Results suggest higher AA, more positive IGs, and accumulating ?10 mins at an intensity indicative of a slow walk (M10 >75mg), is characteristic of more favourable disease profiles. Future studies utilising these raw accelerometer metrics could provide valuable, standardised accelerometer data that can be used to deliver more personalised care (i.e. precision medicine).
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Systematic review of groin wound surgical site infection incidence after arterial intervention.The objectives were to determine the surgical site infection incidence (including superficial/deep) fter arterial intervention through non?infected groin incisions and identify variables associated with incidence. MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled trials and observational studies of adults undergoing arterial intervention through a groin incision and reported surgical site infection. Infection incidence was examined in subgroups, variables were subjected to meta?regression. One hundred seventeen studies reporting 65 138 groin incisions in 42 347 patients were included. Overall surgical site infection incidence per incision was 8.1% (1730/21 431): 6.3% (804/12 786) were superficial and 1.9% (241/12 863) were deep. Superficial infection incidence was higher in randomised controlled trials (15.8% [278/1762]) compared with observational studies (4.8% [526/11 024]); deep infection incidence was similar (1.7% (30/1762) and 1.9% (211/11 101) respectively). Aneurysmal pathology (? = ?10.229, P <.001) and retrospective observational design (? = ?1.118, P =.002) were associated with lower infection incidence. Surgical site infection being a primary outcome was associated with a higher incidence of surgical site infections (? = 3.429, P =.017). The three?fold higher incidence of superficial surgical site infection reported in randomised controlled trials may be because of a more robust clinical review of patients. These results should be considered when benchmarking practice and could inform future trial design.
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SeHCAT study: a useful tool to investigate chronic diarrhoea?Introduction The SeHCAT (tauroselcholic [75 selenium] acid) test is the investigation of choice for patients with suspected bile acid diarrhoea (BAD). NICE guidelines advocate against the routine use of SeHCAT for the diagnosis of BAD in patients with chronic diarrhoea of unknown cause.1 We aimed to evaluate the diagnostic yield of SeHCAT testing in relation to risk factors for BAD and assess the tolerability of cholestyramine as a first-line treatment. Methods Retrospective data was collected from 84 sequential patients who had undergone SeHCAT testing at Russells Hall Hospital between January 2022 and July 2022. Data on patient demographics, comorbidities, referral reason, outcome and treatment were collected from electronic records. BAD was defined as less than 15% retention of SeHCAT after 7 days and classified into three subtypes: type 1 (secondary to ileal disease/resection); type 2 (primary or idiopathic); and type 3 (secondary to other gastrointestinal disorders).2 Results Mean age at the time of SeHCAT scanning was 50.5 years. Male:female ratio was 1:2.5. The most common reason for referral was suspected BAD type 2 which accounted for 50.0% of all scans performed. of the 84 patients, 52.4% were diagnosed with BAD following SeHCAT. The mean bile acid retention score for all patients was 18.0%. of patients referred with suspected BAD type 1 and 3, 76.5% and 75.0% were positive, respectively. In patients referred with suspected BAD type 2, a positive scan was found in 33.0%. Cholestyramine was initiated as the first line treatment in 88.6% of cases with confirmed BAD. 23.1% of those commenced on cholestyramine had subsequently switched to colesevelam. Reasons included lack of availability of cholestyramine (66.7%), poor response (22.2%) and intolerable side effects (11.1%). Conclusions SeHCAT is a useful test to investigate chronic diarrhoea in patients with comorbidities related to the development of BAD types 1 and 3. Although patients without underlying risk factors for BAD represent the majority of referrals, the overall diagnostic yield of SeHCAT testing in this cohort is low. This supports current NICE recommendations against routine SeHCAT use. Furthermore, cholestyramine is generally well tolerated as a first line bile acid sequestrant, with the largest barrier to long term treatment being availability of this medication.
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MYC/BCL6 double hit lymphoma negative for t(3;8) bcl6A small proportion of large B cell non-Hodgkin lymphoma (NHL) has�MYC�and�BCL6�rearrangements, detectable by fluorescence in-situ hybridisation (FISH) break-apart probes. There are conflicting reports on the prognosis of this group. A proportion of them have a single�t(3;8)�BCL6
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Review of MND patients known to the specialist palliative care team to improve service provision.Introduction Dudley Group NHS Trust provides support to patients with a diagnosis of Motor Neurone Disease, working in conjunction with the Regional Specialist Motor Neurone Disease service based at University Hospital's Birmingham and Primary Care Serivces. Care is provided by the Specialist Palliative Care (SPC) department, Dudley Rehabilitation Service, Community Dietitians, Speech and Language services, and District Nursing. Currently all patients are discussed in a bimonthly MDT meeting attended by the MND CNS (from UHB) and health professionals from the SPC team, Dietician and Speech and Language Therapist. A review of MND patients known to the specialist palliative care team to see if any themes was carried out. Method Using a proforma a review of patients known to the Specialist Palliative team on the 5.4.22 and deaths during 2022 was carried out using Somerset where MDT and visits are recorded. Results Eighteen patients known to the specialist palliative care team during this period, 12 male and 6 female. Of the 18 patients 10 died during the review period (Jan - July 2022) with 6 dying at home and 4 in hospital. With regards to the hospital deaths 2 had no DNACPR or ACP in community and this was completed in hospital. Advance care planning discussions were documented for 9 of the patients. There was documentation that some of the patients were GSF blue and therefore, not commenced yet, however, for a number there was documentation that ACP discussions had been challenging. DNACPR in place for 11 of the 18, however for 3 of these were completed in hospital. Discussion This review has provided useful information regarding the challenge of Advance care planning and that 40% of deaths occurred in hospital. Next steps are to agree standards for referral, discharge and min review when on the caseload and who should be involved including nursing, medical and therapy.
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Review of patients known to community specialist palliative care team that are admitted to Dudley Group of Hospitals NHS FT.Introduction The Specialist Palliative Care team in Dudley is an integrated team and therefore, when patients known to the team are admitted to Russells Hall Hospital an email alert is triggered that the hospital team can process. Approximately 50% of the patients on the hospital caseload are patients known to the community part of the integrated team. Therefore, a review of these admissions was planned to identify any themes to improve patient outcomes. Method Review of March 2022 patients on the hospital caseload using proforma to capture information including diagnosis, reason for admission and if admission was organised by the specialist palliative care team. Results In March 2022 there were 24 admissions to Russells Hall Hospital for 19 patients known to the community team. Two patients had 3 admissions and 1 patient 2 admissions. Most patients had a cancer diagnosis. With regards to the admissions 5 were arranged by the community specialist palliative care team. The admissions were for a range of reasons including possible malignant spinal cord compression, chemotherapy side effects, symptoms including pain, nausea and vomiting and breathlessness that required further investigation. The minimum a patient should be seen in community known to the specialist palliative care team is monthly and of the admissions only 1 patient had not been seen within a month of admission. Discussion With the caseload held by the hospital team having approximately 50% of patients known to the community team this review has provided assurance that admissions were appropriate. Next steps include a review of criteria for prioritisation of patients either known to the integrated team or ward referrals and criteria for minimum number of visits including consideration of phase of illness supporting the need of specialist input.
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Biologic use regulates the impact of inflammation on ischemic cardiovascular risk in rheumatoid arthritis.Chronic inflammation contributes to enhanced cardiovascular risk in patients with rheumatoid arthritis (RA). Biologic disease modifying antirheumatic drugs (bDMARDs) have been shown to effectively control inflammation in many conventional synthetic DMARD non-responders and improve cardiovascular outcomes. We here explored whether baseline bDMARD use may influence the impact of disease activity and systemic inflammation on long-term cardiovascular risk in patients with RA. We studied 4370 patients with RA who were free of cardiovascular disease upon registration to�Annternational�Cardiovascular�Consortium for people with�RA�(ATACC-RA) and followed prospectively. Prespecified outcomes included (a) major adverse cardiovascular events (MACE) defined as non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death and (b) any ischemic cardiovascular events (CVE) comprising MACE, coronary revascularization, stable angina pectoris, transient ischemic attack and peripheral arterial disease with or without revascularization. Missing covariate data were imputed using multiple imputation with 10 repetitions. Multivariable Cox models stratified by center evaluated the impact of disease activity [based on 28 joint counts and C-reactive protein (DAS28-CRP)], systemic inflammation (CRP), bDMARD use and their respective interactions on CVE risk after adjusting for age, gender, hypertension, diabetes, family history of CAD, smoking and total cholesterol to high-density lipoprotein ratio. Two corroborating sensitivity analyses were performed; the first included patients enrolled in the cohort on or after January 1, 2000, when bDMARD use became more prevalent among enrollees. The second used inverse probability of treatment weights (IPTW) to balance differences in bDMARD treated and untreated patients. Throughout 26534 patient years of follow-up, 239 first MACE and 362 total ischemic CVE were recorded. Among bDMARD nonusers, incidence of MACE and any ischemic CVE was [9.3 (95% CI 8.2-10.6) and 14.2 (12.8-15.8) events/1000PY respectively. Corresponding rates for bDMARD users were [5.4 (95% CI 2.9-10.1) and 8.2 (5.0-13.6) events/1000PY respectively. In the entire cohort, DAS-28 CRP and CRP(ln) associated with greater risk of MACE [(adjusted hazards ratio [HR] 1.19 (95%CI 1.06-1.34), p=0.004 and HR 1.15 (1.02-1.28), p=0.017 respectively], while for all ischemic CVE the association was significant for DAS-28 CRP [adjusted HR 1.1 (95%CI 1.07 to 1.30)], but not CRP(ln) [HR 1.06 (0.97 to 1.16)]. In bDMARD nonusers at baseline, higher DAS28-CRP and CRP(ln) associated with greater risk of MACE [adjusted HR 1.21 (95%CI 1.07-1.37), p=0.002 and HR 1.16 (1.04-1.30), p=0.009 respectively]. However, this was not the case in bDMARD users [p-for-interaction= 0.017 and 0.011 correspondingly, Figure 1]. In contrast, no significant interaction between DAS28-CRP or CRP and bDMARD use on any ischemic CVE risk was observed (p-for-interaction= 0.167 and 0.237 respectively). Both sensitivity analyses yielded similar results. Higher disease activity and systemic inflammation at baseline associated with greater risk of MACE in bDMARD nonusers but not in patients receiving bDMARDs. This may suggest the presence of additional bDMARD-specific benefits directly on atherosclerotic plaque �such as plaque stabilization[1]� above and beyond their effects on systemic inflammation.