2014

Does compliance with the 2 week wait colorectal cancer referral system lead to a higher cancer detection rate? (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Kaur P., *Cheetham M. , *McCloud J.

Citation:
Colorectal Disease, July 2014, vol./is. 16/(73), 1462-8910 (July 2014)

Abstract:
Background: Current guidelines suggest that patients with a suspected colorectal cancer are seen within 2 weeks of the referral made by general practitioners. Recent data has shown an increase in referrals with a decrease in cancer yield, with up to 25% of all referrals made not meeting referral guidelines. This study aims to determine if there is a higher cancer detection rate in referrals compliant with the referral criteria. Method: A retrospective study of patients referred to a 2-week wait colorectal clinic over a 3-month period was performed. Referral proformas and initial clinic letters were assessed to determine compliancy with the 2 week wait criteria and number of cancers diagnosed. Results: 287 patients were seen in the 3 month period. 38% of referrals were not compliant with the referral criteria. The main reasons for noncompliance were age of the patient (28%) and duration of symptoms (21%). 15 (5.2%) patients were diagnosed with cancer. Compliant referrals had higher cancer detection rate, 13/180 patients (7.2%) when compared with non-compliant referrals, 2/107 patients (1.9%). Conclusion: Compliance with the referral criteria is associated with a higher cancer detection rate. Better education for general practitioners may help to reduce the number of non-compliant referrals reducing work load on strained colorectal units.

 

Laparoscopic ileocaecal resection for Crohn's disease: Initial experience in Shrewsbury (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Vidyasankar V., *Cheetham M. , *McCloud J

Citation:
Colorectal Disease, July 2014, vol./is. 16/(189), 1462-8910 (July 2014)

Abstract:
Aim: Randomised controlled trials have demonstrated short-term advantages to laparoscopic surgery for ileocaecal Crohn’s disease. Following the introduction of laparoscopic colorectal surgery, we extended our repertoire to include laparoscopic Crohn’s resections. The aim of our study was to assess the safety and outcome following the introduction of laparoscopic resection for ileocaecal Crohn’s. Method: Between January 2008 and November 2012, 30 patients (12 men and 18 women, Median age 30 years), underwent laparoscopic ileocaecal resection for Crohn’s disease. 27 patients had stricturing disease, 2 patients presented with a mass and 1 presented with perforation. Patients were given an intraoperative spinal anaesthetic followed by PCA for 48 hours. All patients were commenced on an enhanced recovery programme. Results: Mean operative time was 90 min. Mean hospital stay was 3 days (range 3-7 days). Two patients (6%) required conversion to open surgery because of a fixed mass (n = 1) and dense adhesions (n = 1). One patient (3%) required reoperation due to haemorrhage. One patient (3%) had prolonged hospital stay due to ileus. One patient (3%) had an anastomotic leak. There were no deaths in this series. Conclusion: Our study demonstrates that laparoscopic resection of ileocaecal Crohn’s disease can be safely performed at a district general hospital with a short length of stay and minimal morbidity.

Link to more details or full-text:

 

Does traction on the cervix under anaesthesia tell us when to perform a concomitant hysterectomy? A 2-year follow-up of a prospective cohort study (2014)

Posted on by

Type of publication:
Journal article

Author(s):
Madhu C., *Foon R., Agur W., Smith P.

Citation:
International Urogynecology Journal and Pelvic Floor Dysfunction, September 2014, vol./is. 25/9(1213-1217), 0937-3462;1433-3023 (September 2014)

Abstract:
Introduction and hypothesis: Variations exist in urogynaecological practice to decide on hysterectomy in managing prolapse. This study evaluates the outcomes of uterine preservation during anterior colporrhaphy with apparent uterine descent with cervical traction under anaesthesia. We hypothesize that cervical traction should not be used to assess uterine prolapse. Methods: Thirty-five women opting for surgery for symptomatic anterior prolapse (> stage 2) with no uterine prolapse (point C at -3 or above) were recruited. ”Validated cervical traction” was applied under anaesthesia. Only an anterior repair was performed. Incontinence Modular Questionnaire Vaginal Symptoms (ICIQ-VS) questionnaires were used for follow-up. Wilcoxon test was used for statistical analysis. Results: Stage 2 uterine prolapse (POPQ) was demonstrated in all women with traction under anaesthesia. Follow-up was possible in 29 women, 5 did not respond and 1 needed a hysterectomy at 6 months (2.86 %, 95 % CI 0.07-14.91 %). The mean follow-up time was 23 months (range: 13-34 months). There was a significant reduction in the ICIQ-VS scores from 22.7 (pre-operative) to 7.97 at 23 months (p

Link to more details or full-text:

Use of a massive haemorrhage protocol in a UK district general hospital is associated with a reduction in mortality (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
Lambert L.,Taylor B.,Alistair W.

Citation:
Intensive Care Medicine, September 2014, vol./is. 40/1 SUPPL. 1(S208), 0342-4642 (September 2014) (also published in Anaesthesia, June 2014, vol./is. 69/(118), 0003-2409 (June 2014))

Abstract:
INTRODUCTION. Massive haemorrhage is associated with significant morbidity and mortality. In the context of major trauma managed in a large centre, the use of a massive haemorrhage protocol emphasizing early haemostatic resuscitation reduces mortality (1). However, it is not clear if these models are effective in non-trauma patients (2). There is some concern that these protocols may increase the wastage of blood products which might be a concern in smaller hospitals. (3) OBJECTIVES. To audit the activation of and compliance with a massive haemorrhage protocol in a UK district general hospital. To assess if compliance with the protocol resulted in a difference in mortality, morbidity, length of ICU stay, or use of blood products. METHODS. Retrospective audit over 12 months analyzing the case notes of all patients who had suffered a massive haemorrhage against a massive haemorrhage protocol which emphasizes early haemostatic resuscitation. RESULTS. The protocol was activated in 9 patients, but unfortunately notes were unavailable for one as he was undergoing outpatient treatment. A further 9 patients were identified as having had a massive transfusion, without activation of the protocol, from blood bank data as having been issued emergency uncrossmatched group O blood, or having had more than 10 units of any blood products in a 24 h period. Where a massive haemorrhage protocol was used, 1/8 patients (12.5 %) died. Where a major transfusion was conducted without activation of the protocol, 7/9 patients died (77.8 %). This finding was statistically significant (p = 0.0152) using a 2-tailed fishers exact test. Fewer units of red cells (p = 0.0011) and FFP (p = 0.0034) were used in patients managed according to the protocol, but there was no difference in the use of platelets or cryoprecipitate. Two patients in the group where the protocol had not been activated were given cryoprecipitate despite normal fibrinogen levels, and a further two in this group were not given cryoprecipitate despite fibrinogen levels under 1 g/l CONCLUSIONS. Use of a massive haemorrhage protocol which focuses on rapid haemorrhage control, haemostatic resuscitation and early use of blood is associated with a lower mortality than management of major bleeds without the protocol. This appears to apply in predominantly non-trauma patients in a non-specialist centre. This was a retrospective audit, and the group in whom the protocol was not activated had a higher expected mortality, therefore the results warrant further research.

Link to more details or full-text:

 

Multilevel bypass grafting: Is it worth it? (2014)

Posted on by

Type of publication:
Journal article

Author(s):
Sharples A., Kay M., Sykes T., Fox A., Houghton A.

Citation:
Annals of Vascular Surgery, October 2014, vol./is. 28/7(1697-1702), 0890-5096;1615-5947 (01 Oct 2014)

Abstract:
Background Traditionally, multilevel arterial disease has been treated with an inflow procedure only but simultaneous multilevel bypass graft procedures have been attempted. However, these procedures are potentially high risk. We report our single-center experience of performing multilevel bypass grafts over the last 15 years.Methods We retrospectively identified patients undergoing simultaneous aortoiliac and infrainguinal bypasses between January 1996 and January 2011 at a single district general hospital.Results There were 32 multilevel procedures performed. Indication for surgery was acute ischemia in 10 (31.3%), critical ischemia without tissue loss in 10 (31.3%), with tissue loss in 10 (31.3%), and claudication in 2 (6.3%). In 23 (71.9%) cases inflow was restored using a direct iliofemoral or aortofemoral reconstruction. In the remaining 9 (28.1%), an extra-anatomic bypass was constructed. Two (6.3%) patients died within 30 days of surgery. Twenty-nine (90.6%) patients survived to discharge. Twenty-eight patients (87.5%) were alive 1 year after surgery. Limb salvage was 96.9%, 85.7%, and 75.9% at 30 days, 1 year, and 5 years, respectively. Twelve (37.5%) patients required a total of 19 further ipsilateral vascular procedures.Conclusions Our results demonstrate that multilevel bypass procedures can be performed with good long-term outcomes and acceptable mortality, in what is typically a high-risk group with extensive comorbidities. In patients with severe critical limb ischaemia and tissue loss, who have a combination of aortoiliac and infrainguinal disease, there are significant benefits to a primary multilevel grafting procedure.

Link to more details or full-text:

Incidence of metachronous colorectal tumours at one year surveillance colonoscopy (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Bajwa A., *McConnell C., *Odulaja M., *Chandra A., *Luke D., *Cheetham M.

Citation:
Colorectal Disease, September 2014, vol./is. 16/(59), 1462-8910 (September 2014)

Abstract:
Aim: The National Institution for health and care excellence (of United Kingdom) updated their guidelines for colorectal cancer follow up in 2011. This included the recommendation for a 1 year post op surveillance colonoscopy to detect metachronous malignant and premalignant colorectal tumours. The aim of this study was to assess the efficacy of this aggressive surveillance policy. Method: Seventy-five consecutive patients who had undergone colorectal resections with curative attempt over a 12 month period after the publication of the 2011 guidelines. Outcome after their 1 year surveillance colonoscopy was examined to determine the incidence of new colorectal cancers and adenomatous polyps. Results: Of 75 (male = 47) patients (median (range) 71 (34-89)) were included. No new colorectal cancers were detected at 1 year surveillance colonoscopy. New adenomatous polyps were detected in 11 of the 75 patients (15%). Conclusion: The 2011 NICE guidelines include both a recommendation for full pre operative colonoscopy to detect synchronous tumours, and one and 5 yearly post operative colonoscopies to detect metachronous lesions. The evidence for the efficacy for early surveillance is unclear. We detected no new colorectal cancers and only 15% had new adenomatous polyps at one year indicating that early surveillance may not be warranted.

Link to more details or full-text:

 

Dentistry in nasal reconstruction (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Bhatia S., *Mihalache G.

Citation:
British Journal of Oral and Maxillofacial Surgery, October 2014, vol./is. 52/8(e104-e105), 0266-4356 (October 2014)

Abstract:
Introduction: Popularity of aesthetic nasal surgery is testament to the importance patients place on the cosmetic appearance of the nose. Some nasal defects following tumour surgery require a Rhinectomy or partial Rhinectomy. Nasal defects can have significant psychological and functional morbidity. There are various surgical options for reconstruction of nasal defects. There a variety of reconstructive methods including prosthetic. Dentists are used to taking intra oral impressions.We used this expertise to reconstruct patient specific splints. Where the original nose is present prior to tumour excision we use that to make a two part splint to allow fabrication of a neo nose with good results. Materials:We present a series of patients that underwent partial rhinectomy for tumour. At presentation the nasal shape was largely intact. Impressions were taken of the nose, both intra and of the external nose. A two part interlocking splint was made to facilitate reconstruction and allows remodelling like the original nose. Three layer composite reconstructionwas carried out with intra oral lining for mucosa, auricular cartilage for cartilage and a variety of skin flaps for external skin. Results: Nasal form and function was remarkable with good cosmesis. Good functional result with reconstruction of the external valve too. Conclusions: The use of the prefabricated individual splints allow for a better result with good forma and function of partial nasal reconstruction.

Link to more details or full-text:

 

Posaconazole responsive cerebral aspergillosis in an immunocompetent adult (2014)

Posted on by

Type of publication:
Journal article

Author(s):
Ellenbogen J.R., Waqar M., Denning D.W., Cooke R.P.D., *Skinner D.W., Lesser T., Javadpour M.

Citation:
Journal of Clinical Neuroscience, October 2014, vol./is. 21/10(1825-1827), 0967-5868;1532-2653 (01 Oct 2014)

Abstract:
Cerebral aspergillosis is a rare manifestation of invasive aspergillosis that usually affects immunocompromised patients. There are few treatment options for recurrent disease and experiences with immunocompetent patients are lacking. We report the clinical course of an immunocompetent patient with recurrent cerebral aspergillosis, following initial treatment with burr hole aspiration and voriconazole, who showed remarkable response to posaconazole. The patient remains clinically well with no evidence of recurrence on MRI 7 years following diagnosis. To our knowledge this is the first reported experience with posaconazole in an immunocompetent patient with cerebral aspergillosis.

Link to more details or full-text:

Leonardo da Vinci partnership project: Enhance it (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
Salek T., Martin J., Gasljevic V., Horvath A., Borg C., Mestric Flegar Z., Jakovcic M., Silhavik J., Adonics A., Szlamka Z., Brincat I., Buttigieg D., Ciantar N., Sciortino A., Adkins A., *Bennett T., Rice K., Taylor Y.

Citation:
Clinical Chemistry and Laboratory Medicine, November 2014, vol./is. 52/11(eA360-eA361), 1434-6621 (November 2014)

Abstract:
Aim: The aim of this Partnership project is to share and develop good practice in continuing professional development for biomedical scientists and from this to collaboratively develop an EU-toolkit for delivery of high quality continuing professional deelopment activities provided by European hospital laboratories. Methods: University of Wolverhampton (UK), Department of clinical biochemistry of Tomas Bata hospital in Zlin (CZE), Pathology department of the Mater Dei Hospital of Malta, Croatian Metrology Society and Horvath and Dubecz Consulting, Ltd., Budapest (Hungary) are participants of the project. The project is divided into five parts: – identify core elements of good practice by the comparison of approaches to CPD used within partner organizations and countries – define European quality standards and criteria for accreditation and evaluation of local hospital CPD activities – develop a framework for inclusion of reflective practice in CPD activities – produce guidelines for European hospital laboratories on managing and organizing quality CPD opportunities for laboratory staff – devise exemplar hospital laboratory CPD activities for provision on a new European hospitals CPD providers Community of Practice network. Results: The first exemplar activity and first project part has been completed, the common website www.enhanceit.eu has been created. Part 1 of the toolkit, including its checklist, has been completed to general positive acceptance of all participants-both trainers and trainees. Conclusion: The project has successful progress and we hope it improve CPD practice in European Union.

Link to more details or full-text: http://www.degruyter.com/dg/viewarticle.fullcontentlink:pdfeventlink/$002fj$002fcclm.2014.52.issue-11$002fcclm-2014-0890$002fcclm-2014-0890.pdf?format=INT&t:ac=j$002fcclm.2014.52.issue-11$002fcclm-2014-0890$002fcclm-2014-0890.xml