2025

Medical Acute Take Handover (2025)

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Type of publication:

Service improvement case study

Author(s):

*Dr Peter Fitzroy (QIP lead), *Dr Joshua Wilcox, *Consultant Mr A. Farquharson

Citation:

SaTH Improvement Hub, January 2025

Abstract:

Improve documentation by ensuring 100% compliance to all ward entries on general surgical wards at RSH by ensuring name, GMC number and signature annotated by attending clinician by 25 November 2024.

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Staff Bereavement Support - OWEN Room SECC (2025)

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Type of publication:

Service improvement case study

Author(s):

*Jules Lewis, Lead Nurse for Staff Bereavement Support and *Penny Watson Admin Support for Staff Bereavement Support

Citation:

SaTH Improvement Hub, January 2025

Abstract:

To develop an OWEN Room for staff bereavement support sessions; a calm, inviting, comfortable and safe space that allows staff to share how they are feeling, be heard and supported

Link to PDF poster

DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study (2025)

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Type of publication:

Journal article

Author(s):

Issa, Mohamed Talaat; *Sultana, Emiko; Hamid, Mohammed; Mohamedahmed, Ali Yasen; Albendary, Mohamed; Zaman, Shafquat; Bhandari, Santosh; *Ball, William; Narayanasamy, Sangara; Thomas, Pradeep; Husain, Najam; Peravali, Rajeev; Sarma, Diwakar.

Citation:

International Journal of Colorectal Disease. 40(1):68, 2025 Mar 15.

Abstract:

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.

METHODS: We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient
demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.

RESULTS: A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated
with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.

CONCLUSION: The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant
lesions.

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Comparison of hook plates vs. locking plates for Neer type IIB fractures of lateral end clavicle: A systematic review (2025)

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Type of publication:

Systematic Review

Author(s):

*Patel, Ravi; Khan, Muhammad Murtaza; Gibson, William; Banerjee, Robin; Pardiwala, Asif.

Citation:

Chinese Journal of Traumatology.  2025 Feb 19. [epub ahead of print]

Abstract:

PURPOSE: Surgical management of the lateral end of clavicle fractures hasbeen a challenge for orthopedic surgeons considering the high rate ofnon-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate vs. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications.

METHODS: A search of the literature was made with the keyword "clavicle" in PubMed/Ovid Medline/Embase and University of Edinburgh online library "discover Ed". A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors.

RESULTS: A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studies. The most commonly reported incidence of complication was acromial osteolysis. The quality of studies was assessed using modified Coleman score. Other than 2 studies that were considered for the study that met the "fair" standard all of them were considered "poor" based on the modified Coleman score.

CONCLUSION: Both hook plate and locking plate provide acceptable operative treatment options for the lateral end of clavicle fracture. However, a consideration of surgeons' experience, the likelihood of a second operation, and the size of the lateral fragment should be considered when choosing between the 2 types of implants.

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259 Shortened High-dose Palliative Radiotherapy (SHiP-Rt) for Lung Cancer - a Single-arm, Multi-centre, Phase-II Study (NCT06483308) (2025)

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Type of publication:

Conference abstract

Author(s):

Raj S.; Ellanna G.; Vicky S.; Jo H.; Matthew J.; Louise H.; Manreet T.; Apurna J.; Qamar G.; *Anirban C.; Charles P.; Jane R.; Bleddyn J.; Janet D.

Citation:

Lung Cancer. Conference: 23rd Annual British Thoracic Oncology Group Conference 2025. Belfast Ireland. 200(Supplement 1) (no pagination), 2025. Article Number: 108368. Date of Publication: 01 Feb 2025.

Abstract:

Introduction Significant advances in systemic therapy have improved survival for patients with advanced-stage non-small cell lung cancer (NSCLC). However, current treatment strategies and dose-fractionation for high-dose palliative radiotherapy (RT) are based on trials from the 1990s, when RT planning was simple, typically parallel-pair or 3-dimensional conformal, with less precise delivery. Contemporary lung RT uses 4D-CT, volumetric modulated arc radiotherapy (VMAT), aided by online cone beam CT verification, which enable greater accuracy, better target volume coverage, whilst reducing doses to normal organs at risk. Methods and Results: The SHiP-Rt study aims to evaluate the safety and efficacy of reducing the number of RT fractions and RT duration, using contemporary planning, verification, and delivery techniques. This single-arm, multi-centre, phase-II study will evaluate the shortened hypofractionated accelerated palliative RT regimen of 30 Gy in 6 alternate-day fractions, with strict normal tissue dose constraints. We aim to recruit 37 patients, across 4 sites within the West Midlands. The RTTQA will support quality assurance for the RT. Patients with locally-advanced or metastatic NSCLC, who are candidates for high-dose palliative RT, before or after first-line systemic therapy are eligible for recruitment. The primary objective of this study is to assess the safety of the proposed dose-fractionation. Secondary objectives include evaluating toxicity profiles, patient-reported outcome measures (PROMS), Time to Progression (TTP), feasibility and the NHS cost-saving. Developed in collaboration with the Warwick CTU, this study was favourably reviewed by NCRI CTRad, NCRI lung CSG, and the RTTQA. Funding was awarded by the UHCW Charity and Coventry Hospitals Charity. Conclusion This study is open to recruitment. The potential advantages from this regimen include RT given in fewer fractions and hospital visits, resulting in cost-savings for the NHS and opportunity benefits for other patients. If successful, this study will support a phase-III randomised controlled trial to assess efficacy.

Glycerol intoxication syndrome in young children, following the consumption of slush ice drinks (2025)

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Type of publication:

Journal article

Author(s):

Brothwell, Shona Lc; Fitzsimons, Patricia E; Gerrard, Adam; Schwahn, Bernd C; Stockdale, Christopher; Bowron, Ann; Anderson, Mark; Hart, Claire E; Hannah, Romanie; Ritchie, Francesca; *Deshpande, Sanjeev A; Sreekantam, Srividya; Watts, Gemma; Yap, Sufin; Mundy, Helen; Veiraiah, Aravindan; Collins, Abigail; Cozens, Alison; Morris, Andrew A; Crushell, Ellen.

Citation:

Archives of Disease in Childhood. 2025 Mar 11. [epub ahead of print]

Abstract:

INTRODUCTION: Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.

OBJECTIVE: To describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).

METHODS: A retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.

RESULTS: Almost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years – 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.

CONCLUSION: Consumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children,
especially those under 8 years of age, should avoid slush ice drinks containing glycerol.

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