specialist centre
Recently Published Documents


TOTAL DOCUMENTS

175
(FIVE YEARS 67)

H-INDEX

18
(FIVE YEARS 2)

Author(s):  
Andrew R Melville ◽  
Karen Donaldson ◽  
James Dale ◽  
Anna Ciechomska

Abstract Objective To externally validate the Southend GCA Probability Score (GCAPS) in patients attending a GCA Fast-Track Pathway (GCA FTP) in NHS Lanarkshire. Methods Consecutive GCA FTP patients between November 2018 and December 2020 underwent GCAPS assessment as part of routine care. GCA diagnoses were supported by USS +/- TAB and confirmed at 6 months. Percentages of patients with GCA according to GCAPS risk group, performance of total GCAPS in distinguishing GCA/non-GCA final diagnoses, and test characteristics using different GCAPS binary cut-offs, were assessed. Associations between individual GCAPS components and GCA, and the value of USS and TAB in the diagnostic process, were also explored. Results 44/129 patients were diagnosed with GCA, including 0/41 GCAPS low risk patients (GCAPS <9), 3/40 medium risk (GCAPS 9–12), and 41/48 high risk (GCAPS >12). Overall performance of GCAPS in distinguishing GCA/non-GCA was excellent [ROC AUC 0.976 (95% CI 0.954–0.999)]. GCAPS cut-off ≥10 had 100.0% sensitivity and 67.1% specificity for GCA. GCAPS cut-off ≥13 had highest accuracy (91.5%), with 93.2% sensitivity and 90.6% specificity. Several individual GCAPS components were associated with GCA. Sensitivity of USS increased by ascending GCAPS risk group (nil, 33.3%, 90.2% respectively). TAB was diagnostically useful in cases where USS was inconclusive. Conclusion This is the first published study describing application of GCAPS outside the specialist centre where it was developed. Performance of GCAPS as a risk stratification tool was excellent. GCAPS may have additional value for screening GCA FTP referrals and guiding empirical glucocorticoid treatment.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Katie Gray ◽  
Mridul Rana ◽  
Carlo Ceresa ◽  
Venkatesha Udupa ◽  
Zahir Soonawalla ◽  
...  

Abstract Background A considerable number of patients undergoing pancreaticoduodenectomy require supplemental nutrition in the postoperative period. However, there remains no national consensus on the optimal postoperative supplemental feeding modality. Furthermore, at our institution a variation in practice exists when considering post-operative entera (via the naso-jejunal (NJ)) or parenteral nutrition (PN). This study aimed to evaluate the utility of post-operative enteral or parenteral nutrition at our centre and to explore risk factors predisposing patients to post-operative nutritional deficits requiring supplementation.  Methods We retrospectively analysed the electronic case records of all patients undergoing a pancreaticoduodenectomy between November 2019 and November 2020 at our HPB specialist centre. Key patient demographic data and post-operative nutritional requirements with route, length and indication for supplemental feeding as well as biochemical markers, length of stay (LoS) and complications were collected and analysed. Data were analysed via intention to treat analysis. Results 48 patients underwent a pancreaticoduodenectomy, of which 26 had an NJ tube inserted intra-operatively. 16 (33%) patients required supplemental feeding, via NJ route in 7 and PN in 9. 2 patients were intolerant to NJ feeds and progressed to PN. NJ fed patients had shorter LoS (12(10-42) vs. 28(14-63) days)(p = 0.09) compared to PN feeding. PN-related line infection or thrombosis in 4 (36%) patients. Supplemental feeding met daily kcal requirements in 13 (81%) patients, but PN was associated with greater weight loss (-5%) than NJ feeding (-3%). Significantly increasing the risk of needing supplemental nutrition: advanced age(p = 0.04), ASA≥2(p = 0.04) and anastomotic leak(p = 0.02). Conclusions In this group of patients, NJ feeding was largely well-tolerated and the majority of patients met their required daily kcal via this route. Due to the increased incidence of complications associated with PN, NJ feeding should be considered as the 1st line option for post-operative nutritional supplementation, with intra-operative insertion of an NJ tube considered for higher-risk patients.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Helen Whitmore ◽  
Rola Salem ◽  
Matt Browning ◽  
Kirk Bowling ◽  
Petros Christopoulos ◽  
...  

Abstract Background Acute pancreatitis or inflammation of the pancreas is a common surgical pathology that presents with a spectrum of severity. The condition itself ranges from a mild/moderate self-limiting pathology to one associated with a systemic inflammatory response that can lead to organ dysfunction and death. We aim to investigate the aetiology/management and outcomes of patients presenting with pancreatitis in a benign specialist surgical unit with dedicated upper GI surgical care. Methods A retrospective analysis of all patients presenting and falling under surgical care with biochemical/radiological pancreatitis was conducted, using hospital archiving systems, reviewing operative notes and follow up events was conducted over an 8-year period. Results Within our benign specialist centre, 1393 patients were treated over an 8-year period. 73% of patients presenting with acute pancreatitis were male, whereas only 37% were female. The age range of patients presenting was 12 to 100 years, with the median age being 44 years. Within our population, 36.8% of acute pancreatitis was caused by gallstones, and 29.6% caused by alcohol and 33.6% other causes. 81% of patients seen had mild/moderate self-resolving pancreatitis requiring only fluids and analgesia. 19% had complicated pancreatitis requiring complex medical/surgical treatment.4.8% patients developed pancreatic necrosis, and 3.7% developed pancreatic pseudocysts. 8 patients required necrosectomy, 19 patients required cystogastrostomy and 1 patient required distal pancreatectomy with no 90-day mortality. Conclusions Our specialist unit with the support of gastroenterology, nutrition team, radiology and ITU have managed a large cohort of pancreatitic patients, the small number patients who require a surgical intervention have had good outcomes.


2021 ◽  
pp. 00508-2021
Author(s):  
Oleksandr Khoma ◽  
Jin-soo Park ◽  
Felix Michael Lee ◽  
Hans Van der Wall ◽  
Gregory L Falk

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.


2021 ◽  
pp. 1-7
Author(s):  
Steve Jones ◽  
Leanne Smith ◽  
Katie Ainsworth

Background: The COVID-19 pandemic has seen working practice in Cystic Fibrosis (CF) move to more remote clinical models. This study assesses the impact of shifting working models on the relationships between families of young people with CF and CF Multi-disciplinary Teams (MDT) as well as parents perceptions of working remotely. Methods: Six semi-structured interviews with parents of young people under the care of a regional UK CF specialist centre were analysed using Inductive content analysis. Results: Three domains emerged: Interpersonal Relationships, Remote Clinics and CF in the Context of COVID-19. The enduring and close relationships between the MDT and families were discussed as well as the acceptability of remote clinics moving forwards. Conclusions: The importance of the quality in the relationship between families and CF MDTs is vital to enhance ongoing care. Remote working was acceptable in the context of COVID-19 and with some considerations could be useful moving forwards.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rebecca Swan ◽  
Nicholas Ventham ◽  
Dimitrios Damaskos

Abstract Aims Within this region, Upper GI and Colorectal subspecialties are located at separate hospitals. This study aims to determine outcomes of critically unwell patients undergoing emergency colorectal surgery off-site at the non-colorectal specialist centre. Methods An observational retrospective study of emergency colorectal laparotomies at a major acute teaching hospital (non-colorectal specialist centre) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. The NELA predicted mortality risk was obtained from notes or retrospectively calculated. Subgroup analysis of colorectal surgeon involvement was performed.  Results One hundred and eighteen patients were included (median age 64 years, 55% female).  The median NELA mortality score was 5.8% (IQR 1.9 – 14.7%). The 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 31%. Patients having an anastomosis had a lower median NELA score compared those patients who did not (1.6% vs. 7.85%). Forty five (38%) patients had Clavien-Dindo grade IV-V complication. Colorectal Surgeon involvement in the operation (23/118), was associated with a lower 30-day mortality (17.4% colorectal surgeon vs. 23.2% emergency general surgeon alone) albeit in patients with a lower median NELA score (4.5% vs. 6.7%) and a similar rate of primary anastomosis was achieved (31.6% vs. 30.9%). Conclusions The high mortality rate highlights a specific group of acutely unwell patients unfit for transfer to the subspecialist unit. Good outcomes were seen where a colorectal surgeon was involved, however a similar rate of primary anastomosis was demonstrated.


Sign in / Sign up

Export Citation Format

Share Document