Impact of faecal haemoglobin based triage of bowel symptoms presenting to primary care on colorectal cancer diagnosis.

AIM: Faecal immunochemical testing (FIT) for faecal haemoglobin was introduced into primary care in National Health Service Tayside in 2015 as an adjunct to clinical assessment of new bowel symptoms. We aimed to assess the impact of FIT-based triage in primary care on colorectal cancer (CRC) diagnosis. METHOD: Cancer audit data between January 2016 and December 2019 were reviewed to identify all patients diagnosed locally with CRC. The mode of presentation and stage at diagnosis were noted and patient records were interrogated to identify whether FIT and full blood count (FBC) had been performed prior to referral. Results were compared between the FIT and non-FIT groups. RESULTS: In all, 1245 patients were diagnosed with CRC of whom 581 (46.7%) presented through primary care. FIT was performed prior to referral in 440/581 (75.7%), with the proportion increasing from 62.3% in 2016 to 85.8% in 2019. At faecal haemoglobin ≥10 µg Hb/g faeces, sensitivity for CRC was 94.1%. Over the study period the annual proportion of non-emergency presentations increased significantly; presentations from primary care increased from 43.1% to 53.5% (P = 0.0096). After excluding non-FIT patients who had an overt CRC at referral, there was no difference in stage at diagnosis between FIT and non-FIT cancers. Safety-netting with FBC was widely used in our cohort with 97.3% of FIT patients having also had FBC. CONCLUSION: FIT-based triage of new bowel symptoms in primary care is associated with increased non-emergency presentation of CRC but this did not influence stage at diagnosis.

Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy.

GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.

Climate Change and Gastroenterology: Planetary Primum Non Nocere and How Industry Must Help.

Climate change is a global emergency. Increasing awareness has led to policy changes regarding global industry emissions. The healthcare industry carbon footprint is large and growing more and more. Gastroenterology, with its heavy reliance on industry, is a major contributor toward this growth. For a significant change toward reducing the field's carbon footprint, it would involve serious industry commitment. At present, there are no clear guidelines or regulations on controlling healthcare-related industry emissions and improving sustainability. This narrative review aims to provide practical suggestions at each step of the supply chain can lead to greater sustainability.

In-patient hospital mortality patterns by day of the week: an analysis of admissions to a regional renal unit.

BACKGROUND AND AIMS: Higher mortality rates have been reported for patients admitted at a weekend compared to a weekday. Our aim was to assess in-patient mortality patterns by day of the week, in a tertiary renal unit. METHOD AND RESULTS: Mortality related to day of admission and day of death was analysed over a two-year period at Glasgow Western Infirmary renal unit. Typical caseload was also assessed over two random four-week periods. As a proportion of admissions, 30-day mortality was 46/540 (8.5%) on a weekend day compared with a weekday 107/2013 (5.3%) (RR1.60, p = 0.005). Thirty-day mortality rate was 46/208 = 0.22 deaths/weekend day of admission compared with 107/523 = 0.20 deaths/weekday of admission (incident rate ratio = 1.08, p = 0.67). There was no significant increased risk of death on a weekend day compared to a weekday (RR1.23, p = 0.23). A higher proportion of weekend admissions were from other hospitals. Acute kidney injury and haemodialysis patients formed a higher percentage of admissions. CONCLUSION: Admission day mortality expressed as a death rate/day does not differ between weekend/weekday admissions. Admission day mortality expressed as a proportion of total admissions was significantly higher at weekends. This suggests admission case-mix/workload differs at weekends with fewer 'well' patients admitted. In-patient mortality patterns are complex and any conclusions made should take into account case mix and workload.

A case of posterior reversible encephalopathy syndrome in a child with Crohn's disease treated with Infliximab.

BACKGROUND AND AIMS: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterised by headache, seizures, visual disturbance, altered mental status and vasogenic oedema on neuro-imaging. We report a rare case of PRES in a 8-year-old female with Crohn's disease (CD) following Infliximab administration and colectomy. METHOD: Clinical case reported including a review of current literature regarding PRES and Infliximab. RESULTS: This is one of several cases of PRES reported recently in proximity to Infliximab administration. CONCLUSIONS: Awareness of this rare condition in patients receiving immunosuppressive treatment is important to prevent poor outcomes for patients. The increasing number of these cases recognised in patients receiving Infliximab should be kept under close clinical surveillance due to the possibility of a link between the two.