Prevalence and management of recurrent respiratory papillomatosis (RRP) in the UK: cross-sectional study.

OBJECTIVES: To estimate the number of patients with recurrent respiratory papillomatosis currently managed in secondary and tertiary health care in the UK and the frequency of its treatment with radiofrequency cold ablation (Coblation™ ). DESIGN: Cross-sectional survey of ENT consultants in the UK with validation using Hospital Episode Statistics (HES) inpatient data. SETTING: Online survey. PARTICIPANTS: ENT consultants in the UK. MAIN OUTCOME MEASURES: Number of recurrent respiratory papillomatosis patients currently managed in acute care in the UK and frequency of use of Coblation. RESULTS: A total of 283 ENT consultants from 128 UK NHS healthcare trusts and health boards completed the online survey. Responses were received from 86% of surveyed organisations, and an estimated 45% of all ENT consultants in UK. The estimated number of recurrent respiratory papillomatosis patients from the cross-sectional survey was 918 (at August 2015) which included 730 patients in England. The number of recurrent respiratory papillomatosis patients in England estimated from Hospital Episode Statistics (2014/15 financial year) was up to 741. A total of 42 Coblation procedures conducted in the UK were identified from the cross-sectional survey; 36 were conducted in England compared with 34 identified from Hospital Episode Statistics. CONCLUSIONS: The numbers of recurrent respiratory papillomatosis patients and Coblation procedures identified in England from a cross-sectional survey and Hospital Episode Statistics were in broad agreement. Our study estimated 1.42 recurrent respiratory papillomatosis patients per 100 000 in the general UK population. We also estimated that Coblation procedures accounted for 3% of interventional treatments conducted in the UK recurrent respiratory papillomatosis population.

Effect of procedure volume on outcomes after iliac artery angioplasty and stenting.

BACKGROUND: Service reorganization to concentrate complex vascular services in hospitals with high caseload volume aims to reduce mortality and complication rates. The present study assessed the relationship between caseload volume and outcome for iliac artery angioplasty and stenting in England using a routinely available national data set (Hospital Episode Statistics, HES). METHODS: Routine administrative data for iliac artery angioplasty and stent procedures performed in England between 2007 and 2011 were analysed. Associations between centre volume and outcomes (death, complications and duration of hospital stay) were tested and compared for two methods of stratification (quartiles and quintiles) and two statistical tests (odds ratios and the Cochran-Armitage test for trend). Multivariable analysis was also performed. RESULTS: There were 23,308 episodes of care recorded in HES with Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, fourth revision, codes L54.1 or L54.4 corresponding to iliac artery intervention. There was a gradual increase year by year in number of procedures performed. Univariable and multivariable analysis showed no association between centre volume and either death or complications (multivariable odds ratio, OR 1.00, 95 per cent confidence interval 1.00 to 1.00) for elective and non-elective procedures. Age was associated with higher mortality and complication rates in elective procedures, and with mortality in non-elective procedures. The risk of death after elective iliac angioplasty or stenting was significantly higher in women (multivariable OR 4.98, 2.09 to 13.26). CONCLUSION: There was no association between the outcomes of endovascular iliac artery intervention and centre volume, but outcomes were significantly worse with increasing age and female sex.

Remote measurement of the leak around the uncuffed tracheal tube: objective measurement and physical characteristics.

BACKGROUND: We have developed a technique for measuring a characteristic of the tracheal tube (TT)-trachea interface: the leak conductance (LC). This study aimed to validate the technique in the laboratory and to compare LC with measurements of fractional volume loss (FVL) in neonates undergoing mechanical ventilation. METHODS: LC, expressed as leak flow at a lung pressure of 10 cm H(2)O, was derived remotely from ventilator pressure and flow signals. Validation was by simulating breathing circuits for 10 models in which LC was measured directly. LC was compared with FVL for different settings of PEEP, inspired pressure, and time at plateau pressure. Clinically, LC was measured for 135 infants admitted to paediatric intensive care after cardiac surgery and compared with FVL. RESULTS: No significant differences were found between direct and remote laboratory measurements of LC (P>0.05). FVL varied with PEEP, plateau pressure, and time at plateau (P<0.05) but LC did not (P>0.05). The between-patient standard deviation (sd) of LC (0.4 litre min(-1)) exceeded the within-patient sd of lc (0.05 litre min(-1); P<0.05); the between-patient sd of FVL (22.1%) exceeded the within-patient sd of FVL (1.3%; P<0.05). The median LC was 0.38 (inter-quartile range 0.29-0.46) litre min(-1). LC was correlated with FVL (r=0.82; 95% confidence interval 0.76-0.88) but wide ranges of FVL were observed for patients with similar LC. CONCLUSIONS: LC can be derived remotely and was correlated with FVL, a conventional proxy for tube fit. It may be a better measure of TT fit than FVL.

Characterization of the ultrasound beam produced by the MIST therapy, wound healing system.

The MIST Therapy wound healing device (Celleration, Eden Prairie, MN, USA), which uses low-frequency ultrasound to deliver an atomized saline spray to acute wounds, was evaluated in a laboratory environment. The output of the MIST device was characterized by its frequency, transmission in the presence and absence of the saline spray and intensity. When measured up to 500 mm away from the transducer tip, the transmission of 39.5 kHz ultrasound was not significantly attenuated by the saline itself. In the absence of the saline spray, the acoustic intensity range of the MIST device was calculated to be 429-188 mW cm(-2) across the manufacturer-specified treatment range (12.5-20 mm). Because of the acoustic impedance mismatch between air and soft tissue, the MIST Therapy device would deliver only 0.1% of this incident intensity into the wound site.