Charing Cross Hospital Research Articles

ENTIMOS: Decision Support Tool Highlights Potential Impact of Non-intravenous Therapies for Multiple Sclerosis on Patient Care via Clinical Scenario Simulation.

Administration of intravenous (IV), high-efficacy treatments (HETs) for the treatment of multiple sclerosis (MS) poses a high resourcing and planning burden on infusion centres, resulting in treatment delays that may increase the risk of breakthrough disease activity. Simulation tools can be used to systematically analyse capacity scenarios and identify and better understand constraints, therefore enabling decision-makers to optimise patient care. We have previously applied ENTIMOS, a discrete event simulation model, to assess scenarios of patient flow and care delivery using real-life data inputs from the neurology infusion suite at Charing Cross Hospital London. The model predicted that, given current capacity and projected demand, patients would experience high-risk treatment delays within 30 months. This study aimed to address key healthcare challenges for MS patient care management as seen from a neurologist's perspective. We used ENTIMOS to predict the impact of several distinct and clinically plausible scenarios on patient waiting times at the same MS infusion suite and to quantify mitigation strategies needed to assure continuity of care. We used real-world experience of an expert neurologist to identify five clinical scenarios: (1) switching patients to a subcutaneous (SC) MS treatment of the same therapeutic agent, in the same hospital setting; (2) extending opening times to the weekend; (3) reducing the number of infusion chairs (to simulate social distancing measures applied during the coronavirus disease 2019 [COVID-19] pandemic); (4) increasing demand for infusions; and (5) increasing the scheduling approval time. Patient waiting time for next due infusion and time to high-risk treatment delays (≥ 30 days) were the main analysed model outputs. Previously published base case results were used as reference. All hypothetical scenarios were run over a 3-year horizon (with the exception of scenario 1, which was run over a 3- and 5-year horizon). Strategies to mitigate treatment delays were analysed and discussed. Switching 50% of patients to SC treatment of the same therapeutic agent administered in hospital postponed the predicted high-risk treatment delays to shortly beyond the 3-year simulation timeframe (month 38). Weekend opening reduced waiting times from 20 days to 4 days and prevented treatment delays, however, at elevated labour costs. Reducing the infusion chairs increased waiting time to 53 days on average and 86 days at the end of the simulation, leading to high-risk treatment delays within 6 months. An increased demand for infusions increased waiting time to 26 days on average and 47 days at the end of the simulation, leading to high-risk treatment delays within 22 months. Prolonged scheduling approval time did not reduce the waiting time, nor postpone the high-risk treatment delays. Decision makers need transparency on capacity constraints to better plan resourcing at infusion suites and MS treatments. Our results showed that various mitigation measures, such as increasing capacity by additional infusion chairs per year and transferring patients to other infusion suites, may help prevent treatment delays. Switching patients from IV to an SC version of the same therapeutic agent reduced the waiting time moderately and postponed high-risk treatment delays. It was insufficient to prevent high-risk treatment delays in the long term.

Fertility outcomes following surgery and multiagent chemotherapy in malignant ovarian germ cell tumor survivors: a survey study

ObjectiveTo assess fertility outcomes in long-term survivors of malignant ovarian germ cell tumors treated with fertility-sparing surgery with or without additional chemotherapy.MethodsWomen diagnosed and treated for malignant ovarian germ cell...

Editorial Comment.

No AccessJournal of UrologyAdult Urology21 Jun 2023Editorial CommentThis article comments on the following:Biopsy Assessment of Oncologic Control 3 Years Following Primary Partial Gland Cryoablation: A Prospective Cohort Study of Men With Intermediate-risk Prostate Cancer Taimur T. Shah Taimur T. ShahTaimur T. Shah Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003569.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. REFERENCES 1. . Biopsy assessment of oncologic control three years following primary partial gland cryoablation: a prospective cohort study of men with intermediate risk prostate cancer. J Urol. 2023; 210(3):000-000. Google Scholar 2. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2023; 388(17):1547-1558. Crossref, Medline, Google Scholar 3. PACE-A: an international phase 3 randomised controlled trial (RCT) comparing stereotactic body radiotherapy (SBRT) to surgery for localised prostate cancer (LPCa)—primary endpoint analysis. J Clin Oncol. 2023; 41(6_suppl):298. Crossref, Google Scholar 4. . MP80-16 Black patients have worse continence outcomes at 12 months following robotic-assisted radical prostatectomy. J Urol. 2023; 209(suppl 4):e1159. Abstract, Google Scholar 5. Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry. Eur Urol. 2019; 76(1):98-105. Crossref, Medline, Google Scholar 6. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study. Prostate Cancer Prostatic Dis. 2021; 24(2):567-574. Crossref, Medline, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology7 Jun 2023Biopsy Assessment of Oncologic Control 3 Years Following Primary Partial Gland Cryoablation: A Prospective Cohort Study of Men With Intermediate-risk Prostate Cancer Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taimur T. Shah Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Expand All Advertisement PDF downloadLoading ...

A Surgical Perspective on Large Language Models.

*Plastics and Reconstructive Surgery Department, Charing Cross Hospital, Imperial College Healthcare Trust, London, U.K †Fellow in Clinical Artificial Intelligence, The London Medical Imaging & AI Centre for Value Based Healthcare, London, UK Funding/ Support: Nil to declare Manuscript category: Surgical Perspectives The authors report no conflicts of interest. [email protected]

What constitutes a 'skin expert' in the social media era?

Journal Article Accepted manuscript What constitutes a ‘skin expert’ in the social media era? Get access Laksha Bala, Laksha Bala Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust https://orcid.org/0000-0002-8242-379X Search for other works by this author on: Oxford Academic Google Scholar Nada Khalil, Nada Khalil Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust Search for other works by this author on: Oxford Academic Google Scholar Neil P Patel, Neil P Patel Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust https://orcid.org/0000-0003-2613-6056 Search for other works by this author on: Oxford Academic Google Scholar Khawar Hussain Khawar Hussain Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust Corresponding author: Dr Khawar Hussain. Email: Khawar.Hussain1@nhs.net Search for other works by this author on: Oxford Academic Google Scholar Clinical and Experimental Dermatology, llad125, https://doi.org/10.1093/ced/llad125 Published: 30 March 2023 Article history Received: 22 March 2023 Revision received: 26 March 2023 Accepted: 28 March 2023 Published: 30 March 2023

Improving detection of undiagnosed HIV through routine screening in a central London emergency department

HIV is a global public health issue. Routine testing for HIV should be performed on all 16–59 years old attending emergency departments (EDs) in high-prevalence areas in the UK.In August...

Athena: Specialty Certificate Examination case for outpatient medical dermatology.

A twenty-year-old black woman presents to clinic with a two-year history of recurrent nodules and abscesses affecting the groins and axillae. She manages this with intermittent courses of oral antibiotics from the GP when she has a flare. She smokes 10 cigarettes per day and drinks 7 units of alcohol per week. She mentions that over the last six months she has experienced abdominal pain, diarrhoea, and fatigue. There is no recent history of foreign travel.

Diagnostic Performance of a Noninvasive Breath Test for Colorectal Cancer: COBRA1 Study

Diagnostic Performance of a Noninvasive Breath Test for Colorectal Cancer: COBRA1 Study

ENTIMOS: A Discrete Event Simulation Model for Maximising Efficiency of Infusion Suites in Centres Treating Multiple Sclerosis Patients.

BackgroundImproved multiple sclerosis (MS) diagnosis and increased availability of intravenous disease-modifying treatments can lead to overburdening of infusion centres. This study was focused on developing a decision-support tool to help infusion centres plan their operations.MethodsA discrete event simulation model (‘ENTIMOS’) was developed using Simul8 software in collaboration with clinical experts. Model inputs included treatment-specific clinical parameters, resources such as infusion chairs and nursing staff, and costs, while model outputs included patient throughput, waiting time, queue size, resource utilisation, and costs. The model was parameterised using characteristics of the Charing Cross Hospital Infusion Centre in London, UK, where 12 infusion chairs were deployed for 170 non-MS and 860 MS patients as of March 2021. The number of MS patients was projected to increase by seven new patients per week.ResultsThe model-estimated waiting time for an infusion is, on average, 8 days beyond clinical recommendation in the first year of simulation. Without corrective action, the delay in receiving due treatment is anticipated to reach 30 days on average at 30 months from the start of simulation. Such system compromise can be prevented either by adding one infusion chair annually or switching 7% of existing patients or 24% of new patients to alternative MS treatments not requiring infusion.ConclusionENTIMOS is a flexible model of patient flow and care delivery in infusion centres serving MS patients. It allows users to simulate specific local settings and therefore identify measures that are necessary to avoid clinically significant treatment delay resulting in suboptimal care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40258-022-00733-0.

‘Psychoanalysis is one more way of taking people seriously’: Adam Phillips in conversation with Emma Williams

Adam Phillips is a leading psychoanalyst and author. Phillips was educated at Clifton College and studied English Literature at Oxford University. He trained to be a psychoanalyst at the Institute of Child Psychology. Across the course of his professional career, he has worked at Guys Hospital, with a school for ‘maladjusted children’, at Camberwell Child Guidance Clinic and at Charing Cross Hospital in the Department of Child Psychiatry. He now works in private practice. Phillips is the author of many works, including Terrors and Experts (1997), In Writing: Essays on Literature (2016), Attention Seeking (2019) and his most recent book, The Cure for Psychoanalysis (2021). He also served as the General Editor of the New Penguin Classics Translations of the works of Sigmund Freud. The conversation begins by exploring the way mental health has become a topic of public interest as a result of the COVID-19 pandemic. The opportunities and challenges in Phillips's experience working with schools and for young people's mental health services during the 1970s, 1980s and 1990s are then discussed. Questions about the nature of psychoanalysis are introduced, and the discussion turns towards the relationship between philosophy, literature and psychoanalysis. There is a brief discussion of connections between Phillips's work and the philosophy of Stanley Cavell. Phillips's essays on schools and education are explored in connection with ideas of omniscience, sadomasochism and ‘experiments in living’. The conversation ends with a glimpse of school as a place to cultivate one's interest and one's sociability with others.

Mentorship in dermatology: a necessity in difficult times.

Clinical and Experimental DermatologyVolume 47, Issue 3 p. 622-623 Perspective Mentorship in dermatology: a necessity in difficult times Khawar Hussain, Corresponding Author Khawar Hussain khawar.hussain1@nhs.net orcid.org/0000-0003-2116-7718 Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK Correspondence: Dr Khawar Hussein, Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK. E-mail: khawar.hussain1@nhs.netSearch for more papers by this authorNeil Patel, Neil Patel orcid.org/0000-0003-2613-6056 Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UKSearch for more papers by this authorLouise Fearfield, Louise Fearfield orcid.org/0000-0002-1122-4216 Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKSearch for more papers by this authorNerys Roberts, Nerys Roberts Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKSearch for more papers by this authorRichard Staughton, Richard Staughton Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKSearch for more papers by this author Khawar Hussain, Corresponding Author Khawar Hussain khawar.hussain1@nhs.net orcid.org/0000-0003-2116-7718 Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK Correspondence: Dr Khawar Hussein, Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK. E-mail: khawar.hussain1@nhs.netSearch for more papers by this authorNeil Patel, Neil Patel orcid.org/0000-0003-2613-6056 Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UKSearch for more papers by this authorLouise Fearfield, Louise Fearfield orcid.org/0000-0002-1122-4216 Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKSearch for more papers by this authorNerys Roberts, Nerys Roberts Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKSearch for more papers by this authorRichard Staughton, Richard Staughton Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKSearch for more papers by this author First published: 05 January 2022 https://doi.org/10.1111/ced.15071Citations: 2 Conflict of interest: the authors declare that they have no conflicts of interest. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume47, Issue3March 2022Pages 622-623 RelatedInformation

Delayed follow‐up of glaucoma patients due to COVID‐19 pandemic – impact on disease progression

AbstractPurposeTo determine the impact of delayed follow‐up on the disease course in patients with glaucoma.MethodsA retrospective case series of 224 glaucoma patients. Data analysis from the hospital electronic medical record was performed on patients attending the glaucoma clinic between April and May 2021 at Charing Cross Hospital, London, United Kingdom, after easing of the national lockdown due to COVID‐19 pandemic. The main outcome measures included increased intraocular pressure (IOP), worsening of visual field (VF) defect, thinning of retinal nerve fibre layer (RNFL) and the posterior pole using spectral domain Optical Coherence Tomography (OCT).ResultsNotes from 224 patients were analysed. Among them, 24 patients were identified to develop a progression of glaucoma. Majority of patients (10, 42%) had open angle glaucoma, 6 (25%) had normal tension glaucoma, 5 (21%) were glaucoma suspects, 2 (8%) had narrow angle glaucoma and 1 (4%) had angle closure glaucoma. The mean IOP (±SD) pre‐lockdown was 15.4 ± 3.8 mmHg and post‐lockdown was 16.7 ± 5.4 mmHg (p < 0.05). The average RNFL thickness pre‐lockdown was 79.7 ± 15.7 µm and post‐lockdown was 78.8 ± 15.6 µm (p > 0.05). Of the 24 patients who developed progression, 16 had an increase in IOP (mean ∆ IOP was 3.8 ± 1.8 mmHg; p < 0.05), 19 patients had a clinically significant RNFL thinning (mean ∆ was 3.3 ± 1.4 µm; p < 0.05) and 9 patients had worsening of VF. The average timing between pre‐ and post‐lockdown visit was 15.1 months (SD ± 7.6).ConclusionsThese results confirm that a proportion of patients developed glaucoma progression during the COVID Lockdown which could be attributed to delayed follow‐up. Further analyses of these data will be needed to confirm how the results of this study could help to guide future decisions making and guidance on prioritising and managing glaucoma patients if disruption to standard of care occurs.

Improving single-agent chemoresistance risk identification in gestational trophoblastic neoplasia.

In The Lancet Oncology, Antonio Braga and colleagues 1 Braga A Paiva G Ghorani E et al. Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort study. Lancet Oncol. 2021; (published online June 25.)https://doi.org/10.1016/S1470-2045(21)00262-X Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar report the results of a multicentre, retrospective study involving the largest cohort of patients with gestational trophoblastic neoplasia presenting with an International Federation of Gynaecology and Obstetrics (FIGO) risk score of 5 or 6, in a low risk setting. 2 Kohorn EI Goldstein DP Hancock BW et al. Workshop report: combining the staging system of the International Federation of Gynecology and Obstetrics with the scoring system of the World Health Organization for trophoblastic neoplasia. Report of the Working Committee of the International Society for the Study of Trophoblastic Disease and the International Gynecologic Cancer Society. Int J Gynecol Cancer. 2000; 10: 84-88 Crossref PubMed Scopus (75) Google Scholar , 3 Goldstein DP Ross S Berkowitz RS Horowitz NS Optimal management of low-risk gestational trophoblastic neoplasia. Expert Rev Anticancer Ther. 2015; 15: 1293-1304 Crossref PubMed Scopus (12) Google Scholar Indeed, in so-called low-risk patients (ie, those with stage I or stage II–III disease and a FIGO risk score of 0–6), patients can have heterogeneous outcomes in terms of chemosensitivity to single-agent chemotherapy; in particular, patients with a FIGO risk score of 0–1 have a complete remission rate of 75% compared with approximately 53% in patients with a FIGO risk score of 2–4 and approximately 33% in patients with a FIGO risk score of 5–6. 4 Sita-Lumsden A Short D Lindsay I et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000–2009. Br J Cancer. 2012; 107: 1810-1814 Crossref PubMed Scopus (88) Google Scholar Therefore, whether patients with a FIGO risk score of 5–6 should be treated with a multiagent approach, which is more aggressive than a single-agent approach, is controversial, 5 Winter MC Treatment of low-risk gestational trophoblastic neoplasia. Best Pract Res Clin Obstet Gynaecol. 2021; (published online Feb 2.)https://doi.org/10.1016/j.bpobgyn.2021.01.006 Crossref PubMed Scopus (1) Google Scholar , 6 Lok C van Trommel N Massuger L Golfier F Seckl M Clinical Working Party of the EOTTDPractical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease. Eur J Cancer. 2020; 130: 228-240 Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 7 Braga A Mora P de Melo AC et al. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. World J Clin Oncol. 2019; 10: 28-37 Crossref PubMed Google Scholar even though most patients who do not respond to first-line single-agent chemotherapy can have complete remission after second-line single-agent chemotherapy. Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort studyApproximately 60% of women with gestational trophoblastic neoplasia presenting with a FIGO risk score of 5 or 6 achieve remission with single-agent therapy; almost all remaining patients have complete remission with subsequent multiagent chemotherapy. Primary multiagent chemotherapy should only be given to patients with metastatic disease and choriocarcinoma, regardless of pretreatment human chorionic gonadotropin concentration, or to those defined by our new predictors. Full-Text PDF

Direct to Thrombectomy.

Direct to Thrombectomy.

David Bruce Bamber

David Bamber was an anaesthetist at Charing Cross Hospital, later part of the Imperial College Healthcare NHS Trust, for more than 30 years. He was born in Preston, the only...

Laryngeal Sarcoidosis and Swallowing: What Do We Know About Dysphagia Assessment and Management in this Population?

IntroductionSarcoidosis is a chronic granulomatous disease of unknown aetiology and laryngeal involvement is seen in a small percentage of cases. Dysphagia is a common but under-reported symptom. Little is known about how dysphagia typically presents or is managed in the context of this fluctuating disease. We present our case series using an SLT-led model of assessment and management.MethodsA literature search was conducted for any articles that reported both laryngeal sarcoidosis and dysphagia. We then analysed a case series of laryngeal sarcoidosis patients treated at Charing Cross Hospital. We report on multidimensional swallowing evaluation and rehabilitative interventions.ResultsSeventeen papers report both laryngeal sarcoidosis and dysphagia, with only one paper giving details on the nature of the dysphagia and the treatment provided.In our case series (n = 7), patients presented with FOIS Scores ranging from 5 to 7 pre-operatively (median = 6). Aspiration (median PAS Score = 6 and Range = 3–8) and pharyngeal residue were common. Sensory issues were also prevalent with most unaware of the extent of their difficulties. Management interventions included safe swallowing advice, compensatory strategies, exercises and close surveillance given their potential for repeated surgical interventions.ConclusionLaryngeal sarcoidosis is a rare condition. Dysphagia is under-reported and our experience highlights the need for specialist dysphagia intervention. Further research is required to understand dysphagia management requirements in the context of this fluctuating disease process.

A comparison of pre-radiotherapy extractions prior to and during the pandemic at charing cross hospital

Osteoradionecrosis has considerable morbidity and can adversely affect the quality of life of patients who undergo radiotherapy as part of the treatment for their head and neck cancer. This can be reduced by a thorough dental assessment and extractions of teeth with poor prognosis prior to radiotherapy, ideally at least ten days before radiotherapy commences. Aim and objectivesThe dental department at Charing Cross Hospital has an established pathway to assess patients prior to radiotherapy. The aim of the audit was to evaluate whether during the coronavirus pandemic there was timely dental assessment prior to radiotherapy and extractions carried out in sufficient time before start of radiotherapy in accordance with the Royal College of Surgeons 2012 guidelines. MethodData was collected retrospectively from patient records over two eight monthly periods (May 2019 -Jan 2020 prior to the pandemic and April 2020 – November 2020 during the pandemic). Parameters analysed included: the number of patients referred; time interval between referral and assessment; number of patients requiring extractions and time interval between extraction completion and commencement of radiotherapy. ResultsSeventy-six patients with head and neck cancer were referred for dental assessment over the audit period. The most recent audit showed 96.4% of patients were assessed within ten days of referral. Extractions were undertaken on 63.6% of patients, 92.9% were in excess of ten days before radiotherapy, 42.9% over 20 days. ConclusionsNational guidelines for extractions are being met in 92.9% of cases and the majority in excess of minimum timing recommended. The dental clinic is providing quality care for this patient group as measured by this audit, showing a positive service outcome.

924 The Effect of COVID On the Skin Cancer Referral Pathway

Abstract Introduction Due to COVID resulting in all elective surgeries being cancelled; it was thought that patients with suspected skin cancer maybe seeing a specialist and having surgery later than. So, to tackle this as lockdown occurred, the Plastic Surgery department at Charing Cross Hospital secured a minor operation room in outpatients, to keep treating suspected skin cancer. But did it work? Method Data was collected from an interval of 2 months before the pandemic (December-January) and 2 months post the pandemic (April-May). Each suspected skin cancer patient who was put on the two weeks wait referral during that time had their receipt of referral, first appointment with a specialist and date of surgery (if that was done) recorded. Results Before COVID 81% of patients were seen by a specialist in 2 weeks compared to 89% after COVID. Also, 78% of patients had achieved surgery within 62 days before the pandemic, compared to 86% after the pandemic. Conclusions In conclusion, the results showed that the implementation of the minor operation room at short notice enabled the department to meet capacity. Thus, it is utilisation going forward can improve how quickly skin cancers are managed.

65 Comparison of Frax and Qfracture in Predicting Fragility Fractures in Patients Presenting with Falls

Abstract Introduction Falls are a major risk factor for fragility fractures and patients should be appropriately assessed to reduce future fragility fracture risk. National guidelines provide recommendations on assessing fracture risk using calculators to guide therapy initiation. FRAX and QFracture are the two main calculators used, however they differ considerably in their inputs. The aim of this study was to compare the risk estimation and performance between these two frequently used calculators to help determine their appropriate utility. Methods Data from patients aged ≥70 years admitted with a fall to the Acute Medical Units at Charing Cross Hospital between 1st Dec 2018–31st March 2019 were retrospectively collected, covering all inputs required for the two risk calculators. The 10-year major osteoporotic and hip fracture risks were calculated using FRAX and QFracture and compared. The one-year major osteoporotic and hip fracture risks from QFracture were assessed against actual one-year fracture rates. Results Conclusions Risk calculators are effective tools to aid the decision of bone therapy initiation. Here we demonstrate that there is a strong correlation between the two commonly used calculators. However, in terms of absolute risk values there is a mean 8.9% difference with QFracture providing higher risks in this “fallers” group. As absolute treatment thresholds are frequently used to guide bone therapy initiation, opposing recommendations may result. Therefore, there is a need to further explore calculator performance and determine which would more accurately serve different patient groups.

Shane Godbolt: the Charing Cross years (1970-1991).

This article looks at the period in Shane's career when she was based in the library at the Charing Cross Hospital Medical School (1970-1984) and then the Charing Cross and Westminster Medical School (1984-1991), following the merger. The topics covered include audio-visual materials and new technology, user education, staff training and development, word processing and automation in the library and Shane's involvement and activities in the wider profession.