Royal Stoke University Hospital Research Articles

Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

BackgroundIntraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy (MT). Most patients undergoing MT are also given thrombolysis. Antiplatelet agents are contraindicated within 24 hours of thrombolysis. We...

Tibial fractures treated with mono-lateral fixation: Principles of design and application.

This paper presents the outcome of a data review of patients treated with the IOS external fixation system at the Royal Stoke University Hospital: a fixation designed to meet four requirements for external fixation proposed in this paper. Demographic data and outcome were collected and assessed. From 69 initial patients, 64 patients (55 males and 9 females) had an average age of 35.9 years. The mean time to union was 127 days. There were no incidences of malunion, or refracture post fixation removal attributable to the treatment method. In addition, in this cohort, there was no incidence of pin tract infection resulting in osteomyelitis. Of all the factors assessed the only factor to have any significant effect on healing was smoking: an average delay of 31 days. An examination of RUST (radiographic union score tibia) and modified RUST scores illustrated a potential false negative of up to 80%. Hence, this study cannot support the use of either scoring system to diagnose fracture healing. IOS external fixation was shown to be an effective method for the treatment of unstable tibial fractures. The reduction at fixation removal was shown to be very good. There was no incidence of osteomyelitis. It is, therefore, suggested that appropriately used external fixation is a viable alternative to intramedullary nailing if designed and surgically applied using four design principles outlined in this paper. Furthermore, it is proposed that external fixation be designed and applied to meet these four principles.

Evaluation of the impact of a Pharmacy Technician within the Emergency Department, Royal Stoke University Hospital

Abstract Introduction The Emergency Department (ED) at the Royal Stoke University Hospital has come under increasing pressure, and it is well published that patients within the ED are at a higher risk of medication misadventure and missed doses of critical medicines1. This was a particular risk at the Royal Stoke in winter 2022/23 with the re-introduction of ED corridor care and patients waiting over 24 hours for a medical bed. A prescribing pharmacist has been in post in the ED since 2019, but additional funding was obtained for a pharmacy ED technician to support for 6 months during winter pressures. Aim The aim of this service evaluation was to assess the impact of the pharmacy technician within the ED, with a particular focus on medicines reconciliation, allergy status recognition and pharmacist prescribing activity. Methods Ethical approval was not required for this project, as it was a service evaluation. Data was collected over an 11 week period, Monday-Friday from October-December 2022. Data was collated into an Excel® spread sheet and assessed the number of patients reviewed by the pharmacy technician and prescribing pharmacist, the number of medicines prescribed by a prescribing pharmacist (including number of critical and non-critical medicines), and any missed allergy status’ by the clerking practitioner. Results Over 11 weeks, the pharmacist prescriber was able to prescribe 183 medicines, 46 of which were critical medicines. 23 patients were identified as having allergies (with 61% being penicillin allergy) which had previously not been documented by the clerking practitioner within the ED and/or patients were not wearing the appropriate red allergy wristband. This included 2 patients who had previously experienced anaphylaxis as a result of their drug allergy. Finally, comparing the data from the time period with the pharmacy technician, to without a pharmacy technician, demonstrated an almost 10-fold increase in pharmacist prescribing activity. Discussion/Conclusion This service evaluation has demonstrated the significant positive impact of a pharmacy technician within the ED. The data collected for this service evaluation was limited as it was only collected on weekdays, and further work should be done to assess the impact of a 7 day service. It is therefore recommended that permanent funding is secured all year round for ED pharmacy technician support, ideally 7 days per week. This will increase medicines reconciliation activity allowing ED pharmacists to focus on clinical review and prescribing for patients, increasing the number of patients seen by pharmacy, allowing earlier identification of patients on critical medicines, reducing the number of missed doses and potential harm. A pharmacy technician also allows earlier confirmation of patients’ allergy status, further reducing harm within the ED.

British Nuclear Medicine Society Clinical Guidelines for Gastric empty.

aDepartment of Physics and Nuclear Medicine, Consultant Physician in Nuclear Medicine, Sandwell and West Birmingham NHS Trust, Birmingham bHead of Nuclear Medicine Physics, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire cMedical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK Received 14 December 2022 Accepted 28 March 2023. Correspondence to Alp Notghi, Department of Physics and Nuclear Medicine, Consultant Physician in Nuclear Medicine, Sandwell and West Birmingham NHS Trust, City Hospital, Dudley Road, Birmingham B18 7QH, UK, E-mail: [email protected]

PO-03-045 MAGNETIC RESONANCE IMAGING IN PATIENTS WITH MRI UNLABELLED CARDIAC IMPLANTABLE ELECTRONIC DEVICES. ASSOCIATED RISK, SAFETY AND LONG TERM CLINICAL OUTCOMES FROM A SINGLE U.K TERTIARY CENTRE

Cardiac implantable electronic devices (CIEDs) that are deemed not to be MR Conditional were historically considered to be a contraindication for MRI. However, a growing body of evidence exists that has shown that MR Unlabelled CIEDs can be scanned safely, providing adequate protocols are followed and associated levels of risk are appropriately recognised. Individualising absolute risk is complex as the number of cases reported with specific generator and lead combinations are small. A comprehensive cardiology-radiology multidisciplinary pathway exists at Royal Stoke University Hospital (RSUH), which considers the associated safety risks involved together with the clinical benefit of the scan. The objective of this study is to determine how many patients with MR Unlabelled CIEDs underwent MRI at Royal Stoke University Hospital, the associated risks, together with the clinical and safety outcomes. A retrospective observational study was performed using local electronic dating reporting systems that were used to review baseline characteristics and clinical outcomes. Descriptive statistics were performed to determine outcomes. 102 patients underwent 132 scans over 72 months with 59% requiring Direct Cardiologist supervision. Inactive, battery depleted CIEDs were noted in 3 patients and 1 patient had an epicardial system implanted in the abdominal region. 1 scan was performed <6weeks prior to implantation and a total of 3 patients underwent MRI when the CIED was at its replacement indicator. 17 patients had reported lead abnormalities, 13 of these having redundant leads and 4 with abnormal lead parameters and pacing dependency. In total, 38% of patients were pacemaker dependant, 57% had non-conditional generators and 9% had reported generator abnormalities. From the calculated pre scan associated risk, 27% were deemed low risk, 48% intermediate, 23% High and 2% Extremely high. From the two who were deemed Extremely high risk, one patient had several redundant leads with an ICD and pacing dependency. Another was pacemaker dependant, with a non-conditional generator at the replacement indicator and an asynchronous mode was unable to be programmed. The clinical question was answered in 96% of patients, with no acute complications and no adverse events reported over a mean follow up of 470days. A comprehensive multidisciplinary clinical pathway has allowed for patients with MR Unlabelled CIEDS to access to MRI for several years, with no reported adverse events.

P-67897775-126 - Scooter related maxillofacial injuries- A six-year retrospective study at Royal Stoke University Hospital

<h3>Purpose</h3> Maxillofacial injuries related to push-bikes have been well documented. An often-overlooked area is maxillofacial trauma related to scooters. Our aim is to describe non-motorized and motorized scooter-related maxillofacial injuries with a view to focus on prevention of these injuries. We also aim to address an ever-growing incidence of eScooter-related maxillofacial trauma. <h3>Method/Study Design</h3> Patients presenting at RSUH were identified via the ED database via keyword search ‘scooter' and ‘face' between 2015 and 2021. Notes were reviewed and information regarding age, gender, mechanism, type of injury, treatment, helmet use and type of scooter was collated and analyzed. <h3>Results</h3> A total of 37 patients were identified including use of an escooter (n=2). Nearly 80% were Male (n=29) and 8 Female. Most patients fell off the scooter (n=35) whilst two patients were involved in collisions. The most common age groups of patients were 5-9 and 10-14 with 14 patients each fitting in to those age groups. Lacerations (n=24) and dentoalveolar (n=18) injuries were sustained as well as one zygomatic and one orbital fracture recorded. 81% patients were managed operatively under LA and GA. <h3>Conclusion</h3> The use of nonmotorized scooters by children can result in facial trauma. Cases are usually non-life threatening but most will require surgical intervention and can result in loss of function and cosmetic defects. These injuries are potentially preventable with the use of helmets with faceguards and patient/parent education. The rise of eScooter use in the UK should remain a cause for concern as the trial programs expand.

TP6.2.18 Initial experience with routine postoperative nasal high-flow oxygen as part of enhanced recovery following oesophagectomy for cancer

Abstract Introduction Pulmonary complications occur in up to 38% of patients undergoing oesophagectomy and are associated with significant risk of mortality. Nasal high-flow oxygen (NHFO) has previously been shown to reduce respiratory complications following major abdominal surgery, however, its use in oesophagectomy has not previously been assessed. We report our results using NHFO routinely as part of our enhanced recovery protocol (ERP) in consecutive patients undergoing oesophagectomy for cancer at a single tertiary referral centre. Methods We recently incorporated routine postoperative NHFO following oesophagectomy as part of our ERP at Royal Stoke University Hospital. We conducted a prospective study of patients undergoing surgery between November 2019 and September 2020. The primary outcome measure was complications related to delivery of NHFO. Secondary endpoints included rates of pulmonary complications and mortality within 30 days of surgery. Results Fifty patients underwent oesophagectomy during the study period. The median age was 66 years (range 43-78 years) and male to female ratio was 4:1.Majority (49/50) of patients underwent 2-stage oesophagectomy while one underwent 3-stage oesophagectomy. All patients received postoperative NHFO. There were no complications related to NHFO. The 30-day overall pulmonary complication rate was 30%.Of these, 28% developed pneumonia,4% pulmonary embolism,and 2% pleural effusions requiring drainage. There were no deaths within 30 days of surgery. Conclusion Routine postoperative NHFO in consecutive patients undergoing oesophagectomy is safe and feasible with lower pulmonary complication rates than previously reported, leading to better overall outcomes. The value of NHFO in oesophagectomy requires further evaluation in a randomized clinical trial.

EP.WE.47Cholecystectomy During COVID-19: A Single Centre Experience

BackgroundThe COVID-19 pandemic has significantly impacted healthcare delivery globally with consequent restructuring of surgical services during the peak period and prioritisation of emergency and cancer surgery over elective operations.We present outcomes for laparoscopic cholecystectomy during the peak period for COVID-19 in the UK and compare this with data for the same period in 2019MethodologyThis is a prospectively study. Analysis of collected data on patients who underwent laparoscopic cholecystectomy during the peak period for COVID-19 from 1st March 2020 – 30th June 2020 (study cohort) at the Royal Stoke University Hospital. Data from the same period in 2019 (control cohort) was compared and analysed.Results104 patients underwent a laparoscopic cholecystectomy during the peak period compared to 217 during the same period in 2019.Median age in the study cohort was 51.5 years (15-84 years) and 52 years (19-91 years) in the control cohort (p = 0.49). Male to Female ratio was 1:2 in the study cohort and 1:2.2 in the control cohort (p = 0.67)Emergency admissions constituted the majority of cases and there was no statistically significant difference between both groups (61.5% vs 61.8%, p = 0.49). Most cholecystectomies were for biliary colic (41.3% vs 35.5%) and cholecystitis (37.5% vs 43.8%), and there was no statistically significant difference between both groups (p = 0.31 and p = 0.29 respectively).ConclusionThis study demonstrates that laparoscopic cholecystectomy was feasible and safe in patients with symptomatic gall bladder disease during the peak period for COVID-19 when compared to a historic cohort in 2019.

EP.FRI.857 Audit and quality improvement project; data entry into the NELA database from Royal Stoke university hospital

Abstract Aims During the period December-2018 to November-2019 a total of 84 cases were entered on the NELA website, corresponding to HES data suggesting 392 laparotomies. This suggests a possible case acquisition of 21% prompting us to look at our data acquisition in detail. Methods Interrogation of the NELA data from January–March 2020 was done from NELA website and hospital records. Results Analysis revealed that during this period 45 patients had laparotomy recorded whereas hospital database recorded 68 laparotomies. Of the 45 cases entered on the NELA database, only 1 patient had a complete data set entered. 22 cases had 87% data entry and 22 cases had &amp;lt;50% of the data fields completed. Firstly, we were not capturing all patients who underwent an emergency laparotomy and secondly our data entry for the patients we did report was incomplete. This led us to engage in a quality improvement project with following measures - Conclusions We re-assessed the case ascertainment and completeness of data collection in the period April 2020 – June 2020 and case ascertainment rate increased to 54% and all the entries were complete and locked.

Cardiology referrals before and during the COVID-19 pandemic: a health service evaluation

Background/Aims The COVID-19 pandemic has resulted in unprecedented changes to healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on referrals to cardiology services in a tertiary hospital. Methods Royal Stoke University Hospital has a cardiac assessment nurse team that provides rapid access to specialist cardiology opinion. All referrals are recorded on a database, which was used to determine how COVID-19 affected the number and types of referrals to cardiology during March–September 2019 and March–September 2020. Results A total of 12 447 referrals were made to the cardiac assessment nurse teams over the evaluation period. Compared to the average number of referrals across all months, there was a decline of 10.5%, 31.2% and 18.5% during March, April and May 2019 respectively. Comparing 2020 to 2019, there were more 999 calls (17.7% vs 15.7%) and accident and emergency referrals (46.5% vs 45.0%), and fewer interhospital referrals (16.0% vs 19.6%). In terms of advice provided for the 999 referrals, a greater number were advised to go to the accident and emergency department (10.5% vs 0%) and direct phone advice provided to those in other settings increased (11.7% vs 0.1%) in 2020. Conclusions The COVID-19 pandemic was associated with a reduction in the number of overall referrals to cardiology, while also demonstrating a shift towards more advice to attend the accident and emergency department for assessment or direct phone advice being provided about management in the community.

23 Reaudit and Completing the Audit Cycle of Quality of Informed Consent for Surgery on Neck of Femur Fracture in Royal Stoke University Hospital

Abstract Using guidelines highlighted by the British Orthopaedic Association an reaudit was performed within our department to assess the adequacy of informed consent for NOF fractures to complete the audit cycle. 50 patients were included in the Audit and reaudit. Risk was classified as common, less common, rare and ‘other’. The adequacy of informed consent was evaluated by assessing the quality and accuracy of documentation. Infection, bleeding risks, clots and anaesthetic risks were documented in all patients (100%). Areas of improvement were seen in the documentation of neurovascular injuries (98%), pain (90%) and altered wound healing (87%). There was no significant change in the documentation of failure of surgery (83%) and neurovascular injuries (98%). The Poorly documented risk factors from the initial audit were seen to improve which included mortality (70%), prosthetic dislocation (90%) and limb length discrepancy (50%). There has been a significant improvement in the quality of Informed consent in the department and this could be attributed to the installation of ward posters and verbal dissemination of information to junior doctors. Recommendation for interventions would be to present in the next clinical governance meeting and presenting at the new junior doctors’ induction at August.

A simple but vital innovation in the care of kidney patients.

Julie Cumberlidge, Deputy Associate Chief Nurse, Medicine Division, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust (Julie.cumberlidge@uhnm.nhs.uk), describes an innovation by the Trust's Haemodialysis Team, runner-up in the BJN Awards 2020 Renal Nurse of the Year category.

An Audit on "Atrial Fibrillation &amp; Anti-Coagulation" at University Hospitals of North Midlands NHS Trust (2015-2017)

Background: During hospital admission, it was noticed that most patients with atrial fibrillation (new or old) diagnosis have no clear documented plan about anticoagulation. It was considered a significant risk for patient safety. Aim: To determine whether patients with atrial fibrillation diagnosis were on anticoagulation or not, if not have the reasons been documented in the medical notes. If new-onset atrial fibrillation whether CHADSVASC and HASBLED scores have been used or not for anticoagulation purpose. Settings: County Hospital Stafford &amp; Royal Stoke University Hospital (UHNM 2015-2017). Materials and Methods: Prospective audit, a total of 100 patient's data (50 patients per cycle) were analysed by using specific audit Performa based upon NICE Atrial Fibrillation 2014 Guidelines [1]. Statistical Analysis: Data was coded, entered in an excel spreadsheet and analysed by translating into percentages and proportions. Results: Initial audit showed that out of 50 patients with atrial fibrillation diagnosis, 30 were already on anticoagulation and 20 were not on anticoagulation. Only 2 out of 20 were assessed for anticoagulation and 18 were not assessed. AF Performa was introduced in the clerking sheet post initial audit. Re-audit after 6 months showed 43 out of 50 patients were on anticoagulation and 7 were not. Out of these 7 patients, 3 patients had absolute contraindications (Subdural Haematoma, Rectal bleeding and major haematoma), 2 patients were assessed for anticoagulation however were not followed up and 2 were not assessed. Results comparison is explained in (Table 1). Conclusions: This audit has demonstrated significant improvement in overall anticoagulation rates in suitable patients which have helped in improving patient safety.

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

IntroductionThe coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients.MethodsThis retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019).ResultsThere was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died.ConclusionsDuring the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

Mechanical thrombectomy: can it be safely delivered out of hours in the UK?

BackgroundMechanical thrombectomy was approved by NICE as a treatment for stroke in 2016. However, most of the evidence is from studies conducted during working hours. Only few centres in the UK perform thrombectomies out-of-hours. The Royal Stoke University Hospital (RSUH) has offered thrombectomies over 24 h (24/7) since 2010. The aim of this service review is to compare the outcomes for patients treated in regular working hours to those treated outside normal working hours within this unit.MethodsThis retrospective service analysis includes all patients treated with mechanical thrombectomy at RSUH since the start of the service in January 2010 to June 2019. Data on key demographics, timings, procedural complications, and long-term outcomes including death and disability at 90 days were collected. In-hours was defined as the time between 8:00–17:00 h, Monday to Friday; out-of-hours was defined as any time outside this period.ResultsIn total, 516 mechanical thrombectomies were performed in this time period; data were available on 501 of these. Successful recanalization (TICI 2b/3) was achieved in 86% of patients. By 90 days 96 (19%) had died and 234 (47%) were functionally independent (modified Rankin Scale score ≤ 2). 211 (42%) of the procedures were performed in-hours and 290 (58%) out-of-hours. Door-to-CT and door-to-groin times were significantly longer out-of-hours than in-hours, but thrombectomy duration was significantly shorter. There were no significant differences in complications and short- and long-term outcomes.ConclusionMechanical thrombectomy was delivered safely and effectively 24/7 in this UK hospital, with no difference in clinical outcomes.

Essential to health yet overlooked: the vital role of the lymphatic system.

British Journal of NursingVol. 29, No. 13 At a GlanceEssential to health yet overlooked: the vital role of the lymphatic systemMargaret Sneddon, Rebecca ElwellMargaret Sneddon(E-mail Address: [email protected])Honorary Senior Research Fellow, School of Medicine, Dentistry and Nursing, University of Glasgow and Trustee, British Lymphology SocietySearch for more papers by this author, Rebecca ElwellMacmillan Lymphoedema Advanced Nurse Practitioner, Royal Stoke University Hospital and Trustee, British Lymphology SocietySearch for more papers by this authorMargaret Sneddon; Rebecca ElwellPublished Online:10 Jul 2020https://doi.org/10.12968/bjon.2020.29.13.744AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Brown L for the British Lymphology Society. Who has a predisposition to lymphoedema and why? British Lymphology Society Lymph Fact Series. 2019. https://tinyurl.com/y8dez5gm (accessed 24 June 2020) Google ScholarMortimer PS, Rockson SG. New developments in clinical aspects of lymphatic disease. J Clin Invest. 2014;124(3):915-921. https://doi.org/10.1172/JCI71608 Crossref, Medline, Google ScholarRossitto G, Sneddon M, Rockson SG. The lymphatic system In: Touyz RMDelles C (eds). Textbook of vascular medicine. Cham (Switzerland): Springer 2019:45-57. https://doi.org/10.1007/978-3-030-16481-2_5 Crossref, Google ScholarWoods M. Care of skin that is oedematous or at risk of oedema. Br J Nurs. 2019;28(11):674-676. https://doi.org/10.12968/bjon.2019.28.11.674 Link, Google Scholar FiguresReferencesRelatedDetailsCited byBritish Lymphology Society's EveryBodyCan campaign: 2021 relaunchMargaret Sneddon4 February 2021 | British Journal of Community Nursing, Vol. 26, No. 2 9 July 2020Volume 29Issue 13ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 July 2020 Published in print 9 July 2020 Information© MA Healthcare LimitedPDF download

The use of virtual health care as an option for lymphoedema services.

British Journal of NursingVol. 29, No. 13 CommentThe use of virtual health care as an option for lymphoedema servicesRebecca Elwell, Margaret SneddonRebecca Elwell(E-mail Address: [email protected])Macmillan Lymphoedema Advanced Nurse Practitioner, Royal Stoke University Hospital, and Trustee, British Lymphology SocietySearch for more papers by this author, Margaret SneddonHonorary Senior Research Fellow, University of Glasgow, and Trustee, British Lymphology SocietySearch for more papers by this authorRebecca Elwell; Margaret SneddonPublished Online:10 Jul 2020https://doi.org/10.12968/bjon.2020.29.13.784AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Lymphology Society. Assessing vascular status in the presence of chronic oedema prior to the application of compression hosiery. Position document to guide decision making. 2020. https://tinyurl.com/y8ootluo (accessed 26 June 2020) Google ScholarClarke C, Whitmore L, Webb A. Patient education pictorial boards: improving patients' understanding of venous leg ulcer and compression therapy. Wounds UK 2020; 16(2): 54-60. https://tinyurl.com/y9yxwpsy (accessed 26 June 2020) Google ScholarFletcher J, Barrett S for Wounds UK. Best practice statement. Improving holistic assessment of chronic wounds: how to meet patient expectation using the new best practice statement. 2018. https://tinyurl.com/ya898mta (accessed 26 June 2020) Google ScholarNHS Employers. The staff engagement toolkit. An online resource, supporting you to increase staff engagement in your organisation. 2013. https://tinyurl.com/y7f5b53j (accessed 26 June 2020) Google ScholarNHS England. The NHS five-year forward view. 2014. http://tinyurl.com/oxq92je (accessed 26 June 2020) Google ScholarNHS England, NHS Improvement. The NHS long term plan. January 2019. https://tinyurl.com/y6dzmk2o (accessed 26 June 2020) Google ScholarNHS England. Using online consultations in primary care. Implementation toolkit (PowerPoint document). January 2020. https://tinyurl.com/y9yck7d2 (accessed 26 June 2020) Google ScholarQueen's Nursing Institute. Nursing in the digital age. Using technology to support patients in the home. 2018. https://tinyurl.com/yxlr95l2 (accessed 26 June 2020) Google ScholarRoxby AC, Greninger AL, Hatfield KM et al.. Detection of SARS-CoV-2 among residents and staff members of an independent and assisted living community for older adults—Seattle, Washington, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14): 416–418. https://doi.org/10.15585/mmwr.mm6914e2 Crossref, Medline, Google ScholarWounds UK. Best practice statement. Compression hosiery. 2nd edn. 2015. https://tinyurl.com/yb4rvql8 (accessed 26 June 2020) Google Scholar FiguresReferencesRelatedDetailsCited byChallenges and opportunities identified for lymphoedema services in Wales during the COVID-19 pandemicMarie Gabe-Walters, Rhian Noble-Jones27 February 2021 | British Journal of Nursing, Vol. 30, No. 4 9 July 2020Volume 29Issue 13ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 July 2020 Published in print 9 July 2020 Information© MA Healthcare LimitedPDF download

Healthcare utilisation in children with SMA type 1 treated with nusinersen: a single centre retrospective review

BackgroundNusinersen has been used to treat spinal muscular atrophy type 1 (SMA1) in the UK since 2017. While initial trials showed neuromuscular benefit from treating SMA1, there is little information...

2495 A Retrospective Review of Outpatient Endometrial Ablation Using Minitouch for Treatment of Heavy Menstrual Bleeding

Study Objective To determine the outcomes of using Minitouch endometrial ablation as outpatient treatment for heavy menstrual bleeding (HMB) at an established ambulatory gynecology center in a UK teaching hospital. Design Retrospective cohort study. Setting Procedures were performed as outpatient at Central Treatment Suite at Royal Stoke University Hospital, as per department-approved protocol by one of six gynecology consultants. Patients were reviewed from 4 months post-op at consultation or by telephone. Patients or Participants Between March 2017 and March 2019, 35 patients with HMB who opted for outpatient endometrial ablation received the treatment. Interventions Minitouch without/with intracervical local anesthesia. Diagnostic outpatient hysteroscopy +/- endometrial sampling was performed immediately before treatment procedure confirming suitability. Where present, intrauterine device was removed before ablation. Patients were not selected for timing of their menstrual cycle and received no endometrial pre-treatment. Measurements and Main Results In 24 months, 35 patients received treatment. Average patient age was 46 (range 31-55). One patient was nulliparous, 9(26%) had previous caesarean section, 30(86%) received previous treatment for HMB. Utero-cervical length ranged from 6-10cm. Histology confirmed normal endometrium in all cases. Procedure was well tolerated overall with no failure of equipment. Average treatment time was 145s (Range 33-229s). Vasovagal episode was the only observed peri-operative complication (2/35, 5.7%) requiring conservative management. No uterine perforation occurred. No patient required emergency hospital admission post-op. To date, 22 patients were reviewed. Average time to follow-up was 4.9 months. 91% reported satisfactorily improved bleeding patterns including amenorrhea or oligomenorrhoea (14/22, 64%) and less HMB (6/22, 27%). 9% reported same or worsened bleeding requiring further management. Conclusion With its flexibility and smaller size over other devices minimizing the need for cervical dilatation and patient discomfort, the use of Minitouch for outpatient treatment of HMB at our center was shown to be well-tolerated, with high reliability of procedure completion, good safety and efficacy outcomes.

Abstract WP367: Effect of the Introduction of a New Pathway for Prevention of Venous Thromboembolisim (VTE) Including Neuromuscular Electrical Stimulation (NMES) on Symptomatic VTE on Immobile Stroke Patients

Background: Venous Thromboembolism (VTE) prophylaxis using Intermittent Pneumatic Compression (IPC) is not possible in all stroke patients. We introduced a new VTE pathway which includes Neuromuscular Electrical Stimulation of the peroneal nerve using the geko TM device (Firstkind Ltd UK) as an alternative prevention strategy for this patient group. In addition, compliance with VTE prophylaxis was reviewed 4-hourly as part of comfort rounds. Methods: This is a prospective audit of the new pathway. All stroke patients admitted to the Acute Stroke Unit at Royal Stoke University Hospital between 1 Nov 2016 and 3 Mar 2018 were included. In line with UK guidelines patients unable to mobilize independently were prescribed IPC in addition to standard measures, e.g. hydration, mobilization, and aspirin where indicated, unless patients were palliative, fully anticoagulated, or refused the intervention. Patients who could not use IPC (intolerance, falls risk, out of stock) were switched to the geko TM device. Results: In total 999 stroke patients were included. Of these 187 (18.7%) required no prophylaxis, 125 (12.5%) were fully anti-coagulated, and 687 (68.7%) required mechanical VTE prophylaxis (MP). Of these 463 (67.3%) received IPC and 122 (17.7%) the geko TM device as their only intervention. A further 81 (11.8%) patients became intolerant to IPC and were prescribed the geko TM as a secondary intervention and 21 (3.1%) refused treatment. The geko TM was used in 203 (29.5% of MP). At 90 days there were 15 (1.5%) VTE (symptomatic DVT or PE). Of these 13 occurred in the MP group: 11 (6 DVT, 5 PE) in the ‘IPC only cohort’, 1 in ‘IPC with secondary geko TM ’, 0 in the ‘geko TM only’ cohort, and 1 (PE) in ‘refused prophylaxis’. A further 2 VTE where recorded: 1 (DVT) in ‘prophylaxis not required’ and 1 (DVT) in ‘on anticoagulant’. The geko TM was used for a mean of 9 days/patient and was well tolerated without serious adverse events. Conclusion: The new strategy of increased surveillance, and use of the geko TM device where indicated, for patients who cannot use IPC was associated with a low overall incidence of symptomatic VTE (1.5%). The incidence in high risk immobile patients requiring MP was 1.9% (13/687), which is lower than the 6.6% in a comparable patient population in the CLOTS-3 study.