ABSTRACT
Introduction: There are approximately 2,400 new cases of testicular cancer in the UK annually. NICE guidelines recommend all suspected patients to be referred on the 2 week-wait pathway, with a 31 day target to commence treatment following decision to treat. The COVID-19 pandemic has decimated routine hospital service provision and led to the cancellation of 36,000 cancer operations in the UK during the first wave. Our aim was to assess the impact of the pandemic on our testicular cancer patients. Patients and Methods: Eleven trusts in the West Midlands deanery performed a retrospective analysis of all testicular cancer patients between January 2015 to December 2020. The pre-COVID cohort (January 2015-February 2020) were compared to the COVID cohort (March 2020-December 2020). Parameters assessed included date of referral, first clinic appointment, operation, and post-operative tumour markers. Sperm banking and pathological stage was also compared. Results: A total of 830 patients were included. Pre- COVID n=753, COVID n=77. Conclusions: There was statistically no significant difference in time from initial referral to first clinic appointment, duration from clinic to theatre, timeliness of post-operative tumour markers and pathological stage of tumour. Sperm banking was performed significantly more in the COVID era (25.7 vs 10.3%). This reflects consistency in the management of testicular cancer patients during the COVID period. Of note less patients were assessed on average during the COVID era (92 v 146/year) implying that we may experience an increase in patients with later presentations and advanced disease;further analysis will be required to confirm this.
ABSTRACT
INTRODUCTION AND OBJECTIVE: To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for transurethral resection of bladder tumours (TURBT) during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosol-generating procedures. We aimed to compare outcomes of TURBT using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity. METHODS: We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar and Web of Science), identifying studies comparing the outcomes of TURBT using spinal anaesthesia versus spinal with an obturator nerve block. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data. RESULTS: Searches of electronic databases resulted in 107 articles, from which four randomised control trials (RCTs) and three cohort studies met the eligibility criteria, enrolling a total of 448 patients. The use of spinal anaesthesia with an obturator nerve block was associated with a significantly reduced risk of obturator reflex (p <0.00001), bladder perforation (p=0.02), incomplete resection (p <0.0001) and 12-month tumour recurrence (p=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity (0/159). CONCLUSIONS: Our meta-analysis suggests that TURBT employing spinal anaesthesia with an obturator nerve block is superior to the use of spinal anaesthesia alone. During the COVID-19 pandemic, where avoidance of aerosol-generating procedures (AGPs) such as a general anaesthesia is paramount, the use of an obturator nerve block with spinal anaesthesia is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade.
ABSTRACT
Introduction: To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for transurethral resection of bladder tumours (TURBT) during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosolgenerating procedures (AGPs). We aimed to compare outcomes of TURBT using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity. Methods: We conducted a comprehensive search of electronic databases, identifying studies comparing the outcomes of TURBT using SA versus SA+ONB. The Cochrane risk-of-bias tool for RCTs and the Newcastle- Ottawa scale for observational studies were used to assess the studies. Random effects modelling was used to calculate pooled outcome data. Results: Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB was associated with a significantly reduced risk of obturator reflex(P<0.00001), bladder perforation(P=0.02), incomplete resection(P<0.0001) and 12-month tumour recurrence(P=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity(0/159). Conclusions: Our meta-analysis suggests that TURBT employing SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as general anaesthesia is paramount, the use of SA+ONB is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade.
ABSTRACT
INTRODUCTION: Optimising glycaemic control in type 1 diabetes (T1D) remains challenging. Flash glucose monitoring with FreeStyle Libre 2 (FSL2) is a novel alternative to the current standard of care self-monitoring of blood glucose (SMBG). No randomised controlled trials to date have explored the potential benefits of FSL2 in T1D. We aim to assess the impact of FSL2 in people with suboptimal glycaemic control T1D in comparison with SMBG. METHODS: This open-label, multicentre, randomised (via stochastic minimisation), parallel design study conducted at eight UK secondary and primary care centres will aim to recruit 180 people age ≥16 years with T1D for >1 year and glycated haemoglobin (HbA1c) 7.5%-11%. Eligible participants will be randomised to 24 weeks of FSL2 (intervention) or SMBG (control) periods, after 2-week of blinded sensor wear. Participants will be assessed virtually or in-person owing to the COVID-19 pandemic. HbA1c will be measured at baseline, 12 and 24 weeks (primary outcome). Participants will be contacted at 4 and 12 weeks for glucose optimisation. Control participants will wear a blinded sensor during the last 2 weeks. Psychosocial outcomes will be measured at baseline and 24 weeks. Secondary outcomes include sensor-based metrics, insulin doses, adverse events and self-report psychosocial measures. Utility, acceptability, expectations and experience of using FSL2 will be explored. Data on health service resource utilisation will be collected. ANALYSIS: Efficacy analyses will follow intention-to-treat principle. Outcomes will be analysed using analysis of covariance, adjusted for the baseline value of the corresponding outcome, minimisation factors and other known prognostic factors. Both within-trial and life-time economic evaluations, informed by modelling from the perspective of the National Health Service setting, will be performed. ETHICS: The study was approved by Greater Manchester West Research Ethics Committee (reference 19/NW/0081). Informed consent will be sought from all participants. TRIAL REGISTRATION NUMBER: NCT03815006. PROTOCOL VERSION: 4.0 dated 29 June 2020.