Altnagelvin Area Hospital

Vitamin D is a key regulator of musculoskeletal growth, immune regulation, and cognitive function in children. As children in the United Kingdom (UK) and Ireland are at risk of vitamin D deficiency due to the northern latitude, supplementation is recommended. To our knowledge, the effect of supplementation on status and related health outcomes has not been investigated in children residing in the UK/Ireland. To examine the effect of vitamin D3 supplementation on vitamin D status and related health outcomes in children. The D vitamin in children study was a double-blind, randomized, placebo-controlled trial, conducted among healthy children (aged 4-11 y). Children received 12 wk of either 10 μg/d vitamin D3 or a placebo devoid of vitamin D (control) in the form of an oral spray. The primary outcome, plasma 25-hydroxyvitamin D, and secondary outcomes, including grip strength, balance, cognitive function, winter status, immune markers, and bone turnover markers, were assessed pre- and postintervention. One hundred eighteen participants completed the study (mean age 8.1 ± 1.8 y; 51% girls). Supplementation significantly increased 25-hydroxyvitamin D concentration (from 66.31 ± 17.26 nmol/L to 69.04 ± 16.93 nmol/L) compared to a decline in the placebo group (63.67 ± 19.48 nmol/L to 56.29 ± 18.58 nmol/L; P < 0.001) and prevented deficiency during the extended winter months. No effects were observed on muscle function, cognitive function, immune function, or bone turnover markers. Vitamin D insufficiency is prevalent in UK/Irish children, and supplementation in the form of an oral spray is effective in achieving/maintaining an adequate status in most children. Further research is warranted to elucidate mechanisms underpinning nonresponse to supplementation and to further investigate the potential beneficial effects of supplementation on cognitive function. This trial was registered at clinicaltrials.gov as NCT05018988.

Abstract Background Symptom-based triage systems can be unreliable in deciding which patients require colonoscopy. Faecal calprotectin (FC), is thus often used to guide referrals, as it rises in inflammatory bowel disease (IBD) due to neutrophilic infiltration of intestinal mucosa (1). Although its role as a screening tool for IBD is debated, FC shows a sensitivity of around 93% and specificity of 94% in distinguishing IBD from non-inflammatory conditions (2). The British Society of Gastroenterology (BSG) recommend local audit to guide the FC threshold for endoscopy referral (3). In the Western Trust, FC values &amp;lt;50µg/g make IBD unlikely, 50-150µg/g warrant repeat testing after two weeks and values &amp;gt;150µg/g suggest IBD and prompt onward referral. This retrospective study of 8,264 patients in the Western Trust aimed to establish the FC level most strongly associated with positive colonoscopy findings. Methods A retrospective observational study was conducted on patients who had a colonoscopy between 2022 and 2024. Reports were reviewed using the Northern Ireland Electronic Care Records (NIECR) to compare referral reasons, colonoscopy findings and FC levels. Referral reasons included raised FC (&amp;gt;50µg/g), altered bowel habit (ABH), per rectal (PR) bleeding, IBD screening, Iron deficiency anaemia (IDA) workup, and polyp or cancer screening. Colonoscopy findings were categorised as polyps, diverticulosis, haemorrhoids, known IBD, non-specific inflammation, tumours, new IBD or normal. Results Referral reasons were polyp or cancer screening (3,060), ABH (2,058), PR bleeding (1,627), IDA workup (446), raised FC (413), and IBD screening (660). Colonoscopy findings were coded as polyps (2,959), diverticulosis (1,736), haemorrhoids (941), known IBD (453), non-specific inflammation (248), tumours (161), new IBD (63), and normal results (1,689). Among the 413 patients referred for raised FC, 25 (6%) were newly diagnosed with IBD (average age 46). The remaining 38 new IBD cases arose from other referral categories, including PR bleeding (12), IBD screening (8), ABH (9), cancer screening (5) and IDA workup (4). 70% of new IBD patients had FC levels &amp;gt;300µg/g. Of the remaining 350 patients referred for raised FC who did not have IBD, colonoscopy showed haemorrhoids in 43, diverticulosis in 98, polyps in 62, non-specific inflammation in 24, tumours in 7 and normal findings in 116. Conclusion Although FC levels above 300 µg/g are associated with IBD, elevated results are also seen in a substantial proportion of patients with non-inflammatory findings. FC should thus be interpreted in the overall clinical context rather than as an isolated indicator. Locally validated FC thresholds are therefore essential to ensure appropriate use of endoscopy services.

Patients with ankylosing spondylitis (AS) are vulnerable to cervical spinal fractures despite minute trauma. As there is a lack of consensus on which surgical approach is the most efficacious in treating cervical spinal fractures in AS patients, we sought to compare the posterior-only and combined (anterior-posterior) approach regarding intraoperative and postoperative complications. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (ID: CRD42024284877). Studies published up to May 20, 2025, were searched in PubMed, MEDLINE, and CENTRAL (Cochrane Central Register of Controlled Trials) with predetermined terms. Studies reporting outcomes, including intraoperative and postoperative complications and mortality rate, were evaluated. Included studies underwent a risk of bias assessment. Seventeen studies (one prospective, 16 retrospective) involving 858 patients (with AS and cervical spine fractures) with an average age of 59.9 years were included. The most common mechanism of injury was minor trauma (173, 66%), and C6-7 was the most common level injured (185, 50.6%). Although the posterior-only approach yielded fewer intraoperative complications (4 (4.8%) vs. 2 (15%); p>0.05), postoperative complications (17 (7.5%) vs. 16 (22.6%); p>0.05), and instrument-related complications (1 (2.8%) vs. 3 (12.5%); p>0.05) compared to the combined approach, the difference was not statistically significant. However, the combined approach recorded a significantly lower mortality rate (3 (9.2%) vs. 13 (24.5%); p>0.05) when compared with the posterior-only approach. The results of this systematic review suggest that both the combined and posterior-only approaches have advantages and disadvantages and approach selection should be done on a case-by-case basis. Future randomized controlled trials directly evaluating the efficacy of surgical approaches in such patients are needed to form a consensus.

<h3>Introduction</h3> The National Health Service (NHS) has been working to reduce its carbon footprint since 2008.¹ More recently a target has been made to achieve net zero by 2045 for emissions the NHS has the ability to influence.² It is estimated that 5% of NHS England’s carbon footprint is secondary to patient travel.^{1 2} In Northern Ireland, all Hepatology patients requiring care from a level 2 centre have been cared for at the Royal Victoria Hospital (RVH) in Belfast. For a cohort of these patients this requires significant travel for reviews. <h3>Methods</h3> In January 2025, following the appointment of a District General Hepatologist at Altnagelvin Area Hospital (AAH), Londonderry, an outreach clinic was set up. The aim was to provide care closer to home for patients requiring level 2 Hepatology input, with an added benefit of reducing CO2 emissions. A full day clinic was provided by a visiting Hepatologist from the Level 2 centre and local Hepatologist. A second clinic was held in April 2025, with an ongoing plan for 3 monthly clinics. To date, a total of 26 patients have been seen at the clinics, with a total 28 patient visits. The distance for return journeys to the RVH and AAH were recorded for each patient visit and the total distance saved was calculated. An estimate was then made of the CO2 emissions saved, based on the average CO2 emissions for a new petrol car in 2022 of 143.0 g/km.³ In reality the savings may be higher. <h3>Results</h3> The average distance saved per patient was 124.3 miles, with a median of 138.6 miles. The total number of miles saved for patients was 3481.6 miles. The estimated total CO2 emissions saved was 736.80kg, accounting for the visiting Consultant’s travel. On average each patient saved 28.62 kg in CO2 emissions, with a median of 31.90kg. The minimum average time saved per patient journey was over 2 hours, with a median of 138 minutes saved per visit. Feedback from patients on this change was overwhelmingly positive. There was only one patient who would have preferred to attend the RVH due to road quality and equidistant to both hospitals. <h3>Discussion</h3> The implementation of a Hepatology outreach clinic in AAH shows clear benefit to patients with reduced distance and travel time. The CO2 emission reductions from the provision of this service is notable and will only be multiplied over time. <h3>Reference</h3> Tennison, Imogen <i>et al</i>. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. <i>The Lancet Planetary Health</i> 2021;5(2):e84–e92 DOI: 10.1016/S2542–5196(20)30271–0 NHS England. (2022) Delivering a ‘Net Zero’ National Health Service. London. (p4, p14.). Department for Transport &amp; Driver and Vehicle Licensing Agency (DVLA). (2023) Vehicle licensing statistics: 2022. Available at: https://www.gov.uk/government/statistics/vehicle-licensing-statistics-2022/vehicle-licensing-statistics-2022 (Accessed: 29 May 2025).).

Abstract Aim The Association of Upper Gastrointestinal Surgeons (AUGIS) recommends common bile duct stone (CBDS) extraction via single-stage Laparoscopic cholecystectomy (LC) and Bile duct exploration (BDE) as the preferred approach. This improves cost-effectiveness, resource utilisation, and hospital stay. We evaluated five-year experience focusing on success rates of BD clearance, complications, and predictors of outcomes. Method All BDE cases at Altnagelvin Area Hospital from January 2019 to July 2024 were included. Data were collected on liver function tests (bilirubin, alkaline phosphatase [ALP], gamma-glutamyl transferase [GGT]), common bile duct (CBD) diameter in pre-operative USS and MRCP, intraoperative findings, and postoperative outcomes. Complications necessitating further intervention were recorded. Results Of 80 BDE procedures, 19 (23.8%) had initial ERCP attempts, with 8 (10%) abandoned, 7 (8.8%) unsuccessful in clearing the ducts, and 4 (5%) requiring BDE. Mean bilirubin was 47±57.06 μmol/L with 44(55%) having normal bilirubin, ALP 306±283 U/L, and GGT 517±480 U/L. CBD diameter averaged 10.66±2.6 mm. Procedures were predominantly laparoscopic (73, 91.3%), with 4 (5%) requiring conversion to open surgery and 2 (2.5%) planned as open. Complete clearance was achieved in 74 (92.5%) and intraoperative cholangiogram (IOC) was performed in 59 (73.8%). Postoperative ERCP was required in 6 (7.5%), and 3 (3.75%) underwent reoperation for complications, including bile leaks. Conclusions LCBDE is the preferred approach for patients with a CBD diameter &amp;gt;7 mm. Our data suggested bilirubin is an unreliable predictor for CBDS; a triple assessment combining clinical presentation, liver function tests, and radiological evidence offers better diagnostic accuracy.

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Alcohol and drug dependent individuals have consistently exhibited elevated impulsivity and some studies have indicated that impulsivity recorded in young adults predicts future alcohol abuse. Research also indicates that depressed individuals with higher impulsivity are more likely to report suicidal ideation even when they are less depressed, which may indicate that impulsivity could more strongly predict suicidality than severity of depressive symptoms. The aim of this study was to investigate the mediating role of impulsivity on suicidal behaviour and self-harm among students with depression, alcohol and substance abuse disorders. Participants were first-year undergraduate students (n=1829) across Ulster University (NI) and Letterkenny Institute of Technology - now known as Atlantic Technological University Donegal (ROI), who were recruited as part of the World Mental Health International College Student Initiative. Participants completed an online survey utilising the WMH-Composite International Diagnostic Interview Screening Scales (CIDI-SC). Mediation analyses were conducted in three different stages. A high prevalence of depression and substance use disorders, suicidal ideation, plans, attempts and self-harm were observed. Impulsivity was found to partially mediate the association between depression and suicidal behaviours and substance use disorders and suicidal behaviours. Impulsivity was significantly associated with suicide ideation, attempts and self-harm, but not suicide plans. Males were more likely to be impulsive, and higher levels of depression and substance use disorders were related to higher impulsivity. The main findings of this study reinforce the role of impulsivity in mediating the relationship between depression and suicidality and substance use and suicidality. College wellbeing services may consider whether screening for impulsivity, rather than for example substance abuse, could be more beneficial and less prone to under-reporting, when assessing for suicide risk among vulnerable students.

Abstract Aims Oncoplastic breast conserving surgery (BCS) has developed to facilitate adequate oncological resection whilst maintaining cosmesis. Volume replacement surgery allows immediate reconstruction with transposition of autologous tissue. One approach is the use of chest wall perforator flaps (CWPF). This increases access for patients to enhanced oncoplastic techniques facilitating BCS, in the setting of larger tumour size, reducing the mastectomy rate in our unit. Our aim was to analyse a series of patients undergoing CWPF in our DGH and determine whether oncological outcomes were comparable to traditional breast conserving surgery. Methods Patients undergoing CWPF reconstruction were identified using theatre records for a period of 12 months (Jan-Dec2023). Data was collected including patient demographics, histopathological findings and post-operative course and treatments. Results A total of seven patients were identified with median age 48 . Range of tumour sizes: 17mm-51mm. All were performed in the immediate setting with all undergoing SLNB. 3/7 required further surgery in the form of re-excision of margins. One patient developed a seroma, requiring aspiration once without further complication. Patient satisfaction is anecdotally high; however, this has not been quantified. Conclusions The utilisation of CWPF within our DGH has shown satisfactory outcomes. Performing these in the immediate setting means some patients have required re-excision of margins and replacement of flaps (similar to local figures for WLE without volume replacement) without impacting patient satisfaction. We advocate that CWPF significantly increases the options available as routine practice for suitable patients. OBCS is possible within the DGH without compromising oncological treatments or cosmesis.