Bolton NHS Foundation Trust

Safety and efficacy of short-term ventricular assist devices (VAD) remains incompletely understood, particularly in younger children. This systematic review and meta-analysis aims to evaluate outcomes, including bridging success, complications, and mortality, associated with short-term VAD support in paediatric heart transplant candidates. A systematic search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from inception to 2 December 2024. Eligible studies reported patients ≤ 18 years supported by short-term VADs. This review was registered in PROSPERO (ID: CRD42023468125). Twelve retrospective studies met the inclusion criteria, encompassing 532 paediatric patients (mean age 10.0 years, < 0.1–18.3, mean weight 39.5 ± 30.3 kg). Pooled proportions show that with a mean support duration of 15.2 days, 50.7% were successfully bridged to transplant (95% CI 36.4%, 65.0%; I2 = 91.1%) with a 24.8% waitlist mortality (95% CI 17.6%, 31.9%; I2 = 63.8%), 14.0% (95% CI 7.2%, 20.9%; I2 = 97.5%) weaned off support and 5.4% (95% CI 2.6%, 8.3%; I2 = 39.1%) remaining on support. Complication rates were high with haemorrhage (38.9%), renal impairment (35.2%), cerebrovascular events (29.5%), infection (17.8%), and thromboembolism (9.9%) being the most reported. Short-term VADs offer a feasible bridge to transplant in paediatric patients, with success rates comparable to registry data. However, high rates of serious complications and waitlist mortality persist, particularly in these younger children. These findings demonstrate the need for improved patient selection, standardized outcome reporting, and development of safer, size-appropriate devices for paediatric use.

In the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT), surgical fixation was compared with cast immobilization, with the primary endpoint being the outcomes at one year. The aim of the current study was to assess the radiological outcomes (union and the development of osteoarthritis (OA)) of the two forms of treatment at five years. Patients who remained in the trial at five years after randomization were invited to have plain radiographs and a CT scan of the injured wrist, and a posterior-anterior radiograph of the contralateral wrist. This imaging was reviewed by three observers independently for union of the fracture and the distribution and severity of OA. This analysis followed a pre-specified statistical analysis plan. The relationship between OA and the Patient-Rated Wrist Evaluation (PRWE) scores at five years was assessed. Of the 439 patients who were randomized, 267 (60.8%) provided imaging at five years. Their characteristics were similar to those of the original cohort. A total of 182 patients (68.2%) (n = 92 fixation, n = 90 cast) had complete union and seven had a nonunion (2.6%; n = 3 fixation, n = 4 cast). Fractures with a minimum of 20% union at one year consolidated with the passage of time without intervention. Progression of OA in the joints around the scaphoid was seen in both groups from baseline to five years. By five years, 140 patients (52.4% of those with imaging at five years) had OA in at least one joint with similar prevalences in both groups. The prevalence of OA, the number of arthritic joints and the maximum severity of OA, was similar in the two groups. A total of 344 of the initial cohort of 439 patients (78.4%) provided a valid PRWE score at five years and the mean score was higher in those with more severe OA, indicating worse pain and function. Between one and five years after randomization, union consolidated in those with > 20% bridging without intervention. The proportion of patients with full, almost full, partial, slight, and nonunion for the two forms of treatment remained similar at five years. The prevalence and severity of OA increased during the five years but was similar in both groups.

<h3>Background</h3> Acute exacerbations of interstitial lung disease (AEILD) are devastating events with high mortality. A definite AEILD is defined by &lt;30-day deterioration in respiratory symptoms, not due to cardiac, thrombotic or pneumothorax causes, with new bilateral ground-glass changes on a background of ILD.¹ High-resolution CT imaging is central to this definition, yet its use during AEILD admissions is variable and understudied. We evaluated whether CT imaging during AEILD admission was associated with survival and differences in care. <h3>Methods</h3> We conducted a multicentre retrospective observational study of ICD-10-coded primary ILD admissions in patients ≥18 years, across 11 NHS hospitals in North West England between 01.01.2017 and 31.12.2019. AEILD events were identified using clinical criteria via manual review. Events were grouped by whether thoracic CT imaging was performed. Primary outcome was time to death from admission commencement. <h3>Results</h3> 511 AEILD admissions were identified; 192 (37.6%) had CT imaging. Median survival was significantly longer in the CT group (144 vs. 100 days; p=0.027); mean survival was also higher (493.8 vs. 394.7 days). Respiratory team involvement was more frequent in the CT group (79.2% vs. 62.1%; p&lt;0.001), as was high-dose intravenous methylprednisolone use (11.5% vs. 3.8%; p=0.002). Mean length of stay was longer in the CT group (11.5 vs. 6.6 days; p&lt;0.001), while palliative care input was more common in the non-CT group (20.1% vs. 14.6%). Baseline demographics, lung function and comorbidity scores were similar. <h3>Discussion</h3> CT imaging during AEILD admissions was associated with improved survival, more respiratory specialist input and greater use of high-dose steroid treatment. This may reflect diagnostic certainty influencing care escalation, or that in the non-CT group some patients were too unstable to undergo imaging and further management. <h3>Conclusion</h3> Hospitalised AEILD patients face high mortality. Our findings suggest variation in CT use may influence care and outcomes. Further prospective studies are needed to determine whether CT imaging contributes directly to improved survival or is a proxy for more intensive management. <h3>Reference</h3> Collard HR, <i>et al. Am J Respir Crit Care Med</i>. 2016;<b>194</b>(3):265–75.

With the global rollout of COVID-19 vaccines, vaccine safety remains a priority. Emerging concerns have raised the potential risk of a long COVID-like syndrome following vaccination, informally called long Vax and provisionally termed post-COVID-19 vaccination syndrome (PCVS). Our narrative review describes the putative manifestation, pathophysiology, and therapeutic approaches of PCVS based on the available evidence, mostly from case reports/series and observational studies. Our review noted that PCVS typically manifests within days to weeks post-vaccination, with symptoms lasting months to years. PCVS may present as recognized diagnoses such as postural orthostatic tachycardia syndrome (POTS), small-fibre neuropathy (SFN), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), or as long-term sequelae of myocarditis, vaccine-induced thrombotic thrombocytopaenia (VITT), or immune thrombocytopaenia purpura (ITP). Symptomatically, PCVS overlaps with long COVID, such as fatigue and brain fog, but PCVS may involve more frequent paraesthesia and less dyspnoea. We also review pathophysiological hypotheses of PCVS, focussing on the vaccine-derived spike protein and related immune responses. Finally, we discuss potential therapies used to treat patients with PCVS or related conditions, primarily documented in case reports/series, which could guide future clinical research. Overall, PCVS remains a poorly understood condition that requires more research to elucidate its prevalence, prognosis, risk factors, and treatments.

Background Antenatal screening for Trisomy 21 (T21) in the UK is performed primarily in the first trimester. Nuchal Translucency (NT), gestational age, Free β-HCG and PAPP-A are used in combination, creating the ‘combined’ test. Multivariate Gaussian distribution models then determine the chance of T21 expressed as an odds ratio. This study investigates the use of machine-learning algorithms in the prediction of T21 in first-trimester singleton pregnancies and compares their performance to existing screening models. Methods A total of 86,354 anonymised, first trimester, singleton pregnancy screening cases, including 211 with T21, were used to train and test machine-learning models using adaptive boosting technology. Test case results were compared with pregnancy outcome data to assess performance. Results A machine-learning model was able to outperform current multivariate distribution models (McNemar’s p = .006, AUC 0.978 vs 0.974). False positive rates were reduced from 3.82% to 2.28% (95% CI: 3.56–4.08 and 2.08–2.48 respectively) and overall screen positive rates were reduced from 4.00% to 2.48% (95% CI: 3.74–4.28 and 2.27–2.70 respectively). Conclusions Machine-learning algorithms offer demonstrable improvements to first-trimester singleton T21 screening without major changes to the UK programme. Larger datasets and improved outcome data would likely offer further increases in performance.

Mantle cell lymphoma (MCL) represents a rare subtype of non-Hodgkin lymphoma, with approximately 4% of patients experiencing central nervous system (CNS) involvement. There is a higher likelihood of CNS Infiltration in patients who have elevated Ki-67 Levels, a marker associated with prognosis and CNS involvement. Herein, we present the case of a 72-year-old individual of British ancestry, known to have stage 4A MCL, exhibiting a Ki-67 index of 10%. He had just completed six cycles of Rituximab and Bendamustine with a good radiological response. The patient presented with episodic vacant states accompanied by confusion, recurrent dysphasia, and frontotemporal headaches followed by visual and auditory hallucinations upon hospital admission. Initial imaging studies failed to reveal compelling evidence of secondary central nervous system lymphoma (SCNSL), leading to a presumptive diagnosis of transient ischemic attack (TIA) given the patient's recurrent visits to the emergency department. However, subsequent evaluation by cerebrospinal fluid (CSF) analysis showed lymphocytic infiltrates with a negative bioFire test. Additional testing with the haematological malignancy diagnostic service (HMDS) unveiled findings consistent with CNS involvement secondary to known MCL. Our case report underscores the imperative for thorough CSF analysis in patients with MCL, irrespective of a seemingly low proliferation index such as Ki-67. This will promptly identify and manage potential CNS involvement.

Stigma of mental health conditions hinders recovery and well-being. The Honest, Open, Proud (HOP) program shows promise in reducing stigma but there is uncertainty about the feasibility of a randomized trial to evaluate a peer-delivered, individual adaptation of HOP for psychosis (Let's Talk). A multi-site, Prospective Randomized Open Blinded Evaluation (PROBE) design, feasibility randomised controlled trial (RCT) comparing the peer-delivered intervention (Let's Talk) to treatment as usual (TAU). Follow-up was 2.5 and 6 months. Randomization was via a web-based system, with permuted blocks of random size. Up to 10 sessions of the intervention over 10 weeks were offered. The primary outcome was feasibility data (recruitment, retention, intervention attendance). Primary outcomes were analyzed by intention to treat. Safety outcomes were reported by as treated status. The study was prospectively registered: https://doi.org/10.1186/ISRCTN17197043. 149 patients were referred to the study and 70 were recruited. 35 were randomly assigned to intervention + TAU and 35 to TAU. Recruitment was 93% of the target sample size. Retention rate was high (81% at 2.5 months primary endpoint), and intervention attendance rate was high (83%). 21% of 33 patients in Let's talk + TAU had an adverse event and 16% of 37 patients in TAU. One serious adverse event (pre-randomization) was partially related and expected. This is the first trial to show that it is feasible and safe to conduct a RCT of HOP adapted for people with psychosis and individual delivery. An adequately powered trial is required to provide robust evidence.

Abstract Background Incorrect coding practices for elective surgical procedures carry significant financial implications at Trust level. In this project, we aimed to audit the current coding practices pertaining to laparoscopic cholecystectomies performed within the NHS WWL Foundation Trust during November 2021-October 2022 and calculate the financial burden resulting from this. Method A list of 194 patients undergoing a cholecystectomy and their allocated HRG coding at time of discharge was compiled by the coding department. A comorbidity and complication index (CCI) for each of these patients was calculated using the operation note together with hospital and GP records. With this information, the correct HRG coding for each patient was calculated and compared to their allocated coding at discharge to calculate the difference in tariffs generated. Results 69.23% of 194 procedures carried out during the reported time period were coded incorrectly. This amounted to a financial burden of £72,232 lost in potential tariffs, equating to £372.33 per cholecystectomy performed. Commonest CCI of 3 in 29% of patients with corresponding HRG code GA10J Commonest incorrectly allocated coding GA10K denotes a presumed CCI of 0 Conclusion High percentage of incorrectly coded procedures with significant financial implications at Trust level Currenty coding practice often incorrectly presumes a CCI index of 0 with subsequent incorrect GA10K coding. However, the appropriate coding for the vast majority of patients undergoing a laparoscopic cholecystectomy was GA10J. Education and awareness is underway to make improvements at a Trust level before re-auditing of data can commence.