East Lancashire Research Articles

450 Outcomes of Groin Hernia Surgery in ELHT: A Comparative Retrospective Study with NICE, BHS, and EHS Statistics

Abstract Aim The aim of this study was to evaluate the results of groin hernia surgery, at East Lancashire Hospitals Trust (ELHT) by comparing the severity of pain and recurrence rates with established standards set by the National Institute for Health and Care Excellence (NICE) British Hernia Society (BHS) and European Hernia Society (EHS). Method This retrospective analysis involved patients who underwent groin hernia repair between 2019 and 2021 at ELHT trust hospitals. The selection criteria were based on guidelines provided by the BHSs Hernia Commission Guide. Data was collected from records during the specified time frame. Results Out of all cases chronic pain occurred in 2.90% which's notably lower compared to the 10 12% range reported by the European Hernia Society. Furthermore, the recurrence rate at ELHT was found to be 2.51% below the rate of 15% mentioned by the European Hernia Society. Conclusions Based on these findings it can be concluded that ELHT has achieved outcomes in groin hernia surgery when compared to benchmarks set by the European Hernia Society. Notably ELHT demonstrated rates of chronic pain and recurrence highlighting successful surgical interventions and providing valuable insights for best practices in hernia surgery. These results have implications for optimizing outcomes. May influence future guidelines and practices, in groin hernia surgery.

British Textile Biennial: Affirming the Roots of Textiles in East Lancashire and the Contemporary Curatorial Venture

British Textile Biennial: Affirming the Roots of Textiles in East Lancashire and the Contemporary Curatorial Venture

Ethnic density and first episode psychosis in the British Pakistani population: findings from the East Lancashire Early Intervention Service.

Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups. To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire. Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas. A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased. Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.

P09 Lancashire and South Cumbria Critical Care Network Vancomycin Project

Abstract Background This project was a collaborative piece of work across a critical care network that included specialist advice from colleagues including aseptic/technically trained pharmacists and microbiology to optimize care for critical care patients in Lancashire and South Cumbria. We used several members of our workforce including pharmacists, nursing staff, microbiologists, rotational doctors and consultants to work towards a harmonized guideline. Methods During our initial meeting, we identified that different centres were using different glycopeptides and administering them differently: East Lancashire Hospitals (ELHT)—continuous vancomycin infusion; Blackpool Cardiac and Blackpool General—continuous vancomycin infusion, with no formal guideline in place but adopted from ELHT; Lancashire Teaching Hospitals—intermittent vancomycin infusions; and University Hospitals Morecambe Bay—teicoplanin is glycopeptide of choice. Our consultant microbiologist discussed the use of glycopeptides and what infections they are used for in critical care. The pharmacokinetics of vancomycin and the benefit of using a continuous infusion was also discussed. We decided to undertake a clinical audit of our vancomycin guidelines at ELHT to ensure that we had an evidence base to implement our guideline and provide assurance to the working group. We agreed to reconvene the working group after this audit was completed and after the concerns of colleagues had been addressed. Results and conclusions We presented the results of our audit and highlighted the opportunities harmonizing this guideline would provide. We discussed various scenarios such as stepping up from a ward protocol to a continuous infusion and the different methods of calculating creatinine clearance and if this would influence the first 24 h of the infusion. One comment was concerning the administration of vancomycin and the number of times nurses will be changing bags for patients requiring higher doses, i.e. the majority of patients would usually be on 3 g/day or more depending on concentrations. This would mean changing the bag more than twice a day; as much as there is a therapeutic benefit to continuous vancomycin infusions, considering the max. concentration for peripheral and central lines allows for larger volumes, it would be beneficial (except in fluid restricted cases) to have a slightly larger volume to reduce the number of bag changes and plastic consumption. We considered this comment and discussed it with our aseptic services lead pharmacist. We attended a meeting of the ICS Aseptics Working Party across Lancashire and South Cumbria. WE discussed the proposed guideline and requested that aseptic units across Lancashire and South Cumbria developed worksheets to manufacture 5 g in 600 mL or 10 g in 1.2 L for central use to stop breaking the line when changing a bag and reducing plastic consumption. We also met with critical care practice educators across the network to discuss how we can promote this guideline and ensure nursing staff and prescribers are aware of how to prescribe and administer continuous vancomycin infusions. One of our units noted that they have had a few incidents with incorrect concentrations of vancomycin being made up for patients. We developed an e-learning package to educate our workforce.

HPB P57 Outcomes of Transarterial Chemoembolization (TACE) at East Lancashire Hospitals NHS Trust

Abstract Background Hepatocellular carcinoma (HCC) accounts for 85%–90% of all primary liver cancers and is a significant cause of morbidity and mortality worldwide. The aim of this study was to evaluate the efficacy and safety of the procedure at ELHT. TACE is an image-guided IR locoregional therapy for unresectable hepatocellular carcinoma patients to improve their survival. It has emerged as an efficacious palliative option for inoperable cases as it is less invasive and known to have fewer complications. It may also act as a bridge for liver transplantation. Methods This is a retrospective study with data collected over 2 years. Treatment-naive patients aged 18 and above with unresectable HCC with a Child-Pugh Class A/B were selected. Treatment response was assessed after every TACE session using CT or MRI within 6 weeks of TACE, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Safety was assessed based on technical success and the number of complications. Results 35 patients underwent TACE (median age - 79). The commonest underlying etiologies were liver cirrhosis (25%) and alcohol (22%). Of the total 90 sessions, partial response was seen in 44% (39 sessions) followed by complete response in 23% (21). For 22% (20), the outcome was stable disease. Since 74% of the patients had multiple sessions, efficacy per patient showed a result of complete response in 44% and partial response in 18%.1 year survival rate was 60%, 21% had a recurrence and 22.8% developed complications (3 liver abscesses). The technical success achieved was 97.7%. Conclusions TACE is safe and effective for treating HCC patients, who are unsuitable for thermal ablation or surgery as it offers comparable survival benefits. ELHT showed a successful disease control (complete, partial response + stable disease) of 89% through TACE. Liver abscess was the commonest compilation in our study (22%) - this was higher when compared with the existing literature (an average of approximately 6%).

Evaluating the Usage of Musculoskeletal Spinal Drop-In Services in East Lancashire: A Retrospective Audit of Performance Standards.

Lower back pain (LBP) is a prevalent musculoskeletal disorder (MSD) that places a significant burden on patients as well as healthcare and economic systems. Musculoskeletal (MSK) spinal drop-in clinics in the North West of the United Kingdom (UK) have been introduced to provide more targeted therapies for those suffering from LBP. A retrospective audit was conducted from January to February 2017 to evaluate the utilization of the spinal clinic in relation to individual patient Keele STarT Back prognostication scores and to compare these with national guidelines. A total of 50 patients' case notes were reviewed over the four-week period. The focus was placed on how patients were made aware of the clinic, whether they had been seen by a primary care provider, and if first-line therapies had been administered. The results of this study demonstrate that some improvement is required in patient management and seek to provide recommendations for optimizing the service.

A retrospective study to assess visual field improvement following augmented trabeculectomy

To explore the visual field (VF) changes two years following augmented trabeculectomy.A retrospective study of patients who underwent augmented trabeculectomy surgery with mitomycin C by a single surgeon at East Lancashire Teaching Hospitals NHS Trust over 3 years. Patients with a minimum of two years postoperative follow-up were included. Baseline characteristics, intraocular pressure (IOP), VF, number of glaucoma medications, and complications were recorded.In total, 206 eyes were included, 97 (47%) patients were female, and the mean age was 73.8 ± 10.3 (range 43 to 93) years. One hundred thirty-one (63.6%) eyes were pseudophakic before trabeculectomy. The patients were divided into three outcome groups according to VF outcome. Seventy-seven (37.4%) patients had stable VF, 35 (17.0%) patients showed VF improvement, and 94 (45.6%) had VF deterioration. The overall mean preoperative IOP was 22.7 ± 8.0 mmHg and postoperative IOP 10.4 ± 4.2 mmHg, with a reduction of 50.2% (P < 0.001). In total, 84.5% of postoperative patients did not require glaucoma medications. A higher number of patients with postoperative IOP ≥15 mmHg had deteriorating VF (P < 0.001). Based on preoperative MD distribution, VF improvement or stability was more achievable with patients with a preoperative VF defect up to -12 dB (n = 41, 59.4%) and in those with greater than -24 dB (n = 25, 64.1%).Trabeculectomy continues to be an effective means of lowering IOP in patients with uncontrolled glaucoma and is important in stabilizing or improving visual fields. We recommend early trabeculectomy to prevent further VF deterioration. This may help in maintaining VF for driving status and, thus, quality of life.

The implementation of genetic testing at east Lancashire Hospital Trust; The role of the BCN

The implementation of genetic testing at east Lancashire Hospital Trust; The role of the BCN

The role of knowledge, primary care and community engagement to improve breast-screening access for Pakistani women in the United Kingdom: A secondary analysis of a qualitative study.

Breast cancer incidence is rising among Pakistani women in the United Kingdom. However, uptake of breast screening remains low. This study aimed to improve access to breast screening for British-Pakistani women by exploring their knowledge of breast cancer and the role of primary care and community networks to support screening access amongst British-Pakistani women. We undertook a secondary qualitative analysis of 18 semi-structured interviews with British-Pakistani women from East Lancashire in the United Kingdom. Anonymized transcripts of the interviews were used for a thematic analysis. Three themes were identified in the interviewees' responses: (i) 'Women's knowledge of breasts and breast cancer', which described how a cultural taboo exists around Pakistani women's bodies and around breast cancer; (ii) 'Role of primary care', which detailed how General Practitioners can support informed decisions and offer a trusted and valued information source; (iii) 'Community engagement', which described the potential to disseminate breast-screening information through the whole community, including primary care providers, all family members and mosques. Our analysis suggested three main targets for future interventions to improve access to breast screening for British-Pakistani women: (i) co-produced strategies to increase knowledge of breasts and breast screening; (ii) greater collaboration with local General Practitioners to support women to make informed choices about screening; and (iii) community engagement involving General Practitioners and community leaders, to inform everyone - not just screening-age women - about breast cancer and screening.

An Assessment of Housing Market Renewal in East Lancashire

An Assessment of Housing Market Renewal in East Lancashire

Velvet caps and tassles: East Lancashire, class and the FA cup

ABSTRACT This article fuses theoretical concepts taken from philosophic, economic, social and cultural discourses in the process of outlining developments in Association Football, in East Lancashire, in the last quarter of the nineteenth century. It continues the challenge to conventional histories that surround mass games and public schools, extending the revisionist critique with an imaginative use of new and original empirical evidence. It outlines the continuing presence of a working-class footballing culture, arguing that the structure of football was a product of industrialisation, urbanisation and population growth. Consequently, a far-reaching restructuring of the class system facilitated the rise of a newly formed lower middle class who used their social and cultural capital to form and administer football clubs’ in East Lancashire. These teams eventually broke the dominance of southern-based amateur clubs in the F.A. Cup. These new hierarchies and class system ultimately gave birth to professional football by the late 1870s.

"Primary Pulmonary Angiosarcoma in 25-Year Old Patient"

Hind Elhassan1*, Abdelrahman Abdelbar1, Danielle Bury2, Stuart Mellor3, Andrew Nicholson4 and Joseph Zacharias1 Author Affiliations 1Cardiothoracic Department, Blackpool Teaching Hospital NHS Foundation Trust, UK 2Histopathology Department, Blackpool Teaching Hospital NHS Foundation Trust, UK 3Radiology Department, East Lancashire Hospital NHS Foundation Trust, UK 4Histopathology Department, Royal Brompton & Harefield NHS Foundation Trust, UK Received: February 14, 2022 | Published: February 23, 2022 Corresponding author: Hind Elhassan, Cardiothoracic Department, Blackpool Teaching Hospital NHS Foundation Trust, UK DOI: 10.26717/BJSTR.2022.42.006703

Reducing the Time from Diagnosis to Treatment in Patients with Colorectal Liver Metastases

Introduction: Approximately 33% of patients with colorectal cancer (CRC) are diagnosed with liver metastases (CRLM). The Hospital Episode Statistic data from 2018-2019 identified suboptimal performance in managing CRLM cases at East Lancashire Teaching Hospitals NHS Trust (ELHT).

'Never waste a crisis': a commentary on the COVID-19 pandemic as a driver for innovation in maternity care.

The coronavirus (COVID-19) pandemic has resulted in rapid changes in many areas of health care worldwide.1 Some organisational and governance controls on innovation have been relaxed, to enable rapid adaptation to changing circumstances. The speed of innovation raises a range of ethical, governance and organisational issues. It is important to assess what changes have been instituted, which ones should be maintained, and how to encourage effective innovations in future.

865 Reducing Delays in Cholecystectomy Surgery of Patients Admitted with Gallstone-Related Disease Within Gold Standard Time Frame Set Out By NICE

Abstract Introduction As per NICE guidelines, Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) aims for 80% of eligible patients with gallstone-related disease to receive their cholecystectomy within 8 days of presentation1. Only 63.6% of eligible patients at East Lancashire Hospitals NHS Trust (ELHT) had their surgery within the target time. This project was done to identify the reasons behind ELHT not achieving the set target and to implement changes to overcome this. Method This was a retrospective review of a prospectively collected data of 444 patients from the ELHT Chole-QuIC database (July 2019-November 2020). Data were analysed in three periods: initial period (July 2019-November 2019), pre-COVID-19 period (December 2019-February 2020), COVID-19 period (March 2020-November 2020). Time to surgery was established. If the 8-day target was not met, reasons behind the delay were recorded. Results During the first cycle, the main reasons delays included the patients being temporarily unfit (13.8%), insufficient theatre capacity (13.8%) and variations in treatment plans (11.32%). 8% of patients had re-admissions related to their gallstone disease. Changes were implemented forward included a clear local gallstone disease management pathway and CholeQuIC referral system, increasing theatre capacity, and allocating pre-operative assessment slots. Gold standard cholecystectomy target period improved from 63.6% to 67.4% within three months of changes. However, the figure drastically reduced during the COVID-19 pandemic (36.3%) as elective surgeries were temporarily suspended. Conclusions The implementation of a gallstone disease management pathway, a coordinated referral system and additional theatre capacity contributed to the increase in cholecystectomies that were performed within the 8-day national target period.

1294 Online Education for Patients Undergoing Elective Orthopaedic Surgery During A Global Pandemic

Abstract Introduction lective hip and knee joint replacement patients at the East Lancashire Hospitals NHS Trust (ELHT) are required to attend the ‘Hip and Knee Joint School’. This is an award-winning patient education programme. Pre-pandemic, it was a day at the hospital dedicated to introducing patients to the specifics of a hip and knee joint replacement surgery. This takes the patient from the process of anaesthesia to post-operative ward care. Method Due to the virulent transmission of COVID-19, strict social distancing rules have been implemented. Therefore, it was decided that converting the joint school into online videos would be the best medium for patient education. Various healthcare professionals contributed to the videos included orthopaedic surgeons, anaesthetists, specialist nurses, healthcare assistants, occupational therapists, and physiotherapists. Results Eleven videos were filmed, edited, and approved by the trust’s communications team. These included, ‘Introduction to the Joint School’, ‘You and your surgery’, ‘Leading up to your operation’, ‘Your Operation Journey’, ‘Introducing the Anaesthetist’ ‘Total Hip Replacement Surgery’, ‘Total Knee Replacement Surgery’, ‘Post-op Wound Care’, ‘Your Safe Discharge Home’, ‘FAQ’s’ and ‘COVID-19 Green Pathway’. Conclusions The global pandemic has driven innovation and novel ideas in medicine. We have seen similar changes in our trust with the online patient education videos being a prime example. This joint school was originally started in our trust, but now as it had been converted to videos, we believe that it can be modified and used across all trusts in the NHS.

1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy

Abstract Introduction Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI). Method A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded. Results In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%). Conclusions The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.

Provision of a local anaesthetic minor procedures service by surgical advanced clinical practitioners: 5-year study

BackgroundSurgical advanced clinical practitioners (SACPs) form part of the extended surgical workforce drawn from a variety of allied healthcare backgrounds. The primary aim of this study was to determine whether there was a financial benefit in having minor surgical procedures undertaken by dedicated SACPs compared with operating lists assigned to consultant surgeons.MethodsThis was a retrospective cohort study including all patients who had minor ‘lumps and bumps’ procedures undertaken between April 2014 and August 2019 at East Lancashire Hospitals NHS Trust under local anaesthetic by the general surgery team. Clinical patient information, including lesion type, was collected along with operating room staffing levels and duration of operation. The cost of the procedure was calculated as operating time multiplied by cost of staff per minute according to local banding.ResultsA total of 1399 patients had a lesion excised; 907 procedures were carried out by a doctor, and the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time taken between SACPs and doctors (20 (i.q.r. 14–28) min). Minor procedures carried out on consultant surgeon lists cost 62.3 per cent (€25.33) more on average than those on SACP lists (median €65.96 versus 40.63 respectively; P < 0.001).ConclusionA dedicated and independent SACP ‘lumps and bumps’ list was financially beneficial. Operating times were similar to those of doctors. These lists safely free trainee and consultant surgeons to undertake more complex work.

Design and Development of a Low Cost Pulse Oximeter

There are various types of pulse oximeters (POs) including ‘reflectance POs’, which can be used on more sites like the forehead, chest or cheeks and work the same way as ‘transmission POs’ which is the most commonly used device for the continuous measurement of % blood oxygen saturation and pulse/heart rate. This paper describe the design and development of a low cost pulse oximeter (PO) specifically focused on the use of ‘Reflectance Photo-Plethysmo-Graphy’ (RPPG) technology, and compare with commonly used pulse oximeter devices at the East Lancashire Hospitals. The design arrangement involved the use of an Arduino Mega 2560 Circuit Board as microcontroller, Pulse Sensor, Light Emitting Diodes (LEDs) and Liquid Crystal Display (LCD), which allowed subsidising to make a functional device for accurate readings of Heart Rate (HR) in beats per minute (BPM) and % Blood Oxygen Saturation (SpO2). RPPG technique was successfully implemented within the design and development of the PO prototype, contrasting against the more conventional method of transmission pulse oximetry for obtaining HR and SpO2 values. It is concluded that the RPPG pulse oximeter is a more cost effective method of operation with comparable results.

Changing clinical patterns of Rhegmatogeneous Retinal Detachments during the COVID19 pandemic lockdown in the North West of the UK.

The UK Government imposed a COVID19 lockdown (LD) restricting all but essential activities from 24th March 2020. Subsequently, there has been a significant reduction in casualty attendances nationwide including for ophthalmic emergencies. We aim to study the presentation of rhegmatogenous retinal detachments (RRD) and significant vitreous haemorrhage caused by posterior vitreous detachment (PVD-VH) in three tertiary centres covering most of the North West of England in the 6 weeks before and during the lockdown. A retrospective multicenter non-randomised consecutive case series study was designed to collect information on all cases of RRD and PVD-VH requiring surgery presenting to the vitreoretinal departments of Manchester Royal Eye Hospital, East Lancashire NHS Foundation Trust and the Lancashire NHS Foundation Trust from 11th February to 4th May 2020. A total of 137 eyes of 137 patients were identified between the three centres of which 132 eyes were operated for RRD. Of these, 86 (64.7%) were operated pre-LD compared with 46 eyes (34.8%) during LD. Forty-five out of 86 eyes (52.3%) were macula-off pre-LD compared with 31 out of 46 eyes (67.3%) during LD (p = 0.06). There was lower proportion of non-PVD related RRD during LD (11 pre-LD to 1 during LD, p = 0.05). PVR was present in four cases during LD compared to 2 before (p = 0.19). There was a clinically significant reduction in the overall incidence of RRD in our centres with an increase in the proportion of macula-off and proliferative vitreoretinopathy during the LD period compared to a similar period before.