Staff Publication

Current trends in head and neck surgery: Use of recurrent laryngeal nerve monitoring (RLNM) (2014)

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Type of publication:
Conference abstract

Author(s):
Babatola O., *Karamchandani D., *Ahsan S.F.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S39)

Abstract:
Introduction: Aim is to understand the patterns of use of nerve monitoring in UK surgical practice. Methods: An electronic questionnaire was sent to the 434 members of the ENT-UK expert panel in 2012. 86 members (22.4%) of the panel identified themselves as having an interest or subspecialty related to thyroid surgery. The survey contained 8 questions on their current practice in thyroid or parathyroid surgery, their typical use of the recurrent laryngeal nerve stimulator and any patient selection criteria that they may have. Demographic data on the surgeon's year of gaining consultancy and number of procedures performed per annum was also obtained. Results: Of 100 respondents (23.04% response rate) of this panel, 50 of these surgeons performed thyroid and/or parathyroid surgery on a regular basis and the following results pertain to this group. 58.3% use the RLNS in almost all cases that they perform. A further 12.5% used it in fewer than half of their cases. 29.2% did not use the stimulator at all. Conclusions: Currently there appears to be no true consensus among the surgeons performing thyroid surgery on use of RLNS in thyroid surgery.

Link to more details or full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00373-2/pdf

Laparoscopic anti-reflux surgery (LARS): Determine the hiatal defect repair using the intra-operatively calculated surface area (SA) cm2 (2014)

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Type of publication:
Conference abstract

Author(s):
*Sukha A., *Adjepong S., *Pattar J., *Sigurdsson A.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S100)

Abstract:
Introduction: The aim of this study was to evaluate laparoscopic antireflux surgery (LARS) techniques when repairing hiatal defects using the intra operatively calculated surface area (SA) at single-centre Upper Gastrointestinal Laparoscopic Unit. Methods: 100 patients (mean age = 59, average BMI 31) with symptoms of GORD underwent LARS. The SA (cm2) was calculated using an endoscopic ruler and the formula;(1/2 x base x height) x2. The method of closure; Surgisis +/-simple tension free sutures, was recorded for each hiatal closure. Results: The mean calculated SA repaired was 9.0cm2 and there was a 2%(2) recurrence rate. There were 3 modalities of repair; 1) Surgisis, posterior and anterior sutures (mean SA=10.0cm2, average BMI = 28); 2) Surgisis and posterior sutures (mean SA=9.5cm2, average BMI=29); 3) posterior sutures only (mean SA =6.1cm2, average BMI=32, mean number of sutures 3). Conclusions: It was found that the greater the average SA cm2 of the hiatus hernia the greater the number of modalities of repair used. There was no correlation found between BMI and the surface area of the hiatus hernia. Currently there are no set standard for method of repair based on the SA of the defect; however guidelines have been derived from this study.

Link to more details or full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00735-3/pdf

Mortality following acute native artery embolecotmy for arterial embolism unrelated to peripheral arterial disease (PAD): 18 year review (2014)

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Type of publication:
Conference abstract

Author(s):
*Lambert J., *Premaratne S., *Jaipersad A., *Houghton A., *Fox A., *Merriman K.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S114)

Abstract:
Introduction: Arterial embolism unrelated to peripheral vascular disease (AEUPAD) is known to be associated with risk factors such as malignancy, atrial fibrillation and thrombophilias. This study aimed to determine survival following embolecotmy of native arteries for AEUPAD. Methodology: Retrospective analysis was performed of a prospectively maintained database in a single vascular centre for the past 18 years, for all native artery embolectomies. Patients with PAD and graft embolectomies were excluded. Kaplan-Meier survival analysis was performed to calculate overall survival. Relationship between death and known risk factors were also assessed. Results: From 1994 to 2012, 192 patients had 204 native artery embolectomies for AEUPAD. 11 had multiple embolectomies. 100(49%) were male, mean age 72.5 (range: 9-102) years. Embolectomies performed; femoral 115 (56%), popliteal 47(23%), brachial 40 (17%), iliofemoral 1(0.4 %) and tibial 2(0.8%). 80 (41.60%) of patients were alive at the time of analysis. Kaplan-Meier estimates 69.77% survival 12 months post embolecotmy, decreased to 46.42% and 18.61% within 2 and 5 years respectively. Age (p<0.0001) and male sex (p=0.0451) were associated with death. Smoking had a negative correlation with mortality (p=0.0080). Conclusions: There is high mortality following embolecotmy. Though basic investigations are performed, further assessment may be necessary to prevent high mortality.

Link to full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00812-7/pdf

Incidence of malignancy in solitary thyroid nodules (2015)

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Type of publication:
Journal article

Author(s):
Keh, S M, *El-Shunnar, S K, Palmer, T, *Ahsan, S F

Citation:
Journal of Laryngology and Otology, Jul 2015, vol. 129, no. 7, p. 677-681

Abstract:
This study aimed to investigate the prevalence and clinical significance of solitary thyroid nodules in patients who underwent thyroid surgery. A retrospective review was performed of the case notes of all adult patients who underwent thyroid surgery from January 2003 to December 2009. All patients with solitary thyroid nodules identified by ultrasonography were included. In total, 225 patients underwent thyroid surgery. The prevalence of solitary thyroid nodules was 27.1 per cent (61 out of 225 patients). Seventy-two per cent of patients were women and the mean age at presentation was 52 ± 16 years. In all, 75.4 per cent of solitary nodules had neoplastic pathology and the malignancy rate was 34.4 per cent. The sensitivity and specificity of fine needle aspiration cytology for neoplasm detection were 73.9 per cent and 80.0 per cent, respectively. There was no association between the various ultrasonography parameters and malignancy risk (p > 0.05). Solitary thyroid nodules should be investigated thoroughly with a high index of suspicion because there is a high probability (34.0 per cent) of malignancy.

The subscapularis splitting technique: Beware the aberrant axillary nerve (2014)

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Type of publication:
Journal article

Author(s):
Singh R.A., Ahmed B., Hay B.A., *Hay S.M.

Citation:
Techniques in Shoulder and Elbow Surgery, December 2014, vol./is. 15/4(130-133)

Abstract:
The subscapularis splitting technique has become a very common approach for the open management of shoulder instability, including repair of Bankart lesions, capsular shift procedures, and the increasingly popular Latarjet procedure. It is often used for young athletes, as the attachment and the length of subscapularis are preserved while other open approaches may result in restricted rotation of the shoulder, particularly external rotation. The current literature reports that routine exposure of the axillary nerve is not necessary during anterior stabilization procedures using a subscapularis muscle-splitting approach if proper precautions are taken to protect the nerve. We present a case in which the axillary nerve was fortuitously noted to be coursing in an abnormally lateral position anterior to the subscapularis belly exposing the nerve at risk during subscapularis split. Our case clearly represents an important anatomic variant which must be considered when performing the subscapularis splitting approach, as serious and functional deficits will result if the nerve is irrevocably damaged. Beware the aberrant axillary nerve.

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Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach (2015)

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Type of publication:
Journal article

Author(s):
Parry-Smith W., Thorpe D., Ogboro-Okor L., *Underwood M. , Ismaili E., Kodampur M., Todd R., Douce G., Redman C.W.E.

Citation:
Cytopathology, June 2015, vol./is. 26/3(188-193)

Abstract:
Objectives: Vaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance. Methods: The local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected. Results: In total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated. Conclusion: A high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings.

Does a preprinted Evacuation of Retained Products of Conception (ERPC) consent form improve information provided to patients who are undergoing an ERPC compared to a generic hospital consent form? (2015)

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Type of publication:
Conference abstract

Author(s):
*Khattak H., *Bakhai K., *Zainab O.M., *Jones C., *Swain K., *Biswas N.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, April 2015, vol./is. 122/(21)

Abstract:
Introduction The General Medical Council (GMC) highlights in Good Medical Practice that obtaining informed consent is one of the duties of a doctor. The GMC advocate in the consent guidelines that the process of consenting is a partnership between the doctor and patient to come to a mutually agreed decision. There may be important medico-legal implications for doctors who obtain uninformed consent. This audit investigated the documentation of this clinical interaction. In the light of this, an original audit on 'ERPC Consent' was carried out in 2013. The audit highlighted that 'serious risks' were not consistently recorded. We therefore encouraged the use of a preprinted ERPC consent form. A re-audit was carried out in 2014. Methods A total of 30 case notes and consent forms were obtained, which is 71% of total ERPCs performed over a 3-month period in 2013. These were analysed using a pro forma and results presented at a local clinical governance meeting. As a result of this meeting, the preprinted form was re-introduced. A re-audit was performed, using the same pro forma with 25 case notes (51% of all ERPCs) over a 3 month period in 2014. The results were analysed and also presented to clinical governance. Results The original audit found that in 2013 only 20% of the forms used to take consent were the ERPC specific forms. After re-auditing in 2014, the number rose to 80%. This showed significant results for improvement in documentation for serious risks, in particular infertility (from 37% to 80%), significant cervical trauma (from 10% to 52%), damage to blood vessels (from 47% to 84%) and thrombosis (from 80% to 88%). Conclusion In conclusion, the complete audit cycle showed that there is a significant improvement in documentation of serious risk factors associated with surgical management of miscarriage and provision of information leaflets to the patients about ERPC. However, we recognise that small sample size may have limited our results and therefore propose a re-audit of all ERPCs performed in 2014.

Link to full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201504001-00048&LSLINK=80&D=ovft

High-grade vaginal intraepithelial neoplasia (VAIN2/3): comparison of clinical outcomes between treated and untreated patients in an observational cohort study (2015)

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Type of publication:
Conference abstract

Author(s):
*Pandey B., *Papoutsis D., *Guttikonda S., *Ritchie J., *Reed N., *Panikkar J., *Blundell S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, April 2015, vol./is. 122/(149)

Abstract:
Introduction We aimed to compare the clinical outcomes between treated and untreated patients with high-grade vaginal intraepithelial neoplasia (VAIN2/3) in our colposcopy unit. Methods The clinical records of all patients diagnosed with VAIN and vaginal cancer over the time period of 1981-2012 were retrieved and reviewed. The primary outcome was to identify the progression of treated versus untreated patients with VAIN2/3 to vaginal cancer and to compare persistent VAIN disease in both subgroups. The secondary outcome was to identify any associations between particular demographic features of treated/ untreated VAIN2/3 patients with their clinical outcome. Results During the time period of this observational cohort study 36 patients of which 11 patients with VAIN1, 19 with VAIN2/3 disease and 6 with vaginal cancer were identified. In those with VAIN2/3 (n = 19) the diagnosis was made in a younger age in the subgroup of treated patients (n = 8) versus the untreated patients (n = 11) (47 +/- 7.1 versus 54.3 +/- 11.5 years old). Nulliparity and smoking status were similar between the two cohorts. The median follow-up for the untreated women was 7 years (range 1-22 years). In the treated VAIN2/3 group, median time from diagnosis to treatment was 4 years (range 0.2-7 years), and median follow-up after treatment was 7 years (range 0.5-18 years). Treatment methods were ablation (n = 4), excision of lesion (n = 2) and vaginectomy (n = 2). There were no cases of treated VAIN2/3 patients (0%) that progressed to vaginal cancer, whereas n = 3 cases of untreated VAIN2/3 patients (21.4%) progressed to vaginal cancer. Following initial VAIN2/3 diagnosis, 8/11 cases of untreated VAIN2/3 (72.7%) had persistent disease as identified in follow-up cytology/colposcopy/vaginal biopsies. In the treated VAIN2/3 patients, 5/5 cases (100%) had persistent disease post-diagnosis but after treatment this decreased to 2/7 cases (28.5%). Conclusion Treated VAIN2/3 patients were of younger age but of similar smoking status and parity in comparison to untreated patients. Three cases of untreated VAIN2/3 progressed to vaginal cancer, whereas there were no such cases of patients receiving treatment for VAIN2/3. The VAIN2/3 patients who received treatment had a higher rate of persistent VAIN disease at followup post-diagnosis (100% versus 72.7%), but after treatment this rate fell down to 28.5%. Further studies are needed to conclude whether treatment of VAIN2/3 disease reduces the rate of VAIN disease persistence and affects the progression to vaginal cancer.

Link to full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201504001-00343&LSLINK=80&D=ovft

Teenage pregnancy: incidence and outcomes in a rural Shropshire district general hospital trust (2015)

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Type of publication:
Conference abstract

Author(s):
*Moores K.L., Ritchie J., *Calcott G., *Underwood M. , *Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, April 2015, vol./is. 122/(319)

Abstract:
Introduction The UK has the highest rate of teenage pregnancy across Western Europe; however, the rate has been reducing and is currently at its lowest since 1969. Perceptions exist of worse outcomes in teenage pregnancies among healthcare professionals and the public alike. The review sought to determine outcomes of teenage pregnancy (2013-2014) and compare rates of teenage pregnancy (2008-2013) at Shrewsbury and Telford Hospitals (SaTH) NHS Trust and compare with local population outcomes. Methods A 12-month retrospective review of teenage pregnancy outcomes and comparison with outcomes of all deliveries at SaTH between April 2013 and March 2014, a total of 4916 deliveries, was conducted. Data sources included the MEDWAY Hospital Database. Recorded pregnancy outcomes were classified into two categories: outcomes in mothers aged 19 years or younger at time of delivery and outcomes in all mothers who delivered at SaTH in the study period. Parameters assessed included mode of delivery; blood loss; perineal trauma; birthweight; Apgar scores. Teenage pregnancy rates over the last 6 years were compared to recorded rates in 1996. Results The rate of teenage pregnancy has continued to reduce; especially in those aged <16 years. Over 90% of teenage mothers had a vaginal delivery and were half as likely to require caesarean delivery (RR 0.49; 95% CI 0.33-0.75). Low rates of instrumental deliveries were seen in each category; no failed instrumental deliveries occurred among teenage mothers. Teenage mothers were not at a statistically significant increased risk of preterm delivery; however, mean term birthweights were lower among teenage mothers; 3302 g compared with 3464 g in the total population; and mean Apgar scores were the same in both groups. No difference was seen in rates of severe perineal trauma; however, more than 60% of teenage mothers had an intact perineum. Furthermore, teenage mothers had significantly lower rates of postpartum haemorrhage (RR 0.66, 95% CI 0.48-0.90). Conclusion Thus, one may suggest a lower risk of harm to teenage parturients and their babies compared with the local population, contrary to current general beliefs.

Link to full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201504001-00718&LSLINK=80&D=ovft

How can health professionals improve the management of postnatal depression: the patients' perspective (2015)

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Type of publication:
Conference abstract

Author(s):
*Jones, C.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, April 2015, vol./is. 122/(324)

Abstract:
Introduction Having felt 'lost' myself and almost 'let down' with the management of my own postnatal depression (PND), I wondered whether my view was an anomaly or whether there is a general mismanagement of the illness but from a patient's point of view. There is an increased understanding and awareness of the illness in recent years, largely in part to the use of social media and charitable awareness campaigns. Methods I created a simple online survey asking volunteers who have had PND to provide answers to questions surrounding their help seeking behaviour and how they feel the health professionals treated them and how they feel that their health professionals could improve. This survey was shared amongst a private, online postnatal depression forum in which individuals could opt to take part. There was also an opportunity for those taking part to add 'free text'. These results were collated and analysed. Results A total of 53 responses were obtained. 29% of the responses state they became unwell during pregnancy, 10% between birth and hospital discharge, 22% in the first 6 weeks and the remainder throughout the rest of the first year. All ladies experienced more than one symptom, but in their view, the most alarming symptoms were anxiety (15%), anger (13%), no bond with baby (18%) and imagining or planning own death (24%). 9% of all responders did not seek any help, 38% obtained help in first 6 weeks, 22% in first 6 months and the remainder thereafter. 83% of responders went to their own GP as their first contact. When asked about the first point of contact, in relation to ease of appointment, empathy, knowledge and respect, the responses were mixed. The free text highlighted a few common themes of concern, concerns over computer usage in consultations and lack of follow-up arrangements. Conclusion In conclusion, PND management varies between locations. There are positives and negatives within the patient's journey. I believe we can improve this by returning to our instincts, by acknowledging the distress and managing the mother with compassion.

Link to full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201504001-00729&LSLINK=80&D=ovft