A multicentre study assessing the role of routine colonoscopy after acute uncomplicated diverticulitis and the incidence of colorectal cancer diagnosis.

PURPOSE: The low rates of colonic malignancy detected on interval colonoscopy for patients diagnosed with diverticulitis have led recent studies to question the utility of the practice. The aim of this study was to assess the detection rate of colorectal cancer on colonoscopy for patients with a first episode of acute uncomplicated diverticulitis across three separate centres in Ireland and the UK. METHODS: A retrospective review was performed of patients with a first episode of acute, uncomplicated diverticulitis who underwent interval colonoscopy at three separate centres in the UK and Ireland between 2007 and 2019. The follow-up period was one year. RESULTS: A total of 5485 patients were admitted with acute diverticulitis between the three centres. All patients had CT verified diverticulitis. A 90.8% (n = 4982) underwent subsequent colonic evaluation with colonoscopy. Of these, a histologically proven diagnosis of colorectal carcinoma was made in 1.28% (n = 64). CONCLUSION: Routine colonoscopy following an episode of acute, uncomplicated diverticulitis may not be necessary in every patient. It may be appropriate to reserve this more invasive investigation for those with higher risk factors for malignancy.

Analysis of Different Routes of Hysterectomy Based on a Prospective Algorithm and Their Complications in a Tertiary Care Institute.

Introduction: Hysterectomy is the most common gynaecological operation worldwide. The objective of the study is to analyze the various routes of hysterectomy and its complications when the decision of route is based on using a prospective algorithm tree. Methodology. It is an observational study to analyze the route of hysterectomy based on using a prospective algorithm. The decision tree is based on pelvic pathology, uterine size, vaginal access, pelvic adhesion, competency of the surgeon, choice of the patient, and complication of different routes of hysterectomy. Data were collected from preoperative, intraoperative, and postoperative records. Demographic factors, indications, routes of hysterectomy, and complications were recorded and analyzed by using SPSS software version 22. Observation. Among the malignant or suspected malignant pathology groups, TAH was performed in 89 cases and TLH was performed in 3 cases. Among the benign disease groups, VH was performed in 137(38.2%) cases, TAH was performed in 118(32.9%) cases, and TLH was performed in 104 (28.9%) cases. Operative time and a number of blood transfusions were significantly less with VH (p value < 0.0001 and 0.004) compared to abdominal and total laparoscopic hysterectomy. Postoperative complication such as fever was more with abdominal hysterectomy (p-value<0.00001) compared to VH and TLH. Vaginal discharge was more with VH and TLH compared to TAH (p value -0.004) and wound infection was more in the abdominal route (p value 0.001). Conclusion: The abdominal route was the route of choice for surgery in malignancy or suspected malignant pathology. In benign pathology, VH was the most common and preferable route of surgery. Complications were found to be minimal with vaginal hysterectomy.

Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India.

Introduction Hypertensive disorders frequently complicate pregnancy and contribute substantially to maternal and perinatal morbidity and mortality. Identification of risk factors for hypertensive disorders of pregnancy (HDP) can help determine the particular patient group which requires appropriate intervention. Methods This prospective cross-sectional hospital-based study conducted from January 2016 to January 2019 included all pregnant women beyond 20 weeks of gestation complicated by HDP. The objectives were to determine the incidence of HDP and associated maternal and perinatal mortality and morbidity rates along with factors influencing it. Data collected were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed with the Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY). Results In our study, out of 5460 deliveries, 402 (7.4%) cases had HDP, 27.6% had gestational hypertension, 27.6% had mild preeclampsia, 33.6% had severe preeclampsia, and 11.2% had eclampsia. Fifty-four (13.4%) cases required admission in the intensive care unit and 12 (2.9%) ended in maternal deaths. The cause of maternal mortality was cerebral hemorrhage in eight (66.6%) cases and pulmonary edema in four (33.3%) cases. All maternal deaths occurred in women with severe preeclampsia and eclampsia and eclampsia was significantly higher. Maternal deaths were more when systolic blood pressure (SBP) was ≥ 160mmHg, diastolic blood pressure (DBP) was ≥ 110mmHg, significantly more with 3+ proteinuria, but no association was found with age, parity, booking status, socio-economic status, gestational age, or mode of delivery. All mothers with HDP received treatment with antihypertensives. There were 60 (14.9%) cases of perinatal mortality. Perinatal deaths were more in unbooked cases and preterm HDP, significantly more with SBP ≥160 mmHg, DBP ≥110 mmHg and ≥2+proteinuria, but no association was found with parity or mode of delivery. Besides mortality, there was a significant burden of maternal and perinatal morbidity, which was more in women with severe preeclampsia and eclampsia. Conclusion Routine antenatal screening for HDP in all pregnant women with appropriate and timely interventions in women at risk may help reduce HDP-related maternal and perinatal morbidity and mortality.

Is Elective Cancer Surgery Safe During the COVID-19 Pandemic?

BACKGROUND: The COVID-19 pandemic has resulted in a significant decrease in the number of elective cancer operations performed. Cancer patients are felt to be a high-risk group for COVID-19, and therefore, concerns have been raised regarding the safety of operating during this time; however, the potential risk of cancer progression if untreated must also be considered. The aim of this study was therefore to identify the incidence of COVID-19 post-operatively in patients undergoing elective cancer surgery of all types. METHODS: Data were collected on all patients who had an elective therapeutic cancer operation in a single large district general hospital, where standard COVID-19 precautions were in place, between 01/02/2020 and 27/4/2020, Follow-up was for a minimum of 2 weeks post-discharge. The primary outcome was the incidence of COVID-19 during the follow-up period. RESULTS: A total of 621 elective cancer surgeries, from a range of specialities, were performed during the study period, with 55% (n = 341) being done as day cases. None of the patients were positive for COVID-19 post-operatively using reverse transcriptase polymerase chain reaction testing. CONCLUSIONS: The risk of COVID-19 following elective cancer surgery in this group of high-risk patients appears to be minimal in this study. With further precautions being introduced to reduce the risk of transmission of COVID-19, an increase in the rate of elective cancer surgery should be a current priority for all hospitals where possible.

The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital.

INTRODUCTION: Patients with suspected pancreaticobiliary cancers frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) to obtain brush cytology for confirmatory diagnosis. The outcome of this often leads to the management of the patient and can avoid more invasive investigations. There is a wide range of sensitivities and specificities reported in the literature. AIMS: To determine the accuracy of the brush cytology obtained at ERCP by performing a retrospective audit of all patients admitted to Guy's and St. Thomas' Hospital for ERCP during 2008-2013. Also, to evaluate the impact of cytology results on patient care following ERCP. METHOD: Data were collected from 4 January 2008 to 27 December 2013. This involved analysing EndoSoft (the in-house software for endoscopic data entry), Pathnet (the pathology database) and Electronic Patient Records. RESULTS: 162 patients underwent brush cytology during ERCP. 58 patients had positive cytology. With intention-to-treat analysis, sensitivity was 54.7%, specificity was 100.0% and negative predictive value was 53.9% with a positive predictive value of 100%. Patients with a positive brush cytology result required fewer investigations compared with patients with a negative cytology result. CONCLUSIONS: Our results compare favourably with previous studies in the field. Brush cytology has been ignored in recent times due to perceived poor results and efficacy. Our audit shows that it can reduce the number of investigations required to reach a diagnosis of malignancy and so is a valuable tool in the diagnosis of pancreaticobiliary malignancies. However, better guidance on preparation of samples for cytology is needed to reduce the number of insufficient samples.

Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

RATIONALE, AIMS AND OBJECTIVES: In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. METHODS: Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. RESULTS: Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. CONCLUSION: Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.