Teaching Hospitals NHS Foundation Trust Research Articles

Baseline Clinical Factors Associated with Cessation of Growth Hormone Therapy in Patients with Severe Growth Hormone Deficiency - Real World Evidence

Background: Growth hormone replacement is indicated in adults with severe growth hormone (GH) deficiency, adult growth hormone deficiency assessment (AGHDA) score of at least 11 and are receiving treatment for other pituitary hormone deficiencies. There are no data looking at the cessation of GH replacement in adult patients with severe GH deficiency and the factors that predict the likelihood of patients continuing or stopping growth hormone replacement. Methods: We audited patients on the GH register between January 2006 and January 2023 in Hull University Teaching Hospitals NHS foundation Trust, a UK tertiary hospital. Baseline characteristics, the cause of GH deficiency, AGHDA score at diagnosis and the reason for stopping GH were collected. Proportions were compared between patients adhering to GH replacement and those who had ceased it. Logistic regression analysis was used to identify factors independently associated with cessation of GH. Results: The study comprised 141 adult patients with a mean age of 52 years, of which 75 (53%) were female. 54 (38%) individuals had discontinued GH replacement therapy. Predominant reasons for discontinuation were lack of therapeutic benefit (46%) and a change in clinical indication (26%). Among patients who discontinued GH therapy, the most frequent cause of GH deficiency was idiopathic (57%), while for those on GH replacement, pituitary surgery was the leading cause of GH deficiency (53%). Logistic regression analysis showed no baseline factor was statistically significantly associated with GH cessation, except female gender which had a borderline significance (P = 0.05). Conclusions: In this real-world investigation of patients with severe GH deficiency, over two in five individuals who discontinued GH therapy cited the absence of perceived benefits. We show a borderline association of female gender with GH cessation and large population-based studies will be needed to investigate this and other causes of GH cessation.

Effectiveness of a bespoke educational video for healthcare professionals (HCPs) on arginine vasopressin deficiency (AVP-D) and desmopressin in sheffield teaching hospitals NHS foundation trust (STH NHS FT)

Effectiveness of a bespoke educational video for healthcare professionals (HCPs) on arginine vasopressin deficiency (AVP-D) and desmopressin in sheffield teaching hospitals NHS foundation trust (STH NHS FT)

Assessing the Role of Flexible Sigmoidoscopy for Patients With Positive Fecal Immunochemical Test (FIT) and Rectal Bleeding as a Sole Symptom Within the Fast-Track Pathway.

Background Rectal bleeding is a frequent symptom, with causes ranging from benign conditions to serious diseases like colorectal cancer (CRC) and inflammatory bowel disease (IBD). In the UK, the two-week wait (2WW) referral pathway, which includes the fecal immunochemical test (FIT), plays a key role in triaging suspected CRC cases. This study evaluates the effectiveness of flexible sigmoidoscopy (FS) in detecting significant bowel pathologies (SBPs) in FIT-positive patients with isolated rectal bleeding. Methods We reviewed records of 344 patients with isolated rectal bleeding and a positive FIT result, referred to the 2WW pathway at York and Scarborough Teaching Hospitals NHS Foundation Trust from February to December 2023. All patients underwent colonoscopy. Findings from colonoscopy were used as a standard to compare with the expected reach of FS. Pathologies were categorized into SBPs (cancer, IBD, polyps ≥10 mm) and non-SBPs, and the location of SBPs in relation to the splenic flexure was also assessed. Results The average age of patients was 61.58 years. Significant bowel pathology (SBP) was identified in 89 of 344 (25.9%) patients, including 16 (18%) patients with cancer, 21 (23.6%) patients with IBD, and 52 (58.4%) patients with large polyps. All cases of cancer and IBD were found distal to the splenic flexure, while 21.1% (11/89) of large polyps were proximal. Higher FIT values (>100 µg Hb/g feces) and older age were significantly associated with SBPs. However, age and higher FIT values did not predict whether SBPs were proximal or distal. Conclusion For FIT-positive patients with isolated rectal bleeding, FS can serve as an effective initial diagnostic tool. Patients without detected cancer can be downgraded from the fast-track pathway to routine colonoscopy follow-up to avoid missing proximal premalignant lesions. This approach enhances resource utilization while ensuring comprehensive patient care. Further studies are needed to improve triage criteria and diagnostic accuracy within the 2WW pathway.

The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.

Background Biliary dyskinesia (BD) is a disorder characterised by abdominal pain of biliary origin (i.e., sudden steady pain at the right upper quadrant of the abdomen or the epigastrium, the absence of gallstones on ultrasound (US)), and a decreased gallbladder ejection fraction (GBEF) on a cholecystokinin-cholescintigraphy hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Patients experiencing symptoms suggestive of biliary obstruction, but lacking gallstones, yet exhibiting abnormal gallbladder emptying, may find therapeutic benefit from laparoscopic cholecystectomy. Common symptoms include recurrent, intense, and enduring pain, often exacerbated by fatty food consumption, localised in the upper right quadrant or epigastric region. This pain may radiate to the back or shoulder, persisting for at least 30 minutes but not exceeding several hours, and it is sometimes accompanied by nausea and vomiting. Abnormal gallbladder emptying is typically indicated by a GBEF below 35% on cholescintigraphy following cholecystokinin administration. Objective This study represents a single-centric review focusing on 88 patients over a five-year period who presented with features of dysfunctional gallbladder and underwent cholescintigraphy. The primary aim was to identify whether there is any role for laparoscopic cholecystectomy in symptom improvement among these patients. Methods This was a retrospective cohort study involving data collection using electronic medical records. Eighty-eight patients who underwent the HIDA scan between January 2019 and December 2023 at Wirral University Teaching Hospital NHS Foundation Trust (WUTH) were identified and separated into two groups, either hypofunctioning gallbladder (EF<35% ) or hyperfunctioning gallbladder (EF>80%). Normal HIDA scan patients (EF between 35%-80%) were excluded. The frequency of laparoscopic cholecystectomy and subsequent symptom improvement were recorded. Results Fifty-one patients were diagnosed with gallbladder dyskinesia (BD). Of these, 36 patients (30 females, mean age 43) were diagnosed with hypofunctional gallbladder (EF<35%), where 17 patients underwent laparoscopic cholecystectomy, resulting in symptom improvement in 10 patients (58.8%). Conversely, 15 patients were diagnosed with hyperfunctional gallbladder (13 females, mean age 48.6). Only two patients (13%) underwent laparoscopic cholecystectomy with 100% symptom improvement in both patients. Conclusions In conclusion, our retrospective study highlights the significance of the HIDA scan in identifying gallbladder hypofunction among patients presenting with biliary symptoms. The findings establish the efficacy of laparoscopic cholecystectomy as a management approach, with a notable proportion of patients experiencing symptom improvement (58.8%). These results contribute to our understanding of biliary dysfunction management and emphasise the importance of individualised treatment strategies for optimal patient outcomes. Further, randomised controlled trials (RCTs) are warranted to validate these findings and explore additional factors influencing symptom resolution in this patient population.

Changing the culture around hospital-based nutrition.

Following a serious incident and inquest after the death of a patient due to choking at Sheffield Teaching Hospitals NHS Foundation Trust, the Trust put in place an action plan and implemented strategies to reduce the risk of recurrence. Four key actions were identified as essential to try to reduce the risk of a similar event: introduction of a standard operating procedure for mealtimes that included a pre-meal safety 'pause'; use of an electronic communication icon to indicate modified diet/fluid requirements, from emergency department and onward as a patient is transferred; job-specific mealtime safety training; and use of bedside posters with specific dietary requirements (in line with the International Dysphagia Diet Standards Initiative Framework). A new role of Lead Educator for Nutrition was introduced to support the changes and provide training. Changes were also made to the incident reporting system to ensure easy identification of events relating to dysphagia, so that these could be monitored, themes identified and lessons shared. A series of audits following the changes have shown that more staff across disciplines and teams have accessed training on nutrition and hydration practices, wards have increased the use of the icon and posters, and successfully implemented pre-meal safety pauses. The Lead Educator for Nutrition has helped embed learning, and increased awareness and knowledge about nutrition and hydration.

APCP CONFERENCE ABSTRACTS: 2023

APCP CONFERENCE ABSTRACTS: 2023

Adequacy of intraoperative patient handover

Background: Intraoperative handover is essential for patient safety as failure in communication may lead to morbidity and mortality. Effective handover plays a key part in ensuring the continuity, quality, and safety of patient care.1 SBAR (situation, background, assessment, recommendation) provides a structured handover approach and is endorsed by the hospital policy.2 It can make handovers quicker yet more effective, thereby releasing more time for clinical care. Handover should be structured to ensure continuity of care.3 The aim of this hospital Quality Improvement Project was to compare the handover given between anaesthesia residents using an internationally defined handover template (Association of Anaesthetists), followed by a training package and re-audit. Methods: Eight operating lists on 5 days with a total of 120 handovers were checked for the information given at the time of handover. This was cross checked with the international standards on a proforma. After the first audit, residents received training and a checklist was provided in each operating room. Later on, a loop audit was done to check compliance. This time the total number of handovers assessed was 131. Results: There were total 23 residents when this audit was performed; 26.1 % (n=6) were female and 73.9% (n=17) were male. In the first audit, compliance with mentioning the situation was 61.7% (n=74); background was mentioned in 9.1% (n=11) cases; assessment was provided in 5% (n=6) of the times; recommendations were given in 43.3% (n=52) of the cases. The loop audit after the training package showed improvement in the results (Fig. 4). The compliance was as follows: situation 87.8% (n=115), background 93.9% (n=120), assessment 90.1% (n=118), and recommendations were 100% (n=131). Conclusions: A comprehensive and standardised handover of important patient information is vital for ensuring continuity of care, patient safety, and avoids poor/inadequate communication. By completing an audit cycle, we improved the quality of handover. 1.Boet S, Djokhdem H, Leir SA, Théberge I, Mansour F, Etherington C. Br J Anaesth 2020; 125: 605–132.Oswal S, Ingham C, Sykes A. Postoperative handover protocol. Bradford Teaching Hospitals NHS Foundation Trust. 2018. (Accessed 20/03/2023)3.Jullia M, Tronet A, Fraumar F, et al. Eur J Anaesthesiol 2017; 34: 471–6

Aortic dissection secondary to giant cell arteritis.

British Journal of Hospital MedicineEarly view Case ReportAortic dissection secondary to giant cell arteritisConnor Cotton, Sarah Chatharoo, Pankaj ChaturvediConnor CottonCorrespondence to: Connor Cotton; E-mail Address: [email protected]Department of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this author, Sarah ChatharooDepartment of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this author, Pankaj ChaturvediDepartment of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this authorConnor Cotton; Sarah Chatharoo; Pankaj ChaturvediPublished Online:17 Apr 2023https://doi.org/10.12968/hmed.2022.0529AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Agard C, Ponge T, Fradet G et al.. Giant cell arteritis presenting with aortic dissection: two cases and review of the literature. Scand J Rheumatol. 2006;35(3):233–236. https://doi.org/10.1080/03009740500395252 Crossref, Medline, Google Scholarde Boysson H, Espitia O, Samson M et al.. Giant cell arteritis-related aortic dissection: a multicenter retrospective study. Semin Arthritis Rheum. 2021;51(2):430–435. https://doi.org/10.1016/j.semarthrit.2021.03.001 Crossref, Medline, Google ScholarEvans JM, O'Fallon WM, Hunder GG. Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis: a population-based study. Ann Intern Med. 1995;122(7):502. https://doi.org/10.7326/0003-4819-122-7-199504010-00004 Crossref, Medline, Google ScholarHiratzka LF, Bakris GL, Beckman JA et al.. Faculty opinions recommendation of 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/sir/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13): e266–369. https://doi.org/10.1161/CIR.0b013e3181d4739e Medline, Google ScholarKermani TA, Warrington KJ, Crowson CS et al.. Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis. 2013;72(12):1989–1994. https://doi.org/10.1136/annrheumdis-2012-202408 Crossref, Medline, Google ScholarMackie SL, Dejaco C, Appenzeller C et al.. British society for rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology. 2020;59(3):e01–e23. https://doi.org/10.1093/rheumatology/kez672 Crossref, Medline, Google ScholarNayar AK, Casciello M, Slim JN, Slim AM. Fatal aortic dissection in a patient with giant cell arteritis: a case report and review of the literature. Case Rep Vasc Med. 2013;2013:1–4. https://doi.org/10.1155/2013/590721 Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 17 April 2023 Information© MA Healthcare LimitedAcknowledgementsThe authors would like to thank Sarah Gardner, Library and Information Service, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Knowledge, Doncaster, for her help with the literature search.PDF download

19 - Curative-intent treatment for lung cancer at Bradford Teaching Hospitals NHS Foundation Trust (BTHFT): influence of fitness testing and access to treatment

19 - Curative-intent treatment for lung cancer at Bradford Teaching Hospitals NHS Foundation Trust (BTHFT): influence of fitness testing and access to treatment

Mental health burden for NHS healthcare staff during the COVID-19 pandemic: First results of a longitudinal survey

BackgroundThe current investigation aimed to assess the mental health burden on healthcare workers during the early stages of the COVID-19 pandemic. MethodsA link to an online survey was sent to an estimate of 18,100 employees of Sheffield Teaching Hospitals NHS Foundation Trust (STH) who had access to email. The survey was completed between 2nd and June 12, 2020.1390 healthcare workers (medical, nursing, administrative and other professions) participated in the first survey. Data from a general population sample (n = 2025) was used for comparison. Severity of somatic symptoms was measured by the PHQ-15. Severity and probable diagnosis of depression, anxiety, and PTSD were measured by the PHQ-9, GAD-7, and ITQ. Linear and logistic regressions were performed to determine if population group predicted the severity of mental health outcomes, and probable diagnosis of depression, anxiety, and PTSD. Additionally, ANCOVAs were performed to compare mental health outcomes between occupational roles in HCWs. Analysis was performed using SPSS. FindingsHealthcare workers are more likely to experience greater severity of somatic symptoms, as well as severity and probable diagnosis of depression and anxiety, compared to the general population, but not increased traumatic stress symptoms. Scientific and technical, nursing and admin staff were more likely to experience worse mental health outcomes, compared to medical staff. InterpretationThe COVID-19 pandemic has led to increased mental health burden in some, but not all healthcare workers during the first acute phase of the pandemic. The findings from the current investigation provide valuable insights into which healthcare workers are particularly vulnerable to developing adverse mental health outcomes during and after a pandemic.

POSTER ABSTRACTS

POSTER ABSTRACTS

Doing today’s work today: real-time data recording and rolling audit in an IVF clinic

The assisted conception unit at Sheffield Teaching Hospital NHS Foundation Trust provides in vitro fertilisation treatment. A team of seven embryologists provides a routine clinical laboratory service, involving culture and...

Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke

HomeStrokeVol. 53, No. 9Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextScreening for Aspiration Risk Associated With Dysphagia in Acute Stroke Elizabeth Boaden, PhD, Jane Burnell, MSc, Lucy Hives, MSc, Paola Dey, MD, Andrew Clegg, PhD, Mary W. Lyons, MPH, C. Elizabeth Lightbody, PhD, Margaret A. Hurley, PhD, Hazel Roddam, PhD, Elizabeth McInnes, PhD, Anne W. Alexandrov, PhD and Caroline L. Watkins, PhD Elizabeth BoadenElizabeth Boaden Correspondence to: Elizabeth Boaden, PhD, Senior Research Fellow, Stroke Research Team, Brook Building 247, University of Central Lancashire, Preston, PR1 2HE. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4647-6392 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Jane BurnellJane Burnell https://orcid.org/0000-0002-4601-1632 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Lucy HivesLucy Hives https://orcid.org/0000-0003-4125-4034 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Paola DeyPaola Dey https://orcid.org/0000-0003-4555-1917 Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom (P.D.). Search for more papers by this author , Andrew CleggAndrew Clegg https://orcid.org/0000-0001-8938-7819 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Mary W. LyonsMary W. Lyons https://orcid.org/0000-0001-7532-2301 Liverpool School of Tropical Medicine, United Kingdom (M.W.L.). Search for more papers by this author , C. Elizabeth LightbodyC. Elizabeth Lightbody https://orcid.org/0000-0001-5016-3471 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom (C.E.L.). Search for more papers by this author , Margaret A. HurleyMargaret A. Hurley https://orcid.org/0000-0002-2502-432X Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Hazel RoddamHazel Roddam https://orcid.org/0000-0002-0637-1801 Faculty of Allied Health and Well-being (H.R.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author , Elizabeth McInnesElizabeth McInnes https://orcid.org/0000-0002-0567-9679 Nursing Research Institute, Australian Catholic University, Sydney, Australia (E.M.). Search for more papers by this author , Anne W. AlexandrovAnne W. Alexandrov https://orcid.org/0000-0002-4060-6766 Department of Acute and Tertiary Care, University of Tennessee Health Science Center (UTHSC), Memphis (A.W.A.). Search for more papers by this author and Caroline L. WatkinsCaroline L. Watkins https://orcid.org/0000-0002-9403-3772 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Search for more papers by this author Originally published22 Aug 2022https://doi.org/10.1161/STROKEAHA.122.037998Stroke. 2022;53:e424–e425"Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke." Stroke, 53(9), pp. e424–e425FootnotesFor Sources of Funding and Disclosures, see page e425.Correspondence to: Elizabeth Boaden, PhD, Senior Research Fellow, Stroke Research Team, Brook Building 247, University of Central Lancashire, Preston, PR1 2HE. Email [email protected]ac.uk

Usability engineering in practice: developing an intervention for post-stroke therapy during a global pandemic

This paper provides an overview of the usability engineering process and relevant standards informing the development of medical devices, together with adaptations to accommodate situations such as global pandemics where use of traditional face-to-face methods is restricted. To highlight some of those adaptations, a case study of a project developing a novel electronic rehabilitation device is referenced, which commenced in November 2020 amidst the COVID-19 pandemic. The Sheffield Adaptive Patterned Electrical Stimulation (SHAPES) project, led by Sheffield Teaching Hospitals NHS Foundation Trust (STH), aimed to design, manufacture and trial an intervention for use to treat upper arm spasticity after stroke. Presented is an outline and discussion of the challenges experienced in developing the SHAPES health technology intended for at-home use by stroke survivors and in implementing usability engineering approaches. Also highlighted, are the benefits that arose, which can offer easier involvement of vulnerable users and add flexibility in the ways that user feedback is sought. Challenges included: restricted travel; access to usual prototyping facilities; social distancing; infection prevention and control; availability of components; and changing work pressures and demands. Whereas benefits include: less travel; less time commitment; and greater scope for participants with restricted mobility to participate in the process. The paper advocates a more flexible approach to usability engineering and outlines the onward path for development and trialling of the SHAPES technology.

Psychological/social factors associated with transfer readiness in young people with juvenile idiopathic arthritis

The aim of this study is to investigate the relationships between psychological/social factors and transfer readiness from paediatric to adult rheumatology services in pre- and post-transfer young people (YP) with juvenile idiopathic arthritis (JIA). Participants completed questionnaires measuring a broad range of psychological/social factors (generalised anxiety, pain-specific anxiety, pain-related thoughts, depression, prosocial behaviours, problem behaviours, arthritis-related quality of life (QoL), social support, family functioning) and transfer readiness (transfer-related knowledge and skills, health-related self-efficacy). JIA disease activity was measured on the same day as the questionnaires. This study received all relevant ethical and regulatory approvals, and informed consent was received from or on behalf of all participants. In total, 40 pre-transfer YP with JIA aged 10-16 years (M = 13.54 years, 26 females) and their parents/guardians participated at Sheffield Children's NHS Foundation Trust, and 40 post-transfer YP with JIA aged 16-24 years (M = 20.16 years, 26 females) participated at Sheffield Teaching Hospitals NHS Foundation Trust. For both pre- and post-transfer YP, greater transfer readiness was associated with lower generalised anxiety levels, lower pain-specific anxiety levels, fewer pain-related thoughts, lower depression levels, fewer problem behaviours, better arthritis-related QoL, better social support, and better family functioning. Greater transfer readiness was also associated with less JIA disease activity for post-transfer YP only. A broad range of psychological/social factors were associated with transfer readiness in pre- and post-transfer YP with JIA. This highlights the importance of assessing and addressing YP's psychological/social well-being during their transition to adult services. Key Points • A wide range of psychological and social factors may be associated with how ready young people with juvenile idiopathic arthritis feel to move from paediatric to adult rheumatology services. • Transition outcomes may be improved by comprehensively assessing and addressing young people's psychological and social well-being.

Information Provision for Stroke Survivors and Their Carers: Cochrane Review

HomeStrokeVol. 53, No. 7Information Provision for Stroke Survivors and Their Carers: Cochrane Review No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextInformation Provision for Stroke Survivors and Their Carers: Cochrane Review Thomas F. Crocker, MA, MSc, PhD, Lesley Brown, PhD, Natalie Lam, PGDip, MPH, Faye Wray, MSc, PhD, Peter Knapp, RGN, BA, PhD and Anne Forster, BA, PhD Thomas F. CrockerThomas F. Crocker Correspondence to: Thomas F. Crocker, MA, MSc, PhD, Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7450-3143 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Lesley BrownLesley Brown https://orcid.org/0000-0001-5499-9145 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Natalie LamNatalie Lam https://orcid.org/0000-0001-8591-444X Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Faye WrayFaye Wray https://orcid.org/0000-0001-9351-5019 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Peter KnappPeter Knapp https://orcid.org/0000-0001-5904-8699 Department of Health Sciences, University of York, the Hull York Medical School, United Kingdom (P.K.). Search for more papers by this author and Anne ForsterAnne Forster https://orcid.org/0000-0001-7466-4414 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author Originally published27 Jun 2022https://doi.org/10.1161/STROKEAHA.121.038162Stroke. 2022;53:e269–e270"Information Provision for Stroke Survivors and Their Carers: Cochrane Review." Stroke, 53(7), pp. e269–e270FootnotesFor Sources of Funding and Disclosures, see page e270.Correspondence to: Thomas F. Crocker, MA, MSc, PhD, Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom. Email tom.[email protected]nhs.ukReference1. Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers.Cochrane Database Syst Rev. 2021; CD001919. doi: 10.1002/14651858.CD001919CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 2022Vol 53, Issue 7 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.121.038162 Originally publishedJune 27, 2022 Keywordsstroke rehabilitationanxietyconsumer health informationeducationsurvivorsPDF download Advertisement SubjectsMeta AnalysisRehabilitationSecondary Prevention

Phenotyping of idiopathic pulmonary arterial hypertension: a registry analysis

SummaryBackgroundAmong patients meeting diagnostic criteria for idiopathic pulmonary arterial hypertension (IPAH), there is an emerging lung phenotype characterised by a low diffusion capacity for carbon monoxide (DLCO) and a smoking history. The present study aimed at a detailed characterisation of these patients.MethodsWe analysed data from two European pulmonary hypertension registries, COMPERA (launched in 2007) and ASPIRE (from 2001 onwards), to identify patients diagnosed with IPAH and a lung phenotype defined by a DLCO of less than 45% predicted and a smoking history. We compared patient characteristics, response to therapy, and survival of these patients to patients with classical IPAH (defined by the absence of cardiopulmonary comorbidities and a DLCO of 45% or more predicted) and patients with pulmonary hypertension due to lung disease (group 3 pulmonary hypertension).FindingsThe analysis included 128 (COMPERA) and 185 (ASPIRE) patients with classical IPAH, 268 (COMPERA) and 139 (ASPIRE) patients with IPAH and a lung phenotype, and 910 (COMPERA) and 375 (ASPIRE) patients with pulmonary hypertension due to lung disease. Most patients with IPAH and a lung phenotype had normal or near normal spirometry, a severe reduction in DLCO, with the majority having no or a mild degree of parenchymal lung involvement on chest computed tomography. Patients with IPAH and a lung phenotype (median age, 72 years [IQR 65–78] in COMPERA and 71 years [65–76] in ASPIRE) and patients with group 3 pulmonary hypertension (median age 71 years [65–77] in COMPERA and 69 years [63–74] in ASPIRE) were older than those with classical IPAH (median age, 45 years [32–60] in COMPERA and 52 years [38–64] in ASPIRE; p<0·0001 for IPAH with a lung phenotype vs classical IPAH in both registries). While 99 (77%) patients in COMPERA and 133 (72%) patients in ASPIRE with classical IPAH were female, there was a lower proportion of female patients in the IPAH and a lung phenotype cohort (95 [35%] COMPERA; 75 [54%] ASPIRE), which was similar to group 3 pulmonary hypertension (336 [37%] COMPERA; 148 [39%] ASPIRE]). Response to pulmonary arterial hypertension therapies at first follow-up was available from COMPERA. Improvements in WHO functional class were observed in 54% of patients with classical IPAH, 26% of patients with IPAH with a lung phenotype, and 22% of patients with group 3 pulmonary hypertension (p<0·0001 for classical IPAH vs IPAH and a lung phenotype, and p=0·194 for IPAH and a lung phenotype vs group 3 pulmonary hypertension); median improvements in 6 min walking distance were 63 m, 25 m, and 23 m for these cohorts respectively (p=0·0015 for classical IPAH vs IPAH and a lung phenotype, and p=0·64 for IPAH and a lung phenotype vs group 3 pulmonary hypertension), and median reductions in N-terminal-pro-brain-natriuretic-peptide were 58%, 27%, and 16% respectively (p=0·0043 for classical IPAH vs IPAH and a lung phenotype, and p=0·14 for IPAH and a lung phenotype vs group 3 pulmonary hypertension). In both registries, survival of patients with IPAH and a lung phenotype (1 year, 89% in COMPERA and 79% in ASPIRE; 5 years, 31% in COMPERA and 21% in ASPIRE) and group 3 pulmonary hypertension (1 year, 78% in COMPERA and 64% in ASPIRE; 5 years, 26% in COMPERA and 18% in ASPIRE) was worse than survival of patients with classical IPAH (1 year, 95% in COMPERA and 98% in ASPIRE; 5 years, 84% in COMPERA and 80% in ASPIRE; p<0·0001 for IPAH with a lung phenotype vs classical IPAH in both registries).InterpretationA cohort of patients meeting diagnostic criteria for IPAH with a distinct, presumably smoking-related form of pulmonary hypertension accompanied by a low DLCO, resemble patients with pulmonary hypertension due to lung disease rather than classical IPAH. These observations have pathogenetic, diagnostic, and therapeutic implications, which require further exploration.FundingCOMPERA is funded by unrestricted grants from Acceleron, Bayer, GlaxoSmithKline, Janssen, and OMT. The ASPIRE Registry is supported by Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Risk factors for SARS-CoV-2 seroprevalence following the first pandemic wave in UK healthcare workers in a large NHS Foundation Trust.

Background: We aimed to measure SARS-CoV-2 seroprevalence in a cohort of healthcare workers (HCWs) during the first UK wave of the COVID-19 pandemic, explore risk factors associated with infection, and investigate the impact of antibody titres on assay sensitivity. Methods:HCWs at Sheffield Teaching Hospitals NHS Foundation Trust were prospectively enrolled and sampled at two time points. We developed an in-house ELISA for testing participant serum for SARS-CoV-2 IgG and IgA reactivity against Spike and Nucleoprotein. Data were analysed using three statistical models: a seroprevalence model, an antibody kinetics model, and a heterogeneous sensitivity model. Results:Our in-house assay had a sensitivity of 99·47% and specificity of 99·56%. We found that 24·4% (n=311/1275) of HCWs were seropositive as of 12th June 2020. Of these, 39·2% (n=122/311) were asymptomatic. The highest adjusted seroprevalence was measured in HCWs on the Acute Medical Unit (41·1%, 95% CrI 30·0-52·9) and in Physiotherapists and Occupational Therapists (39·2%, 95% CrI 24·4-56·5).Older age groups showed overall higher median antibody titres. Further modelling suggests that, for a serological assay with an overall sensitivity of 80%, antibody titres may be markedly affected by differences in age, with sensitivity estimates of 89% in those over 60 years but 61% in those ≤30 years. Conclusions:HCWs in acute medical units and those working closely with COVID-19 patients were at highest risk of infection, though whether these are infections acquired from patients or other staff is unknown. Current serological assays may underestimate seroprevalence in younger age groups if validated using sera from older and/or more severe COVID-19 cases.

Invasive cervical cancer audit: What lessons can we learn locally and where would we stand with regard to duty of candour?

To identify lessons learned locally from the invasive cervical cancer audit. To estimate the impact that the application of 'Duty of Candour' may have upon our future service provision. Retrospective cohort study with interval analysis of all women diagnosed with cervical cancer at Sheffield Teaching Hospitals NHS Foundation Trust between 1 April 2007 to 31 December 2019. Data were collected prospectively with retrospective categorisation by screening history and invasive cervical cancer audit outcomes as satisfactory, satisfactory with learning points, and unsatisfactory. Statistical analysis was performed using the chi-squared test and paired t-test. Cervical cancer was diagnosed in 344 women. Seventy-eight (23%) had no record of prior cervical cytology, 108 (31%) had delayed attendance to the screening programme, 102 (30%) were detected by routine screening, and 56 (16%) were screening programme compliant. Satisfactory management was undertaken in 301 (87.5%) cases, 26 cases (7.5%) were satisfactory with learning points, and 17 cases (5%) were considered as unsatisfactory. Seventeen cases were applicable to the Duty of Candour process equating to 1.3 cases per year, incurring minimal impact upon future service provision. Invasive audit categorisation is subject to bias, however, with the potential for considerable intra- and inter-observer variation; the authors accordingly recommend that a further study be conducted to investigate both the consistency and reproducibility of the invasive cervical cancer audit categorisation.

A Cloud-Based Deep Learning Framework for Remote Detection of Diabetic Foot Ulcers

This research proposes a mobile and cloud-based framework for the automatic detection of diabetic foot ulcers and conducts an investigation of its performance. The system uses a cross-platform mobile framework which enables the deployment of mobile apps to multiple platforms using a single TypeScript code base. A deep convolutional neural network was deployed to a cloud-based platform where the mobile app could send photographs of patient's feet for inference to detect the presence of diabetic foot ulcers. The functionality and usability of the system were tested in two clinical settings: Salford Royal NHS Foundation Trust and Lancashire Teaching Hospitals NHS Foundation Trust. The benefits of the system, such as the potential use of the app by patients to identify and monitor their condition are discussed.