2023

A Case of the Cascade Stomach; Laparoscopic Sleeve of Fundoplication (2023)

Posted on by

Type of publication:Conference abstract

Author(s):*Davies S.; *Maharaja G.; *Riera M.

Citation:14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023

Abstract:A Case of the Cascade Stomach; Sleeve of Fundoplication Introduction The cascade stomach is a long standing known entity often referred to as 'cup and spill deformity' but very little is known on the management of these cases particularly surgically. Cases often present with acid reflux and vomiting due to the physiological and anatomical deformity of the stomach and are subsequently referred to the benign upper gastrointestinal/bariatric surgeon to manage. Surgical options reported in the literature are sparse but include gastropexy, laparoscopic sleeve gastrectomy and laparoscopic fundoplication. Methods We present this unusual condition as a case report, discuss the challenges in management and propose surgical management options. Conclusion Although rare this cases propose a challenge to the benign UGI surgeon as currently there is very little in the literature to support best management options. This unusual case was managed with a laparoscopic Nissen's fundoplication and we further propose that this should potentially be the standard recognised course of treatment in these cases due to the pathophysiological nature of this condition and the functional process which often leads to these patients to be high risk of acid reflux.

Improving the care of patients with obesity needing joint replacement - time for a combined ortho-bariatric approach? (2023)

Posted on by

Type of publication:Conference abstract

Author(s):Sinha Y.; Ikram S.; Ballinger T.; Gouveia S.; Burak M.; Wiggins T.; *Bathgate S.;

Citation:Obesity Surgery. Conference: 14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023. Birmingham United Kingdom. 33(Supplement 1) (pp S129), 2023. Date of Publication: July 2023.

Abstract:Introduction Patients with obesity awaiting joint replacement surgery of the lower limbs may benefit from referral to weight-management services. (1) NICE provides BMI criteria for referral to tertiary bariatric services, however this does not always translate into clinical practice. (2, 3) Our aim was to assess the number and management of patients with obesity attending orthopaedic clinics for consideration of lower limb joint replacement. Methods A retrospective analysis was undertaken of all patients attending orthopaedic clinics for joint replacement secondary to osteoarthritis, in the lower limbs, at a single centre, over a two year period. Details of demographics, BMI, comorbidities and management plans were recorded from electronic patient records. Results 335 patients (60% of 558 cases) had BMI recorded and were used for subsequent analysis. 36% (n=120) of patients were eligible for referral to weight-management services. 10% (n=32) were refused joint replacement surgery due to BMI, of which 81% (n=26) were eligible for referral to weight-management services. Instead of surgery, these 32 patients were offered: physiotherapy (n=10, 38%), analgesia (n=12, 46%), non-specific weight-loss advice (n=16, 62%), GP referral for weight-loss (n=6, 23%), and tertiary service referral for weight-loss (n=2, 8%). Conclusions BMI is an important risk factor for orthopaedic operations and increased efforts should be made to record it pre-operatively. An MDT approach would capture the notable proportion of patients who are not being appropriately referred to weight-management services which may impact on their quality of life and postoperative outcomes.

Retrospective multicentre study comparing survival outcomes in chronic lymphocytic leukaemia (CLL) with genetic risk stratification (2023)

Posted on by

Type of publication:Conference abstract

Author(s):Qureshi I.; Mandal A.; Foster N.; Rose S.; Sharma K.; McIlroy G.; *Cherian G.; *Lane S.; Wandroo F.; Talbot G.; Pemberton N.; Parry H.; Moss P.; Paneesha S.

Citation:British Journal of Haematology. Conference: 63rd Annual Scientific Meeting of the British Society for Haematology. Birmingham United Kingdom. 201(Supplement 1) (pp 67-68), 2023. Date of Publication: April 2023.

Abstract:Purpose: This retrospective West Midlands multicentre study of CLL patients was conducted to review results of genetic testing in CLL patients and impact on survival. Method(s): 349 patients across the West Midlands were included in this retrospective study collected between December 2018 and March 2022. Clinical centres were asked to obtain data relating to the type and number of lines of treatment, overall response and reported genetic abnormalities. Treatment and response were categorised as per international workshop on chronic lymphocytic leukaemia (iwCLL) criteria.1 Genetic testing comprised fluorescence in situ hybridisation (FISH) for copy number abnormalities of 17p &11q, IgHV mutation status and Oxford Gene Technology CLL Next-Generation Sequencing (NGS) Panel to detect sequence variants in key genes associated with CLL (including NOTCH1, SF3B1, BIRC3, ATM and TP53). Patients were risk stratified into good, poor or not poor risk categories as per Rodriguez-Vicente et al.2 Statistical Analysis and Results: For 349 patients analysed, 143 (41%) patients were under active surveillance, and 206 (59%) patients received 1st line treatment. Out of the 206 patients that received 1st line treatment, 92 (44%) patients proceeded to 2nd line treatment, 31 (15%) patients proceeded to 3rd line treatment and 21 (10%) of patients required treatment beyond 3rd line Within the poor risk category, 173 patients were identified with 38 had TP53 deletion or mutation and 135 patients had other poor risk mutations such as NOTCH1, SF3B1, ATM. Statistical analysis did not show a difference in survival either from the diagnosis or from the date of NGS sample in the two groups of high-risk patients. Conclusion(s): The data identifies a cohort of patients with poor outcome that are negative for TP53 mutation, highlighting the importance of NGS in CLL patients at the point of treatment.

Acoustic Times or . . . Scan you believe it! - A quality publication. Ultrasound governance: communicating standards during a pandemic (2023)

Posted on by

Type of publication:Conference abstract

Author(s):*Brown H.

Citation:Ultrasound. Conference: 53rd Annual Scientific Meeting of the British Medical Ultrasound Society. Cardiff United Kingdom. 31(2) (pp NP32), 2023. Date of Publication: May 2023.

Abstract:Introducing new governance processes into a multisite ultrasound department during a pandemic led to the re-thinking of the models of communication used to share governance objectives. The introduction of peer review audit can be challenging for staff. Clear communication is vital to ensure staff are not threatened by the process and are able to use it as a learning opportunity to shape their practice and development, thereby improving patient safety. A monthly newsletter Acoustic Times was introduced to explain the processes and changes giving the opportunity to provide the evidence base and links to national guidance. Peer review audit and learning meetings were introduced and held virtually across sites to identify and share any individual or group learning points. Processes and documents were either redesigned or introduced, with supporting rationale and evidence provided through the newsletter including: evidence based protocols; standard setting; peer review audit, including supporting learning outcomes and CPD; actionable reporting; preceptorship; service user feedback; and equipment QA. Further supported learning was provided on critical reflection, specific focus on technical aspects of clinical examinations, sharing of external learning events, CPD and inhouse ultrasound training. Benefits of the newsletter include: more focus on improving consistency of practice and setting standards; faster reporting of audit findings and reaudits; and improved engagement with consultant colleagues. It also provides an accessible record of the development of governance processes which has been shared with sonographers in other organisations. Setting and communicating clearly defined quality standards and protocols is key to the design of safe working practices and patient safety in healthcare environments.1 Open and honest governance processes with clear, accessible and useable documentation are key in staff engagement and ownership of quality improvement.

Evaluating the lasting effects of teaching sudden unexpected death in infancy and childhood (SUDIC) through simulation (2023)

Posted on by

Type of publication:Conference abstract

Author(s):Layman S.; Beatty C.; Williams C.; *Belfitt A.; Copeman A.

Citation:Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2023. Glasgow United Kingdom. 108(Supplement 2) (pp A276-A277), 2023. Date of Publication: July 2023.

Abstract:Objectives Paediatricians play a vital role in managing and facilitating investigations in sudden unexpected death in infancy or childhood (SUDIC). SUDIC is a rare occurrence, and many paediatric trainees and consultants have very little experience of the process. The SUDIC simulation course was created due to recommendations by The Kennedy Report. The aim of the course was to bridge the gap between knowledge and clinical experience for senior paediatric trainees and consultants in the West Midlands in managing SUDIC. To assess the longevity of learning from the course, a survey was disseminated to all previous candidates. Its aim was to understand how important the simulation course had been in improving paediatricians' confidence and understanding of the SUDIC process when they were involved in a SUDIC after attending the course. Methods Candidate sign-in sheets were retrospectively reviewed for the 17 SUDIC courses run since January 2016. 195 previous candidates were invited to complete a survey via email. Our aim was to evaluate how the course had impacted subsequent experience of the SUDIC process. Specific questions were included to assess how confident candidates had been in various roles in the SUDIC process using a combination of multiple-choice, free-text, and Likert scales. Results 43% of respondents had been a senior paediatric registrar when they attended. Other candidates were consultants, nurses, or more junior paediatricians. 43% had attended between 1-5 SUDIC events since the course, with 4% having attended more than 10. 47% had been involved in examining the body. 40% involved in an unsuccessful resuscitation and SUDIC investigations, and 43% explained the SUDIC process to bereaved parents. 100% agreed that the course had improved their confidence in explaining the SUDIC process, taking a SUDIC history and performing SUDIC investigations. 94% felt confident in contributing to the child death process with 89% feeling confident in examining the body. Candidates particularly valued the multi-professional approach to the course, especially working with police officers. With further thematic analysis of free text responses, candidates most often reported lasting benefits to supporting and communicating with the family, and understanding the practicalities of the SUDIC process. Conclusion Participation in a SUDIC simulation course is an important educational experience, which continues to be relevant to participants and their clinical practice many years after they have attended. Our survey suggests that simulation-based education is an excellent modality to facilitate learning around the SUDIC process for paediatricians and other health professionals involved.

Link to full-text (NHS OpenAthens account required)

Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures (2023)

Posted on by

Type of publication:Journal article

Author(s):*Selim, Amr; Al-Hadithy, Nawfal; Diab, Nader M; Ahmed, Abdulla Mohamed; Kader, Khaled Fawzy Abdel; Hegazy, Mohamed; Azeem, Hazem Abdel; Barakat, Ahmed Samir.

Citation:Sicotj. 9:28, 2023.

Abstract:INTRODUCTION: Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries. MATERIALS AND METHODS: A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head. RESULTS: Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker's ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25 mm with a P-value < 0.001. CONCLUSION: The modified TAD had the highest reliability in the prediction of lag screw cut-out. A value <= 25 mm could potentially protect against lag screw cut-out in trochanteric hip fractures.

Link to full-text (open access - no password required)

Impelling Factors for Contracting COVID-19 Among Surgical Professionals During the Pandemic: A Multinational Cohort Study (2023)

Posted on by

Type of publication:Journal article

Author(s):Yang, Wah; Bangash, Ali Haider; Kok, Johnn Henry Herrera; Cheruvu, Chandra; Parmar, Chetan; Isik, Arda; Galanis, Michail; Di Maggio, Francesco; Atici, Semra Demirli; Abouelazayem, Mohamed; *Bandyopadhyay, Samik Kumar; Viswanath, Yirupaiahgari K S.

Citation:Journal of Clinical Medicine Research. 15(4):233-238, 2023 Apr.

Abstract:Background: Medical workers, including surgical professionals working in coronavirus disease 2019 (COVID-19) treating hospitals, were under enormous stress during the pandemic. This global study investigated factors endowing COVID-19 amongst surgical professionals and students. Methods: This global cross-sectional survey was made live on February 18, 2021 and closed for analysis on March 13, 2021. It was freely shared on social and scientific media platforms and was sent via email groups and circulated through a personal network of authors. Chi-square test for independence, and binary logistic regression analysis were carried out on determining predictors of surgical professionals contracting COVID-19. Results: This survey captured the response of 520 surgical professionals from 66 countries. Of the professionals, 92.5% (481/520) reported practising in hospitals managing COVID-19 patients. More than one-fourth (25.6%) of the respondents (133/520) reported suffering from COVID-19 which was more frequent in surgical professionals practising in public sector healthcare institutions (P = 0.001). Thirty-seven percent of those who reported never contracting COVID-19 (139/376) reported being still asked to practice self-isolation and wear a shield without the diagnosis (P = 0.001). Of those who did not contract COVID-19, 75.7% (283/376) were vaccinated (P < 0.001). Surgical professionals undergoing practice in the private sector (odds ratio (OR): 0.33; 95% confidence interval (CI): 0.14 – 0.77; P = 0.011) and receiving two doses of vaccine (OR: 0.55; 95% CI: 0.32 – 0.95; P = 0.031) were identified to enjoy decreased odds of contracting COVID-19. Only 6.9% of those who reported not contracting COVID-19 (26/376) were calculated to have the highest "overall composite level of harm" score (P < 0.001). Conclusions: High prevalence of respondents got COVID-19, which was more frequent in participants working in public sector hospitals. Those who reported contracting COVID-19 were calculated to have the highest level of harm score. Self-isolation or shield, getting two doses of vaccines decreases the odds of contracting COVID-19.

Link to full-text (open access - no password required)

The Effects of Vitamin D on Markers of Glucose and Obesity in Postmenopausal Women: A Meta-Analysis of Randomized Controlled Trials (2023)

Posted on by

Type of publication:Systematic Review

Author(s):Hao, Lei; Lu, Aiyangzi; Gao, Hui; Niu, Jianfei; Prabahar, Kousalya; *Seraj, Shaikh Sanjid; Pan, Yongmei.

Citation:Clinical Therapeutics. 2023 Aug 17. [epub ahead of print]

Abstract:PURPOSE: The effect of vitamin D effect on glucose markers and obesity in postmenopausal women remains controversial. The current literature contains little information on vitamin D dosage and duration for optimal efficacy in postmenopausal women. This meta-analysis was undertaken to assess the impact of vitamin D on glucose markers and obesity in postmenopausal women. METHODS: A number of databases were used dated up to January 5, 2023, with no language restrictions (PubMed/MEDLINE, Web of Science, EMBASE, and Scopus). Treatment response from baseline was estimated from the mean within-group analysis, and SDs were used to calculate the treatment response. FINDINGS: Nine eligible articles with 12 comparisons qualified for the final quantitative analysis. An overall decrease was noted in fasting blood glucose (weighted mean difference [WMD], -3.56 mg/dL; 95% CI, -5.49 to -1.64; P < 0.001), homeostatic model assessment for insulin resistance (WMD, -1.168 mm; 95% CI, -2.001 to -0.33; P = 0.006), insulin (WMD, -2.26 units; 95% CI, -4.35 to -0.18; P = 0.033), and glycosylated hemoglobin (WMD, -0.41%; 95% CI, -0.54 to -0.29; P < 0.001) after vitamin D administration in postmenopausal women. In subgroup analyses, a notable decrease in fasting blood glucose was detected when the intervention course was >6 months and dosage <=1000 IU/d (WMD, -3.48 mg/dL). The present study showed that vitamin D was not associated with body mass index, body weight, or waist circumference in postmenopausal women. IMPLICATIONS: Vitamin D is beneficial for glucose markers but not obesity in postmenopausal women. An individualized dosage regimen of vitamin D should be followed depending on the clinical outcome target of postmenopausal women.

Introducing ACHILES, a new decision tool for accurate heel ulcer diagnosis (2023)

Posted on by

Type of publication:Poster presentation

Author(s):*Beard, Nicola; *Merlin-Kwan, Elizabeth

Citation:Wounds UK annual conference, 6th – 8th November 2023, Harrogate

Abstract:The ACHILES tool is an innovative and inclusive tool that offers value and sustainability due to its ease of use. The Tool has been designed to be simple and practical to use, with very little training and equipment required, regardless of clinical designation, yet support standardisation and a consistent approach to define, treat and report heel ulcers.

Link to PDF poster

Surgical experience and identification of errors in laparoscopic cholecystectomy (2023)

Posted on by

Type of publication:
Journal article

Author(s):
Humm, Gemma L; Peckham-Cooper, Adam; *Chang, Jessica; Fernandes, Roland; Gomez, Naim Fakih; Mohan, Helen; Nally, Deirdre; Thaventhiran, Anthony J; Zakeri, Roxanna; Gupte, Anaya; Crosbie, James; Wood, Christopher; Dawas, Khaled; Stoyanov, Danail; Lovat, Laurence B.

Citation:
British Journal of Surgery. 2023 Aug 23. [epub ahead of print]

Abstract:
BACKGROUND: Surgical errors are acts or omissions resulting in negative consequences and/or increased operating time. This study describes surgeon-reported errors in laparoscopic cholecystectomy. METHODS: Intraoperative videos were uploaded and annotated on Touch SurgeryTM Enterprise. Participants evaluated videos for severity using a 10-point intraoperative cholecystitis grading score, and errors using Observational Clinical Human Reliability Assessment, which includes skill, consequence, and mechanism classifications. RESULTS: Nine videos were assessed by 8 participants (3 junior (specialist trainee (ST) 3-5), 2 senior trainees (ST6-8), and 3 consultants). Participants identified 550 errors. Positive relationships were seen between total operating time and error count (r2 = 0.284, P < 0.001), intraoperative grade score and error count (r2 = 0.578, P = 0.001), and intraoperative grade score and total operating time (r2 = 0.157, P < 0.001). Error counts differed significantly across intraoperative phases (H(6) = 47.06, P < 0.001), most frequently at dissection of the hepatocystic triangle (total 282; median 33.5 (i.q.r. 23.5-47.8, range 15-63)), ligation/division of cystic structures (total 124; median 13.5 (i.q.r. 12-19.3, range 10-26)), and gallbladder dissection (total 117; median 14.5 (i.q.r. 10.3-18.8, range 6-26)). There were no significant differences in error counts between juniors, seniors, and consultants (H(2) = 0.03, P = 0.987). Errors were classified differently. For dissection of the hepatocystic triangle, thermal injuries (50 in total) were frequently classified as executional, consequential errors; trainees classified thermal injuries as step done with excessive force, speed, depth, distance, time or rotation (29 out of 50), whereas consultants classified them as incorrect orientation (6 out of 50). For ligation/division of cystic structures, inappropriate clipping (60 errors in total), procedural errors were reported by junior trainees (6 out of 60), but not consultants. For gallbladder dissection, inappropriate dissection (20 errors in total) was reported in incorrect planes by consultants and seniors (6 out of 20), but not by juniors. Poor economy of movement (11 errors in total) was reported more by consultants (8 out of 11) than trainees (3 out of 11). CONCLUSION: This study suggests that surgical experience influences error interpretation, but the benefits for surgical training are currently unclear.

Link to full-text [open access - no password required]