Airedale General Hospital

Abstract Introduction A pus swab specimen can determine the microbiological characteristics of infections and therefore help guide antimicrobial management. The current evidence in their utlity in superfical cutaneous abscesses is limited. Aims Primary AIms: Assess current practice in the use of pus swabs for general surgery patients undergoing incision and drainage of cutaneous abscesses. Methods A retrospective analysis of clinical coded data between 1 January 2023 and 1 January 2024 was performed. Data included location, pus swab use, and if so, were the results reviewed and did they change clinical pratice. A cost analysis was also performed. Results A total of 338 patients were identfied of these, 231 patients were including in the analysis: exclusion was due to lack of data, other speciality, duplication, and coding errors. The most common site of abscesses were: trunk (79), perianal/ischiorectal (58), axilla (28), groin (28), gluteal (11), pilonidal (12) and other (15). A pus swab was sent in 85% (196/231) of cases. 36% (70/196) of results were chased. 4% (3/70) wer used to guide antimicrobial therapy. Of these 4%, two patients had necrotising fasciitis and one had a mesh infection. Out of the 197 swabs taken, over 209 micro-organisms were isolated with an estimated cost of £1733 for the culture and sensitivity testing of these organisms. Conclusions The use of pus swabs generates a significant use of resources and cost with minimal clinical benefit in the use of simple cutaneous abscess in the general surgical patient.

Abstract Aims Despite regular screening for colorectal cancer (CRC) in the UK, one in six patients presents with advanced tumour-causing bowel obstruction. NICE recommends self-expanding metallic stents (SEMS) for left-sided colorectal cancer-related bowel obstruction. ESGE advises SEMS for palliation and in patients with a high risk of mortality. We audited the patients with CRC who were treated with stenting at our hospital. Methods In this retrospective audit, cases of CRC over five years from 2019 to 2024 were identified using our online patient database and input from colorectal nurse specialists. Patients who underwent stenting for CRC with curative intent and for palliation were included in the study. Results Overall, 28 patients underwent colonic stenting during the five years: 15 (54%) male and 13 (46%) female. Of 28, 22 (79%) patients had surgery, 16 (73%) had laparoscopic procedures. Two surgeries were converted to open procedures. Out of 22 patients, 8 (36%) had a stoma. Five patients had surgery for right-sided cancer, while 17 patients had surgery for left-sided cancer. Two (7%) underwent NART, and 7 (25%) received NACT. Fifteen (68%) patients had adjuvant treatment post-procedure. The overall 90-day mortality was around 18%. Conclusion Colonic stenting for CRC is a feasible and effective approach for obstructing CRC, which can be used as a bridge to surgery. This helps to optimise and stage the patient to provide the best treatment plan. The CReST trial reported a significant reduction in stoma formation (47.5%) in patients who were stented, which has been reflected in our study.

IntroductionSouth Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients.MethodThe UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed.ResultsOf the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, P<0.001). Despite adjustment for traditional AF risk factors, South Asians had a significantly lower OR of AF compared to white British stroke patients (OR: 0.40, 95%CI: 0.33:0.49, P<0.001). Among confirmed AF cases, 31.8% of South Asians and 41.4% of white British were untreated at admission (P = 0.02). Antiplatelet treatment was significantly higher among South Asians at both admission (South Asian: 47.4% vs. white British: 29.9%, P<0.001) and discharge (South Asian: 49.5% vs. white British: 34.7%, P = 0.001), although anticoagulation treatment was similar across both ethnic groups at admission (South Asian: 28.5% vs white British: 28.1%, P = 0.93), and discharge (South Asian: 45.1% vs white British: 43.1%, P = 0.64).ConclusionStroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.

This article presents a discussion based on a case study of an eight-month-old boy with petechial rash who presented at the emergency department (ED). Blood tests were obtained and intravenous antibiotics were administered. The patient was admitted to the children's ward and was discharged the next day. It was suspected that the rash was caused by a non-specific viral illness. Non-blanching rashes, such as petechial rash, in well children often lead to diagnostic and treatment dilemmas in the ED. Clinicians fear missing the diagnosis of invasive meningococcal disease, which results in blood tests, cannulation and early administration of antibiotics. Non-blanching rashes have many potential causes and extensive tests and antibiotic treatment may not always be necessary and have the potential to cause harm. A tailored approach to investigate, treat and discharge well children with petechial rash from the ED is advocated.

Abstract Introduction Laparoscopic colorectal cancer resection (LCCS) has been shown to reduce blood loss when compared to open surgery. There are no national guidelines regarding need for pre-operative group and save(G&amp;S) sampling in LCCS patients. Our study aims to assess the necessity of G&amp;S samples through identifying rates of post-operative transfusion following LCCS. Methods Retrospective study of all patients who underwent LCCS between 1st January 2019 and 31st December 2019. Results Of 102 surgical procedures, 42 right hemicolectomy, 21 anterior resection, 19 sigmoid colectomy, 12 left hemicolectomy, and 8 APER. The median age was 67(range 56-86) years. All received two valid G&amp;S samples. 13 cases were converted. The median pre-operative haemoglobin was 127g/L, and median post-operative haemoglobin was 114g/L. The median blood loss was &amp;lt;100mls. Only 4(3.9%) patients required post-operative transfusion, 3 of whom were converted due to intra-operative bleeding. The fourth case had decreased haemoglobin post-operatively without need for return to theatre. A significant difference was evident in pre-operative haemoglobin level in patients who needed transfusion compared to those who did not (P = 0.031). A total of 9 units were transfused. Twenty-one pre-operative cross-matched units were not used. Conclusion Evidently, blood transfusion is most likely required in open conversion cases due to intra-operative blood loss, as well as in patients with low pre-operative haemoglobin. A patient specific approach to assessing requirement for pre-operative G&amp;S in elective LCCS patients is required to improve cost-effectiveness, particularly taking into account those with normal pre-operative haemoglobin.

Dyslipidemia is a very common medical disorder affecting nearly 33.5% of US adults over 20years of age. It represents the major risk factor for non-alcoholic fatty liver (NAFLD) and cardiovascular diseases, which is the most common cause of death worldwide. Elafibranor is a peroxisome proliferator-activated receptor (PPAR) alpha and delta dual agonist. A novel dual peroxisome proliferator-activated receptor alpha/delta (PPAR-α/δ), elafibranor, the agonist is an emerging therapy with promising hepatoprotective results. To estimate the efficacy of elafibranor in patients with liver abnormalities especially non-alcoholic steatohepatitis (NASH). We searched the following databases: PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant clinical trials assessing the use of silymarin in patients with NAFLD. Risk of bias assessment was performed using Cochrane's risk of bias tool. We included the following outcomes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), HOMA-IR, total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C). We included four clinical trials. We found that elafibranor significantly reduced the levels of ALT {MD = -4.60 [-8.17, -1.04], (P = 0.01)}, GGT {MD = -16.57 [-26.59, -6.56], (P < 0.01)}, TC {MD = -0.37 [-0.66, -0.08], (P = 0.01)}, TG {MD = -0.37 [-0.51, -0.24], (P < 0.01)}, ALP {(MD = -14.45 [-18.99, -9.91], (P < 0.01)}, and LDL {MD = -0.20 [-0.33, -0.07], (P = 0.003)}. There was no significant difference regarding HOMA-IR {MD = -0.32 [-0.88, 0.24], (P = 0.26) and AST (P = 0.53). PPAR-alpha/delta dual agonist, elafibranor, is a promising drug that improves most metabolic parameters in dyslipidemic patients.

ABSTRACT Introduction Raman and Infrared spectroscopic techniques are being used for the analysis of different types of cancers and other biological molecules. It is possible to identify cancers from normal tissues both in fresh and fixed tissues. These techniques can be used not only for the early diagnosis of cancer but also for monitoring the progression of the disease. Furthermore, chemical pathways to the progression of the disease process can be understood and followed. Areas covered More recently, Artificial Intelligence (AI), Neural Network (NN), and Machine Learning are being combined with spectroscopy, which is making it easier to understand the chemical structural details of cancers and biological molecules more precisely and accurately. In this report, these aspects are being outlined by using breast cancer as a specific example. Expert opinion A pathway showing to combine vibrational spectroscopy with AI and ML has immense potential in predicting various stages of different disease processes, in particular, in cancer diagnosis, staging, and designing treatment. This will result in improved patient care pathways.

Multi-agency working to safeguard children is increasing in the UK. Nurses encounter children who are at risk of, or subject to, abuse and neglect. They are required to be able to recognise indicators that suggest a child may have been abused or neglected and know what actions to take in response as part of their role. Without support to manage the negative effects of their involvement in safeguarding children, nurses can become stressed, and prolonged stress can lead to difficulty engaging in future cases. To explore the experience of nurses involved in safeguarding children and to identify the systems they access to support them with the emotional effects of this work. This was a phenomenological study that involved semi-structured interviews. The eight study participants were hospital-based nurses who worked in children's areas and were involved in safeguarding children work. Thematic analysis was undertaken to identify themes from the data. The study identified some of the emotional effects of safeguarding children work experienced by nurses, which can be long lasting. It found that these nurses access various support systems in relation to their safeguarding work, such as case discussion, team support, child supervision and training. It is important that managers understand the potential effects of safeguarding children work, so that they can ensure nurses have access to appropriate support. Managers should also promote access to support systems and address barriers that prevent nurses from accessing them.