Knowledge Hub @ Bedfordshire Hospitals NHS FT
The Knowledge Hub, managed by the Danielle Freedman Library is a digital repository - a central location for Bedfordshire Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.
The Knowledge Hub replaces the academic report previously published by Research & Development.
Some items are added to the repository automatically by the library team, if you do not find your item or you would like more information about submitting your work to the Knowledge Hub please contact library@besdft.nhs.uk
Recent Submissions
Item Telemedicine: Benefits for cardiovascular patients in the COVID-19 era.(2022)The recent pandemic with SARS-CoV-2 raises questions worldwide regarding telemedicine for housebound patients, including those with cardiovascular conditions. The need for further investigation, monitoring and therapeutic management are advancing practical issues which had not been identified for consideration prior to the pandemic. Using the marketing assessment, we identified the needs of the patients and evaluated the future steps necessary in the short term to meet them. The research found progress made via telemedicine in monitoring and conducting minor decisions (like up-titrating the doses of different medication regimens) in patients with several cardiovascular diseases (heart failure, atrial fibrillation, high blood pressure), as there is a worldwide trend to develop new telemonitoring biosensors and devices based on implantable delivered transcatheter. The worldwide telemedicine trend encourages a switch from small and hesitating steps to a more consistent assessment of the patients, based on high technology and Interventional Cardiology. Cardiovascular telemedicine, although made a sustainable effort in managing patients' health, has many obstacles to overcome before meeting all their needs. Data security, confidentiality and reimbursement are the top priorities in developing remote Cardiology. The regulatory institutions need to play an integrative role in leading the way for defining the framework of future telemedicine activities. The SARS-CoV-2 outbreak with all its tragedy served to reinforce the message that telemedicine services can be life-saving for cardiovascular patients. Once the Covid-19 era will fade away, telemedicine is likely to remain a complementary service of standard care. There is still room to improve the remote identification and investigation of heart disease, provide an accurate diagnosis and therapeutic regimen, and update regulations and guidelines to the new realities of technological progress in the field.Item Management of the two-week wait pathway for skin cancer patients, before and during the pandemic: Is virtual consultation an option?(2022)Background: Although telemedicine emerged more than 100 years ago, the recent pandemic underlined the role of remote assessment of different diseases. The diagnoses of cutaneous conditions, especially malignant lesions, have placed significant stress on the fast-track pathway for general practitioners (GPs), dermatologists, and plastic surgeons. The aim of the study was to compare (pre- and during the pandemic) the ability of professionals to face the challenge. Methods: The study was composed of 1943 consecutive patients (mean age 61.9 ± 18.3, 53.8% female) assessed by GPs, face-to-face (988 patients, 50.8%, between October 2019 and March 2020) and by virtual (video/photo) visits (955 patients, 49.2%, between March 2020 and October 2020) for skin lesions, and referred to secondary care via the two-week wait pathway for suspected skin malignancy. Results: The two groups had similar primary skin malignancies identification rates (24.3% vs. 22.1%, p = 0.25). The virtual visits identified squamous cell carcinoma (SCC) better than face-to-face consultations (p = 0.04), but identified basal cell carcinoma less-well (BCC, p = 0.02), whereas malignant melanoma (MM) was equally identified in the two groups (p = 0.13). There was no difference in the median breach time (days) of the two-week wait pathway (12, IQR = 6 vs. 12, IQR = 5, p = 0.16) in the two groups. Virtual assessments (by GPs) of skin lesions suspected of malignancy, and referred via the two-week wait pathway, increased the probability of diagnosing SCC by 42.9% (p = 0.03), while for malignant melanomas, face-to-face and virtual consultations were alike (p = 0.12). Conclusions: The equivalent outcomes in the management of skin cancers (SCC, MM) via the two-week pathway through virtual consultations and face-to-face appointments underline the role of telemedicine as a reliable alternative to face-to-face assessments.Item Atopic polygenic risk score is associated with paradoxical eczema developing in psoriasis patients treated with biologics.(2023)Biologic therapies for psoriasis can cause paradoxical eczema. The role of genetic factors in its pathogenesis is unknown. To identify risk variants, we conducted a GWAS of 3,212 patients with psoriasis, of whom 88 developed paradoxical eczema. Two lead SNPs reached genome-wide significance (P ≤ 5 × 10−8) for association with paradoxical eczema: rs192705221 (near UNC5B, P = 9.52 × 10−10) and rs72925168 (within SLC1A2, P = 1.66 × 10−9). Genome-wide significant SNPs from published GWAS were used to generate polygenic risk scores (PRSs) for atopic eczema, general atopic disease, or a combination, which were tested for association with paradoxical eczema. Improvement over a clinical risk model was assessed by the area under the curve. All three atopy polygenic risk scores were associated with paradoxical eczema (P < 0.05); polygenic risk score for a combination of atopic eczema and general atopic disease had the strongest association (OR = 1.83, 95% CI = 1.17−2.84, P = 0.0078). Including atopic polygenic risk scores in the multivariable model, which included age, sex, atopic background, and psoriatic arthritis history, increased the area under the curve from 0.671 to 0.681−0.686. Atopic genetic burden is associated with paradoxical eczema occurring in biologic-treated patients with psoriasis, indicating shared underlying mechanisms. Incorporating genetic risk may improve treatment outcome prediction models for psoriasis.Item Is it time to change practice in patients with unilateral inguinal hernia: A comparative study of laparoscopic vs open hernia repair in LMIC country.(2022)Aim Our aim was to assess if a return to regular activity is improved in patients undergoing one-sided inguinal hernia repair. This is critical in LMIC countries where finances are constrained, and the cost of laparoscopic repair is significantly higher than the open technique. Method The study was conducted at Aga Khan University Hospital, Pakistan. Patients between ages 16 to 65 planned for unilateral inguinal hernia repair were selected using non-probability consecutive sampling. Patients were selected from 1st May 2016 till 30th April 2017 and were divided into two groups. Group A included patients having laparoscopic TAP repair while Group B consisted of Liechtenstein hernia repair. All patients were followed at 1 week for resumption of regular activities, at 1 and 3 years for recurrence, the study was concluded on 30th April 2020. Results A total of 60 patients were enrolled in this study. Group A and B each had included 30 patients. The mean duration of return to work in group A was 5.33 ± 4.46 days and for group B it was 6.83 ± 4.58 days. There was 1 recurrence seen at 3 years in Group A. Conclusions Hernia recurrence is not different from the technique of repair at 1-year follow-up. Laparoscopic repair although is associated with little early return to work when compared with open technique but this difference was not statistically significant in our study. The decision of the type of repair should be balanced between surgeon expertise and patient's wishes.Item Compliance of carotid endarterectomy pathway at a vascular unit: A regional audit.(2022)Aim To identify reasons for delays in a pathway for patients presenting with Transient Ischemic Attack (TIA) and requiring Carotid Endarterectomy (CEA). Method Bedford hospital is a vascular unit covering 3 hospitals (Bedford, Milton Keynes and Luton Hospital) requiring a complex referral system. Patients who develop TIA secondary to carotid disease are referred to the vascular team. This audit includes patients who underwent carotid endarterectomy from Dec 2020 to Jun 2021. Data was initially collected and analysed as a single vascular unit. The analysis included all steps of referrals and investigations, a subset of data was analysed to identify delays related to each hospital. Results A total of 73 patients were included in the analysis, overall delays (>14 Days) from the onset of symptoms to surgery was 57.5%, the delays were 19 (55%) at LDH, 14 (50%) BHT, 9 (90%) at MKUH. 41 (56%) were delayed referrals to the vascular team. 36 (49%) delays were related to factors after the referral was made. 8 (10%) patients had secondary events awaiting CEA. Conclusions The audit demonstrated that there were significant delays in the carotid endarterectomy referral pathway, there were patients who had delays at multiple levels, delays can be due to the complex referral system between 3 different hospitals. 10% of the patients had developed secondary events while awaiting treatment.
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