West Middlesex University Hospital (WMUH) is an acute NHS hospital in Isleworth, West London, operated by Chelsea and Westminster Hospital NHS Foundation Trust. It is a teaching hospital of Imperial College School of Medicine and a designated academic health science partner (Imperial College Academic Health Sciences Partnership). West Middlesex University Hospital serves patients in the London Boroughs of Hounslow, Richmond upon Thames and Ealing. The hospital has over 400 beds and provides a full range of clinical services including accident and emergency, acute medicine, care of the elderly, surgery and maternity.
Perianal pouch fistula can significantly affect quality of life, yet no disease-specific patient reported outcome measure (PROM) exists. We have developed and validated a 14-item PROM—the Pouch Anal and Vaginal Fistula Quality of Life scale (PAVF-QoL-14). COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance for PROM development was used to develop and validate PAVF-QoL-14. A systematic literature review and semi-structured patient interviews (n = 14) identified key domains. Cognitive interviews and item-level content validity index with experts refined the draft questionnaire. Psychometric evaluation included principal component analysis (PCA), internal consistency testing, and construct validity assessment against Hospital Anxiety and Depression Scale (HADS) and Short-Form 12 (SF-12). Test–retest analysis was performed on 76 patients. An initial 34-item draft scale was generated and refined through cognitive interviews (n = 10) and psychometric testing (n = 76). Flesch readability score was 63
Background Bronchial washing can be inefficient or unsafe due to aerosolisation, poor yield and loss of sample. The setup and connectivity of sampling containers is often challenging. Furthermore, the process of bronchoscopy in the intensive care unit is inadequately reported.We tested whether a novel closed bronchoscopy sampling system is safer and more efficient than the standard sampling technique. We recorded variation in bronchoscopy practice in mechanically ventilated patients.Methods A multicentre randomised controlled trial saw 188 bronchoscopies performed in mechanically ventilated patients requiring diagnostic sampling. The closed-system Ambu bronchosampler (ABS) was compared to standard sampling containers (SSC) with single-use bronchoscopes (Ambu A4) for primary outcomes of safety (spill, unplanned disconnection) and efficiency (ease of connectivity, setup, loss of sample and % volume retrieved), secondary efficiency outcomes and the tertiary outcomes of the bronchoscopy process.Results ABS was safer than SSC; spills 0% versus 23.7% (0/94 vs 22/93), p<0.001; unplanned tube disconnections 5.3% vs 21.3% (5/95 vs 20/93), p<0.001; unplanned container disconnections 2.1% vs 7.5% (2/95 vs 7/93), p=0.08. Efficiency was significantly higher in ABS than SSC (acceptable/(very) easy) setup 98.9% vs 82.8% (94/95 vs 77/93), connectivity 100% vs 54.7% (88/88 vs 47/86), upright 98.9% vs 10.8% (94/95 vs 10/93) and sample loss 11.6% vs 48.4% (11/95 vs 45/93), all p<0.001. Volume retrieved percentage unchanged (33.0% vs 35.4%, p>0.2).Bronchoscopy for infection in 80.9%, therapeutic lavage in 51% and infrequently otherwise. Prior imaging in 93.2%, preprocedural checklists/timeouts in 83.5% and post-procedure chest X-rays in 78.2%.Mandatory ventilation was most common peribronchoscopy. Neuromuscular blockade in 73.8% and recruitment manoeuvres in 34.7%. The bronchoscope was not removed intraprocedurally in 80.2% of cases. Positive microbiology was found in 45.7% of samples. Adverse events were rare (<5%).Conclusions Closed-system bronchoscopic sampling was safer (less spill and unplanned disconnections) and more efficient (setup, connectivity and loss prevention) than standard containers. Closed-system diagnostic sampling devices should be the standard during bronchoscopy.Trial registration number ClinicalTrials.gov NCT05964075.
BACKGROUND:Vertebral artery (VA) anomalies, particularly those associated with congenital atlantoaxial dislocations, are well documented in the literature. Typically, these anomalies are linked to persistent first intersegmental artery variants or occur in conjunction with occipitalization of the atlas. The case presented in this report is unique due to the presence of bilateral ectatic VAs with an anomalous course beneath the posterior arch of C1, in the absence of occipitalization of the atlas. This finding adds to the growing recognition of anatomical variability in patients with congenital conditions such as os odontoideum and Klippel-Feil syndrome (KFS). OBSERVATIONS:The authors present the case of a 65-year-old female patient with progressive cervical myelopathy, os odontoideum, and KFS. The preoperative imaging revealed the VA anomalies, and additional caution was exercised intraoperatively. The patient underwent C1-4 fixation and foramen magnum decompression using robot-assisted cervical fusion and neuronavigation. LESSONS:In patients with fused cervical segments, VA anomalies may be overlooked in preoperative imaging, highlighting the need for intraoperative vigilance. Robot-assisted surgery and neurophysiological monitoring significantly improve the safety and precision of the procedure, ensuring optimal outcomes in complex cases like this. https://thejns.org/doi/10.3171/CASE25493.
BACKGROUND:Chronic subdural haematoma (cSDH) is a common neurological condition. Surgery remains the preferred treatment for symptomatic patients. Delays in surgery can occur due to logistical, clinical or medication-related factors. We investigated the relationship between time to surgery and postoperative functional outcomes in symptomatic cSDH. METHOD:Retrospective multicentre cohort study conducted from 2012 to 2023 across five UK neurosurgical units within the National Health Service system, with 1-year follow-up. Of the 1508 patients referred for surgical intervention for cSDH, 1015 remained for analysis. 213 were excluded due to missing data and 280 for ≥30-day wait for surgery to mitigate extreme outliers. Postoperative functional outcome was assessed using the modified Rankin Scale, categorised as 'favourable' (0-3) and 'unfavourable' (4-6). Predictors of outcome were identified using multivariable logistic regression, and the association between time to surgery and outcome was evaluated by marginal effects analysis. Factors influencing time to surgery were analysed by multivariate linear regression. RESULTS:Of 1015 patients, 838 (82.6%) had 'favourable' outcomes and 177 (17.4%) had 'unfavourable' outcomes. Surgical delay was significantly longer in patients with 'unfavourable' outcomes (mean 4.4 vs 2.9 days, p<0.001) and independently associated with poorer outcomes (OR=1.05 per day, p=0.002). Risk increased linearly for each additional day of delay, up to 28% by day 30. Delayed time to surgery included older age (p=0.007), antiplatelet use (p<0.001), high Glasgow Coma Scale Score and Low Frailty Score. CONCLUSION:Surgical delay significantly worsens outcomes in cSDH. Older age, antiplatelet therapy, milder neurological presentation and low frailty scores were key contributors to delay.
