Staff Publication

The spectrum of renal allograft failure (2016)

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Type of publication:
Journal article

Author(s):
*Chand S. , Atkinson D., Collins C., Briggs D., Ball S., Sharif A., Skordilis K., Vydianath B., Neil D., Borrows R.

Citation:
PLoS ONE, September 2016, vol./is. 11/9(no pagination)

Abstract:
Background: Causes of "true" late kidney allograft failure remain unclear as study selection bias and limited follow-up risk incomplete representation of the spectrum. Methods: We evaluated all unselected graft failures from 2008-2014 (n = 171; 0-36 years post-transplantation) by contemporaryclassification of indication biopsies "proximate" to failure, DSA assessment, clinical and biochemical data. Results: The spectrum of graft failure changed markedly depending on the timing of allograft failure. Failures within the first year were most commonly attributed to technical failure, acute rejection (with T-cell mediated rejection [TCMR] dominating antibody-mediated rejection [ABMR]). Failures beyond a year were increasingly dominated by ABMR and 'interstitial fibrosis with tubular atrophy' without rejection, infection or recurrent disease ("IFTA"). Cases of IFTA associated with inflammationin non-scarred areas (compared with no inflammation or inflammation solely within scarred regions) were more commonly associated with episodes of prior rejection, late rejection and nonadherence, pointing to an alloimmune aetiology. Nonadherence and late rejection were common in ABMR and TCMR, particularly Acute Active ABMR. Acute Active ABMR and nonadherence were associated with younger age, faster functional decline, and less hyalinosis on biopsy. Chronic and Chronic Active ABMR were more commonly associated with Class II DSA. C1q-binding DSA, detected in 33% of ABMR episodes, were associated with shortertime to graft failure. Most non-biopsied patients were DSA-negative (16/21; 76.1%). Finally, twelve losses to recurrent disease were seen (16%). Conclusion: This data from an unselected population identifies IFTA alongside ABMR as a very important cause of true late graft failure, with nonadherence-associated TCMR as a phenomenon in some patients. It highlights clinical and immunological characteristics of ABMR subgroups, and should inform clinical practice and individualised patient care.

Link to more details or full-text: http://search.proquest.com/docview/1821784851/F5FCCBF39FE8431CPQ/4?accountid=49082

Preoperative risk factors for conversion from laparoscopic to opencholecystectomy: a validated risk score derived from a prospective U.K.database of 8820 patients (2016)

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Type of publication:
Journal article

Author(s):
Sutcliffe R.P., Hollyman M., Hodson J., Bonney G., Vohra R.S., Griffiths E.A., Fenwick S., Elmasry M., Nunes Q., Kennedy D., Khan R.B., Khan M.A.S., Magee C.J., Jones S.M., Mason D., Parappally C.P., Mathur P., Saunders M., Jamel S., Haque S.U.L., Zafar S., Shiwani M.H., Samuel N., Dar F., Jackson A., Lovett B., Dindyal S., Winter H., Rahman S., Wheatley K., Nieto T., Ayaani S., Youssef H., Nijjar R.S., Watkin H., Naumann D., Emeshi S., Sarmah P.B., Lee K., Joji N., Heath J., Teasdale R.L., Weerasinghe C., Needham P.J., Welbourn H., Forster L., Finch D., Blazeby J.M., Robb W., McNair A.G.K., Hrycaiczuk A., Charalabopoulos A., Kadirkamanathan S., Tang C.-B., Jayanthi N.V.G., Noor N., Dobbins B., Cockbain A.J., Nilsen-Nunn A., de Siqueira J., Pellen M., Cowley J.B., Ho W.-M., Miu V., White T.J., Hodgkins K.A., Kinghorn A., Tutton M.G., Al-Abed Y.A., Menzies D., Ahmad A., Reed J., Monk D., Vitone L.J., Murtaza G., Joel A., Brennan S., Shier D., Zhang C., Yoganathan T., Robinson S.J., McCallum I.J.D., Jones M.J., Elsayed M., Tuck L., Wayman J., Aroori S., Kimble A., Bunting D.M., Hosie K.B., Fawole A.S., Basheer M., Dave R.V., Sarveswaran J., Jones E., Kendal C., Tilston M.P., Gough M., Wallace T., Singh S., Downing J., Mockford K.A., Issa E., Shah N., Chauhan N., Wilson T.R., Forouzanfar A., Wild J.R.L., Nofal E., Bunnell C., Madbak K., Rao S.T.V., Devoto L., Siddiqi N., Khawaja Z., Hewes J.C., Rodriguez D.U., Sen G., Carney K., Bartlett F., Rae D.M., Stevenson T.E.J., Sarvananthan K., Dwerryhouse S.J., Higgs S.M., Old O.J., Hardy T.J., Shah R., Hornby S.T., Keogh K., Frank L., Al-Akash M., Upchurch E.A., Frame R.J., Hughes M., Jelley C., Weaver S., Roy S., Sillo T.O., Galanopoulos G., Cuming T., Cunha P., Tayeh S., Kaptanis S., Heshaishi M., Eisawi A., Abayomi M., Ngu W.S., Fleming K., Bajwa D.S., Chitre V., Aryal K., Ferris P., Silva M., Lammy S., Mohamed S., Khawaja A., Ghazanfar M.A., Bellini M.I., Ebdewi H., Elshaer M., Gravante G., Drake B., Ogedegbe A., Mukherjee D., Arhi C., Giwa L., Iqbal N., Watson N.F., Aggarwal S.K., Orchard P., Villatoro E., Willson P.D., Mok K.W.J., Woodman T., Deguara J., Garcea G., Babu B.I., Dennison A.R., Malde D., Lloyd D., Slavin J.P., Jones R.P., Ballance L., Gerakopoulos S., Jambulingam P., Mansour S., Sakai N., Acharya V., Sadat M.M., Karim L., Larkin D., Amin K., Khan A., Law J., Jamdar S., Sampat K., O'shea K.M., Manu M., Asprou F.M., Malik N.S., Chang J., Johnstone M., Lewis M., Roberts G.P., Karavadra B., Photi E., Hewes J., Gould L., Rodriguez D., O'Reilly D.A., Rate A.J., Sekhar H., Henderson L.T., Starmer B.Z., Coe P.O., Tolofari S., Barrie J., Bashir G., Sloane J., Madanipour S., Halkias C., Trevatt A.E.J., Borowski D.W., Hornsby J., Courtney M.J., Virupaksha S., Seymour K., Robinson S., Hawkins H., Bawa S., Gallagher P.V., Reid A., Wood P., Finch J.G., Parmar J., Stirland E., Gardner-Thorpe J., Al-Muhktar A., Peterson M., Majeed A., Bajwa F.M., Martin J., Choy A., Tsang A., Pore N., Andrew D.R., Al-Khyatt W., Santosh Bhandari C.T., Chambers A., Subramanium D., Toh S.K.C., Carter N.C., Mercer S.J., Knight B., Vijay V., Alagaratnam S., Sinha S., Khan S., El-Hasani S.S., Hussain A.A., Bhattacharya V., Kansal N., Fasih T., Jackson C., Siddiqui M.N., Chishti I.A., Fordham I.J., Siddiqui Z., Bausbacher H., Geogloma I., Gurung K., Tsavellas G., Basynat P., Shrestha A.K., Basu S., Chhabra A., Harilingam M., Rabie M., Akhtar M., Kumar P., Jafferbhoy S.F., Hussain N., Raza S., Haque M., Alam I., Aseem R., Patel S., Asad M., Booth M.I., Ball W.R., Wood C.P.J., Pinho-Gomes A.C., Kausar A., Obeidallah M., Varghase J., Lodhia J., Bradley D., Rengifo C., Lindsay D., Gopalswamy S., Finlay I., Wardle S., Bullen N., Iftikhar S.Y., Awan A., Leeder P., Fusai G., Bond-Smith G., Psica A., Puri Y., Hou D., Noble F., Szentpali K., Broadhurst J., Date R., Hossack M.R., Goh Y.L., Turner P., Shetty V., *Riera M., *Macano C.A.W., *Sukha A., Preston S.R., Hoban J.R., Puntis D.J., Williams S.V., Krysztopik R., Kynaston J., Batt J., Doe M., Goscimski A., Jones G.H., Smith S.R., Hall C., Carty N., Ahmed J., Panteleimonitis S., Gunasekera R.T., Sheel A.R.G., Lennon H., Hindley C., Reddy M., Kenny R., Elkheir N., McGlone E.R., Rajaganeshan R., Hancorn K., Hargreaves A., Prasad R., Longbotham D.A., Vijayanand D., Wijetunga I., Ziprin P., Nicolay C.R., Yeldham G., Read E., Gossage J.A., Rolph R.C., Ebied H., Phull M., Khan M.A., Popplewell M., Kyriakidis D., Hussain A., Henley N., Packer J.R., Derbyshire L., Porter J., Appleton S., Farouk M., Basra M., Jennings N.A., Ali S., Kanakala V., Ali H., Lane R., Dickson-Lowe R., Zarsadias P., Mirza D., Puig S., Al Amari K., Vijayan D., Sutcliffe R., Marudanayagam R., Hamady Z., Prasad A.R., Patel A., Durkin D., Kaur P., Bowen L., Byrne J.P., Pearson K.L., Delisle T.G., Davies J., Tomlinson M.A., Johnpulle M.A., Slawinski C., Macdonald A., Nicholson J., Newton K., Mbuvi J., Farooq A., Mothe B.S., Zafrani Z., Brett D., Francombe J., Spreadborough P., Barnes J., Cheung M., Al-Bahrani A.Z., Preziosi G., Urbonas T., Alberts J., Mallik M., Patel K., Segaran A., Doulias T., Sufi P.A., Yao C., Pollock S., Manzelli A., Wajed S., Kourkulos M., Pezzuto R., Wadley M., Hamilton E., Jaunoo S., Padwick R., Sayegh M., Newton R.C., Farag S.F., Hebbar M., Spearman J., Hamdan M.F., D'Costa C., Blane C., Giles M., Peter M.B., Hirst N.A., Hossain T., Pannu A., El-Dhuwaib Y., Morrison T.E.M., Taylor G.W., Thompson R.L.E., McCune K., Loughlin P., Lawther R., Byrnes C.K., Simpson D.J., Mawhinney A., Warren C., McKay D., McIlmunn C., Martin S., MacArtney M., Diamond T., Davey P., Jones C., Clements J.M., Digney R., Chan W.M., McCain S., Gull S., Janeczko A., Dorrian E., Harris A., Dawson S., Johnston D., McAree B., Ghareeb E., Thomas G., Connelly M., McKenzie S., Cieplucha K., Spence G., Campbell W., Hooks G., Bradley N., Cassidy J.T., Boland M., Burke P., Nally D.M., Hill A.D.K., Khogali E., Shabo W., Iskandar E., McEntee G.P., O'Neill M.A., Peirce C., Lyons E.M., O'Sullivan A.W., Thakkar R., Carroll P., Ivanovski I., Balfe P., Lee M., Winter D.C., Kelly M.E., Hoti E., Maguire D., Karunakaran P., Geoghegan J.G., Martin S.T., Cross K.S., Cooke F., Zeeshan S., Murphy J.O., Mealy K., Mohan H.M., Nedujchelyn Y., Ullah M.F., Ahmed I., Giovinazzo F., Milburn J., Prince S., Brooke E., Buchan J., Khalil A.M., Vaughan E.M., Ramage M.I., Aldridge R.C., Gibson S., Nicholson G.A., Vass D.G., Grant A.J., Holroyd D.J., Jones A., Sutton C.M.L.R., O'Dwyer P., Nilsson F., Weber B., Williamson T.K., Lalla K., Bryant A., Carter R., Forrest C.R., Hunter D.I., Nassar A.H., Orizu M.N., Knight K., Qandeel H., Suttie S., Belding R., McClarey A., Boyd A.T., Guthrie G.J.K., Lim P.J., Luhmann A., Watson A.J.M., Richards C.H., Nicol L., Madurska M., Harrison E., Boyce K.M., Roebuck A., Ferguson G., Pati P., Wilson M.S.J., Dalgaty F., Fothergill L., Driscoll P.J., Mozolowski K.L., Banwell V., Bennett S.P., Rogers P.N., Skelly B.L., Rutherford C.L., Mirza A.K., Lazim T., Lim H.C.C., Duke D., Ahmed T., Beasley W.D., Wilkinson M.D., Maharaj G., Malcolm C., Brown T.H., Shingler G.M., Mowbray N., Radwan R., Morcous P., Wood S., Kadhim A., Stewart D.J., Baker A.L., Tanner N., Shenoy H.

Citation:
HPB, November 2016, vol./is. 18/11(922-928)

Abstract:
Background Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.

Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000 (2016)

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Type of publication:
Journal article

Author(s):
Ness A.R., Waylen A., Hurley K., Jeffreys M., Penfold C., Pring M., Leary S.D., Allmark C., Toms S., Ring S., Peters T.J., Hollingworth W., Worthington H., Fisher S., Rogers S.N., Thomas S.J., Rogers S., Thiruchelvam J.K., Abdelkader M., Anari S., Dykerand K., McCaul J., Benson R., Stewart S., Lester J., Hamidand A., Lamont A., Fresco L., Mehanna H., Lester S., Cogill G., Roy A., Bisase B., Balfour A., Evans A., Gollins S., Conway D., Hall C., Gunasekaran S.P., Lees L., Lowe R., England J., Scrase C., Wight R., Sen M., Doyle M., Moule R., Rowell N., Beaumont-Jewell D., Loo H.W., Goodchild K., Jankowska P., Paleri V., Casasola R., Roques T., Tierney P., Dyson P., Andrade G., Tatla T., Christian J., Winter S., Baldwin A., Davies J., King E., Barnes D., Repanos C., Kim D., Richards S., Dallas N., McAlister K., Hwang D., Berry S., Cole N., Moss L., Palaniappan N., Homer J., Nutting C., Siva M., *Hari C. , Wood K., Simcock R., Waldron J., Hyde N., P Gunasekaran S., Hamid A., Foran B., Ahmed I., Gahir D., O'Hara J., Carr R., Forster M., Sheehan T., Thomas S., Evans M., Wagstaff L., Mano J., Brammer C., Tyler J., Coatesworth A.

Citation:
Clinical Otolaryngology, December 2016, vol./is. 41/6(804-809)

HEART UK statement on the management of homozygous familialhypercholesterolaemia in the United Kingdom (2016)

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Type of publication:
Journal article

Author(s):
France M., Rees A., Datta D., Thompson G., *Capps N., Ferns G., Ramaswami U., Seed M., Neely D., Cramb R., Shoulders C., Barbir M., Pottle A., Eatough R., Martin S., Bayly G., Simpson B., Halcox J., Edwards R., Main L., Payne J., Soran H.

Citation:
Atherosclerosis, December 2016, vol./is. 255/(128-139)

Abstract:
This consensus statement addresses the current three main modalities of treatment of homozygous familial hypercholesterolaemia (HoFH): pharmacotherapy, lipoprotein (Lp) apheresis and liver transplantation. HoFH may cause very premature atheromatous arterial disease and death, despite treatment with Lp apheresis combined with statin, ezetimibe and bile acid sequestrants. Two new classes of drug, effective in lowering cholesterol in HoFH, are now licensed in the United Kingdom. Lomitapide is restricted to use in HoFH but, may cause fatty liver and is very expensive. PCSK9 inhibitors are quite effective in receptor defective HoFH, are safe and are less expensive. Lower treatment targets for lipid lowering in HoFH, in line with those for the general FH population, have been proposed to improve cardiovascular outcomes. HEART UK presents a strategy combining Lp apheresis with pharmacological treatment to achieve these targets in the United Kingdom (UK). Improved provision of Lp apheresis by use of existing infrastructure for extracorporeal treatments such as renal dialysis is promoted. The clinical management of adults and children with HoFH including advice on pregnancy and contraception are addressed. A premise of the HEART UK strategy is that the risk of early use of drug treatments beyond their licensed age restriction may be balanced against risks of liver transplantation or ineffective treatment in severely affected patients. This may be of interest beyond the UK.

Are local, speciality specific career days beneficial for medical students and foundation doctors? (2016)

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Type of publication:
Conference abstract

Author(s):
*Barker V., *Godden M., *Jones C., *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, December 2016, vol./is. 123/(6-7)

Abstract:
The Health Education Midlands holds an annual career day for all specialities to attend, allowing all medical students and foundation doctors to explore different specialities within the local area. The Royal College of Obstetricians and Gynaecologists also provide a careers day, for anyone to attend. Both of these are useful resources however do have some limitations due to number of delegates attending and also number of specialities in attendance. Our local obstetrics and gynaecology school held a pilot, local, careers days to allow any medical student from 4th year and above and any foundation doctor within the region, the opportunity to attend. The day consisted of a variety informal presentations about the 'day in a life' and was given by a variety of trainees across the school. The deputy head of school also came and provided more specific information on training pathways. The day also included several workshops covering resilience, CV building, and practical skills. The informal nature meant that the delegates could feel free to ask any of us any questions they wish to do so during the process. The delegates were asked to provide feedback at the end of the day. We had a total of 42 delegates, of which the majority found the day useful, we did not receive any negative feedback. We hope that the delegates can use this experience when deciding on future careers. We are intending on repeating the careers day again.

Link to full-text: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14447/epdf

Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures (2017)

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Type of publication:
Journal article

Author(s):
Pascale Trepanier, Kim Mallard, Danièle Meunier, Rachel Pike, Derek Brown, Janet P. Ashby, Hugo Donaldson, F. Mustafa Awad-El-Kariem, Indran Balakrishnan, Marc Cubbon, Paul R. Chadwick, Michael Doughton, Rachael Doughton, Fiona Hardiman, *Graham Harvey, Carolyne Horner, John Lee, Jonathan Lewis, Anne Loughrey, Rohini Manuel, Helena Parsons, John D. Perry, Gemma Vanstone, Graham White, Nandini Shetty, John Coia, Camilla Wiuff, Katie L. Hopkins and Neil Woodford

Citation:
Journal of Antimicrobial Chemotherapy, Feb 2017, vol. 72, no. 2, p.596-603

Abstract:
OBJECTIVES:
To estimate UK prevalence and incidence of clinically significant carbapenemase-producing Enterobacteriaceae (CPE), and to determine epidemiological characteristics, laboratory methods and infection prevention and control (IPC) measures in acute care facilities.
METHODS:
A 6 month survey was undertaken in November 2013-April 2014 in 21 sentinel UK laboratories as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project. Up to 10 consecutive, non-duplicate, clinically significant and carbapenem-non-susceptible isolates of Escherichia coli or Klebsiella pneumoniae were submitted to a reference laboratory. Participants answered a questionnaire on relevant laboratory methods and IPC measures.
RESULTS:
Of 102 isolates submitted, 89 (87%) were non-susceptible to ≥1 carbapenem, and 32 (36%) were confirmed as CPE. CPE were resistant to most antibiotics, except colistin (94% susceptible), gentamicin (63%), tigecycline (56%) and amikacin (53%). The prevalence of CPE was 0.02% (95% CI = 0.01%-0.03%). The incidence of CPE was 0.007 per 1000 patient-days (95% CI = 0.005-0.010), with north-west England the most affected region at 0.033 per 1000 patient-days (95% CI = 0.012-0.072). Recommended IPC measures were not universally followed, notably screening high-risk patients on admission (applied by 86%), using a CPE 'flag' on patients' records (70%) and alerting neighbouring hospitals when transferring affected patients (only 30%). Most sites (86%) had a laboratory protocol for CPE screening, most frequently using chromogenic agar (52%) or MacConkey/CLED agars with carbapenem discs (38%).
CONCLUSIONS:
The UK prevalence and incidence of clinically significant CPE is currently low, but these MDR bacteria affect most UK regions. Improved IPC measures, vigilance and monitoring are required.

Obstacles to consent for intravenous rtPAin acute stroke (clinical audit and survey) (2016)

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Type of publication:
Conference abstract

Author(s):
*Alamgir M., *Srinivasan M., *Ghani U.

Citation:
Cerebrovascular Diseases, May 2016, Vol. 41, Supplement 1, p.285-286

Abstract:
Introduction: Intravenous thrombolysis with rTPA is the standard of care for the treatment of acute ischaemic stroke within 3 hrs (up to 4.5 in suitable Pt) after stroke onset. Even with clear evidence of benefit there is increased risk of harm . Due to complex risk & benefit aspects of the treatment the current guidance recommends consent should be obtained for intravenous thrombolysis whenever possible. Our objective was to review the current practice in documentation of consent and also identify the factors which contribute in fauilu-re to obtain consnet Method: We have randomly selected 25 Patient's notes those were admitted from November 2014 to May 2015 and looked for the completed consent form or documentation elsewhere. We have also conducted a survey among Stroke Consultants and medical registrars (who are involved in administration of intravenous thrombolysis) to identify the reasons responsible for failure to obtain consent in acute setting. Results: The documentation of consent was noted to be very poor (either on consent form or documentation elsewhere in notes). Consent form was completed only in 27% cases and there was no clear documentation of reasons for not obtaining consent in the rest. Survey results showed that the only 40% were aware of the consent form in pathway. Reasons of not obtaining consent were , Time pressure = 40%, Patient factors = 40, Ignorance of statistics( Not sure about actual statistics) = 20 %. Conclusion: We have recommended that the use of a consent form with visual illustrations of statistics of risks & benefits to make consent process easier to understand for patients & save time in acute settings. Alternatively suggested that If patient does not have capacity for consent then there should be every effort made to involve the family and next of kin in decision making process (Figure Presented).

Link to more details or full-text: http://misc.karger.com/products/CED_2016_041_S1/index.html

A national colposcopy survey comparing destructive versus excisional treatment for CIN (2016)

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Type of publication:
Conference abstract

Author(s):
Parry-Smith W., *Papoutsis D., Parris D., *Panikkar J., Redman C., *Underwood M.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(99)

Abstract:
Introduction Women found to have high grade CIN should be offered either ablative treatment or large loop excision of the transformation zone with appropriate biopsy. Objective 1) To learn if a trial of ablative versus excisional treatment would be supported by fellow colposcopists in the UK 2) To investigate the current practice amongst colposcopists with regards to ablative treatment for high grade CIN 3) To gain an understanding of aspects of practice such as use of local anaesthetic during punch biopsies Methods An electronic questionnaire was sent to all registered colposcopists in the United Kingdom (total = 1677). Of these, 325 responded (19%). The study was granted ethical approval by the council of the British Society for Colposcopy and Cervical Pathology (BSCCP). Results The majority of colposcopists n = 248 (76%) felt that a study investigating the morbidity and Test of Cure outcomes comparing excisional and destructive treatments was needed. A reduced complication and morbidity rate would be the greatest factor to encourage colposcopists to use destructive treatments more often n = 250 (76.92%). If a destructive treatment were found to have a significantly reduced complication, morbidity, and equal or higher patient satisfaction rate during the procedure, but resulted in a slightly higher need for further treatment 5%, this was acceptable to n = 140 (43.1%) of those surveyed. However, a further treatment rate of 2.5% was acceptable to n = 196 (60.1%). The majority n = 182 (56%) of colposcopists did not perform destructive treatments for high grade disease; For those who did not perform destructive treatments the main reason was that they were not aware of sufficient evidence for its use n = 98 (30.2%) and had no experience nor training n = 33 (10.25%). Cold coagulation was the most common destructive treatment n = 100 (31%) that colposcopists could perform, with diathermy n = 70 (22%), laser n = 11 (3.4%) and cryotherapy n = 10 (3.1%) being less prevalent. The majority of colposcopists took two punch biopsies per patient n = 190 (58.5%), with only n = 45 (13.8%) taking three or more biopsies. Silver nitrate was the most favoured haemostatic technique following punch biopsy n = 217 (66.7%), with n = 269 (87.1%) using no local analgesia. Conclusion A study investigating morbidity and Test of Cure of excisional compared with destructive treatments for high grade CIN would be supported by most participating colposcopists. Variation in practice regarding both treatment and diagnosis exists. This has quality assurance implications for a standardised national screening programme.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00174&LSLINK=80&D=ovft