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Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.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 firstname.lastname@example.org
ItemBariatric-metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry(2023-06)Aim Bariatric-metabolic surgery is approved by the National Institute of Health and Care Excellence (NICE) for people with severe obesity and type 2 diabetes (T2DM) (including class 1 obesity after 2014). This study analysed baseline characteristics, disease severity and operations undertaken in people with obesity and T2DM undergoing bariatric-metabolic surgery in the UK National Health Service (NHS) compared to those without T2DM. Methods Baseline characteristics, trends over time and operations undertaken were analysed for people undergoing primary bariatric-metabolic surgery in the NHS using the National Bariatric Surgical Registry (NBSR) for 11 years from 2009 to 2019. Clinical practice before and after the publication of the NICE guidance (2014) was examined. Multivariate logistic regression was used to determine associations with T2DM status and the procedure undertaken. Results 14,948/51,715 (28.9%) participants had T2DM, with 10,626 (71.1%) on oral hypoglycaemics, 4322 (28.9%) on insulin/other injectables, and with T2DM diagnosed 10+ years before surgery in 3876 (25.9%). Participants with T2DM, compared to those without T2DM, were associated with older age (p < 0.001), male sex (p < 0.001), poorer functional status (p < 0.001), dyslipidaemia (OR: 3.58 (CI: 3.39–3.79); p < 0.001), hypertension (OR: 2.32 (2.19–2.45); p < 0.001) and liver disease (OR: 1.73 (1.58–1.90); p < 0.001), but no difference in body mass index was noted. Fewer people receiving bariatric-metabolic surgery after 2015 had T2DM (p < 0.001), although a very small percentage increase of those with class I obesity and T2DM was noted. Gastric bypass was the commonest operation overall. T2DM status was associated with selection for gastric bypass compared to sleeve gastrectomy (p < 0.001). Conclusion NHS bariatric-metabolic surgery is used for people with T2DM much later in the disease process when it is less effective. National guidance on bariatric-metabolic surgery and data from multiple RCTs have had little impact on clinical practice. ItemYou First: a Cost-Effective Nurse-Led Patient Support Programme - Retrospective Analysis from a Large Multi-Ethnic Setting(2023)Background: The global impact of COVID- ItemDermatitis artefacta in the orofacial region: a case report with literature review(2023)In spite of wide prevalence, deliberate self-injury in the oro-facial region is rarely reported in literature. It is also associated with misinterpretation related to ‘attention seeking’ or ‘mental health crises’ leading to deficient understanding of this phenomenon. A literature review was performed using online search databases looking at dermatitis artefacta in the head and neck region. A case of a patient who was seen in our unit is also presented to give important insights into this condition. In total, 54 cases from 15 publications were included in this observational study. Female gender predilection was notable (4:1) with an average presenting age of 30 years. The face itself was more frequently injured, along with the neck and scalp. Only one-third (34%) of the patients were known to have psychiatric conditions, such as depressive and personality disorders. Dermatitis artefacta is a well-known skin condition caused by deliberate self-injury. It is a complex entity that is frequently unrecognized and underdiagnosed.
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