Barts Health NHS Trust

About: Barts Health NHS Trust is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 3483 authors who have published 3807 publications receiving 81829 citations.

Management of sharps injuries in the healthcare setting

Abstract: #### The bottom line Sharps injuries are common in the healthcare setting. Between 2004 and 2013 a total of 4830 healthcare associated occupational exposures to body fluid were reported in the UK, 71% of these for percutaneous injuries.1 As the reporting system is likely to have recorded only cases with an important exposure, the actual burden of sharps injuries is likely to be much higher. Healthcare workers need to be familiar with immediate management both for themselves if they become injured and for assisting injured colleagues. Many healthcare workers do not know how to manage a sharps injury,2 particularly if this occurs out of hours. This review presents a summary of the immediate management of sharps injuries and outlines the risk assessment and management strategies to prevent the transmission of HIV, hepatitis B virus, and hepatitis C virus. #### Sources and selection criteria We searched PubMed and the Cochrane Library for articles published over the past 20 years using the terms “sharps injury”, “needle stick injury”, and “body fluid exposure” and hand selected the most relevant and appropriate articles. To search for relevant UK national guidelines we also accessed the UK Department of Health and Public Health England …

Acute myocarditis: aetiology, diagnosis and management.

Abstract: Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. A primary diagnosis of myocarditis accounted for 0.04% (36.5 per 100,000) of all hospital admissions in England between 1998 and 2017, although this is likely to be an underestimate of the true burden of myocarditis. The aetiology is broad, including infective and inflammatory conditions as well as exposure to toxic agents. Clinical features are varied and overlap with other acute cardiac conditions making diagnosis a challenge. Cardiovascular magnetic resonance imaging currently serves as the gold standard non-invasive diagnostic modality. If an underlying aetiological process is identified, then therapy may be directed at the cause; however, for most, treatment is supportive and aimed at managing any complications such as heart failure or arrhythmias. There is emerging evidence for immunosuppressive therapy in certain cases. Prognosis is generally good with recovery in most; however, up to 30% with biopsy-proven myocarditis progress to develop a dilated cardiomyopathy and its potential associated complications. All-cause mortality in the UK for patients presenting to hospital with acute myocarditis is approximately 4%.

HER2 Status in High-Risk Endometrial Cancers (PORTEC-3): Relationship with Histotype, Molecular Classification, and Clinical Outcomes.

Abstract: HER2 status has not been investigated in the context of the molecular endometrial cancer (EC) classification. Here, we aimed to determine the clinicopathological features and prognostic significance of the HER2 status in the molecularly classified PORTEC-3 trial population of patients with high-risk EC (HREC). HER2 testing was performed on tumor tissues of 407 molecularly classified HREC. HER2 status was determined by HER2 immunohistochemistry (IHC; all cases) and subsequent HER2 dual in situ hybridization for cases with any (in) complete moderate to strong membranous HER2 IHC expression. The Χ2 test and Spearman's Rho correlation coefficient were used to compare clinicopathological and molecular features. The Kaplan-Meier method, log-rank test, and Cox proportional hazards models were used for survival analysis. We identified 24 (5.9%) HER2-positive EC of various histological subtypes including serous (n = 9, 37.5%), endometrioid (n = 6, 25.0%), and clear cell (n = 5, 20.8%). HER2 positivity was highly associated with the p53-abnormal subgroup (p53abn, 23/24 cases; p < 0.0001). The correlation between p53abn and the HER2 status (ρ = 0.438; p < 0.0001) was significantly stronger (p < 0.0001) than between serous histology and the HER2 status (ρ = 0.154; p = 0.002). HER2 status did not have independent prognostic value for survival after correction for the molecular classification. Our study strongly suggests that molecular subclass-directed HER2 testing is superior to histotype-directed testing. This insight will be relevant for future trials targeting HER2.

Prospective clinical audit of two neuromodulatory treatments for fecal incontinence: sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS).

Abstract: Two types of neuromodulation are currently practised for the treatment of fecal incontinence (FI): sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS) This study compares these therapies, as no data exist to prospectively assess their relative efficacy and costs The subjects of this study were two distinct cohorts undergoing SNS (between 2003 and 2008) or PTNS (2008-onwards) for FI Clinical outcomes assessed at 3 months included incontinence scores and the number of weekly incontinence episodes The direct medical costs for each procedure were calculated from the audited expenditure of our unit Thirty-seven patients (946 % women) underwent permanent SNS and 146 (877 % women) underwent PTNS The mean pre-treatment incontinence score (±SD) was greater in the SNS cohort (14 ± 4 vs 12 ± 4) and the mean post-treatment incontinence scores were similar for the two therapies (9 ± 5 vs 10 ± 4), with a greater effect size evident in the SNS patients In a ‘pseudo case–control’ analysis with 37 “matched” patients, the effect of both treatments was similar The cost of treating a patient for 1 year was £11 374 ($18 223) for permanent SNS vs £1740 ($2784) for PTNS Given the lesser cost and invasive nature of PTNS, where both techniques are available, a trial of PTNS could be considered for all patients