Aintree – Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

Author(s): Tandon A.; Rajendran I.; Aziz M.; Nunes Q.M.; Shrotri M.; Kolamunnage-Dona R.

Source: Annals of the Royal College of Surgeons of England; Apr 2017; vol. 99 (no. 4); p. 325-331

Publication Date: Apr 2017

Publication Type(s): Article

Available in print  at Edge Hill Aintree LIRC –  from ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

Abstract:BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

Database: EMBASE

Aintree – The impact of anti-drug antibodies on drug concentrations and clinical outcomes in rheumatoid arthritis patients treated with adalimumab, etanercept, or infliximab: Results from a multinational, real-world clinical practice, non-interventional study

Author(s): Moots R.J.; Xavier R.M.; Mok C.C.; Rahman M.U.; Mahgoub E.; Kotak S.; Korth-Bradley J.; Pedersen R.; Mele L.; Shen Q.; Vlahos B.; Tsai W.-C.; Al-Maini M.H.; Pavelka K.

Source: PLoS ONE; Apr 2017; vol. 12 (no. 4)

Publication Date: Apr 2017

Publication Type(s): Article

Available in full text at PLoS ONE –  from Directory of Open Access Journals

Available in full text at PLoS ONE –  from National Library of Medicine

Available in full text at PLoS One –  from ProQuest

Available in full text at PLoS ONE –  from EBSCOhost

Abstract:Objective To assess the incidence of anti-drug antibodies (ADA) in patients with rheumatoid arthritis (RA) treated with the TNF inhibitors etanercept (ETN), adalimumab (ADL), or infliximab (IFX), and determine the potential relationship with trough drug concentration, efficacy, and patient-reported outcomes. Methods This multi-national, non-interventional, cross-sectional study (NCT01981473) enrolled adult patients with RA treated continuously for 6-24 months with ETN, ADL, or IFX. ADA and trough drug concentrations were measured by independent assays <2 days before the next scheduled dose. Efficacy measurements included Disease Activity Score 28-joint count (DAS28), low disease activity (LDA), remission, and erythrocyte sedimentation rate (ESR). Targeted medical histories of injection site/infusion reactions, serum sickness, and thromboembolic events were collected. Results Baseline demographics of the 595 patients (ETN: n = 200; ADL: n = 199; IFX: n = 196) were similar across groups. The mean duration of treatment was 14.6, 13.5, and 13.1 months for ETN, ADL, and IFX, respectively. All ETN-treated patients tested negative for ADA, whereas 31.2% and 17.4% patients treated with ADL and IFX, respectively, tested positive. In ADLor IFX-treated patients, those with ADA had significantly lower trough drug concentrations. There were negative correlations between trough drug levels and both CRP and ESR in ADL- and IFX-treated patients. DAS28-ESR LDA and remission rates were higher in patients without ADA. The rate of targeted medical events reported was low. Conclusion ADA were detected in ADL- and IFX-treated but not ETN-treated patients. Patients without ADA generally showed numerically better clinical outcomes than those with ADA.Copyright © 2017 Moots et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Database: EMBASE

Aintree – Ambulatory oxygen in fibrotic lung disease (AmbOx): Study protocol for a randomised controlled trial

Author(s): Visca D.; Tsipouri V.; Mori L.; Maher T.M.; Wells A.U.; Renzoni E.A.; Firouzi A.; Fleming S.; Leung E.; Hopkinson N.; Banya W.; Farquhar M.; Cullinan P.; Whitty J.A.; Adamali H.; Spencer L.G.; Sestini P.

Source: Trials; Apr 2017; vol. 18 (no. 1)

Publication Date: Apr 2017

Publication Type(s): Article

Available in full text at Trials –  from EBSCOhost

Available in full text at Trials –  from BioMed Central

Available in full text at Trials –  from Directory of Open Access Journals

Available in full text at Trials –  from National Library of Medicine

Abstract:Background: Fibrotic interstitial lung diseases (ILDs) are chronic and often progressive conditions resulting in substantial morbidity and mortality. Shortness of breath, a symptom often linked to oxygen desaturation on exertion, is tightly linked to worsening quality of life in these patients. Although ambulatory oxygen is used empirically in their treatment, there are no ILD-specific guidelines on its use. To our knowledge, no studies are available on the effects of ambulatory oxygen on day-to-day life in patients with ILD. Methods/design: Ambulatory oxygen in fibrotic lung disease (AmbOx) is a multicentre, randomised controlled crossover trial (RCT) funded by the Research for Patient Benefit Programme of the National Institute for Health Research. The trial will compare ambulatory oxygen used during daily activities with no ambulatory oxygen in patients with fibrotic lung disease whose oxygen saturation (SaO2) is >94% at rest, but drops to <88% on a 6-min Walk Test. The randomised controlled trial (RCT) will evaluate the effects on health status (measured by the King’s Brief ILD Questionnaire: K-BILD) of ambulatory oxygen used at home, at an optimal flow rate determined by titration at screening visit, and administered for a 2-week period, compared to 2weeks off oxygen. Key secondary outcomes will include breathlessness on activity scores, as measured by the University of California San Diego Shortness of Breath Questionnaire, global patient assessment of change scores, as well as quality of life scores (St George’s Respiratory Questionnaire), anxiety and depression scores (Hospital Anxiety and Depression Scale), activity markers measured by SenseWear Armbands, pulse oximetry measurements, patient-reported daily activities, patient- and oxygen company-reported oxygen cylinder use. The study also includes a qualitative component and will explore in interviews patients’ experiences of the use of a portable oxygen supply and trial participation in a subgroup of 20 patients and carers. Discussion: This is the first RCT of the effects of ambulatory oxygen during daily life on health status and breathlessness in fibrotic lung disease. The results generated should provide the basis for setting up ILD-specific guidelines for the use of ambulatory oxygen. Trial registration: National Clinical Trials Registry, identifier: NCT02286063. Registered on 8 October 2014 (retrospectively registered).Copyright © 2017 The Author(s).

Database: EMBASE

Walton Centre – Fragile X-associated tremor/ataxia syndrome: cognitive presentations.

Br J Hosp Med (Lond). 2017 Apr 2;78(4):230-231. doi:0.12968/hmed.2017.78.4.230.

Connon P1, Larner AJ2.

Author information:

1 Core Medical Trainee year 2 (CMT2), Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool.

2 Consultant Neurologist, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ.

PMID: 28398884

Walton Centre – Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome (CRPS) Recurrence After Amputation for CRPS, and Failure of Conventional Spinal Cord Stimulation.

Pain Pract. 2017 Apr 18. doi: 10.1111/papr.12582. [Epub ahead of print]

Goebel A1,2, Lewis S3, Phillip R3, Sharma M1.

Author information:

1Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.

2Pain Research Institute, University of Liverpool, Liverpool, United Kingdom.

3Defense Medical Rehabilitation Centre Headley Court, Epson, Surrey, United Kingdom.


Limb amputation is sometimes being performed in long-standing complex regional pain syndrome (CRPS), although little evidence is available guiding management decisions, including how CRPS recurrence should be managed. This report details the management of a young soldier with CRPS recurrence 2 years after midtibial amputation for CRPS. Conventional spinal cord stimulation did not achieve paraesthetic coverage, or pain relief in the stump, whereas L4 dorsal root ganglion stimulation achieved both coverage and initially modest pain relief, and over time, substantial pain relief. Implications are discussed. Current evidence does not support the use of amputation to improve either pain or function in CRPS. Dorsal root ganglion stimulation should be considered in those exceptional cases under review for referral for consideration of amputation, before referral, and in those patients with CRPS recurrence in the stump after amputation. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID: 28422399

Walton Centre – Does combining an informant questionnaire with patient performance scales improve diagnostic test accuracy for cognitive impairment?

Author(s): Larner A.J.

Source: International Journal of Geriatric Psychiatry; Apr 2017; vol. 32 (no. 4); p. 466-467

Publication Date: Apr 2017

Publication Type(s): Letter

Database: EMBASE

Walton Centre – Economic Studies in Motor Neurone Disease: A Systematic Methodological Review

Author(s): Moore A.; Hughes D.A.; Young C.A.

Source: PharmacoEconomics; Apr 2017; vol. 35 (no. 4); p. 397-413

Publication Date: Apr 2017

Publication Type(s): Review

Abstract:Background: Motor neurone disease (MND) is a devastating condition which greatly diminishes patients’ quality of life and limits life expectancy. Health technology appraisals of future interventions in MND need robust data on costs and utilities. Existing economic evaluations have been noted to be limited and fraught with challenges. Objective: The aim of this study was to identify and critique methodological aspects of all published economic evaluations, cost studies, and utility studies in MND. Methods: We systematically reviewed all relevant published studies in English from 1946 until January 2016, searching the databases of Medline, EMBASE, Econlit, NHS Economic Evaluation Database (NHS EED) and the Health Economics Evaluation Database (HEED). Key data were extracted and synthesised narratively. Results: A total of 1830 articles were identified, of which 15 economic evaluations, 23 cost and 3 utility studies were included. Most economic studies focused on riluzole (n = 9). Six studies modelled the progressive decline in motor function using a Markov design but did not include mutually exclusive health states. Cost estimates for a number of evaluations were based on expert opinion and were hampered by high variability and location-specific characteristics. Few cost studies reported disease-stage-specific costs (n = 3) or fully captured indirect costs. Utilities in three studies of MND patients used the EuroQol EQ-5D questionnaire or standard gamble, but included potentially unrepresentative cohorts and did not consider any health impacts on caregivers. Conclusion: Economic evaluations in MND suffer from significant methodological issues such as a lack of data, uncertainty with the disease course and use of inappropriate modelling framework. Limitations may be addressed through the collection of detailed and representative data from large cohorts of patients.Copyright © 2016, Springer International Publishing Switzerland.

Database: EMBASE

Walton Centre – Rasch analysis of SF-Qualiveen in multiple sclerosis

Author(s): Milinis K.; Young C.A.; Tennant A.; Mills R.; Rog D.

Source: Neurourology and Urodynamics; Apr 2017; vol. 36 (no. 4); p. 1161-1166

Publication Date: Apr 2017

Publication Type(s): Article

Abstract:BACKGROUND: A 30-item Qualiveen questionnaire was developed to measure the impact of urinary problems on everyday living in spinal cord injury, and subsequently an 8-item SF-Qualiveen was developed for those with multiple sclerosis (MS). The validity of this short form has not been previously examined using modern psychometric techniques, such as the Rasch measurement model. OBJECTIVE: The aim of this study is to test if the short form meets the requirements of the Rasch model. METHODS: A total of 401 patients with clinically definite MS were given the questionnaire at three neuroscience centres in the UK. RESULTS: A total of 258 patients (64.3% response) completed the questionnaire. The original scale failed to meet the expectations of the Rasch model. A two-testlet solution was sought to account for local dependence, differential item functioning and disordered thresholds. After the modifications were made the scale fitted the model (chi2 = 5.93 P = 0.4305), had high internal consistency (alpha = 0.88) and was unidimensional. CONCLUSIONS: SF-Qualiveen is a simple and valid measure of the impact of urinary problems in multiple sclerosis, which meets the requirements of the Rasch measurement model. Summed ordinal scores can be converted to interval-level using the transformation table provided.Copyright © 2016 Wiley Periodicals, Inc.

Database: EMBASE