RSS 1.0South Warwickshire University NHS Foundation Trust
South Warwickshire University NHS Foundation Trust (SWFT) provides the hospital services to South Warwickshire from four hospitals: Warwick Hospital, Leamington Spa Hospital, Stratford Hospital, and Ellen Badger Hospital. We also deliver out-of-hospital community services to the whole of Warwickshire serving a population of more than half a million from various clinics. At South Warwickshire University NHS Foundation Trust, we are committed to operating a dynamic programme of clinical research to pave the way for new approaches to treatment and care. This community represents the research outputs of the entire Trust. The research is arranged under the existing organisational structure of the Trust.
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A-EQUIP : pilot to practice through partnership powerThis article chronicles the journey of the Coventry and Warwickshire A-EQUIP partnership; from undertaking the pilot phase of the new A-EQUIP model, through to a region-wide implementation. Partnership benefits include a 'critical friend' approach as well as shared learning and a wider appreciation of the challenges and successes touching midwives in maternity service delivery across the local patch. This partnership team is optimistic about the future benefits A-EQUIP will bring to midwives, women and babies in their area.
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‘INVENT’ – a collaborative regional multicentre service evaluation and audit of multiple pregnancies : preliminary results from three centresPoster abstract 2600 from the 2019 World Congress of the Royal College of Obstretriscians and Gynaecologists, RCOG 2019. London, United Kingdom.
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Accuracy of intraoperative diagnosis of appendicitis in laparoscopy. Should this affect decision for appendicectomyPoster presentation abstract 942 from the Association of Surgeons in Training (ASiT) Annual Conference 6th-8th March 2020, Birmingham International Convention Centre.
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Supporting children to prepare for the death of a parentPoster abstract P-2 from The Palliative Care Congress, Recovering, Rebounding, Reinventing, 24–25 March 2022, The Telford International Centre, Telford, Shropshire
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The National Joint Registry Data Quality Audit of elbow arthroplastyAims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow. Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them. Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties. Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.
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The West Midlands Evidence Repository (WMER) : a consortium project to connect NHS staff and the public with NHS research (presentation)The West Midlands Evidence Repository (WMER) represents a project which has connected a group of NHS libraries in a consortium. Prior to its establishment, four members of the consortium, from four Black Country Trusts, were part of the British Library national repository project aimed at NHS Trusts, which unfortunately was unsuccessful. Another Trust, from Birmingham, already had its own institutional repository, but this had come up for renewal. The WMER project was therefore established in 2022 to replace these repositories and create a new joint resource. This project represents a new endeavour for the now nine consortium libraries who have come together, requiring new learning and new ways of working. This presentation initially outlines how the consortium was formed, through to the establishment of managing WMER as business as usual and looking to take on new members. But what is WMER? Firstly, WMER is an institutional repository. It stores metadata and, depending on the individual Trust, full text of research outputs in electronic format. This can include formal journal articles, books, and book chapters, as well as grey literature which otherwise is often lost, such as reports, innovation projects, and conference proceedings. As an institutional repository, therefore, WMER allows for the collation of each organisation’s research in one place and archiving of full text of that research where applicable. However, WMER also allows access to that metadata and full text by sharing it publicly online. As a tool to connect people to research, the repository acts within the individual Trusts and the consortium as a knowledge mobilisation and staff awareness tool. Notably, it helps staff to connect to research both internally within their own Trust and externally to research from other organisations. In addition, WMER also enables staff to connect with fellow researchers. This has the potential to foster local and regional research cultures, and lead to collaborative research both within and across organisations. Furthermore, WMER allows the general public to connect with the research conducted within the consortium organisations. This means there is accountability for how public money is spent, but also means the consortium Trusts’ research can be seen and used easily throughout the world, increasing its overall impact, and the reputation of the Trusts as research organisations. In this regard, WMER as an institutional repository is also essential for the organisations to engage with modern research practices embodied by open scholarship or open science and specifically the open access agenda. WMER and the consortium are continuing to grow. More research is being added each day, an additional Trust has recently joined, and six more Trusts have expressed an interest in joining.
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The West Midlands Evidence Repository (WMER) : a consortium project to connect NHS staff and the public with NHS research (poster)Background: The NHS is an organisation that not only utilises research in its day-to-day activities, but also produces a great deal of research itself. Unlike research produced within higher education (HE) institutions however, the ability of people to connect with research created within the NHS is not always as easy. This project is about the development and implementation of a system, an institutional repository, to support people to connect with our research. These systems are commonplace in HE, but relatively less common in the NHS. The implementation of this system and this project however has a distinctly NHS approach, which looks not only to develop connections between research and its audience, but also other connections as well.
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Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial.Background: The National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care. Objectives: To explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective. Design: The trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation. Setting: Five NHS acute trusts in England. Participants: Participants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with 'best usual care' (BUC) or BUC alone. Interventions: All participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session. Main Outcome Measures: Process and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months. Results: Fifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84. Limitations: Poor recruitment was a limiting factor. Conclusions: This feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain. Future Work: Further work is needed to test recruitment from alternative clinical situations. Trial Registration: EudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.
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The effect of education on the knowledge of patients with celiac diseaseAim: The aim of this study was to investigate the effects of education on patients' knowledge of celiac disease, in an Iranian population. Background: Education can increase patients' knowledge regarding their disease, leading to improvements in their health. Methods: This cross-sectional study was conducted on patients who had been diagnosed with celiac disease. The patients attended an educational meeting in September, 2016. During the educational meeting information regarding the epidemiology, diagnosis and treatment of celiac disease was provided to the study subjects. Each patient completed a questionnaire regarding celiac disease before and after the educational meeting. The questionnaires were scored. Study data was analyzed using SPSS version 20. Results: 90 patients were recruited (69 [77%] were women). Analysis of questionnaire responses showed that except for awareness of cross contamination with gluten, the education meeting significantly increased the knowledge of patients with celiac disease regarding epidemiology, diagnosis and treatment (p=0.001). Conclusion: The result of this study shows that an educational meeting can increase the knowledge of CD patients in treatment. Increasing patients' knowledge may lead to improvements in patients' health.
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Recent advances in nutritionThis Hungarian based single center prospective study investigated the effect of infliximab (IFX) and adalimumab (ADA) on the nutritional status of patients with IBD, when administered according to national guidelines over a 12-week period.
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Osteoma of the hyoid: An unusual cause of a neck lumpA 65-year-old man with a 2-month history of left-sided neck swelling presented through the cancer pathway. There was no associated 'red flag' symptoms, and clinical examination revealed a left anterior triangle, non-pulsatile firm swelling atypical of a lymph node. Ultrasound scan imaging confirmed a complex structure with an echogenic centre and hypoechoic periphery, which was confirmed on CT as an osteoma of the hyoid. This is an extremely unusual cause of a neck lump, and an extensive literature review revealed only two previously documented cases.
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Challenging diagnostic issues in adenomatous polyps with epithelial misplacement in bowel cancer screening: 5 years' experience of the Bowel Cancer Screening Programme Expert BoardThe diagnostic difficulties of differentiating epithelial misplacement from invasive cancer in colorectal adenomatous polyps have been recognised for many years. Nevertheless, the introduction of population screening in the UK has resulted in extraordinary diagnostic problems. Larger sigmoid colonic adenomatous polyps, which are those most likely to show epithelial misplacement, are specifically selected into such screening programmes, because these polyps are likely to bleed and screening is based on the detection of occult blood. The diagnostic challenges associated with this particular phenomenon have necessitated the institution of an 'Expert Board': this is a review of the first five years of its practice, during which time 256 polyps from 249 patients have been assessed. Indeed, the Expert Board contains three pathologists, because those pathologists do not necessarily agree, and a consensus diagnosis is required to drive appropriate patient management. However, this study has shown substantial levels of agreement between the three Expert Board pathologists, whereby the ultimate diagnosis has been changed, from that of the original referral diagnosis, by the Expert Board for half of all the polyps, in the substantial majority from malignant to benign. In 3% of polyp cases, the Expert Board consensus has been the dual diagnosis of both epithelial misplacement and adenocarcinoma, further illustrating the diagnostic difficulties. The Expert Board of the Bowel Cancer Screening Programme in the UK represents a unique and successful development in response to an extraordinary diagnostic conundrum created by the particular characteristics of bowel cancer screening.
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Congenital cutaneous lymphadenomaCutaneous lymphadenoma is an uncommon benign neoplasm often considered to be an adamantinoid variant of trichoblastoma. Lesions present in both sexes, between 14 and 87 years of age, and are mainly located on the head and neck. Cases in children are rare and there is only 1 previous case of a congenital lymphadenoma. An 8-year-old Asian girl presented with a congenital lesion on her forehead comprising 4 pink papules, the largest 5 mm in diameter. Microscopy revealed a well-circumscribed tumor within the dermis and subcutis comprising well-demarcated epithelial lobules of basaloid and clear cells with subtle peripheral palisading, growing in a collagenous stroma but lacking retraction artefact. A relatively dense accompanying predominantly lymphocytic inflammatory cell infiltrate including both T-cells (CD3+) and B-cells (CD20+) permeated the nodules and spilled into the stroma. CD68+ histiocytes and CD1a+ Langerhans cells were moderately numerous. This is the second case of congenital lymphadenoma which-in spite of its rarity in childhood-widens the diagnostic possibilities of cutaneous lymphoepithelial tumors in children.
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The national development programme for the management of significant colorectal polyps supports the implementation of higher standards of the bowel cancer screening programmeAim Introduction of the Bowel Cancer Screening Programme (BCSP) led to increased detection of significant colorectal polyps [SCP]. Management of SCP is a clinical dilemma and surgical resection [SR] is often regarded as overtreatment for a largely benign condition, amenable to less invasive endoscopic resection [ER] Method We reviewed all SCP, defined as sessile/flat polyps of >20 mm size, diagnosed in 2014 at 9 hospitals in the U.K. Polyps were considered morphologically benign on endoscopy, or had a biopsy with benign histology. Results 383 patients were treated by primary ER (84%) or SR (12%). The mean size of SCP was 31 mm; 108 (28%) were diagnosed in the BCSP. Whilst there was no difference in the size (29 mm vs. 31 mm, P = 0.15) or the anatomical location (45% vs. 38% right-sided, P = 0.23) of SCP between BCSP and non-screening cohorts, BCSP patients had lower rates of SR (7% vs. 15%, P = 0.02), pre-treatment biopsies (58% vs. 74%, P < 0.01). Non-screening status was an independent risk factor for SR on multivariate analysis [OR: 2.52 (1.08–5.82), P = 0.03]. Conclusion This disparity may be explained by the robust quality assurance of endoscopy within the BCSP. Standardization and education may improve outcomes, and to this effect, a national multi-disciplinary programme titled ‘Significant Polyps and Early Colorectal Cancer (SPECC)’ has been developed.
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Follicular porokeratosis: Four new casesPorokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.
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A recently changed, long-standing nodule on the chest wallA clinicopathological case of a 75‐year‐old white woman presented with a 35‐year history of a chest wall lesion that, in the 6 months prior to presentation, had increased in size and become tender.
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A painful leg ulcerA clinicopathological case of a 59‐year‐old man presented with a 4‐week history of a painful ulcer on his right lower leg.
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Clinical and treatment‐related features determining the risk of late relapse in patients with diffuse large B‐cell lymphomaIt is still unclear whether there are clinically exploitable differences in the biology and behaviour of early versus late relapses in diffuse large B-cell lymphoma (DLBCL). The present study aimed to analyse a large population-based DLBCL cohort in order to identify (i) the frequency of late relapses (LR), (ii) parameters influencing the risk of LR, and (iii) the impact of introducing rituximab on the occurrence of LR. The data of 7247 DLBCL patients was obtained from the Danish Lymphoma Group Registry. Patients with LR had a lower International Prognostic Index and better performance score than early relapse (ER) patients. The use of radiotherapy lowered only the rate of ER while the use of rituximab yielded a lower occurrence of both ER and LR (P < 0·0001 and P < 0·0001, respectively), possibly suggesting a longer-lasting biological effect. Additionally, we found a female overrepresentation among LR patients that had received a rituximab-containing first line treatment. It was found that patients with LR had a significantly better 5-year overall survival compared to ER patients. In conclusion, LR was more frequently associated with low-risk features than ER. Furthermore, we found that the use of modern immunochemotherapy regimens in DLBCL lowers the risk of both ER and LR.
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A double centre retrospective study into rates of postpartum haemorrhage in women on low molecular weight heparinAn investigation the rates of PPH in women prescribed LMWH antenatally at two local hospitals.
