Lee Ingle

Background: According to the National Institute of Cardiovascular Outcomes Research (NICOR) report in 2022, the mean waiting time for urgent coronary artery bypass graft (CABG) surgery in the United Kingdom is 10 days, rather than the recommended 7 days. We conducted a service evaluation of the acute cardiac pathway in our hospital. Methods: All patients who received cardiac surgery in 2022 were considered. 611 patients had cardiac surgery; 585 had elective or acute cardiac surgery; 580 had complete data for analysis. Data were reported in counts and percentages. We determined the associations between pre-operative length of stay and post-operative outcomes using negative binomial analysis. Fine-Gray model was used to address survival bias. Results: Median pre-operative LOS for urgent patients referred directly to CHH was 12 days (IQR 8.0-16.5, p < 0.001). Each additional pre-operative day were associated with an increase of stay (LOS) by 3.2%. Sensitivity analysis on the pre-operative LOS rate ratio shows that this effect is purely confined to the urgent population; RR 1.030, p < 0.001 and absent in elective patients; RR 0.976, p 0.3966. The effect is enhanced in patients presenting to Castle Hill Hospital (CHH) directly as we were able to capture the full duration of their in-hospital LOS; RR 1.035, p < 0.001. Other factors that impact post-operative LOS were presenting ejection fraction (EF), type of surgery and age. Conclusion: Pre-operative LOS was independently associated with prolonged post-operative stay. This effect is confined to the urgent population supporting a service improvement focus on reducing in-hospital delays for the urgent pathway.

Background: Since the Covid-19 pandemic, a surgical backlog for total hip replacement (THR) and total knee replacement (TKR) surgery remains in the United Kingdom. Multimodal prehabilitation pathways (encompassing exercise, nutritional support and psychological wellbeing) can be utilised to ‘optimise” physical and mental resilience prior to the challenge of surgical intervention. BoneFit is an open-label, non-randomised feasibility trial to determine the recruitment and attendance/adherence rates, delivery and implementation challenges, fidelity, acceptability, and safety of a student-led multimodal prehabilitation intervention in people listed for THR/TKR surgery. We will also determine participant and clinician views of the intervention, and identify any challenges and enablers of inter-institutional partnership working. Methods: Individuals listed for THR/TKR surgery aged between 18 to 75 years will be assigned to an intervention (n = 25) or usual-care control group (n = 25). The primary outcome measures will be feasibility of delivering the BoneFit intervention. Physical, psychological, quality of life and clinical outcomes will be assessed at three major time-points; T1 (baseline; 2 months from surgery), T2 (2–10 days from surgery), and T3 (3 months following surgery). We aim to show that the trial is feasible and that we can identify a signal of efficacy based on clinical outcomes collected compared to controls. The study was ethically approved by the Health Research Authority (London Bridge Research Ethics Committee: REC reference: 24/PR/0092) in March 2024. Discussion: The development of a multimodal prehabilitation pathway could improve the physical and mental resilience of individuals awaiting orthopaedic surgery. We aim to determine if this translates to faster discharge and reduced complication rates, thus helping boost surgical throughput and potentially easing surgical backlog. It is likely that the concept of ‘waiting’ lists for surgery should be challenged, rather, individuals should be encouraged to use the time available to ‘prepare’ for surgery. Trial registration: Registration details ClinicalTrials.gov registration number: NCT06341920.

Introduction: A health and lifestyle advisor service embedded within primary care was piloted in Kingston-upon-Hull from January 2021. We aimed to evaluate the first two years of service delivery by identifying patient demographics referred to the service, reason for referral, determine uptake and retention rates, and monitor individual lifestyle-related risk factor changes following discharge. Methods: Anonymised data were extracted from the SystmOne database for all patients referred to the service between January 2021 and January 2023. Results: In the initial two years of the service, 705 unique patients were referred at a mean rate of ∼29 per month. Each unique patient received a median (robust median absolute deviation; [MAD]) of 3 (Steel N, et al 2018) planned consultations prior to discharge over this period. The majority of referrals were for symptom management and health promotion purposes (95%). Of those referred, 69% attended their appointments, and 14% did not attend. The majority of referrals were white British (55%), however, the service did receive a substantial number of referrals from minority ethnic groups, with only 67% of referrals speaking English as their main language. Eighteen distinct languages were spoken. Most referrals were classified as class I obese (59.4%). Across initial and final appointments, median (robust MAD) systolic blood pressure was 130 (15) mmHg and 130 (15) mmHg, and median (robust MAD) waist circumference was 103.0 (13.3) cm and 101.0 (13.3) cm. Conclusion: The evaluation highlighted the demand for this service embedded within primary care settings in Kingston-upon-Hull. Service engagement was evident, and a large proportion of those who engaged were from minority ethnic groups. A high proportion of referrals presented with obesity and/or hypertension which requires further investigation.

Objective: To determine the acceptability and feasibility of delivering early outpatient review following cardiac surgery and early cardiac rehabilitation (CR), compared to standard practice to establish if a future large-scale trial is achievable. Methods: A randomised controlled, feasibility trial with embedded health economic evaluation and qualitative interviews, recruited patients aged 18–80 years from two UK cardiac centres who had undergone elective or urgent cardiac surgery via a median sternotomy. Eligible, consenting participants were randomised 1:1 by a remote, centralised randomisation service to postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control), or postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention). The primary outcome measures related to trial feasibility including recruitment, retention, CR adherence, and acceptability to participants/staff. Secondary outcome measures included health-rated quality of life using EQ-5D-5L, NHS resource-use, Incremental Shuttle Walk Test (ISWT) distance, 30- and 90-day mortality, surgical site complications and hospital readmission rates. Results: Fifty participants were randomised (25 per group) and 92% declared fit for CR. Participant retention at final follow-up was 74%; completion rates for outcome data time points ranged from 28 to 92% for ISWT and 68 to 94% for follow-up questionnaires. At each time point, the mean ISWT distance walked was greater in the intervention group compared to the control. Mean utility scores increased from baseline to final follow-up by 0.202 for the intervention (0.188 control). Total costs were £1519 for the intervention (£2043 control). Fifteen participants and a research nurse were interviewed. Many control participants felt their outpatient review and CR could have happened sooner; intervention participants felt the timing was right. The research nurse found obtaining consent for willing patients challenging due to discharge timings. Conclusion: Recruitment and retention rates showed that it would be feasible to undertake a full-scale trial subject to some modifications to maximise recruitment. Lower than expected recruitment and issues with one of the clinical tests were limitations of the study. Most study procedures proved feasible and acceptable to participants, and professionals delivering early CR. Trial registration: ISRCTN80441309 (prospectively registered on 24/01/2019).

Examining the reliability and validity of the second edition movement assessment battery test (MABC-2) in children with and without motor impairment. In this prospective cohort study, the MABC-2 test and developmental coordination disorder questionnaire 2007 (DCDQ′07) were completed by children and their parents. By using 95% confidence intervals, minimal detectable change (MDC95) was calculated, and concurrent validity was investigated. By applying the MABC-2 test as a reference standard (cut-off fifth centile), sensitivity and specificity were examined. 273 children (mean age: 6.3 ± 2.3 years; 70% male) with and without motor impairment completed the investigation. For test-retest reliability, intra-class correlation coefficients (ICCs) was >0.89 for the MABC-2 test. The MDC95 value for the motor skill test was 5.76. There was a significant correlation between the MABC-2 test and DCDQ′07 (r = 0.60, P < 0.001) and the Go/No-Go test (r = 0.50, P < 0.001). Overall, the sensitivity was very high (90%), the specificity was low (46%), and positive and negative predictive values were high (69% and 81%, respectively). The MABC-2 test can be considered a valid and reliable motor skill assessment tool for children with and without motor impairment.

Lower limb disability is common in chronic stroke patients, and aquatic therapy is one of the modalities used for the rehabilitation of these patients.To summarize the evidence of the effects of aq...