Author: Jason Curtis

RESECT: A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gallagher K.; MacLennan S.; Bhatt N.; Clement K.; Zimmermann E.; Khadhouri S.; Kulkarni M.; Gaba MPhil F.; Anbarasan T.; Asif A.; Light A.; Ng A.; Chan V.W.-S.; Nathan A.; Cooper D.; Aucott L.; Sakthivel D.; Akand M.; Piazza P.; Marcq G.; O'Brien T.; Nielsen M.; Giudice F.D.; Simpson K.; Orecchia L.; Teixeira B.; Geisenhoff A.; Hill G.; Fukuokaya W.; Hidalgo B.G.; El-Hajj A.; Elgamal M.; Fanshawe J.; Wang B.; Lee T.; Manecksha R.; Rivas J.G.; Arda E.; Elhadi M.; Rossi S.; Teoh J.Y.-C.; Kasivisvanathan V.; Hussein I.; Longshaw A.; Kostakopoulos N.; Khadhouri S.A.S.; Kruczynska A.E.; Dimitropoulos K.K.D.; McPhee A.; Gilanliogullari K.P.; Natalie S.; Rutigliani L.; Shallcross O.R.; Dokubo I.I.; Lamb B.W.; Jimie J.H.; Hussein B.; O'Neill C.; Nelson A.R.; MacLeod A.; Arumainayagam N.; Maqboul F.; Agrawal S.; Burns H.; Bekarma H.J.; Mohammad S.; Misurati M.O.; Raslan M.Y.; Anwar A.; Gkikas C.; Alexander C.; Warren H.; Byrnes K.; Edison M.; Croghan S.; Oo E.; Beder D.; Thurtle D.R.; Janebdar H.; Reeves F.; Chua C.U.; Mcalindon J.; Hasan H.; Ng P.Y.; Mayor N.; Attar H.A.; Delacave H.S.T.; Atiyah A.; Atiyah Z.; Jelski J.E.R.; Peacock J.; Davenport K.; Shipstone D.; Malla R.A.; Krishna K.K.I.; Nizov A.; Somov P.; Ahmed Z.; McCann C.; Glackin A.J.; Asaad W.; Bain A.J.; Bordenave M.G.; Ray E.R.; Ghonaimy A.S.; Madaan S.; Fontaine C.L.L.; Daggamseh A.M.K.; Pascoe J.J.; Horn C.; Fuge O.; Laoye A.; Deytrikh A.; Thomas A.G.; Ravishankar K.; Clark M.C.; Panayi Z.; Shillito S.H.; Srirangam S.J.; Bradley C.; Lee X.W.J.W.J.; Mcilhenny C.; Leask J.; sarkar S.; chetwood A.S.A.; Paramore L.; Ali A.S.A.; Odey J.; Sheweita M.S.S.; Ekwueme K.C.; Yogeswaran C.; Mohamed Y.; Trimboli M.; Shafii M.; Duffy S.A.; Morton S.; Bandeira de Mello K.L.; Harris A.; Bruce A.; Fanshawe J.R.; Tan N.J.; Mensah E.; Walters U.; Lami M.; Omar M.A.; Kadhim H.; Gami M.N.; Hawizy A.A.M.H.; Devadoss B.J.; Breish M.; Pina I.; Cresswell J.; Simoes A.; Papadopolous G.G.; Thomas M.M.T.; Ahmed I.I.A.; Sekhon N.C.; Alleemudder A.; Okwuchi D.D.; Willmott S.V.; Majumdar P.; Coyle M.; Simson N.; Egbe A.; Nair A.; Nair M.A.N.; Kailavasan M.; Douglas-Moore J.L.; Elajnaf M.R.; Jackson B.L.; Hamami H.; Hemmant J.; Siraj M.; Craciun M.E.; Lyttle M.; Shendy M.S.; Abdalla A.; Mukherjee R.; Mihuna A.; Kantartzi A.; Atkins C.R.M.; Uddin J.; Motiwala F.; Fanshawe J.B.; Mxxxensah E.; Chan K.H.Y.; Vasdev N.N.V.; Hassan M.M.; Pushkaran A.K.; Salik M.; Barrass B.J.R.; Jones A.; Shakir J.; Waterhouse R.H.; Tan S.; Shah S.; Simpson R.G.; Mohee A.R.; Smith P.M.; Middela S.G.; Gunendran T.; Bhat T.; Mehmood S.M.; Masood S.; Karna S.; Ibiok I.A.; Ollandini G.; Yarwood A.; Hill G.T.; Kanda Swamy G.V.; Healy R.; Faek Halaseh S.A.; Lee S.-M.; Hughes C.M.; Ali O.H.; Boaz R.J.; Gabriel M.M.; Finch W.; Hammad O.O.; Heba S.T.; Yun J.W.; Pandian S.K.; Oliver R.L.; Almpanis S.S.A.; Boxall N.E.; Adamu-Biu F.I.; Pushpa-Rajah J.A.; Miakhil I.; Mera Z.; Sultana A.; Potter J.J.; Coombs L.; Laghari S.; Khan I.A.; Warner R.M.; Olaitan O.; Akman J.; Green W.J.F.; Dooldeniya M.D.; Turo R.K.; Kabia A.A.; Onowa V.E.; Anand C.V.; Tanasescu G.G.T.; Sells L.A.; Acyatan M.G.; Smith T.G.; Lokman U.U.L.; Ramachandra M.; Hodgson D.J.; *Sid Ahmed M.A.M.B.; *Moghe D.; *Ong K.K.; *Tasleem A.M.; Blick C.; Toia B.B.T.; Maduwe Gedara S.R.K.R.K.; Mohsin H.; Bleakley C.; McGrath M.J.; Ng M.G.; Parsons B.; Lindsay J.S.; Volanis D.; Wijayasuriya D.S.C.R.; Wilkinson J.; White A.; Cox A.; Calmuc A.; Fung C.; Taktak S.; Lazarowicz H.P.; Starmer B.; Chippagiri A.S.; Gallegos C.; Kerr E.; Penny N.M.; Green E.A.; Jones C.M.; Colvin H.V.; David R.; Davies M.; Qamar B.Q.; Humayun-Zakaria N.K.; Hussain A.; Dhanasekaran A.K.; Mangera A.F.; Pereca J.L.P.; Akinjise-Ferdinand O.; Rosario D.J.; *Dhother J.; *Mohamed G.; *Jenny Bo Y.N.; *Chin Chin Y.F.Y.F.; *Varma R.K.; *Elves A.; Elmansouri A.J.N.V.; Edris F.F.E.; Voss J.; Parfitt C.M.; Buckland G.R.E.; Antoniou V.; Sinha M.M.; Douglas J.; Campbell J.M.; Bondad J.; Khuoge S.; Gipson C.; Dawam D.; Lecoyte A.; Waley L.G.; Hawthorne R.; Ridgway A.; Warren K.S.; Maniarasu S.; Mistry R.; Stroman L.; Hassan M.; Ayres B.; Pinkney R.T.M.; El-Taji O.; McCabe J.; Oliyide A.E.; Chibuzo I.N.C.; Vaggers S.N.; Dyer J.E.; MacKenzie K.R.; Miller A.; Tait C.D.; Thorman H.E.; Ippoliti S.; Ilie P.C.; Babawale O.D.; Mitchell V.; O'Rourke S.; Ross A.; O'Halloran R.; Hayes J.; Gray S.B.; Day E.K.; Shirwac H.; jaibaji R.; Tang S.C.; Kennedy C.; Szabados B.; Baldini C.; Nowers J.; Sarmah P.P.B.; Williams K.G.; Tan L.J.; Boden A.K.; Simpkins S.J.; Clement K.D.; Khan R.S.S.; Ravindraanandan M.; Lango A.; Kitchen M.; Gommersall L.M.; Thomas M.; Al-Mitwalli A.; Featherstone J.M.; Catto J.; Chari N.; Nikolinakos P.; Ellis D.S.J.; Papadopoulos D.I.; Charitopoulos K.; Carey M.M.; Gordon E.M.; Lau D.H.W.H.; El-Koubani O.; Ayers J.R.S.; Hina S.; Gartner T.; James J.E.G.; Simpson K.R.S.; Mariappan P.; Ibrahim M.E.; Dallash M.H.; Jallad S.; Bencatova Z.; Karanjia R.N.; Whiting D.; Frymann R.J.; Farag S.S.F.; Whitburn J.A.S.; Miah S.; Khattab H.; Kondylis F.; Amin Alsayed Alkhawalka M.A.

Citation:

European Urology. (no pagination), 2025. Date of Publication: 2025.

Abstract:

Background and objective We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates. Methods This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome. Key findings and limitations A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]). Conclusions and clinical implications Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes.

DOI: 10.1016/j.eururo.2025.09.4174

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The Profound Impact of the COVID-19 Pandemic on the Epidemiology of Quadriceps and Patellar Tendon Ruptures: Insights From a Single Trust in the United Kingdom (2025)

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Type of publication:

Journal article

Author(s):

*Murugesan, Thivagar; *Abdullmalek, Hidayatul Rasyidah Syida; *Kondi, Suresh; *Rehman, Hamood Ur; *Carmont, Mike; *Heaver, Catriona; *Okoro, Tosan.

Citation:

Cureus. 17(11):e98022, 2025 Nov.

Abstract:

Introduction Quadriceps and patellar tendon ruptures are uncommon but disabling injuries that require surgical repair. Changes in physical activity patterns during and after the COVID-19 pandemic may have influenced their occurrence. This study compares the incidence, demographics, and seasonal distribution of these injuries before and after the pandemic within a single UK NHS trust. Methods A retrospective review was performed of all patients undergoing primary repair of quadriceps or patellar tendon ruptures at the Shrewsbury and Telford NHS Trust from January 2014 to December 2024. The pre-COVID period (2014-2019) was compared with the post-COVID period (2021-2024), with 2020 excluded due to major service disruption and atypical clinical pathways during the first pandemic year. Annual incidence rates were calculated as cases per 100,000 population, using year-specific catchment population estimates from the Office for National Statistics (ONS). Demographic variables, injury characteristics, and seasonal patterns were extracted from electronic records. Between-period comparisons used the Mann-Whitney U test. No adjustment for age, BMI, or comorbidities was performed. Results A total of 203 patients were identified, including 95 pre-COVID and 108 post-COVID. The median age was 63 years (range 15-90), with a male-to-female ratio of 7.8:1. Injuries occurred most frequently in autumn (28%). The median annual incidence increased from 4.6 per 100,000 pre-COVID to 8.3 per 100,000 post-COVID (incidence rate ratio 1.8, p = 0.0073). The median number of cases per year rose from 16 to 27 between periods. Conclusion The incidence of surgically treated quadriceps and patellar tendon ruptures increased in the post-COVID period. Although the study does not adjust for potential confounders, the findings suggest an association between the post-pandemic era and higher injury rates. Further research with multivariable analysis is needed to clarify contributing factors.

DOI: 10.7759/cureus.98022

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Shoulder Injury Related to Vaccine Administration (SIRVA) After COVID-19 Vaccination: A Retrospective Study (2025)

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Type of publication:

Journal article

Author(s):

*Manoharan, Gopikanthan; *Murugesan, Thivagar; Winton, Jo; Smith, Matthew; Brownson, Peter.

Citation:

Cureus. 17(11):e98023, 2025 Nov.

Abstract:

BACKGROUND: The global administration of billions of COVID-19 vaccine doses has raised concerns about potential adverse effects, contributing to vaccine hesitancy. While transient mild discomfort is common after intramuscular vaccination, persistent and severe post-vaccination shoulder pain has led to recognition of Shoulder Injury Related to Vaccine Administration (SIRVA). SIRVA is characterised by shoulder pain and restricted range of motion typically occurring within 48 hours of inoculation, thought to result from inadvertent vaccine delivery into the subdeltoid bursa. In addition to its clinical definition, SIRVA is also viewed as a medicolegal construct, particularly in the context of vaccine injury compensation frameworks. This study aimed to describe our experience with patients presenting with SIRVA-like symptoms following COVID-19 vaccination, compare these findings with published literature, and assess clinical outcomes.

METHODS: A retrospective study was conducted at a major trauma centre. All patients presenting to the orthopaedics department with atypical shoulder symptoms following COVID-19 vaccination between January and December 2021, with at least six months of follow-up, were reviewed. Only patients meeting the Health Resources and Services Administration (HRSA) Vaccine Injury Table diagnostic criteria for SIRVA were included. Data on demographics, vaccine type, clinical findings, investigations, treatment, and outcomes were collected.

RESULTS: Of the 31 patients presenting with post-vaccination shoulder symptoms, 16 (52%) met the HRSA criteria for SIRVA. The mean age was 54 years, and 63% were female. All patients presented with shoulder pain and reduced range of motion. The mean follow-up duration was 12 months. Most patients (94%) were treated non-operatively with analgesia, nonsteroidal anti-inflammatory drugs (NSAIDs), and physiotherapy. At one-year follow-up, 44% achieved complete or near-complete recovery, while 31% (n =5) reported no improvement and required specialist referral.

CONCLUSION: SIRVA is a rare complication following COVID-19 vaccination and is best considered a medicolegal term rather than a definitive diagnosis. Strict adherence to diagnostic criteria is essential, as overdiagnosis may occur among patients with coincidental post-vaccination shoulder pain. While most cases resolve with conservative management, a subset may experience persistent symptoms. Evidence suggests that SIRVA is more likely related to improper injection technique rather than the vaccine itself.

DOI: 10.7759/cureus.98023

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A Comparison of 1.5-Stage and Two-Stage Revisions for Prosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Meta-Analysis of Outcomes (2025)

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Type of publication:

Systematic Review

Author(s):

*Ibrahim, Abdelrahman; Khamdan, Khadija; Sadiq, Salman; *Lyeeq, Ahmed; Narayanswamy, Nikhil; Saeed, Abu.

Citation:

Cureus. 17(11):e98180, 2025 Nov.

Abstract:

Prosthetic joint infection (PJI) is a devastating complication of total hip and knee arthroplasty. Whilst two-stage revision has long been considered the gold standard treatment, the 1.5-stage revision has emerged as a viable alternative. However, the optimal surgical strategy remains a subject of debate. The aim of this meta-analysis was to evaluate the comparative outcomes of 1.5-stage versus two-stage revision for PJI. A
systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting comparative outcomes of 1.5-stage versus two-stage revision were included, and their risk of bias was assessed. Reinfection, failure of infection eradication, aseptic loosening, overall complications, readmission, and periprosthetic fracture were the evaluated outcome parameters. All comparative studies reporting on patients who underwent either a 1.5-stage or a two-stage revision were included in the final analysis. The 1.5-stage revision was associated with a significantly lower rate of reinfection (odds ratio (OR): 0.62; 95% confidence interval (CI) 0.40-0.96, p = 0.03) but a significantly higher rate of aseptic loosening (OR: 6.12; 95% CI 1.09-34.22, p = 0.04) when compared with the two-stage revision. No significant difference was found in the rates of infection eradication (OR: 1.35; 95% CI 0.80-2.27, p =
0.26), overall complications, readmission, dislocations, or periprosthetic fracture between the two groups. A subgroup analysis for knee PJI was consistent with the main analysis for reinfection. The meta-analysis of the best available evidence indicates that a 1.5-stage revision for PJI is associated with a lower rate of reinfection but a higher risk of aseptic loosening. High-quality randomized controlled trials are needed to
definitively establish the optimal surgical strategy for managing PJI.

DOI: 10.7759/cureus.98180

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Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials. (2025)

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Type of publication:

Systematic Review

Author(s):

Amin, Hamza Muhammad; Hasan, Sundas; Abukhater, Reem; Lilley, Rachel; Atique, Arif; Shoaib, Maheen Sattar; Albustanji, Qutaiba; Sadique, Humza; *Khalid, Saad Muhammad; Hasan, Ali; Majeed, Salman; Shahzad, Muhammad Aamir; Shahzad, Maryam; Ahmed, Mushood; Ahmed, Raheel; Gardezi, Syed Anjum.

Citation:

International Journal of Colorectal Disease. 2025 Dec 30.

Abstract:

BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

METHODS: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

RESULTS: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

CONCLUSION: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

DOI: 10.1007/s00384-025-05014-5

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Learning from Interventions Within Cancer Services (2024)

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Type of publication:

Conference abstract

Author(s):

*Flynn K.; *Poulsom R.; *Wilfred D.;* Lindsey K.; *Tibitendwa A.

Citation:

Journal of Oncology Pharmacy Practice. Conference: 26th Annual BOPA Symposium. Wales United Kingdom. 30(1 Supplement) (pp 74), 2024. Date of Publication: 01 Mar 2024.

Abstract:

Introduction / objectives: This Service Evaluation was carried out to assess interventions for oncology SACT prescriptions, identify trends and potential areas for improvement. The primary objective was to quantify and categorise the interventions of the Cancer Pharmacist team, encompassing IV and oral oncology SACT prescriptions in the inpatient and outpatient setting, over a 12-week period. The secondary objective was to look in more detail at the interventions logged under the high-risk categories of 'Regimen query/error', 'Dose query' and 'Dose error'. This would enable greater understanding of the issues contributing to prescription errors and will form the basis for future work to improve patient safety. Method(s): Cancer pharmacists completed a data collection form for each oncology SACT prescription query over a 12-week period. A support document defining each category ensured standardisation among pharmacists when classifying queries. The data was collated and analysed using Microsoft Excel. Each patient case in the specified high-risk categories was examined retrospectively to provide more detailed insight into the intervention and identify common themes. Result(s): In total, 124 interventions were logged (Fig.1), the highest number related to 'funding queries', 36%, with 'missing prescription' and 'dose query' both at 15%. The high-risk categories accounted for 31%, (n = 39). Of the 39 high-risk interventions, 9 related to intended dose changes that had not been actioned; 14 related to patient factors (bloods, DPYD, co-morbidities), of which 6 involved carboplatin; 5 prescriptions were missing a critical element. Discussion / conclusions: Funding queries were identified as the largest category of interventions; consultants were reminded to complete Blueteq forms when planning treatment to ensure the patient is eligible for the chosen regime. Prescriptions not available in advance mean that treatment cannot be ordered in time from third-party compounders. Pharmacy and oncology are working to find an efficient way of identifying patients scheduled for treatment that has not yet been prescribed to reduce delays to patients due to treatment not being available. From the in-depth analysis of high-risk categories, key areas for service development were identified. 1) Establishing a clear process for communicating changes to planned treatment. 2) Creating a policy and educating staff on carboplatin dosing to reduce unnecessary changes. 3) Improving blood test scheduling with the administration team. 4) Reviewing regimens requiring two prescriptions and considering combined prescriptions. This would reduce the number of prescriptions missing a critical element. Our Service Evaluation had limitations, mainly due to manual documentation. There was a noticeable drop in number of queries logged during extremely busy periods; it is likely that some interventions have been missed. Some duplication was identified when collating the data, particularly where more than one pharmacist was involved in following up a query. Of the 39 high-risk interventions, 4 were excluded from the data, 3 were duplicate entries and 1 had the incorrect patient number documented so further follow up was not possible. Future work will involve liaising with the oncology team to address the areas identified above with reference to improvement projects that have been successful in other hospitals.

DOI: 10.1177/10781552241228011

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Feasibility of same day discharge following total laparoscopic hysterectomy in District General Hospital (2024)

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Type of publication:

Conference abstract

Author(s):

*Malik N.; *Sahu B.; *Parry-Smith W.; *Elsheikh M.;

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: RCOG 2024. Muscat Oman. 131(Supplement 5) (pp 20), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Introduction: Hysterectomy is one of the commonest gynecologic surgical procedures and an increasing number of hysterectomies are being completed minimally invasively. Previously, hysterectomies have been performed as in-patient operative procedures to manage post-operative pain and monitor post-operative complications such as symptomatic anemia or delayed return of bowel function. Studies have described same-day discharge after laparoscopic hysterectomy to be safe and acceptable and same-day discharge can reduce hospital costs and decrease iatrogenic complications associated with hospitalization such as venous thromboembolic complications due to delayed mobilization or infections. A quality improvement project to assess the feasibility of implementing same-day discharge protocols for patients undergoing total laparoscopic hysterectomy (TLH) in district general hospital in west midlands. <br/>Design(s): A quality improvement project was conducted to evaluate success rates of same-day discharge, adherence to pre and postoperative protocols, incidence of complications, readmission rates, and patient satisfaction levels. Material(s) and Method(s): The project involved analysing clinical records of patients who underwent TLH for benign and oncological indications over a six-month period (May2023 to October 2023) at shrewsbury and telford NHS Trust. Compliance with multimodal perioperative protocols, readmission rates, and patient satisfaction were assessed retrospectively. Result(s): Out of 40 cases of Total laparoscopic hystrectomies, 12 cases (30%) were successfully discharged on the same day. Further analysis revealed that oncological cases had a higher same-day discharge rate (40%) compared to benign cases (12%). Reasons for overnight stay were, anxiety (5 patients), Haematuria (2 patients), Surgeons decision (10 patients), drain insitu (3 patients) social reasons (5 patients) and no reason was documented in three patients. Two patients were readmitted in 24-48 h with pain and infection symptoms. Conclusion(s): In gynecology, laparoscopic hysterectomy has become increasingly prevalent due to its minimally invasive nature. This shift aims to enhance patient outcomes and reduce healthcare costs. The findings of this study indicate that same-day discharge following TLH is feasible without compromising patient safety. Key factors contributing to successful implementation include standardized techniques, collaboration with anesthestists and theatre teams, adequate postoperative nursing care, and comprehensive preoperative patient counseling. This study underscores the importance of a coordinated approach involving various healthcare professionals to ensure successful same-day discharge protocols for TLH patients. By optimizing perioperative care pathways and patient education, hospitals can effectively implement same-day discharge practices, thereby improving patient experience and resource utilization.

DOI: 10.1111/1471-0528.17946

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Analysing risk factors for diabetic non-traumatic major amputation in Shropshire and Telford: Early metabolic and risk factor management is the key to prevention (2024)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Al-Samaraaie E.; *Cane C.; *Beard N.; *Moulik P.

Citation:

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2024. London . 41(Supplement 1) (no pagination), 2024. Date of Publication: 01 Apr 2024

Abstract:

Aims: Shropshire and Telford have significantly higher minor and major non-traumatic diabetic lower-limb amputations. We analysed data on risk factors leading to major amputation. Method(s): Data on all 48 major non-traumatic lower-limb amputation in diabetes between April 2022 and March 2023 were analysed. Result(s): 90% type 2 diabetes with 32 (67%) diabetes duration >10 years, 11 (23%) <10 years, 1 was diagnosed at admission. 17 (35%) were female. 38 (80%) were between 50 and 80, 9 (18%) over 80 years age. 26 (54%) had below knee and 22 (46%) above knee amputation. Postcode-based assessment of deprivation indices revealed amputations were higher in patients from most deprived (29%) compared to deprived (25%), average (21%), affluent (20%) and very affluent (4%) areas. 20 (41%) were considered concordant, 18 (37%) non-concordant by the assessing clinician. 21 (42%) were overweight or obese. Half were current or ex-smokers, 58% hypertensive, 79% hyperlipidaemic or on statins, 83% on antiplatelet/anticoagulants. Sixteen (44%) had eGFR >60 mL/min, 17 (35%) 30-60 mL/min, 4 (8%) eGFR 15-30mL/min and none with eGFR <15mL/min. HbA1c was <48 mmol/mol in 10%, 48-68 mmol/mol in 35%, 69-99 mmol/mol in 37% and >100 mmol/mol in 17%. 37% had pre-proliferative/proliferative retinopathy or maculopathy. 80% had high risk feet, 28 (58%) previous foot ulcers and 19 (40%) previous amputation. 80% had neuropathy and peripheral arterial disease and 10% had Charcot. Final cause of amputation was critical ischaemia in 27 (56%), infection/osteomyelitis/sepsis in 7 (15%), spreading gangrene in 10 (21%) and Charcot in 4 (8%). Conclusion(s): Long-standing diabetes with multiple chronic complications and social deprivation were associated with major amputations. Cardiovascular risk factors were generally well managed. Preventive strategies must focus on improving metabolic and risk factor management early in disease.

DOI: 10.1111/dme.15295

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Magtrace Can Sustainably Improve Theatre Efficiency, Operative Capacity, and Patient Experience (2024)

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Type of publication:

Conference abstract

Author(s):

*Lake B.; *Wilson M.; *Appleton D.

Citation:

Annals of Surgical Oncology. Conference: 25th American Society of Breast Surgeons Annual Meeting, ASBrS 2024. Orlando, FL United States. 31(Supplement 2) (pp S498), 2024. Date of Publication: 01 Jun 2024.

Abstract:

Background/Objective: Magtrace is an iron oxide liquid which has revolutionized sentinel lymph node biopsy treatment for breast cancer. It has a flexible injection window which allows patients to have the injection prior to the day of surgery at a convenient time for both the patient and the provider and removes the need for nuclear medicine completely. Magtrace was reviewed by the National Institute for Health and Care Excellence in October 2022 (MTG72) and they highlighted that Magtrace has the potential to reduce cost based on an expectation that its usage would enable hospitals to perform additional sentinel node biopsies due to improved operating room utilization. The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in the UK. This guidance is the gold standard for advice for breast cancer treatment. Our team designed a study to investigate the "additive effect" of Magtrace in improving theatre efficiency, operative capacity, and patient experience (Presented at European Society of Surgical Oncology, to be published in European Journal of Surgical Oncology early 2025). The aim of this study was to assess if these previously described benefits of Magtrace by NICE are sustained in a hospital system. Method(s): All Magtrace cases for sentinel node biopsy at the Shrewsbury & Telford NHS Trust were prospectively recorded. The outcomes measured were operating room utilization, number of sentinel node biopsies performed per week, and patient satisfaction. Result(s): 150 patients undergoing a wide local excision or mastectomy received Magtrace as the sole technique for SLNB. Operating room utilization improved from 77% to 84% (with peak utilisation at 96%) due to a reduction in OR delays and improved OR flow. Previous delays were caused by patients waiting to have radioisotope injections. Significantly more sentinel node biopsies were performed per week, increasing from 6.48 per week (Pre Magtrace 2022) to 8.57 per week (Post Magtrace ) (t-value = 3.53057, p-value < 0.00041). This resulted in a net increase of 2 additional patients per week. The t-value is 3.53057. The p-value is .00041. The result is significant at p < 0.05. The study showed high patient satisfaction with 100% of patients finding injection more convenient on the day of surgery and 100% of patients would recommend Magtrace to a friend or relative. Conclusion(s): Utilising Magtrace for sentinel lymph node biopsy creates a sustained "additive effect" by improving operating room utilization, operating room capacity and demonstrates a high patient satisfaction.

DOI: 10.1245/s10434-024-15410-w

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Menopause training among obstetrics & gynaecology trainees in UK: Are we getting it right? (2024)

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Type of publication:

Conference abstract

Author(s):

*Malik N.; *Sahu B.; *Wood M.; *Afzal M.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: RCOG 2024. Muscat Oman. 131(Supplement 5) (pp 129-130), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: The menopause has garnered significant media attention in recent times due to the rising number of working menopausal women, accounts of women being disregarded, and anxiety surrounding the prescription and usage of hormone replacement therapy (HRT) due to lack of training and knowledge gap among physicians. It is a normal, natural, and inevitable part of ageing. Yet for too long, too many people experiencing menopause have struggled with societal stigma, inadequate diagnosis and treatment, workplace detriment and discrimination. The management of menopausal symptoms requires a comprehensive understanding and specialized training, particularly among obstetrics and gynecology trainees in UK. The national survey was conducted among obstetrics and gynecology trainees to evaluate the depth of knowledge with regards to management of menopause and menopause services provided at their hospital and training opportunities. Participants and Methods: This online Menopause Training review surveyed 103 postgraduate obstetrics and gynecology trainees in the UK from September 2023 to October 2023. The national survey was distributed to all deaneries in the UK for circulation to all their trainees via social media, WhattsApp groups and emails. The survey comprised of questions regarding trainees' level of training, country of training, menopause clinics in their hospital, their clinic regularity, and any designated lead clinician for menopause clinics in their hospital, management of menopause, the trainees' confidence advising patients with menopausal symptoms, and any benefit from their patient care. Result(s): The majority of responders 70 (68.63%) belonged to England followed by 21 (20.59%) Wales and Ireland 11 (10.78%). About 56 (54.36%) had a menopause clinic in their hospital and 46 (45.10%) responders conducting regular clinics. Approximately 44 (42.72%) had a designated lead clinician present in their hospital. Specific trust guidelines on the management of menopause were applied in 30 (29.13%). About 21 (20.39%) respondents felt confident advising patients with menopausal symptoms and 99 (96.12%) participants thought that going through additional formal menopause training could benefit patient care.It is imperative to adopt a novel pedagogical strategy for teaching menopause in healthcare curriculum. Conclusion(s): The survey emphasized that the need for ongoing evaluation and enhancement of menopause training programs for obstetrics and gynaecology trainees in the UK to ensure optimal patient care during this critical life stage.

DOI: 10.1111/1471-0528.17946

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