Hospitals In West Midlands Research Articles

TH2.2 Optimum Timing of Emergency Cholecystectomy for Acute Cholecystitis - A Single Sited Retrospective Cohort Study

Abstract Aim To evaluate timing of emergency cholecystectomy performed at one of the hospital in West Midlands. Methods This is a retrospective single centre study conducted from September 2019 to August 2020. The patients were divided into two groups with those operated within 1 week as emergency group (EG) and those operated after a week but within 6 weeks as delayed group(DG). The outcome is to evaluate post-operative complications, conversion to open, re-admissions, hospital stay, intra-operative blood loss, surgery duration and level of surgeons. Results Among 176 patients, only 88 patients underwent LC. Only 40.9% (36) underwent LC within 1 week of index admission and 12.5% (11) underwent LC after 1 week but within 6 weeks of admission. The remaining 46.5% (41) underwent delayed LC after 6 weeks. 10.6% (5) developed post op complications. Among which only one developed complication in EG and 8.5% (4) developed in DG. Total number of readmissions after LC in both group was 5.5% (5) and 10.2% (9) respectively. Median Length of hospital stay in days (4.03 versus 8.72 days respectively), Duration of surgery was 81(23–153) mins versus 69 (28–122) mins respectively), Intra operative blood loss (64 ml versus 166 ml respectively). Level of surgeon by consultant and Registrar in both groups were 21:6 and 15:5 respectively. None of the patients were converted to open surgery in both group. Conclusion Early LC within 1 week can be performed safely in most patients with AC to minimise the intra-operative blood loss, total hospital stay, post-op complication and readmissions rate.

CPX-351 for Acute Myeloid Leukaemia: Real World Results Are Comparable to Trial Outcomes and Exceeds Them in Non-Adverse Risk Patients- a Multicentre Experience from West Midlands Hospitals on Behalf of West Midlands Research Consortium ( WMRC) UK

Patients with secondary AML or MDS derived AML have poor outcomes compared to de-novo AML. The benefits of intensive chemotherapy without anticipated transplant consolidation have been previously doubted. Outcomes in USA trial centres have not often been closely replicable in real world settings. From November 2018 CPX-351 has been available in the UK for secondary AML, therapy related AML, AML with MDS related Karyotype (AML-MRC) and licensed but not funded for AML with myelodysplastic related changes.ObjectivesHere we report our experience specifically on patient outcomes and toxicity across 5 Hospitals in West Midlands, UKMethodsPatients receiving CPX 351 outcomes were evaluated retrospectively from 2018 to 2021. Baseline genetics, CPX 351 indications, patient's comorbidities, overall survival, remission status, number of cycles delivered, early mortality, reasons for early discontinuation, intensive care admission and time for neutrophil recovery (>0.5) was recorded. Time-to-event outcomes reported here are from a data cut on 01-06-21ResultsIn a total cohort of 57 patients baseline characteristics are shown on table 1 and compared with the original trial CPX-351 group. Median follow up was 376 days (range 21 to 1248 days).The mean age was 63, 17 patients were under 60, 31 males and 26 females.The most common indication for CPX-351 was AML with antecedent MDS/MPN 51% (N=29), therapy related 14% (N=8), MDS related karyotype (AML-MRC) 19% (N=11) and 16% (N=9) other patients.Mean Charleston co-morbidity score was 2.7 (range 0-6), 10.5% (N=6) had previous non myeloid malignancies, 8.7% (N=5) had prior ischaemic heart disease, only 3.5% (N=2) had ejection fractions under 50%.The most common mutations were TP53 21% (N=12), ASXL1 15.7% (N=9), TET2 15.7% (N=9), IDH2 10.5% (N=6), RUNX1 10.5% (N=6), SRSF2 7% (N=4), JAK2 3.5% (N=2), FLT3 5% (N=3), NPM1 5%(N=3) and IDH1 5% (N=3).MRC cytogenetic risk was adverse in 19 patients (33%), intermediate in 35 patients (61%) and favourable in 3 patients (5%).30 patients (53%) had adverse European Leukaemia Network classification, 17 (30%) had intermediate and 10 (17%) had favourable.30-day mortality was 3/57 (5%), 60-day mortality was 6 (10.5%) comparable to the 5.9% and 10.6% rates for the original trial. 9% or 5/57 patients were admitted to ITU with 2 survivors beyond 60 days. Neutropenic fever requiring antibiotics was 100% whereas only 5/57 (9%) had radiological evidence of fungal infection. Only one patient died from COVID 19.The mean time to neutrophil recovery was 35 days with a range of 12 to 84 days.29 patients completed 1 cycle, 25 completed 2 cycles, only 3 completed 3 cycles. The reasons for stopping were death, refractory disease, drop in performance status, alternative chemotherapy chosen or moving to transplantation (39%).Composite remission rate including CRi was 61% 36/57, adverse ELN group demonstrated 50% 15/30, intermediate 76% 13/17 and favourable 80% 8/10. Mutated P53 was associated with a 50% 6/12 rate whereas in wild type P53 the remission rate was 60% 30/45.Overall median survival from diagnosis was 429 days [95% CI 274 to 788 days]. To compare with the original trial, we removed the under 60s and those with less than 1 year follow up, in this cohort of 30 patients the median survival was 289 days (9.5 months) with 95% CI of 255 to 476 days.P53 mutated patients had an estimated median survival of 257 days versus wild type p53 with 524 days hazard ratio of 2.418 (CI 1.077 to 5.248) with p value of 0.032. Median survival for ELN groups was 373 days (adverse), 413 days (intermediate) and not reached for favourable.Of the 36 patients who achieved a remission, 22 went on to receive an allogenic transplant with follow from 254 to 1248 days, median survival estimated 706 days (95% CI 429-not reached). Patients in remission who haven't received a transplant have a similar estimated survival of 788 days (305-not reached) pending longer follow up.ConclusionThis is the first UK multicentre analysis to show comparable results to the landmark trial (median survival 9.5 months in equivalent cases). The improved overall remission rate 61% versus the 47% in the trial and the longer median survival 14 months versus 9.5 months in the trial is expected given the younger age and increase in favourable risk genetics. This study therefore supplies further data of CPX-351 efficacy in younger patients not included in the original studies and may now be used as a standard comparator arm. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Cardiac arrest team role pre-allocation and debriefing: A policy analysis of West Midlands hospitals

Andrea Scapigliati 1,∗, Niccolo Grieco2, Tommaso Pellis3, Giuseppe Ristagno4, Federico Semeraro5, Erga L. Cerchiari5 1 Catholic University of the Sacred Heart, Rome, Italy 2 Intensive Cardiac Care Unit & Prehospital Emergency, Milan, Italy 3 Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy 4 Istituto di ricerche farmacologiche “Mario Negri” –IRCCS, Milan, Italy 5 Maggiore Hospital, Bologna, Italy

Hospital cardiac arrest team composition variability: A policy analysis of West Midlands hospitals

Study purpose: Recent data suggests that cardiac arrest team composition is associated with cardiopulmonary resuscitation quality.1 UK guidelines identify minimum standards for team composition,2 although no such guideline exists in the USA.3 A recent report highlighted the need for further data in relation to cardiac arrest team composition.4 The aim of this study is to examine levels of variability in hospital cardiac arrest team composition.

The Rising Incidence of Terminal 11Q Deletion?

Background and aim: First described in 1973, Jacobsen syndrome is a MCA/MR contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11 with a prevalence of 1/100 000 births. Only 200 cases have been reported to date. There is a wide spectrum of severity of clinical phenotype; facial dysmorphism, multi organ involvement including haematological dysfunction with thrombocytopenia and clotting abnormalities, cardiac defects like hypoplastic heart, and renal anomalies. The presentation depends on the deletion size (5-16MB). There is also a high recurrence risk when a parent has a balanced translocation or deletion 11q in the mosaic form. We share 2 cases of terminal 11q deletion diagnosed in the last 4 months in 1 district general hospital in West Midlands, UK and emphasize the growing need to be aware of this recent genetic condition. Methods and Results: Case 1 presented as Small for gestation (SGA) with thrombocytopenia but no obvious dysmorphic features. Case 2 presented as SGA with facial dysmorphism and thrombocytopenia. Our regional genetics laboratory identified 6 individuals with terminal 11 q deletions in the west midlands in the last 2 years. Conclusion: Half of patients with terminal 11q deletion are diagnosed by 1 year of age and the rest even later. Not all patients present with typical phenotypic features and could easily escape neonatal diagnosis where early detection could improve management of potentially life threatening complications. Clinicians should therefore be more aware of this condition which may only present with thrombocytopenia and SGA.

Exposure to metal fume and infectious pneumonia.

To test the hypothesis that inhalation of metal fume reversibly increases susceptibility to pneumonia, the authors conducted a case-control study. Men aged 20-64 years, admitted to 11 hospitals in West Midlands, England, with community-acquired pneumonia during 1996-1999 were interviewed about their lifetime occupational history, exposure to metal fume, and potential confounding factors. Similar information was collected from controls admitted to the same hospitals with nonrespiratory illness. For cases, exposures were timed relative to the onset of their illness (on average, 6 months before interview). Exposure histories for controls were censored 6 months before interview. Interviews were completed by 525 cases and 1,122 controls (response rates of 74% and 99%). Pneumonia was associated with reported occupational exposure to metal fume in the previous year (adjusted odds ratio (OR) = 1.6, 95% confidence interval (CI): 1.1, 2.4) but not in earlier periods (OR = 1.1). The risk was highest for lobar pneumonia and recent exposure to ferrous fume (OR = 2.3, 95% CI: 1.2, 4.3). The association was not specific to any one microorganism. These findings support the hypothesis that ferrous and possibly other metal fumes reversibly predispose to infectious pneumonia. Research should now focus on the underlying mechanisms and prevention.