2023

UEC WS4- Ward 16 Support Programme (2023)

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Type of publication:
Service improvement case study

Author(s):
*Claire Sapphire, *Madeleine Oliver

Citation:
SaTH Improvement Hub, June 2023

Abstract:
Ward 16s aim was to increase pre 11 discharges to 50% (1 patient a day) of the wards overall discharges and to statistically improve the length of stay by the 15th May 2023.

Link to PDF poster

Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: A randomized controlled trial (2023)

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Type of publication:
Journal article

Author(s):
Norton, Christine; Bannister, Sybil; Booth, Lesley; Brown, Steve R; Cross, Samantha; Eldridge, Sandra; Emmett, Christopher; Grossi, Ugo; Jordan, Mary; *Lacy-Colson, Jon; Mason, James; McLaughlin, John; Moss-Morris, Rona; Scott, S Mark; Stevens, Natasha; Taheri, Shiva; Taylor, Stuart A; Yiannakou, Yan; Knowles, Charles H.

Citation:
Colorectal Disease. 25(11):2243-2256, 2023 Nov.

Abstract:
AIM: The aim was to determine whether specialist-led habit training using Habit Training with Biofeedback (HTBF) is more effective than specialist-led habit training alone (HT) for chronic constipation and whether outcomes of interventions are improved by stratification to HTBF or HT based on diagnosis (functional defaecation disorder vs. no functional defaecation disorder) by radio-physiological investigations (INVEST). METHOD: This was a parallel three-arm randomized single-blinded controlled trial, permitting two randomized comparisons: HTBF versus HT alone; INVEST- versus no-INVEST-guided intervention. The inclusion criteria were age 18-70 years; attending specialist hospitals in England; self-reported constipation for >6 months; refractory to basic treatment. The main exclusions were secondary constipation and previous experience of the trial interventions. The primary outcome was the mean change in Patient Assessment of Constipation Quality of Life score at 6 months on intention to treat. The secondary outcomes were validated disease-specific and psychological questionnaires and cost-effectiveness (based on EQ-5D-5L). RESULTS: In all, 182 patients were randomized 3:3:2 (target 384): HT n = 68; HTBF n = 68; INVEST-guided treatment n = 46. All interventions had similar reductions (improvement) in the primary outcome at 6 months (approximately -0.8 points of a 4-point scale) with no statistically significant difference between HT and HTBF (-0.03 points; 95% CI -0.33 to 0.27; P = 0.85) or INVEST versus no-INVEST (0.22; -0.11 to 0.55; P = 0.19). Secondary outcomes showed a benefit for all interventions with no evidence of greater cost-effectiveness of HTBF or INVEST compared with HT. CONCLUSION: The results of the study at 6 months were inconclusive. However, with the caveat of under-recruitment and further attrition at 6 months, a simple, cheaper approach to intervention may be as clinically effective and more cost-effective than more complex and invasive approaches.

Link to full-text [NHS OpenAthens account required]

Identifying Cases Of Pernicious Anaemia For Offering Baseline/Surveillance Gastroscopies as per BSG Guidance - Service Development In Shropshire (2023)

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Type of publication:
Conference abstract

Author(s):
*Rafique H.; *Rugemintwaza J.; *Mostafa W.; *Smith M.;

Citation:
Gut. Conference: Annual Meeting of the British Society of Gastroenterology, BSG 2023. Liverpool United Kingdom. 72(Supplement 2) (pp A178-A179), 2023. Date of Publication: June 2023.

Abstract:
Introduction Pernicious anaemia (PA) is associated with a higher risk of gastrointestinal malignancies. BSG guidance suggests baseline gastroscopies for individuals aged >=50 years with laboratory evidence of PA, with surveillance offered to those with high-risk chronic atrophic gastritis.1 Shrewsbury and Telford NHS Trust is not currently offering gastroscopies to patients with PA. Our aim was to identify cases of PA suitable for gastroscopies in line with BSG guidance, followed by implementation of pathways for prospective detection of similar future cases. Methods A list of patients who tested positive for intrinsic factor antibodies (IF Ab) or gastric parietal cell (GPC Ab) between 2017-2022 was obtained from the laboratory. Patients aged 50-70y were stratified into groups as follows: Positive IF Ab considered confirmed PA; positive GPC Ab with low B12 levels considered probable PA; positive GPC with historically normal B12 and no anaemia considered unlikely to be PA. Patients who had gastroscopy for any indication in the last 5 years were excluded. Results 50 cases that met the criteria for confirmed or probable PA were deemed suitable for baseline gastroscopy. Pathway for these patients will be agreed with the hospital governance and GP liaison teams and standard letters and information leaflets will be devised. Confirmed cases will be offered gastroscopy, while probable cases will be offered further testing with IF Ab. If diagnosis is confirmed, gastroscopy will be offered, whereas if IF Ab is negative, no further action taken if the B12 deficiency responds to oral supplementation. For prospective detection of future cases, clinical text will be added in all biochemistry reports with low B12 levels prompting clinicians to consider IF Ab testing if PA is possible in clinical context, with referral to gastroenterology for confirmed cases. Cases tested before 2017 who fit the above criteria will be identified. Conclusions The number of confirmed or probable cases of PA in Shropshire is relatively small and sets a realistic target for offering gastroscopies in line with BSG guidance. Similar initiatives across other trusts could identify cases of PA in the respective regions that could be suitable for baseline or surveillance gastroscopies, with prospective detection of future cases leading to better overall management of PA.

The Advanced Colonoscopy Skills Training Required For NHS Bowel Cancer Screening Accreditation: The Outcomes Of An Integrative Literature Review (2023)

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Type of publication:
Conference abstract

Author(s):
*Brayford P.

Citation:
Gut. Conference: Annual Meeting of the British Society of Gastroenterology, BSG 2023. Liverpool United Kingdom. 72(Supplement 2) (pp A169), 2023. Date of Publication: June 2023.

Abstract:
Introduction NHS Bowel cancer screening colonoscopists are required to undertake accreditation for which there are well defined standards, but training to achieve these skills has not been clearly determined. An Integrative Review aimed to identify the training required for independent colonoscopists to develop the advanced skills necessary to achieve Bowel Cancer Screening Accreditation (BCSA). The findings were utilised to develop a training plan which could support independent colonoscopists achieve BCSA. Methods The Integrative Review (IR) utilised the secondary research process described by Whittemore and Knafl (2005) to synthesise and analyse a range of methodologically diverse studies. Key stages of this process included problem identification, literature search, data evaluation, data analysis, conclusion drawing and presentation. Electronic databases including CINHAL, MEDLINE and PubMed were searched in September 2020. The inclusion criteria were English language literature focused on training in the advanced colonoscopy skills from 2012 onwards, excluding beginner colonoscopy training. Results In total this generated 3548 papers of which 3476 were excluded. The full text of seventy-seven papers were screened, identifying twenty-three methodologically diverse papers, meeting the inclusion/exclusion criteria for critical evaluation and analysis within the IR. Five broad themes were found to contribute to the development of the advanced colonoscopy skills required for BCSA-See figure 1. Conclusions It was clear from the IR that training in polyp related skills and knowledge was vital for successful BCSA. In addition, selecting motivated, meticulous colonoscopists and focusing on individual learning needs along with utilisation of audit and feedback all contribute to skill development for BCSA. The IR findings were utilised to develop evidence based individual, local, regional and national recommendations to assist with the advanced colonoscopy skill development necessary for BCSA.