& Knowledge Service

Title

SARS-CoV-2 infection is associated with an increased risk of idiopathic acute pancreatitis but not pancreatic exocrine insufficiency or diabetes: long-term results of the COVIDPAN study

Author(s)

Ravi, K.

Year

2021

Abstract

No abstract available

Letter

Title

​

Author(s)

​

Year

​

Abstract

​

​

Title

Transfusion 2024: A 5-year plan for clinical and laboratory transfusion in England

Author(s)

Cort, J.

Year

2021

Abstract

The Transfusion 2024 plan outlines key priorities for clinical and laboratory transfusion practice for safe patient care across the NHS for the next 5 years. It is based on the outcomes of a multi-professional symposium held in March 2019, organised by the National Blood Transfusion Committee (NBTC) and NHS Blood and Transplant (NHSBT), attended and supported by Professor Keith Willet and Dame Sue Hill on behalf of NHS England and Improvement. This best practice guidance contained within this publication will facilitate the necessary change in pathway design to meet the transfusion challenges and pressures for the restoration of a cohesive, and functional, healthcare system across the NHS following the COVID-19 pandemic.

Article

Title

The significance of urgent ultrasound scan for shoulder dislocation in patients above the age of 40: A prospective British Elbow and Shoulder Society pathway implementation study

Author(s)

Zhou, R; Prasad, G; Robinson, G; Shahane, S; Sinha, A.

Year

2021

Abstract

Background: The highlight of the British Elbow and Shoulder Society pathway for the management of traumatic anterior shoulder instability is early imaging in patients aged over 40 years to assess rotator cuff integrity and early repair, if indicated to optimise function. The senior author set up a protocol in our institute to streamline the diagnostic process for this cohort of patients. This was a retrospective analysis from a prospectively collected database to highlight the importance of early specialist imaging.

Methods: Our protocol is to perform urgent ultrasound scans for all suitable patients above 40 years after first-time traumatic shoulder dislocation. Demographics, associated injuries, ultrasound scan results, operations and functional outcomes were collated.

Results: One year following the introduction of our protocol, 40 patients with a mean age of 67 (range, 42-89; SD = 13.1) had ultrasound. The incidence of full-thickness rotator cuff tears was 57.5% (n = 23). Eleven patients with confirmed full-thickness rotator cuff tears underwent surgery. The mean age of surgical patients was significantly younger than the non-surgical group (p = 0.004).

Discussion: The use of early diagnostic imaging demonstrated a high incidence of full-thickness rotator cuff tears in this cohort of patients. This allowed early surgical repair to optimise function

Article

Title

Before/after intervention study to determine impact on life-cycle carbon footprint of converting from single-use to reusable sharps containers in 40 UK NHS trusts

Author(s)

Ludditt, S.

Year

2021

Abstract

Objectives: To compare global warming potential (GWP) of hospitals converting from single-use sharps containers to reusable sharps containers (SSC, RSC). Does conversion to RSC result in GWP reduction?

Design: Using BS PAS 2050:2011 principles, a retrospective, before/after intervention quantitative model together with a purpose-designed, attributional 'cradle-to-grave' life-cycle tool, were used to determine the annual greenhouse gas (GHG) emissions of the two sharps containment systems. Functional unit was total fill line litres (FLL) of sharps containers needed to dispose of sharps for 1-year period in 40 trusts. Scopes 1, 2 and 3 emissions were included. Results were workload-normalised using National Health Service (NHS) national hospital patient-workload indicators. A sensitivity analysis examined areas of data variability.

Setting: Acute care hospital trusts in UK.

Participants: 40 NHS hospital Trusts using RSC.

Intervention: Conversion from SSC to RSC. SSC and RSC usage details in 17 base line trusts immediately prior to 2018 were applied to the RSC usage details of the 40 trusts using RSC in 2019.

Primary outcome measure: The comparison of GWP calculated in carbon dioxide equivalents (CO2e) generated in the manufacture, transport, service and disposal of 12 months, hospital-wide usage of both containment systems in the 40 trusts.

Results: The 40 trusts converting to RSC reduced their combined annual GWP by 3267.4 tonnes CO2e (-83.9%); eliminated incineration of 900.8 tonnes of plastic; eliminated disposal/recycling of 132.5 tonnes of cardboard and reduced container exchanges by 61.1%. GHG as kg CO2e/1000 FLL were 313.0 and 50.7 for SSC and RSC systems, respectively. A sensitivity analysis showed substantial GHG reductions within unit processes could be achieved, however, their impact on relevant final GWP comparison varied <5% from base comparison.

Conclusions: Adopting RSC is an example of a sustainable purchasing decision that can assist trusts meet NHS GHG reduction targets and can reduce GWP permanently with minimal staff behavioural change.

Article

Title

Merkel Cell Carcinoma staging

Author(s)

Slater, D.N.

Year

2021

Abstract

Patel and Hussain appropriately emphasise that TNM (Tumour, Node, Metastasis) staging is central to the management of Merkel cell carcinoma (MCC).1 Furthermore, as Clinical and Experimental Dermatology is an international journal, it was not wholly inappropriate for the authors to have made use of the TNM staging system developed by the American Joint Committee on Cancer (AJCC).2 It must be noted, however, the latter is not the system used in many parts of the world, where instead there is a preference for the TNM staging system published by the Union for International Cancer Control (UICC).

Letter

Title

A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination

Author(s)

Ali, F.

Year

2021

Abstract

Background: Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of 'massive open online courses' (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills.

Aims/objectives: To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students.

Methods: Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention.

Results: There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543).

Conclusion: Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format. Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.

Article

Title

Optic perineuritis

Author(s)

Rai, H. K.

Year

2021

Abstract

Optic perineuritis (OPN) is a rare inflammatory disorder in which the inflammation is confined to optic nerve sheath. It can be idiopathic or secondary to underlying systemic autoimmune disorder. It usually presents with unilateral progressive diminution of vision with pain on eye movements and optic disc oedema. Hence, clinically OPN mimics optic neuritis resulting in delayed diagnosis and suboptimal treatment. In contrast to optic neuritis, patients with OPN are usually of older age group and more likely show sparing of central vision. MRI is an important tool for diagnosis of OPN apart from optic nerve sheath biopsy. Perineural enhancement on MRI is diagnostic of OPN. Oral corticosteroid therapy gives dramatic and rapid improvement in signs and symptoms. Rapid tapering of steroids increases the risk of relapse. Overall, prognosis of OPN is generally good if adequate treatment is given timely.

Article

Title

Psychological distress and trauma during the COVID-19 pandemic: survey of doctors practising anaesthesia, intensive care medicine, and emergency medicine in the United Kingdom and Republic of Ireland

Author(s)

Tambe, N.

Year

2021

Abstract

No abstact available

Article

Title

The low FODMAP diet for IBS; A multicentre UK study assessing long term follow up

Author(s)

Robinson, K; Elphick, D.

Year

2021

Abstract

Background: The low FODMAP diet (LFD) is effective in managing irritable bowel syndrome (IBS) in the short term. This study assessed the long-term effect of the LFD on symptoms, nutritional composition and socialising.

Methods: Patients with IBS who received dietetic-led LFD advice were approached at long term follow up (>6 months post LFD advice) from six centres across the United Kingdom. Participants completed questionnaires assessing gastrointestinal symptoms, adherence, nutritional intake, dietary acceptability and food related quality of life (QOL).

Results: 205 participants completed the study, with a mean follow up of 44 months (3.7 years). Adequate symptom relief was noted in 60% of individuals at long term follow up, with 76% being on the personalisation phase of the LFD (pLFD). Mean nutritional intake did not differ between individuals on the pLFD versus habitual diet, with no difference in fructan intake (2.9 g/d vs 2.9 g/d, p = 0.96). The majority (80%) of individuals on the pLFD consumed specific 'free-from' products at the long term, with the purchase of gluten or wheat free products being the commonest (68%).

Conclusion: The majority of patients follow the pLFD in the long term, with a large proportion purchasing gluten or wheat free products to manage their symptoms.

Article

Title

Hydration Strategies for Physical Activity and Endurance Events at High (>2500 m) Altitude: A Practical Management Article

Author(s)

Windsor, J. S.

Year

2021

Abstract

A growing number of adventurous athletes are seeking new challenges through endurance events or physical activities held at high altitude (>2500 m). This coincides with a significant increase in the numbers of trekkers who ascend into the world's mountains. Altitude itself influences and complicates the athlete's effective and safe hydration. This article considers the physiology of adaptation to altitude and the effects on hydration at altitude compared with sea level, reviews the "ad libitum versus programmed hydration" controversy in conventional endurance event hydration, examines the evidence for extrapolation of sea level hydration strategies to the high-altitude environment, and synthesizes these disparate factors into a set of practical recommendations for hydration management during high-altitude physical activity. The guidelines will be relevant to participants of physical activity at altitude and health care staff who may care for them in the preparation or performance phases of their adventure.

Article

Title

Does observational study on the effectiveness of the Twin Blocks overestimate or underestimate the results? A comparative analysis of retrospective samples versus randomized controlled trial

Author(s)

Sandler, J.

Year

2021

Abstract

Background and objectives: Class II malocclusion is one of the most common orthodontic problems. The Twin Block appliance has proven to be the most popular appliance for the correction of these malocclusions. Although randomized controlled trials (RCTs) on the Twin Block appliance have reported the changes to be mainly dentoalveolar, several nonrandomized studies have reported a significant skeletal improvement in these patients. Hence, the aim of this study was to compare the effectiveness of Twin Block appliance evaluated using an RCT or retrospectively selected cases (RSC) for the treatment of Class II Division 1 malocclusion in an adolescent population.

Methods: This was a retrospective study. The results for an RCT were selected from a UK Class II multicenter study. Sixty-three patients from the trial were included. This group was matched with retrospectively selected Class II cases treated with a Twin Block functional appliance and their results submitted for Membership in Orthodontics examination in the United Kingdom, from four centers. The primary outcome was skeletal measurement ANB (A point, nasion, B point). Secondary outcomes included final peer assessment rating (PAR) scores and final overjet. Intrarater reliability of measurements was assessed. Independent samples t-test was carried out to look at the difference between the groups.

Results: The reliability assessment showed excellent agreement for all measurements. The data were normally distributed. There was a statistically significant difference favoring the RSC group for final overjet (mean difference [MD] = 1.068, 95% confidence interval [CI] -0.67 to 1.47, P = 0.000) and final PAR (MD = 4.0, 95% CI -0.79 to 5.5, P = 0.000). There was no significant difference in the scores for final ANB (MD = 0.34, 95% CI -0.39 to 1.07, P = 0.33).

Conclusion: The RSCs show significantly improved overjet and PAR scores at the end of treatment and no statistically significant difference for skeletal change. The study raises the question of a potential role of observational studies in evaluating the effect of an intervention in orthodontics

Article