scholarly journals The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom

2017 ◽  
Vol 127 (4) ◽  
pp. 732-739 ◽  
Author(s):  
Paul M. Brennan ◽  
Angelos G. Kolias ◽  
Alexis J. Joannides ◽  
Jonathan Shapey ◽  
Hani J. Marcus ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Research ◽  
Functional Outcome ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Bed Rest ◽  
Repeat Surgery ◽  
Symptomatic Recurrence ◽  
The United Kingdom ◽  
High Flow Oxygen

OBJECTIVESymptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH.METHODSData on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4–6) at NSU discharge < 30%.RESULTSData from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not.CONCLUSIONSThis is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.

scholarly journals Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

2014 ◽  
Vol 21 (3) ◽  
pp. 251-258
Author(s):  
Alfotih Gobran ◽  
Fang-Cheng Li ◽  
Xin-Ke Xu ◽  
Shang-Yi Zhang
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Endovascular Embolization ◽  
Common Disease ◽  
Old People ◽  
Repeat Surgery ◽  
Repeated Surgery ◽  
Surgical Treatments ◽  
Meningeal Artery

AbstractChronic subdural hematoma (CSDH) formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA) is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

scholarly journals Dumfries

1991 ◽  
Vol 15 (5) ◽  
pp. 292-294
Author(s):  
R. G. McCreadie
Keyword(s):  
United Kingdom ◽  
Clinical Research ◽  
Patient Care ◽  
Management Team ◽  
Unit Management ◽  
The United Kingdom

My work has four main strands – patient care, membership of the unit management team, clinical research and the College. At different times I can, or have to, place greater or lesser emphasis on any one of these areas – the result is a job virtually devoid of routine. Let me tell you about each area. I hope by doing so you will also learn a little about what is going on in psychiatry north of the border. You will know we arrange things rather differently from the rest of the United Kingdom.

scholarly journals Informing National Health Service patients about participation in clinical research: A comparison of opt-in and opt-out approaches across the United Kingdom

2020 ◽  
pp. 000486742097326
Author(s):  
Catherine Henshall ◽  
Jennifer Potts ◽  
Sophie Walker ◽  
Mark Hancock ◽  
Mark Underwood ◽  
...  
Keyword(s):  
Mental Health ◽  
United Kingdom ◽  
National Health Service ◽  
Health Service ◽  
Clinical Research ◽  
National Health ◽  
Research Participation ◽  
Research Opportunities ◽  
The United Kingdom ◽  
Opt Out

Objective: Recruitment to clinical research in the National Health Service remains challenging. One barrier is accessing patients to discuss research participation. Two general approaches are used in the United Kingdom to facilitate this: an ‘opt-in’ approach (when clinicians communicate research opportunities to patients) and an ‘opt-out’ approach (all patients have the right to be informed of relevant research opportunities). No evidence-based data are available, however, to inform the decision about which approach is preferable. This study aimed to collect information from ‘opt-in’ and ‘opt-out’ Trusts and identify which of the two approaches is optimal for ensuring National Health Service patients are given opportunities to discuss research participation. Method: This sequential mixed methods study comprised three phases: (1) an Appreciative Inquiry across UK Trusts, (2) online surveys and (3) focus groups with National Health Service staff and patients at a representative mental health Trust. Results: The study was conducted between June and October 2019. Out of seven National Health Service Mental Health Trusts contacted (three ‘opt-out’ and four ‘opt-in’), only four took part in phase 1 of the study and three of them were ‘opt-out’ Trusts. Benefits of an ‘opt-out’ approach included greater inclusivity of patients and the removal of research gatekeepers, while the involvement of research-active clinicians and established patient–clinician relationships were cited as important to ‘opt-in’ success. Phases 2 and 3 were conducted at a different Trust (Oxford Health NHS Foundation Trust) which was using an ‘opt-in’ approach. Of 333 staff and member survey responders, 267 (80.2%) favoured moving to an ‘opt-out’ approach (phase 2). Nineteen staff and 16 patients and carers participated in focus groups (phase 3). Concern was raised by staff regarding the lack of time for clinical research, with clinical work taking precedence over research; patients were concerned about a lack of research activity; all considered research to be beneficial and were supportive of a move to ‘opt-out’. Conclusion: Findings suggest that ‘opt-out’ is more beneficial than ‘opt-in’, with the potential to vastly increase patient access to research opportunities and to enable greater equality of information provision for currently marginalised groups. This should ensure that healthcare research is more representative of the entire population, including those with a mental health diagnosis.

scholarly journals Does time to surgery affect patient-reported outcome in proximal humeral fractures? A subanalysis of the PROFHER randomized clinical trial

2020 ◽  
Vol 102-B (1) ◽  
pp. 33-41 ◽  
Author(s):  
John G. Norman ◽  
Stephen Brealey ◽  
Ada Keding ◽  
David Torgerson ◽  
Amar Rangan
Keyword(s):  
United Kingdom ◽  
Functional Outcome ◽  
The United States ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Altman Plot ◽  
Bland Altman Plot ◽  
Time To Surgery ◽  
The United Kingdom

Aims The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures Methods A total of 250 patients presenting within three weeks of sustaining a displaced proximal humeral fracture involving the surgical neck were recruited at 32 acute NHS hospitals in the United Kingdom between September 2008 and April 2011. Of the 125 participants, 109 received surgery (fracture fixation or humeral head replacement) as per randomization. Data were included for 101 and 67 participants at six-month and five-year follow-up, respectively. Oxford Shoulder Scores (OSS) collected at six, 12, and 24 months and at three, four, and five years following randomization was plotted against time to surgery. Long-term recovery was explored by plotting six-month scores against five-year scores and agreement was illustrated with a Bland-Altman plot. Results The mean time from initial trauma to surgery was 10.5 days (1 to 33). Earlier surgical intervention did not improve OSS throughout follow-up, nor when stratified by participant age (< 65 years vs ≥ 65 years) and fracture severity (one- and two-part vs three- and four-part fractures). Participants managed later than reported international averages (three days in the United States and Germany, eight days in the United Kingdom) did not have worse outcomes. At five-year follow-up, 50 participants (76%) had the same or improved OSS compared with six months (six-month mean OSS 35.8 (SD 10.0); five-year mean OSS 40.1 (SD 9.1); r = 0.613). A Bland-Altman plot demonstrated a positive mean difference (3.3 OSS points (SD 7.92)) with wide 95% limits of agreement (-12.2 and 18.8 points). Conclusion Timing of surgery did not affect OSS at any stage of follow-up, irrespective of age or fracture type. Most participants had maximum functional outcome at six months that was maintained at five years. These findings may help guide providers of trauma services on surgical prioritization. Cite this article: Bone Joint J 2020;102-B(1):33–41

scholarly journals TRIP Database

2018 ◽  
Vol 39 (3) ◽  
pp. 152-154
Author(s):  
Jackie Phinney
Keyword(s):  
United Kingdom ◽  
Clinical Research ◽  
Research Database ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Single Interface ◽  
The United Kingdom

Based in the United Kingdom, TRIP (Turning Research Into Practice) is a clinical research database that allows users to search across multiple sources of information and publication types using a single interface.

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