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Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.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 Physiological Interpretation of Cardiotocograph (CTG): The role of the intrapartum " Fit - Cat ".(2025)Physiological interpretation of cardiotocograph (CTG) involves determining the combination or sequence of features of the fetal heart rate to recognise different types of fetal hypoxic or non-hypoxic (e.g., chorioamnionitis) stresses, as well as scrutinising the CTG trace to differentiate features suggestive of fetal compensatory responses from decompensation. The Fetal Monitoring Checklist was recommended in 2017, and this has been recently endorsed by the International Expert Consensus Statement on Physiological Interpretation of CTG produced by more than 50 CTG experts from over 20 countries. The aim of the Fetal Monitoring Checklist is to exclude or to identify features suggestive of pre-existing fetal compromise by assessing the oxygenation of fetal central organs, placental function and the wider clinical context. This enables the frontline clinicians to ask the question “Is THIS fetus FIT to undertake the progressively hypoxic journey of human labour?” However, some pre-existing risk factors may manifest after the onset of established labour due to the super-imposed hypoxic stress. Similarly, intra-amniotic infection following a recent spontaneous prelabour rupture of membranes may be silent during the incubation period, but it may manifest during labour. In such cases, the use of the Fetal Monitoring Checklist may lead to the clinicians concluding that the “Fetus is FIT for Labour”, although, there is increased risk of fetal compromise with the passage of time and intrapartum super-imposed hypoxic stress. The intrapartum “FIT-CAT” (FIT for labour -Clinical Anticipation Tool) is designed to aid frontline clinicians to anticipate the changes on the CTG which are likely to occur during labour, based on the identified antenatal or intrapartum risk factors. This intrapartum anticipation tool may enable the timely recognition of features on the CTG which heralds the onset of fetal decompensation in fetuses who are deemed “FIT” to commence labour with pre-existing risk factors and/or develop intrapartum risk factors. Prompt recognition and appropriate management based on individualisation of care and the understanding of the impact of clinical context on the CTG trace may help improve perinatal outcomes.Item The role of Prolyl 3-Hydroxylase 1 (P3H1) in tumor development and prognosis: a pan-cancer analysis with validation in colonic adenocarcinoma.(2025)Background: Cancer is a multifaceted disease characterized by unregulated cell proliferation, evasion of apoptosis, and metastasis. Recent studies have highlighted the importance of extracellular matrix remodeling and post-translational modifications in tumorigenesis. Prolyl 3-hydroxylase 1 (P3H1), an enzyme involved in collagen hydroxylation, has gained attention for its role in cancer progression. Methods: This study investigates P3H1 expression, prognostic value, and functional relevance across multiple human cancers using a combination of bioinformatic and experimental approaches. Results: Using The Cancer Genome Atlas (TCGA) data from TIMER2.0 and UALCAN databases, we observed a significant upregulation of P3H1 mRNA and protein in various cancers. Prognostic analysis using GEPIA2 and KM plotter revealed that high P3H1 expression correlates with poorer overall survival in colon adenocarcinoma (COAD), kidney renal clear cell carcinoma (KIRC), and liver hepatocellular carcinoma (LIHC). Further, genetic and promoter methylation analyses showed low mutation frequencies and reduced methylation of P3H1 in specific cancer types. Functional and pathway enrichment analyses indicated that P3H1 is involved in collagen formation, endoplasmic reticulum activity, and pathways such as ECM-receptor interaction and PI3K-Akt signaling. Validation by enzyme linked immunosorbent assay in COAD patient serum samples demonstrated significantly elevated P3H1 levels compared to healthy controls, with an AUC approaching 1.0 by receiver operating characteristic (ROC) curve analysis. This suggests its potential as a diagnostic biomarker. Additionally, functional experiments were conducted in COAD cells to assess P3H1’s role in tumorigenesis. Knockdown of P3H1 in HCT116 cells resulted in a significant reduction in cell proliferation, colony formation, and migratory abilities of these cells. Conclusion: These findings emphasize P3H1’s relevance in COAD, KIRC, and LIHC pathogenesis and possible utility in clinical diagnosis.Item Splenic function following angioembolisation for blunt splenic injury: A systematic review.(2025)Background Splenic artery angioembolisation (SAE) plays an important role in the nonoperative management of blunt splenic injury. In contrast to splenectomy, there is little guidance concerning immune function, and consequently the need for antimicrobial prophylaxis, following SAE. A systematic review was conducted to evaluate the current literature on the topic. Method A systematic review of the currently available literature was performed using the MEDLINE database. Original articles were eligible if they reported at least one marker of splenic function following SAE. Animal studies, literature reviews and case reports were excluded. Two researchers independently assessed the eligibility and quality of the articles and performed the data extraction; these studies were qualitatively analysed. Results Eleven studies were included. A total of 407 patients, of which 243 had undergone SAE, 80 who had undergone splenectomy and 84 healthy controls, were included. All studies used different parameters for assessing splenic function. None reported increased rates of infection or overwhelming postsplenectomy infection following SAE. There was no statistically significant difference between the markers of immunocompetence measured in the SAE group when compared to healthy controls. Ten of the studies concluded that, by the parameters they measured, splenic function was preserved after the procedure. Conclusion All but one of the included studies reported preserved splenic function following SAE. Whilst there is no single parameter that unequivocally demonstrates this, the best available evidence supports this. This may help inform clinical guidelines for post-SAE vaccination and prophylactic antibiotic practice; namely, that there is no indication to do so.Item Patients undergoing major abdominal cancer surgery should receive 28 days of VTE prophylaxis: A single-centre audit of patients treated surgically for colorectal cancer.(2023)Aims The incidence of venous thromboembolism (VTE) following major abdominal cancer surgery is reduced by extended post-operative VTE prophylaxis using low molecular weight heparin, without an associated increase in bleeding risk. The National Institute for Health and Care Excellence (NICE) issued guidance in 2018, recommending 28 days of post-operative VTE prophylaxis for these patients. We audited local compliance for patients undergoing major surgery for colorectal cancer. Methods Clinical records of patients with colorectal cancer were retrieved from a local registry. 104 patients treated surgically between 01/08/2021–24/01/2023 were included in the first audit cycle. Retrospective analysis investigated the nature of operations (elective or emergency) and whether extended VTE prophylaxis was prescribed. Records were examined for documented plans for prophylaxis post-discharge. Data was presented locally and strategies to increase compliance were implemented. Second cycle data is being collected prospectively from 25/01/2023 until the presentation date. Results Of the included patients, 89% underwent elective operations and 11% required emergency surgery. Our first cycle demonstrated 84% compliance with guidance across all patients (88% for elective and 55% for emergency procedures, respectively). An explicitly documented plan for extended prophylaxis was observed for 82% of recipients and 12% of those who did not receive it. Conclusions Compliance to guidance was particularly high for electively treated patients. This should not differ between elective and emergency cases. Documenting post-discharge anticoagulation plans may act as a simple quality improvement measure. We plan to re-audit and present second cycle results following implementation of interventions, including education, posters, and improving electronic discharge processes.
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