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Postmenopausal bleeding in women taking HRT - Quality improvement project (2024)

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Type of publication:

Conference abstract

Author(s):

*Magar C.K.P.; *Radothra A.; Gbenga A.; *Ritchie J.;

Citation:

Post Reproductive Health. Conference: 33rd British Menopause Society Annual Scientific Conference, BMS 2024. Kenilworth United Kingdom. 30(1 Supplement) (pp 33S-34S), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Objective: Since the 'Davina Effect', there has been rise in the demand for HRT, with a significant increase in HRT prescriptions up by 35% compared to 2021/22, as result there has been an increase in patients presenting with Postmenopausal bleeding on HRT attending our one stop hysteroscopy clinic. The aim of this study was to identify the number of cancers in patients presenting with postmenopausal bleeding who are taking HRT attending our one stop hysteroscopy clinic. Method(s): Prospective study with a sample size of 100 cases. Patient selection – Any patient coming to one stop hysteroscopy clinic with Postmenopausal bleeding on HRT. Sample period: 1st January 2023 to end of August 2023. Data was collected from the patient directly in the designed proforma then scanned to the Microsoft Excel. Result(s): 91% were postmenopausal with average age of 50-59 years and 90% of patient were taking continuous combined HRT. 9% were premenopausal on sequential HRT. 61% of women were on HRT for >12 months however 4% were referred within 3 months of HRT and 10% within 3-6 months. Following transvaginal ultrasound scan, 9% of patients were reassured and discharged, 36% underwent endometrial biopsy and 55% underwent hysteroscopy and endometrial biopsy. 2% were diagnosed with endometrial cancer and 89% had normal histology with a benign cause to explained their postmenopausal bleeding. Of the two patients diagnosed with endometrial cancer, one patient had a endometrial thickness (ET) of 4mm and one of 13mm. The patient with an ET of 4mm was also low risk with a normal BMI, and had been on HRT for 6 months. Conclusion(s): Cancer rate detected in our population is 2% which is very similar to the national rate (1-2%). This result highlights the importance of investigating patients with Postmenopausal bleeding on HRT with endometrial thickness of >=4 mm.

DOI: 10.1177/20533691241273937

Standardising Acute Coronary Syndrome Management: The Impact of Electronic Order Sets on Prescribing Compliance in a Tertiary Cardiology Centre. (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Fan L.

Citation:

Heart. Conference: BACPR Annual Conference 2025. Glasgow United Kingdom. 111(Supplement 5) (pp A9), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background Acute Coronary Syndrome (ACS) management relies on timely and accurate prescribing of evidence-based pharmacological therapies as per NICE NG185 guidelines. However, inconsistencies in prescribing practices, especially between cardiology-trained and non-cardiology clinicians, can lead to delays in optimal treatment, inconsistencies in care, and suboptimal discharge planning. Aim To evaluate whether implementing a standardised electronic prescribing order set improves compliance with NICE NG185 recommendations in ACS patients admitted to a tertiary cardiology centre. Method A retrospective review was conducted using EPMA (Electronic Prescribing and Medicines Administration) preintervention (June-October 2022, n=221) and post intervention (February-March 2023, n=76). Patients admitted with STEMI or NSTEMI were assessed within 1-3 days of admission for prescribing compliance with five core ACS medications: aspirin, beta-blockers, statins, proton pump inhibitors (Table present) (PPIs) and ACE inhibitors (ACEi). Following governance approval, a standardised electronic NICE-aligned order set was implemented on the EPMA system. Prescribing compliance pre and post intervention were compared and analysed for significance. Results Pre-intervention (NSTEMI=104, STEMI=117) revealed universal aspirin prescribing (100%), but notable omissions in other therapies: beta-blockers (70.6%), PPIs (72.9%), ACEi (71.5%) and statins (91.4%) [table 1]. Post-intervention (NSTEMI=28, STEMI=48) showed significant prescribing improvements: beta-blockers: +20.2% (p=0.0007), PPIs: +15.3% (p=0.0102), and ACEi: +10.1% (p=0.1143). Statin prescribing showed smaller changes (+3.3%) [table 1]. Conclusion Introducing standardised electronic order sets significantly improved prescribing compliance for ACS medications, particularly beta-blockers and PPIs. This intervention promoted adherence to NICE NG185 guidelines, reduced prescribing variability, streamlined medication reconciliation and improved discharge readiness. Embedding digital decision-support tools into EPMA can enhance early initiation of secondary prevention and facilitate a smoother transition to cardiovascular rehabilitation to optimise ACS care. Future directions will focus on sustainability and scalability across additional clinical settings and specialties to standardise ACS care.

DOI: 10.1136/heartjnl-2025-BACPR.15

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Risk of major adverse cardiovascular events in Crohn's disease patients treated with biologic therapy: A meta-analysis and trial sequential analysis of randomised controlled trials (2025)

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Type of publication:

Conference abstract

Author(s):

Bharadwaj H.; Perros I.; Biggs D.; *Butterworth J.; Gohar F.; Sokhal B.S.; Mallen C.

Citation:

United European Gastroenterology Journal. Conference: The 33rd United European Gastroenterology Week, UEGW 2025. Berlin Germany. 13(Supplement_8) (pp 628), 2025. Date of Publication: 01 Oct 2025.

Abstract:

Introduction: Biologic therapies are the preferred treatment for induction and maintenance of remission in Crohn's Disease, although their cardiovascular safety remains uncertain. This systematic review and meta-analysis aimed to estimate the risk of major adverse cerebrovascular and cardiovascular events (MACCEs) in adult CD patients receiving biologic or small molecule therapies in randomised controlled trials (RCTs). Aims & Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, EMBASE, and Cochrane were searched to identify RCTs that assessed the risk of MACCEs in CD induction and maintenance trials. Data were pooled and analysed using random effects modelling with 95% confidence intervals (CIs). Result(s): 40 RCTs were included, describing 20 induction and 20 maintenance trials. A total of 17,718 patients were included, with 11,148 (62.9%) receiving biologic agents or small molecules. The risk of MACCEs was lower in induction (OR=0.56, 95%CI: 0.24,1.34, P=0.19) and maintenance trials (OR=0.75, 95%CI: 0.35,1.57, P=0.44) compared to placebo or active comparators. MACCE risk remained unaffected by drug agent, drug class, and trial duration. Overall, there was no difference in MACCE risk based on receipt of biological therapy (OR=0.65, 95%CI: 0.37,1.15, P=0.14). Conclusion(s): Biologic agents and small molecules did not increase MACCE risk in CD induction and maintenance trials. A slight cardioprotective effect was observed. Longer follow-up studies with real-world data are required to confirm these findings outside the RCT setting.

DOI: 10.1002/ueg2.70032

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