Good Hope Hospital is a hospital in the Sutton Coldfield area of Birmingham, England. Covering north Birmingham and south east Staffordshire, it is managed by the University Hospitals Birmingham NHS Foundation Trust..
Background Infective endocarditis is a life-threatening condition requiring surgical intervention in certain cases. Despite advances in surgical techniques and medical management, postoperative mortality remains high. Preoperative optimisation, including the assessment of preoperative albumin levels, may play a crucial role in improving surgical outcomes. This systematic review and meta-analysis examine the relationship between preoperative albumin levels and in hospital mortality of patients undergoing cardiac surgery for IE. Materials & Methods Following the PRISMA guidelines, a comprehensive search of PubMed, MEDLINE via Ovid, Embase, Scopus, ClinicalGov, and Cochrane CENTRAL was performed. Studies including patients with IE who underwent cardiac surgery with documented preoperative albumin levels were selected. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted to evaluate the impact of albumin levels on postoperative mortality. Result A total of nine studies involving 1863 patients met the inclusion criteria. Meta-analysis demonstrated significantly lower preoperative albumin levels in patients who did not survive following surgery. A random-effects meta-analysis showed a significant large effect (SMD = 1.14, 95% CI: 0.63 to 1.64). However, heterogeneity was substantial (I 2 = 91%), indicating considerable variability in effect sizes across studies. There was no publication bias with visual inspection of funnel plots and Egger’s test ( p = 0.388). Conclusion Preoperative hypoalbuminemia is strongly associated with increased mortality in patients undergoing surgery for IE. Given that most IE surgeries are non-emergent, addressing low albumin levels preoperatively may offer a significant therapeutic opportunity to improve surgical outcomes.
INTRODUCTION:Pancreatic cancer (PC) treatment in the UK is coordinated via regional referral networks, but formal neoadjuvant chemotherapy (NAC) pathways for borderline resectable and locally advanced PC (BR/LAPC) are rare. This cohort study assessed intranetwork variation in access to diagnostics, time to treatment and patient outcomes following NAC for BR/LAPC in our network. METHODS:All patients with BR/LAPC referred from regional network hospitals between 2017 and 2021 were reviewed. Data were collected on time from first diagnostic computed tomography scan to endoscopy, commencement of NAC, NAC regimens administered and patient outcomes. RESULTS:In the 155 patients who commenced NAC, there were significant differences in median time to biliary drainage and endoscopic ultrasound between referral hospitals. Time from decision to treat to first administration of NAC was long (median 64 days). There were significant differences in the proportion of patients commenced on mFOLFIRINOX (0-100%, p<0.001) and the proportion completing NAC (0-100%, p=0.012). The likelihood of proceeding to surgical resection was similar between centres. CONCLUSIONS:There is significant intranetwork variation in access to interventional endoscopy and choice of NAC regimen. Centralised tracking of patients receiving NAC, development of locally agreed treatment protocols and an update to national guidelines are needed to standardise NAC pathways for BR/LAPC.
Abstract Guidelines exist for epidermal growth factor receptor inhibitor-related adverse events (AEs) such as acneiform rash and pruritus, but real-world skin toxicity management in lung cancer is poorly described. This study assessed current practice and variation in skin AE management among healthcare professionals in the UK. A cross-sectional Medical Science Liaison-led survey of UK healthcare professionals was conducted and descriptive analyses were performed. The respondents were clinical or medical oncologists (n = 23), specialist nurses (n = 17), cancer pharmacists (n = 10) and dermatologists (n = 10). Prophylactic recommendations for managing skin toxicity included emollients (80%), sunscreen (68%), oral antibiotics (15%) and topical corticosteroids (7%). For facial grade 1 AEs, dermatologists reported more frequent escalation of treatment earlier than oncology teams. Dermatologists prescribed topical corticosteroids in 40%, topical antibiotics in 50% and oral antibiotics in 30% of patients, compared with 14%, 18% and 18% of patients managed by oncologists, respectively. For torso AEs dermatologists were also more proactive, with oncology teams prescribing oral antibiotics for grade 2 torso AEs less often (68%) than dermatologists (100%). Dermatologists adopt a more proactive management approach, prescribing topical corticosteroids at least twice as often and topical antibiotics three times as often for grade 1 facial AEs than oncology teams. Oncology teams tend to use less aggressive treatment for lower-grade skin toxicity, which may delay symptom control. Differences in prophylaxis practice suggest inconsistent patient education and thresholds for escalation. Streamlining recommendations with earlier dermatology involvement and clearer multidisciplinary pathways could improve early intervention and patient experience. Funding for this study was provided by Johnson & Johnson Innovative Medicine.
Abstract Dermatology Advice and Guidance (A&G) services support primary care clinicians, reduce unnecessary appointments, and improve access to specialist input. Their effectiveness depends on the provision of adequate clinical detail, high-quality images and information that enables remote clinical decision making. Poor-quality referrals can delay care, increase back-and-forth communication, and lead to avoidable secondary care referrals. Within our trust, all referrals, except 2-week wait, are screened via A&G to ensure appropriate patients are seen within secondary care. This quality improvement project aimed to evaluate and improve the quality and efficiency of dermatology A&G referrals. The first cycle analysed referrals submitted in September 2022 (n = 150). The second cycle, in September 2024, was performed following recommendations to primary care (n = 195). Data collected included referral content, completeness of history, quality of images, need for additional information, general practitioner (GP) response rates to follow-up queries, referral outcomes including whether cases could be managed in intermediate care, conversion rate to appointments, and use of snippets. Referral quality improved between cycles. Additional information requested reduced from 37% to 14%. Photo submissions decreased by 2.5% and adequate-quality photos declined by 11.6%. GP response rates to follow-up requests were unchanged, with one-third responding to original information requested. Approximately one-half of referrals could have been managed within primary or intermediate care. Appointment requests increased from 38.7% in 2022 to 45.6% in 2024. In 2024, 13% of requests were 2-week-wait referrals, compared with 0% in 2022. Of the 2024 requests, 18% were accepted for teledermatology and 69% for face-to-face appointments, compared with 20.7% and 79.3%, respectively, in 2022. Use of response snippets increased from 9% to 27%, demonstrating enhanced utilization of structured response tools. This quality improvement project highlights significant opportunities for service optimization. Targeted education on image acquisition, referral standards and focused education sessions on common conditions may enhance decision making, optimize triage and reduce the need for specialist appointments.
Abstract Paronychia is a common inflammatory nailfold side effect of epidermal growth factor receptor inhibitors used to treat non-small cell lung cancer (NSCLC). It can impair quality of life and prompt treatment modifications. Despite the existence of guidelines, real-world UK practice shows notable variation across specialties. This study evaluates current practice and variation in the management of paronychia among UK healthcare professionals (HCPs). A medical science liaison-led, cross-sectional survey of UK HCPs involved in NSCLC was conducted and descriptive analysis performed. The HCPs included clinical or medical oncologists (n = 23), specialist nurses (n = 17), cancer pharmacists (n = 10) and dermatologists (n = 10). Overall, 70% of HCPs did not follow guidelines for the management of paronychia. Of those who did follow guidelines, there was variation in what was followed, with the European Society for Medical Oncology guidelines being the most commonly used (56%). Emollients were commonly used by all clinicians. Dermatologists reported higher use of topical steroids (100%), topical antibiotics (100%), oral antibiotics (100%) and acetic acid soaks (90%) relative to oncology teams (45%, 70%, 73% and 36%, respectively). Dermatologists also utilized other agents, such as topical beta blockers, that were less frequently used by oncology teams. Dermatologists used topical steroids twice as often and acetic acid soaks nearly three times more often than oncology teams. All dermatologists recommended oral antibiotics and topical antibiotics, whereas only two-thirds of lung oncology teams did. These findings highlight that oncology teams tend to be less aggressive in prescribing, while dermatologists adopted a more inclusive strategy by considering a wider set of interventions. Early involvement of dermatologists in the development of NHS consensus protocols could help prevent severe paronychia and reduce specialist referrals. For severe cases, clearly defined escalation pathways to podiatry and dermatology are warranted. Funding for this study was provided by Johnson & Johnson Innovative Medicine.
