Imaginghttp://hdl.handle.net/20.500.12904/42024-03-28T21:52:22Z2024-03-28T21:52:22Z'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps.Courtney, Carol-AnnGoyal, AmitGarreffa, ECarmichael, Amtulhttp://hdl.handle.net/20.500.12904/176052023-12-20T15:32:38Z'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps.
Courtney, Carol-Ann; Goyal, Amit; Garreffa, E; Carmichael, Amtul
BACKGROUND: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS: STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS: Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
Primary Hyperparathyroidism: Outcomes of Repeated Imaging After Initial Negative Radiological Localization.Karunaratne, Dilharahttp://hdl.handle.net/20.500.12904/175952023-12-20T15:45:32ZPrimary Hyperparathyroidism: Outcomes of Repeated Imaging After Initial Negative Radiological Localization.
Karunaratne, Dilhara
BACKGROUND: Radiological localization imaging aids in the identification of abnormal parathyroid glands resulting in primary hyperparathyroidism (PHPT), thereby facilitating minimally invasive parathyroid surgery. Sometimes initial imaging may fail to identify the abnormal gland and imaging may therefore be repeated. This study explored patient outcomes of repeated parathyroid localization imaging, after initial negative gland localization, at a United Kingdom institution. METHODOLOGY: Data was retrospectively collected and analyzed for patients with PHPT undergoing repeated imaging during a five-year period (2015-2020). The total number of episodes of scanning, types of scans performed, the time interval between scans and the imaging success of gland localization were recorded. We explored the reasons for repeated imaging and attempted to identify any factors that might predict subsequent positive radiological localization. RESULTS: A total of 45 patients were identified who underwent repeated localizing imaging after first localizing imaging was negative. Of these, 39 did not undergo surgery despite repeat imaging being undertaken; 11 out of these 39 patients (28%) had subsequent positive localization scans. Again, a large proportion of patients were managed conservatively, despite the repeated sets of imaging being done. Patients undergoing three or four sets of repetitive imaging did not have imaging or surgical success. CONCLUSION: A streamlined parathyroid pathway should be followed whereby patients should be triaged for suitability for surgery prior to repeated imaging. A second set of scans should be offered when patients are unsuitable for conservative management and are willing and fit to undergo surgery. There is no merit to repeating imaging more than twice.
Development and evaluation of a brief educational cartoon on trainee clinicians' awareness of risks of ionising-radiation exposure: a feasibility pre-post intervention study of a novel educational tool to promote patient safetyThurley, PeterBowker, RBhatti, ImranSkelly, Roberthttp://hdl.handle.net/20.500.12904/3062021-06-03T09:44:38Z2020-11-01T00:00:00ZDevelopment and evaluation of a brief educational cartoon on trainee clinicians' awareness of risks of ionising-radiation exposure: a feasibility pre-post intervention study of a novel educational tool to promote patient safety
Thurley, Peter; Bowker, R; Bhatti, Imran; Skelly, Robert
Background: Over recent decades, CT scans have become routinely available and are used in both acute medical and outpatient environments. However, there is a small increase in the risk of adverse consequences, including an increase in the risk of both malignancy and cataracts. Clinicians are often unaware of these facts, and this represents a challenge for medical educators in England, where almost 5 million CT scans are done annually. New whiteboard methodologies permit development of innovative educational tools that are efficient and scalable in communicating simple educational messages that promote patient safety.
Methods: A short educational whiteboard cartoon was developed to explore the prior observation that adolescents under the care of paediatricians had a much lower risk of receiving a CT scan than those under the care of clinicians who care for adults. This explored the risks after receiving a CT scan and strategies that can be used to avoid them. The educational cartoon was piloted on new doctors who were attending induction training at a busy teaching hospital. Results: The main output was the educational whiteboard cartoon itself. Before the new medical trainees' induction, 56% (25/45) had received no formal training in radiation awareness, and this decreased to 26% (6/23) after the exposure to the educational cartoon (p=0.02). At baseline, 60% (27/45) of respondents considered that young females were at highest risk from exposure to ionising radiation, and this increased to 87% (20/23) after exposure to the educational cartoon (p=0.06). Conclusions: This proof-of-concept feasibility study demonstrates that whiteboard cartoons provide a novel and feasible approach to efficiently promote patient safety issues, where a short succinct message is often appropriate.
2020-11-01T00:00:00ZResponse to Letter to the Editor re Patient and public beliefs about the role of imaging in the management of non-specific low back pain: a scoping reviewTaylor, Stephaniehttp://hdl.handle.net/20.500.12904/3142021-06-03T09:44:40Z2020-09-01T00:00:00ZResponse to Letter to the Editor re Patient and public beliefs about the role of imaging in the management of non-specific low back pain: a scoping review
Taylor, Stephanie
2020-09-01T00:00:00Z