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Development and design of a Delphi protocol to produce a consensus core information set for caesarean section (2025)

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Conference abstract

Author(s):

Greenfield B.; *Elsmore A.; Frizelle J.; Bradley F.; Kingdon C.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 70), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Objectives: Core information sets are a standardised way to guide discussions with patients to aid decision making for surgical procedures. 1-3 Informed decision making is foundational for ensuring women have agency and autonomy towards their pregnancy and reproductive choices.4 This work will produce a consensus expert opinion, via a Delphi method,5 of relevant information necessary for decision making regarding caesarean sections. Method(s): A scoping review of peer-reviewed publications was undertaken using electronic databases, alongside internet searches for patient information relating to caesarean section. Qualitative and mixed-method studies were reviewed to inform domains and questions. Think Aloud interviews with stakeholders (healthcare professionals and lay people) were conducted to ensure correct syntax and legibility, prior to Delphi distribution. Result(s): A total of 305 studies were identified, from which 345 information points were collected. Patient information leaflets, focus-group interviews, and surveys identified 60, 54 and 12 separate points, respectively. These were collated into 64 questions across 11 domains including indications, risks/benefits, and patient experience of elective/emergency caesarean sections. These questions were refined by 7 Think Aloud interviews until no further changes were identified. The resultant online Delphi (REDCap) is ready for distribution. There will be two rounds prior to a stakeholder consensus meeting in Q1 2024. Conclusion(s): The need for a core information set for caesarean section is evidenced by the disparate nature of current decision aids and proliferation of public information. This work has produced an information set ready for prioritisation by a Delphi panel to provide consistent information regarding caesarean sections.

DOI: 10.1111/1471-0528.18006

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Development of a core information set for caesarean section - A scoping review of patient information leaflets (2025)

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Conference abstract

Author(s):

*Elsmore A.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 56-57), 2025. Date of Publication: 01 Jan 2025

Abstract:

Objectives: Good clinical practice mandates that women have full choice and autonomy for their care in pregnancy and childbirth and are armed with key information points to facilitate informed decision making.1 Development of a core information set will allow women to access consistent, accurate information, containing facts that are important to them.2 As part of this work, a scoping review of patient information leaflets was performed to identify information points. Method(s): We performed an internet search for patient information leaflets, articles, and electronic information sources, such as national and international medical, midwifery, or nursing organisations, from health providers (e.g. NHS), and non-governmental organisations. The search terms were 'caesarean section', 'caesarean section UK', and 'caesarean section patient information leaflet'. Data points were extracted and entered into a database in Microsoft ExcelTM. Result(s): Information points were extracted from 50 sources with 60 separate information points collected. Data collection ceased at 50 sources as saturation was reached. Sources included national organisations, trust patient information leaflets, private care providers, and patient organisations. The number of information points per source ranged from 2 to 40. The type of anaesthetic was the most common information point found, in 78% of sources (39/50); the least common was increased risk of neonatal death in first 28 days in 2% of sources (1/50). Conclusion(s): A large degree of heterogeneity of information points within patient information leaflets was noted, reinforcing the need for the development of a core information set for caesarean section. Women must be provided with consistent information regarding different types of delivery

DOI: 10.1111/1471-0528.18006

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Acute stroke goes viral: cases of young and old stroke secondary to primary varicella zoster infection (2024)

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Conference abstract

Author(s):

European Stroke Journal. Conference: 10th European Stroke Organisation Conference Abstracts. Basel Switzerland. 9(1 Supplement) (pp 499), 2024. Date of Publication: 01 May 2024.

Citation:

*Kondalkar K.; *Craik S.; *Osineye B.; *Srinivasan M.

Abstract:

Background and aims: Varicella zoster is a documented risk factor for development of ischemic stroke for up to 1 year following infection. Multiple cases of stroke following zoster reactivation have been reported previously. Here we outline two admissions to our ward in 2023 in which a stroke developed following primary zoster infection. Method(s): An 18 year old woman was admitted with right hand numbness, speech disturbance and headache. A CT angiogram revealed occlusion of the left middle cerebral artery. She was treated with dual antiplatelets. A lumbar puncture was performed and cerebrospinal fluid was positive for Varicella zoster. On further history the patient revealed she had chicken pox 3 months prior. She was treated with intravenous aciclovir and discharged with her neurological symptoms largely resolved. Result(s): A 75 year old male with a background of Non-Hodgkin lymphoma was admitted with acute confusion and right sided weakness and high fever. Examination also revealed a rash to the torso and head. CT revealed an area of low attenuation in the right basal ganglia, MRI revealed multiple bilateral infarctions. Lumbar puncture was performed due to suspected encephalitis and PCR was positive for Varicella zoster. The patient was treated with intravenous aciclovir however suffered a drop in consiousness. A repeat CT revealed catastrophic intracerebral bleed extending into the ventricles. The patient received palliative care and died one day later. Conclusion(s): Varicella zoster infection is an important risk factor for stroke in both younger and older adults and should be considered in unusual presentations.

DOI: 10.1177/23969873241245672

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Lesser Omental Infarction: A Rare Cause of Intraperitoneal Focal Fat Infarction (IFFI) (2025)

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Conference abstract

Author(s):

*Ramesh S.; *Jayaramegowda A.K.

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii18), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Lesser Omental Infarction is a rare type of Intraperitoneal Focal Fat Infarction (IFFI) caused by the cut-off of blood supply to the fat tissue in the lesser omentum. Patients typically present with symptoms and signs mimicking more serious conditions such as perforated gastric ulcer, pancreatitis, or cholecystitis. This report aims to share insights into the clinical presentation, diagnostic challenges, and management strategies for patients with this condition. A 29-year-old gentleman presented with complaints of upper abdominal pain for two days, radiating to the right side. On abdominal examination, there was a soft but tender right hypochondrium. The patient was admitted with a provisional diagnosis of cholecystitis. Blood investigations were unremarkable, except for an elevated C-reactive protein (CRP). Ultrasound abdomen study was normal and ruled out gallbladder pathology. A CT scan of the abdomen suggested lesser omental infarction secondary to torsion. The patient was managed conservatively with analgesics and discharged after resolution of symptoms. Radiological imaging plays a crucial role in diagnosing lesser omental infarction. If missed, the patient may undergo unnecessary investigations and Interventions. When accurately diagnosed, most cases can be managed conservatively with analgesia. Surgical intervention is rarely required and is reserved for cases where devitalized tissue forms an abscess that does not resolve with conservative management.

DOI: 10.1093/bjs/znaf270.065

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Facing the isles: Maxillofacial emergencies unveiled - A tale of two realms (2024)

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Conference abstract

Author(s):

*Kichenaradjou A.; Reddy M.; *Shah N.

Citation:

Craniomaxillofacial Trauma and Reconstruction. Conference: FACE AHEAD 2024. Prague Czechia. 17(1 Supplement) (pp 80S-81S), 2024. Date of Publication: 01 Jun 2024.

Abstract:

The Noble hospital on the Isle of Man likely experiences a lower volume of maxillofacial emergencies compared to district general hospitals in mainland UK. The Island's smaller population and relative tranquillity contributes to this. Common maxillofacial emergencies include facial trauma, dental infections and oral abscesses. In contrast, district general hospitals in mainland UK, like those in Shrewsbury and Telford hospitals, likely to handle a higher volume and variety of maxillofacial emergencies due to their larger catchment areas and higher population density. We audit and present the emergency work undertaken during the year 2023 between Noble hospital and the district general hospital(s) of the Shrewsbury and Telford hospitals NHS.

DOI: 10.1177/19433875241232784

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NHS blood and transplant donor echocardiography standard to improve organ utilisation in heart transplantation (2025)

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Type of publication:

Journal article

Author(s):

Akhtar W; Peck M; *Miller A; Billyard T; Goedvolk C; Ryan M; Soliman Aboumarie H; Gil FR; Berman M; Rubino A

Citation:

The Journal of the Intensive Care Society. 17511437251394267, 2025 Nov 15.

Abstract:

Focused echocardiography plays a vital role in assessing donor hearts and improving donor utilisation in the United Kingdom. A NHS Blood & Transplant working group was established and, through a review of the current evidence and modified Delphi approach, developed guidance for a minimum dataset for image acquisition in donor heart assessment. This is in intended as a pragmatic optional supplementation to current focused echocardiography protocols. We present a donor echocardiography proforma with accompanying educational materials for use in the United Kingdom.

DOI: 10.1177/17511437251394267

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A survey of the current state of training in inflammatory disease (IBD) surgery in the United Kingdom (UK) (2025)

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Conference abstract

Author(s):

Argyriou O.; *El-Sayed C.; Drami I.; Celentano V.; Reza L.

Citation:

Colorectal Disease. Conference: 20th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2025. Paris France. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: Inflammatory Bowel Disease (IBD) surgery demands advanced technical skills due to the complexity and variability of procedures. High-quality training is essential, not only for the management of acute IBD-related emergencies but also for the development of a specialist IBD practice. This survey, developed by the Dukes' Club for UK colorectal surgery trainees and the IBD Subcommittee of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), aims to evaluate the current state of IBD surgical training in the UK and to identify key areas and potential interventions for improvement. Method(s): An electronic survey was designed by members of the Dukes' Club executive committee and the ACPGBI IBD subcommittee, followed by dissemination via various professional networks, between September 2024 and April 2025.The survey investigated a number of key domains, including exposure to IBD procedures (routine/complex), participation in multidisciplinary team (MDT) meetings and joint surgical-gastroenterological clinics, career and fellowship intentions, as well as access to training resources. Result(s): The survey was completed by 103 participants (70% in training, 30% early years consultants).Senior trainees (ST6-ST8) represented 58.4% of the trainee participants.58.4% of trainees reported lack of exposure to IBD MDTs, with only 5.6% undertaking an active role in the MDT.Trainees reported minimal exposure to ileoanal pouch surgery and complex procedures such as strictureplasties and Kono-S anastomosis. In contrast, higher levels of exposure were noted for subtotal colectomies, ileo-caecal resections for Crohn's Disease, and IBD-related perianal fistula procedures. Conclusion(s): The survey demonstrated a lack of focus in IBD surgical training. Apart from high-quality educational activities that are delivered by the Dukes' Club and ACPGBI, a structured approach to ensure better exposure, through the training curriculum, is called for.

DOI: 10.1111/codi.70174

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Incidence and Survival Outcomes of Primary Parotid Follicular Lymphoma (PPFL): a Seer-Based Retrospective Analysis (2025)

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Conference abstract

Author(s):

Backer G.; *Arunachalam J.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1214-1215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary malignant lymphomas of the parotid glands are rare, estimated to account for just 0.6% to 5% of all tumors of the parotid gland. Primary Parotid Follicular Lymphoma (PPFL) is a rare subtype of non-Hodgkin lymphoma (NHL) originating in the parotid gland, often associated with autoimmune disorders such as Sjogren's syndrome. Due to its low incidence, comprehensive population-based studies are scarce, limiting our understanding of epidemiological factors associated with PPFL and how they impact survival outcomes. Aims Using a large, population-based cancer registry, we aimed to evaluate the incidence trends and survival patterns of PPFL for the past 20 years in the US. Methods We conducted a retrospective population-based study utilizing data between 2000-2021 from the SEER (Surveillance, Epidemiology, and End Results) database. SEER is a program of the National Cancer Institute that collects epidemiological and survival data from cancer registries across the United States. We identified and extracted data from patients diagnosed with PPFL using ICD codes specific for primary tumors of the parotid gland (C07.9) and for follicular lymphoma (ICD codes 9690, 9691, 9695, 9698). Demographic data collected included year of diagnosis, age, sex, race, and area of residence. Incidence rates (IR) were calculated per 100,000 population and were age adjusted to the US standard population using SEER*stat 8.4.4. Using GraphPad Prism software, Kaplan-Meier survival analysis was done to calculate overall survival (OS) and cancer specific survival (CSS). Log rank (Mantel-Cox) test was used to compare survival outcomes between different groups. Results 793 patients with primary parotid follicular lymphoma were identified. 52% were male. 56% were older than 65 years at the time of diagnosis. 79% of patients were white, 10% were Hispanic, and 5% were black. 18% of patients had metastatic disease at initial presentation. IR was 0.050 (SE 0.002, 95% CI 0.045-0.055) for the years 2000-2010 and 0.036 (SE 0.002, 95% CI 0.032-0.040) from 2011 to 2021. Incidence was 29.7% higher in males compared to females with p = 0.0001(IR 0.048 vs 0.037, respectively). IR was 0.049 amongst white patients (SE 0.002, 95% CI 0.046 – 0.054), 0.021 amongst black patients (SE 0.003, 95% CI 0.015 – 0.029), and 0.031 amongst hispanic patients (SE 0.004, 95% CI 0.024-0.038). Patients between the ages of 75-79 years had the highest IR of 0.241 (SE 0.024, 95% CI 0.197- 0.293). Median overall survival (mOS) was 174 months. 5-year and 10-year CSS was 90% and 84%, respectively. mOS was 180 months in patients who received chemotherapy. mOS was 106 months in adults older than 65 years, compared to those younger (p<0.0001). White patients had the poorest mOS of 161 months (p=0.0042). There was no statistically significant difference in survival outcome based on gender. mOS was 109 months in patients residing in non metropolitan counties compared to mOS of 187 months in patients residing in metropolitan counties (p=0.0005). Summary/Conclusion PPFL primarily affects older adults, with high incidences in males and white patients. Though CSS rates are generally favorable, overall survival was found to be worse in white patients, adults aged > 65, and people residing in non metropolitan counties. These differences highlight potential disparities in disease outcomes and suggest the need for future research into factors influencing survival and access to care for patients with PPFL.

DOI: 10.1002/hem3.70152

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Exploring Disparities in Survival Outcomes of Primary Cardiac Diffuse Large B-Cell Lymphoma (DLBCL): a Seer Database Analysis (2025)

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Conference abstract

Author(s):

Arvind S.; Shaikh G.; *Arunachalam J.; Naagendran M.S.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 3452-3453), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary Cardiac Diffuse Large B-cell lymphoma (DLBCL) representing only 1.3% of cardiac tumors and 0.5% of extranodal lymphomas is an uncommon but aggressive malignancy that exclusively involves the heart or the pericardium. Favorable clinical outcomes depend on early detection and timely treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Little research currently exists on the impact of healthcare access, socioeconomic and demographic factors on survival rates in primary cardiac DLBCL. Aims This study aims to provide an overview of survival outcomes of primary cardiac DLBCL and their association with demographic and clinical factors. Methods We collected data from SEER (Surveillance, Epidemiology, and End Results), which is a program of the National Cancer Institute (NCI) with statistical information on cancer incidence and survival in the United States. From the Research plus data (17 registries, 2000 – 2021), we extracted patients diagnosed with Diffuse large B-cell lymphoma (DLBCL) using the ICD code 9680/3 and having the primary cancer site as heart using code C38.0. Analysis was stratified based on age, sex, race, marital status, median household income and residency. Survival analysis was done with Graphpad Prism software, and survival outcomes were compared using the Log-rank test. Kaplan-Meier curves were used to visualize the data. Results 134 patients with cardiac DLBCL were identified. 64% of the patient population was 65 and older at diagnosis. 56% males and 44% females. 64% White, 14% Hispanic, 5% Black. 92% of patients lived in counties in metropolitan areas with a population ranging from 250,000 to 1 million. The marital status distribution at the time of diagnosis was as follows: 18% were single (never married), 16% were widowed, 4% were divorced, 2% were separated, 0.75% were in a domestic partnership and 54.5% were married. 72% of patients received chemotherapy, and 10% received external beam radiation therapy. Median overall survival (mOS) for primary cardiac DLBCL was 42 months. Cancer-specific survival (CSS) was 130 months. mOS was 144 months in patients under 65 years, and mOS was 26 months in patients aged 65 and older with p value=0.0010 (HR 2.402, 95% CI 1.470 to 3.926). In stage I disease, mOS was 144 months in < 65 and 33.5 months in 65+ (p = 0.0157). In stage IV, mOS was only 9 months in the 65+ age group, compared to those younger with p = 0.0254. mOS were 109 months in those who were married at the time of diagnosis, compared to a mOS of 25 months in those who were not (p value = 0.0030, HR 0.4825 95% CI 0.2867 to 0.8118). No statistically significant difference was found in overall survival when stratified based on sex, race, residency or median household income. Summary/Conclusion While the median cancer-specific survival of cardiac DLBCL was excellent (~ 10 years), the median overall survival was noted to be significantly lower (3.5 years), highlighting non-cancer causes of mortality. However, our analysis shows that advanced age (>65 yrs) has a significant negative impact on survival. While marital status seemed to be associated with better survival, reflecting the role of social support during cancer care, a firm conclusion requires understanding of additional factors. Future studies should explore the factors contributing to the non-cancer causes of mortality in cardiac DLBCL and poorer survival outcomes in the elderly to assist develop strategies to improve outcomes for this subset.

DOI: 10.1002/hem3.70152

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Epidemiological and Survival Trends of Alk-Positive Large B-Cell Lymphoma: a Seer (Surveillance, Epidemiology, and End Results) Study (2025)

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Conference abstract

Author(s):

*Arunachalam J.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of the European Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1319-1321), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL), representing < 1% of all DLBCLs. Tumor growth is driven by ALK gene rearrangements which lead to proto-oncogene activation. Unlike ALK-positive anaplastic large-cell lymphoma (ALCL), ALK+ LBCL shows plasmablastic immunophenotype and often lacks typical T cell (CD2, CD3) and B-cell (CD20, CD79a) markers. It is known to be more aggressive than typical DLBCL due to limited response to conventional systemic chemotherapies like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), with a dismal 5-year OS of 8% in advanced stage disease. Off-label use of ALK inhibitors has demonstrated encouraging results in multiple case studies. Aims This study aims to analyze the incidence trends, and survival outcomes of ALK+ LBCL using the Surveillance, Epidemiology, and End Results database. SEER provides population-based data on cancer incidence, survival, and treatment outcomes by compiling various cancer registries across the U.S. Methods We conducted a retrospective population-based study between 2010-2021 utilizing the SEER database. Using ICD code 9737/3, we identified patients diagnosed with ALK+ LBCL. Demographic data, including age, sex, race, and stage, were collected. Incidence rates (IR) were calculated per 100,000 and age adjusted to the US standard population. Kaplan-Meier survival analysis was performed using GraphPad Prism to estimate overall survival (OS) and cancer specific survival (CSS). Log rank test was used to detect factors associated with survival outcomes. Results A total of 58 cases of ALK+ LBCL were included. IR was 0.0049 (SE 0.0010, 95% CI 0.0031-0.0073) during the years 2010-2015 and 0.0067 (SE 0.0011, 95% CI 0.0047-0.0094) from 2016-2021. IR was 0.0025 (SE 0.0007, 95% CI 0.0013-0.0044), 0.0035 (SE 0.0007, 95% CI 0.0022-0.0053), 0.0028 (SE 0.0008, 95% CI 0.0015-0.0049), and 0.0052 (SE 0.0015, 95%CI 0.0027-0.0091) in the age groups <20 years, 20-44 years, 45-64 years, and 65+ years respectively. Incidence rate ratio (IRR) was 4.08 (95% CI 2.08 – 7.98) when comparing males and females, indicating that incidence rate in males was 4 times higher than in females. 65% of patients presented with advanced stage disease at the time of diagnosis. Median time from diagnosis to treatment was 13 days. mOS median overall survival was 101 months. The 1-year and 10- year CSS rates were 86%, and 68% respectively. mOS was 53 months for those with advanced stage disease at initial presentation. mOS was 17 months for ages >65 years (p=0.0002), compared to those aged less than 65 years. In Ann Arbor stage I disease, mOS was 144 months in patients < 65 years and 33.5 months in 65+ age group (p = 0.0157). In Ann Arbor stage IV disease, mOS was only 9 months in 65+ age group with p value of 0.0254 when comparing with the younger age group. There was no statistically significant difference in survival outcomes based on sex, and race. Summary/Conclusion This is one of the largest retrospective studies on ALK+ LBCL. We found that incidence of anaplastic lymphoma kinase-positive large B-cell lymphoma is more common in males and adults older than 65. Survival outcomes continue to be poor, especially in older adults. Further multicenter research is warranted to explore the genomic framework and discover novel combination therapies, to improve patient outcomes.

DOI: 10.1002/hem3.70152

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