Salisbury NHS Foundation Trust is an NHS foundation trust based in Salisbury that covers South Wiltshire, North and East Dorset and South West Hampshire. It gained foundation trust status in 2006. Its main site is Salisbury District Hospital, a large general hospital.Stacey Hunter, who began her career as a nurse, was appointed as chief executive officer in June 2020.
The modified Japanese Orthopaedic Association (mJOA) score is the gold-standard measure of neurological functional impairment in degenerative cervical myelopathy (DCM). Although designed for face-to-face (F2F) clinical use, telephone administration has become common, particularly following the shift to telemedicine during the COVID-19 pandemic. POLYFIX-DCM is an ongoing randomised controlled trial of laminectomy and laminectomy and fusion for DCM over 2 or more levels. To enable blinded outcome assessment and centralised follow up, a telephone mJOA was conducted by a small group of investigators. The objective was to evaluate the validity of telephone-administered mJOA assessment. Two prespecified cohorts were analysed. (1) Multicentre (NIHR POLYFIX-DCM): F2F assessments by site investigators at enrolment / before surgery compared with a centralised telephone assessment. (2) Single Centre (Cambridge) assessment: both assessments performed by the same investigators. Agreement was evaluated using Bland–Altman analysis, intra-class correlation coefficient (ICC), and the proportion of pairs within ± 1 mJOA point (the predefined acceptability threshold). Reliability was evaluated against the prespecified criterion of ICC ≥ 0.70. Sensitivity analyses examined site, age, severity, and timing. The multi-centre cohort included 179 paired assessments (F2F and telephone) with mean difference between assessments + 0.24 points (95
Introduction:Intra-articular steroid injection for thumb carpometacarpal joint (CMCJ) osteoarthritis (OA) is routinely offered with evidence of its short-term effectiveness only. One of the factors for reduced effectiveness could be the lack of accuracy of the intra-articular injection. Therefore, this scoping review sought to examine the accuracy of thumb CMCJ injection and examine if clinical effectiveness improves with accuracy by using image guidance. Method:A literature search was undertaken using databases Medline, Emcare, AMED and CINAHL, along with Google Scholar and reference searching. All studies on adults examining accuracy of thumb CMCJ injection and image-guided injections published in English up to the end of 2023 were selected. Results:15 studies met the inclusion criteria. Cadaver studies observed lower accuracy rate of landmark-based injection particularly in presence of thumb CMCJ arthritis. Studies on patients observed an accuracy rate of around 50% with landmark-based injection. Fluoroscopy-guided injection was observed to be more accurate (near 100%) than ultrasound guidance. Clinical effectiveness of accurate intra-articular injection was observed to last from 3 months (DASH 26.7 for intra-articular vs 37.5 for extra-articular, p < 0.05 and VAS score for intra-articular 26.5 vs 39.0 for extra-articular, p < 0.05) up to 6 months (15%-10/66 patients reporting pain relief). Some studies observed accuracy of landmark-based thumb CMCJ injection increased with experience of the clinician. Conclusion:Accuracy of landmark-based thumb CMCJ injection is indeterminate. However, there is lack of robust evidence to support use of image guidance to improve accuracy and clinical effectiveness of steroid injection for thumb CMCJ and warrants further research.
Introduction Despite the known impact of adverse events (AEs) for surgeons, and the potential for AE peer-support models, little is known about usefulness of AE peer-support initiatives in UK surgical settings. This study evaluated: (1) surgeons’ perceptions of current AE support, and (2) the usefulness of a novel peer-support improvement collaborative initiative (SUPPORT) for surgeons. Methods Part 1 surveyed 151 surgeons from 12 hospital trusts/groups in the UK and Ireland. Perceived organisational compassion, attitudes towards support-seeking and vulnerability stigma were assessed. Part 2 surveyed 17 surgical team members pre and post participating in SUPPORT. Surveys measured perceived organisational compassion, confidence in fostering a caring culture, peer-support skills, understanding of barriers to support-seeking and recognition of common responses to AEs. Results Some 88.1% of respondents endorsed the need for surgeon-specific peer support following AEs, while only 24.5% perceived existing support as adequate. In addition, 58.5% reported that there was stigma towards showing vulnerability as a surgeon and only 43.9% of respondents agreed that colleagues would respond compassionately following an AE. Participation in SUPPORT led to improved perceived organisational compassion and increased confidence in fostering a caring culture, peer-support skills, understanding of barriers to support-seeking and recognition of common psychological responses to AEs (p = 0.028 to <0.001). No improvements were observed in vulnerability-related stigma. Conclusions This study highlighted the mismatch between the perceived need for, and provision of, peer support for surgeons following AEs. Despite cultural barriers, the SUPPORT collaborative showed promise in enhancing compassion and key peer-support skills.
Background Circulating tumour DNA (ctDNA) detects minimal residual disease (MRD) and predicts recurrence in resected colorectal cancer (CRC), with implications for adjuvant chemotherapy (ACT) decision-making. Longitudinal ctDNA quantification and dynamics are less well studied. We present results from the ongoing prospective multi-centre TRACC study using a tumour-informed ctDNA assay. Methods TRACC Part B recruited stage I-III CRC patients undergoing curative surgery +/- neo-adjuvant (chemo)radiotherapy and ACT. Blood samples were collected pre-treatment, post-operatively, 3-monthly for year 1 and 6 monthly for years 2–3, with annual imaging. We report a cohort with stage II-III CRC ( n = 122), including a subset with locally advanced rectal cancers ( n = 23). Plasma samples were analysed using a personalisedmultiplex polymerase chain reaction next-generation sequencing (mPCR-NGS) ctDNA assay (Signatera™) targeting mutated loci identified in tumour tissue. The primary endpoint was recurrence-free survival (RFS) by ctDNA status. Exploratory objectives included ctDNA quantification and dynamics. Median follow-up was 35 months (range: 2–64). (NCT04050345) Results Of 122 patients, library preparation for whole exome sequencing of primary tumour tissue was possible in 116. Pre-treatment ctDNA detection rate was 94.0% (109/116). ctDNA detection rate 2–8 weeks post-operatively (MRDpos) was 12.1% (14/116); 10.9% in stage III (23.8% high-risk, 4.7% low-risk) and 13.5% in stage II (23.5% high-risk, 8.6% low-risk). Of MRDpos patients, 78.6% (11/14) recurred. Overall, 18.6% (19/102) MRD negative (MRDneg) patients recurred. Twenty-four-month RFS was 30.8% in MRDpos versus 88.1% in MRDneg patients (HR 8.4, 95% CI 4–18; p < 0.001). In a multivariate analysis, ctDNA detection remained the most significant prognostic factor (HR 7.2, 95% CI 2.94–17.6; p < 0.001)followed by nodal stage (HR 2.58, 95% CI 1.01–6.6; p = 0.047). Among high-risk CRC, ACT conferred survival benefit only in MRDpos patients. Longitudinal ctDNA sampling identified relapse with 80% sensitivity. ctDNA concentration increased exponentially prior to recurrence ( n = 11). ctDNA growth rate was prognostic of RFS (p = 0.021). ctDNA detection was lower in patients with lung-only metastases. Conclusions Post-operative and longitudinal tumour-informed ctDNA testing identifies patients at high CRC recurrence risk and may guide ACT decisions. Further studies are needed to establish the interpretation and utility of longitudinal ctDNA quantification and dynamics to personalise patient management.
