Publications by authors named "R Phillip"

38 Publications

Rehabilitation post-COVID-19: cross-sectional observations using the Stanford Hall remote assessment tool.

BMJ Mil Health 2021 May 26. Epub 2021 May 26.

Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK.

Introduction: The multisystem COVID-19 can cause prolonged symptoms requiring rehabilitation. This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. It hypotheses those with post-COVID-19 syndrome, potentially without laboratory confirmation and irrespective of initial disease severity, will have significant rehabilitation needs.

Methods: Cross-sectional study of consecutive patients referred by general practitioners (April-November 2020). Primary outcomes were presence/absence of anticipated sequelae. Binary logistic regression was used to test association between acute presentation and post-COVID-19 symptomatology.

Results: 155 patients (n=127 men, n=28 women, median age 39 years, median 13 weeks post-illness) were assessed using the tool. Acute symptoms were most commonly shortness of breath (SOB) (74.2%), fever (73.5%), fatigue (70.3%) and cough (64.5%); and post-acutely, SOB (76.7%), fatigue (70.3%), cough (57.4%) and anxiety/mood disturbance (39.4%). Individuals with a confirmed diagnosis of COVID-19 were 69% and 63% less likely to have anxiety/mood disturbance and pain, respectively, at 3 months.

Conclusions: Rehabilitation assessment should be offered to all patients suffering post-COVID-19 symptoms, not only those with laboratory confirmation and considered independently from acute illness severity. This tool offers a structure for a remote assessment. Post-COVID-19 programmes should include SOB, fatigue and mood disturbance management.
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http://dx.doi.org/10.1136/bmjmilitary-2021-001856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159670PMC
May 2021

Thoracoplasty: Still relevant to current practice.

Asian Cardiovasc Thorac Ann 2021 Jul 12;29(6):518-523. Epub 2021 Mar 12.

Department of Surgery, University of Kentucky, Lexington, KY, USA.

Background: Management of residual pleural space remains a challenge in the practice of thoracic surgery. Options include thoracotomy with muscle flap/wound vac, Eloesser procedure, or thoracoplasty. We examine current practice and short-term outcomes of thoracoplasty in the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP).

Methods: A retrospective review of thoracoplasty procedures (by CPT® code 32900, 32905, or 32906) in the ACS NSQIP database from the years 2012 to 2017 was performed. The ACS NSQIP prospectively collects perioperative and rigorous 30-day outcome data for patients undergoing major thoracic surgical nationally.

Results: The dataset contained 131 thoracoplasties in patients with an average age of 48 years (SD 19), average BMI of 26 kg/m (SD 5), 48% female, and 21% of minority race. Forty percent of patients were ASA class III and 10% class IV-V. Five percent of the patients had muscle flap in addition to thoracoplasty. Median operative duration was 101 min (interquartile range 61-167) and 8% of patients required blood transfusion. The average length of hospital stay was 6 days (SD 9), and 93% of patients were discharged home. There was one death, and 23% experienced other major morbidity. Thirty-day readmission occurred in 8% of patients and 6% returned to the operating room within 30 days. Four percent of patients experienced respiratory failure, 4% sepsis, and 5% developed pneumonia.

Conclusions: Short-term outcomes of current thoracoplasty demonstrate low mortality and morbidity. Thoracoplasty should remain in our armamentarium for managing residual pleural space.
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http://dx.doi.org/10.1177/02184923211002408DOI Listing
July 2021

Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service.

BMJ Mil Health 2021 Feb 5. Epub 2021 Feb 5.

Academic Department of Military Medicine, Birmingham, UK

Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.
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http://dx.doi.org/10.1136/bmjmilitary-2020-001681DOI Listing
February 2021

CONCORDE: A phase I platform study of novel agents in combination with conventional radiotherapy in non-small-cell lung cancer.

Clin Transl Radiat Oncol 2020 Nov 22;25:61-66. Epub 2020 Sep 22.

Newcastle University, Newcastle upon Tyne, England, UK.

Lung cancer is the leading cause of cancer mortality worldwide and most patients are unsuitable for 'gold standard' treatment, which is concurrent chemoradiotherapy. CONCORDE is a platform study seeking to establish the toxicity profiles of multiple novel radiosensitisers targeting DNA repair proteins in patients treated with sequential chemoradiotherapy. Time-to-event continual reassessment will facilitate efficient dose-finding.
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http://dx.doi.org/10.1016/j.ctro.2020.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548952PMC
November 2020

Novel micropore particle technology for spinal cord injury chronic wound healing: a new paradigm?

BMJ Mil Health 2020 Aug 4. Epub 2020 Aug 4.

Complex Trauma, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK.

Current management of chronic wounds involves regular wound cleaning, antiseptic dressings and, when indicated, antimicrobials. Micropore particle technology (MPPT) is a novel concept for wound healing, aiming to bolster the action of the immune system by disrupting the wound biofilm and restoring the microbiome. Amicapsil is the first MPPT product licensed for clinical use. Patients with a spinal cord injury (SCI) are more likely to develop chronic wounds due to downregulation in their immune response increasing the risk of a minor wound, such as pressure sore, developing into large, non-healing wounds. At the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, patients with SCI often have chronic wounds causing pain, becoming infected and preventing full engagement with effective rehabilitation. We report on the first case of treatment with Amicapsil at the DMRC Stanford Hall and review MPPT as a potential new paradigm for the treatment of wound healing.
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http://dx.doi.org/10.1136/bmjmilitary-2020-001509DOI Listing
August 2020
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