Derriford Hospital is a large teaching hospital in Plymouth, England. The hospital serves Plymouth and nearby areas of Devon and Cornwall. It also provides tertiary cardiothoracic surgery, neurosurgery and renal transplant surgery for the whole of the South West Peninsula. It is managed by the University Hospitals Plymouth NHS Trust. It was designated a major trauma centre in 2013. A helipad capable of night operation was opened in 2015, to replace the existing daytime-only grass pad. The hospital is used for clinical training of medical students from the Plymouth University Peninsula School of Medicine. It is one of five hospitals with attached Ministry of Defence Hospital Units to cater to service personnel.
The traditional approach to resuscitating injured women of childbearing potential (WCBP) with an unknown RhD type is to transfuse RhD-negative blood products. This is to prevent alloimmunisation to the RhD antigen and ultimately prevent haemolytic disease of the fetus and newborn (HDFN) in future pregnancies should she survive. RhD-negative blood products are scarce in both military and civilian blood stocks. It is likely that only RhD-positive blood products are available for a servicewoman injured in combat. This analysis will review the latest models of D-alloimmunisation following transfusion of RhD-positive blood products to injured WCBPs, the subsequent rates of adverse events from HDFN and describe some surveys of WCBPs’ preferences for transfusion in emergency situations. These data and opinions all point to the same conclusion: RhD-negative blood products should be the first choice for the resuscitation of women at risk of HDFN, but their absence should never lead to withholding a lifesaving transfusion.
Objectives The objective of this study was to investigate the utility of the days alive and out of hospital (DAOH) metric within a cohort of patients undergoing burr-hole drainage of a chronic subdural haematoma (CSDH). We evaluate the validity of the DAOH metric in a national CSDH cohort and examine how the DAOH metric compares to its constituent outcomes (mortality and hospital bed days) at an organisational level.Methods Retrospective cohort study using Hospital Episode Statistics data linked to the national death registry to identify patients who underwent burr-hole drainage of CSDH in English National Health Service neurosurgical units between 1 April 2013 and 31 March 2020. Construct validity was assessed by measuring the patterns of DAOH across categories of known perioperative risk factors. Variation between units in the risk-adjusted values for DAOH, postoperative mortality and days in hospital was explored using funnel plots. Linear regression and logistic regression were used to derive the risk-adjusted rates.Results Overall, 16 450 patients who underwent at least one burr-hole drainage of CSDH were identified during the time period. The median 30-day DAOH was 16 (IQR, 0–24); the median for the 90-day DAOH was 74 (42–84), and was better at measuring the complete stay associated with the index admission. Worse 90-day DAOH values were associated with older age, increasing comorbidities and greater frailty. Risk-adjusted 90-day DAOH values for neurosurgical units varied more markedly than for its constituent outcomes.Conclusions The 90-day DAOH looks to be a valid outcome metric for patients undergoing burr-hole drainage for CSDH that is feasible to derive using national hospital data. Future work should explore how to estimate a minimally important clinical difference for DAOH and evaluate its utility as an outcome measure.
Introduction Pleural mesothelioma (PM) is often presaged by benign asbestos-associated pleural inflammation (AAPI), offering a unique window of opportunity for translational research. The PREDICT-Meso International Accelerator Network is leveraging this natural history to perform target identification and develop novel therapies for early-stage or pre-invasive disease. This requires assembly of a unique bioresource of longitudinal human tissue samples spanning the terminal stages of PM evolution, development of preclinical models for drug screening and reliable tools for risk prediction in patients presenting with AAPI.Methods and analysis Mesothelioma Observational study of Risk prediction and Generation of paired benign-meso tissue samples, Including a Nested MRI Substudy (Meso-ORIGINS) is a prospective, multicentre observational study, comprising two arms (A and B), with a nested MRI substudy in arm A. Arm A will recruit 300 AAPI patients and perform 6-monthly surveillance for 2 years. Suspicion of PM evolution will prompt repeat biopsy and banking, delivering a primary objective of ≥38 longitudinal AAPI-PM tissue pairs. This target reflects a projected PM evolution rate of 14% (95% CI 10.5 to 19.2) derived from a prior multicentre feasibility trial. Multiomic risk profiling will be performed in arm A, using blood proteomics, exhaled breath metabolomics and perfusion MRI. Arm B will recruit 300 patients with suspected PM, permitting collection of multiregion pleural biopsies in patients spanning AAPI and PM timepoints for evaluation of anatomical heterogeneity. Where possible, patients in arm B diagnosed with AAPI will be recruited to arm A for 2-year surveillance +/− repeat biopsy in subsequent PM evolution cases. Pleural fluid will be collected in arm B for cell-line generation and diagnostic biomarker evaluation. Exhaled breath will be collected in arm B for diagnostic biomarker evaluation.Ethics and dissemination The study has ethical approval (REC Ref 21/WS/0120). Results will be disseminated via peer-reviewed journals and national/international scientific conferences. Tissues, data and derived omics will be shared via the PREDICT-Meso Research Tissue Bank (REC Ref 21/WS/0011).Trial registration number ISRCTN22929761.
In health, humans spend approximately one-third of their lives asleep. Sleep involves all organ systems, and it is an inherent mechanism for regulation and optimisation of bodily functions. Critical illness commonly results in a wide range of adverse health outcomes, many of which may theoretically be ameliorated by functions that are enhanced by sleep. Sleep deprivation and its subsequent organ dysfunction leads to muscle weakness, immunocompromise and the cardiovascular changes of the stress responses; these features are common features of critical illness and its sequalae. Sleep is reframed as an inherent mechanism for recovery and repair and a key mechanism for improving critical care outcomes. An understanding of how sleep affects our patients could lead to novel therapies that would enhance their recovery. This review covers sleep physiology, measurements to assess it in the critically ill, common pathological features that impact sleep during critical illness and the logical interventions and areas for research that might optimise sleep related outcomes.
