Kent Hospitals Research Articles

Results of a Phase 2 Trial of the Monocyte-Targeted Histone Deacetylase Inhibitor Tefinostat (CHR-2845) in Chronic Myelomonocytic Leukemia (CMML) — the UK Monocle Study

BackgroundChronic myelomonocytic leukemia (CMML) is a highly heterogeneous myeloid neoplasm with poor prognosis and limited therapeutic options. Tefinostat (CHR-2845) is a cell permeant ester that is converted to an active acid histone deacetylase (HDAC) inhibitor (CHR-2847) by human carboxylesterase 1 (hCE-1), an enzyme predominantly found in cells of monocyte lineage. Pre-clinical studies confirmed selective activity of tefinostat, correlating with hCE-1 expression and acetylation induction, in monocyte derived cell lines, primary CMML and AML (M4/M5) cells (1). A phase 1 study in refractory haematological malignancies showed tefinostat to be well tolerated, with complete remission reported in 1/2 CMML patients (2). Given the compelling rationale for selective activity in monocytoid malignancies, we conducted a phase 2 study to assess safety and efficacy of tefinostat in CMML.MethodsMONOCLE was a single arm phase 2 trial conducted to a Bryant and Day 2-stage design with dual primary endpoints of safety and clinical efficacy. CMML-2 patients were included; additionally CMML-1 patients with symptomatic bone marrow failure or proliferative disease, symptomatic splenomegaly, extramedullary involvement, systemic symptoms or CMML-specific Prognostic Score (CPSS) int-2/high. Tefinostat was administered orally in continuous 28-day cycles starting at 360mg once daily, increasing to 480mg after 4 weeks if well tolerated. Concomitant hydroxycarbamide was permitted only with cycles 1-3. Clinical response was assessed according to International Consortium MDS/MPN Response Criteria (3); responding patients at cycle 6 were permitted to continue therapy. Toxicity was assessed according to CTCAE v4.0.ResultsIn stage 1, 21 patients were enrolled at 9 centers (Jan-Sep 2017). 20 patients received tefinostat (median age 75 years [64-88], M/F 14/6) including 16 with CMML-1 (80%) and 4 CMML-2 (20%), 8 (40%) with myelodysplastic and 12 (60%) myeloproliferative CMML; respective proportions in CPSS low/int-1/int-2/high risk groups were 5/50/40/5%. Myeloid NGS analysis confirmed a molecularly relatively high risk population: 70% ASXL1 mutation frequency and median 4 (2-7) mutations per patient; other most commonly observed mutations being TET2 (65%), SRSF2 (50%), EZH2 (35%) and NRAS (35%). Prior therapy included azacitidine (3 patients) and hydroxycarbamide (7). 17/20 patients had high hCE-1 levels, assessed flow cytometrically at trial entry in monocytoid cells (vs bulk myeloid population). Median number of cycles of tefinostat received was 4 (1-15). Of 13 patients completing ≥3 cycles of tefinostat, 1 patient achieved clinical benefit (partial bone marrow response at cycle 6 with red cell transfusion independence sustained over 15 cycles of treatment), 9 had stable disease (of whom 1 had transient clinical benefit [MPN-SAF symptom reduction] which was not sustained to cycle 6) and 3 had progressive disease. Most frequent non-hematologic adverse events of any grade were raised creatinine (55% patients), fatigue (40%) and nausea/vomiting (30%). Grade ≥3 AEs judged potentially related to tefinostat included thrombocytopenia (3 patients), fatigue (2), raised creatinine (2), anorexia, AV block, nausea and neutropenia (1 each). Creatinine rises were in all cases reversible following tefinostat dose reduction/cessation. Induction of intracellular lysine acetylation in monocytes (a marker of HDAC inhibition) was observed in 50% of patients (including clinical responders), peaking between days 15-28 of cycle 1. While no clear relationship between baseline hCE-1 expression and clinical response was evident, reductions in marrow monocyte and myeloid blast fractions were seen in both clinical responders.ConclusionFollowing failure to achieve a pre-defined minimum number of clinical responses to tefinostat, patient recruitment was not continued into stage 2 of this phase 2 study. Drug tolerability was encouraging although observed renal effects will likely preclude dose escalation in this challenging, often frail patient group. Despite compelling scientific rationale and pre-clinical data favoring this monocyte targeted treatment approach we were unable to demonstrate a clinically significant single agent disease modifying effect in CMML.(1) Zabkiewicz J. Oncotarget 2016; 7: 16650-62(2) Ossenkoppele G. Br J Haem 2013; 162: 191-201(3) Savona M. Blood 2015; 125: 1857-65 DisclosuresKnapper:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Other: Meeting and travel support; Jazz: Other: Meeting and travel support; Daiichi Sankyo: Other: Meeting and travel support; Chroma Therapeutics: Research Funding. Hills:Daiichi Sankyo: Consultancy, Honoraria. Dillon:Teva Pharmaceuticals UK: Consultancy, Honoraria; AbbVie UK: Consultancy, Honoraria. Pocock:Kent & Canterbury Hospital: Employment. Culligan:Pfizer: Honoraria; Takeda: Honoraria, Other: Support to attend conferences; JAZZ: Honoraria; Merck Sharp & Dohme (MSD): Honoraria; Abbvie: Other: Support to attend conferences; Celgene: Other: Support to attend conferences; Daiichi-Sankyo: Other: Support to attend conferences.

Older Patients (pts) with Previously Untreated Classical Hodgkin Lymphoma (cHL): A Detailed Analysis from the Phase 3 ECHELON-1 Study

Older Patients (pts) with Previously Untreated Classical Hodgkin Lymphoma (cHL): A Detailed Analysis from the Phase 3 ECHELON-1 Study

Spirit 2: Final 5 Year Analysis of the UK National Cancer Research Institute Randomized Study Comparing Imatinib with Dasatinib in Patients with Newly Diagnosed Chronic Phase CML

▪Objective. SPIRIT 2 is the largest phase 3 prospective randomized open-label trial comparing imatinib (I) 400mg with dasatinib (D) 100mg daily in newly diagnosed chronic phase CML. The primary endpoint was 5 year event-free survival. Methods. 812 (406 in each arm) of 814 patients recruited started study medication (median age 53.2, 275/812 (33.8%) were over 60 years old). Patients were recruited at 144 hospitals between August 2008 and March 2013 and randomized to receive either imatinib 400mg or dasatinib 100mg daily. Secondary endpoints included overall survival, rates of treatment failure, cytogenetic/molecular response - RT-PCR BCR-ABL/ABL ratio of <0.1%IS(major molecular response (MMR), 3 log reduction, MR3) and deeper. To address the potential confounding effect on the primary endpoint of patients switching from randomized treatment to an alternative TKI or other treatment, exploratory per-protocol analyses were performed using the inverse probability of censoring weighting (IPCW) method.Results. All patients have now completed 5 years of follow-up. 424/812 (52.2%) patients completed the study whilst still taking first line medication: 230/406 (56.7%) on dasatinib, 194/406 (47.8%) on imatinib. Of the patients who discontinued first line therapy, more patients on the imatinib arm switched due to suboptimal PCR response (as decided by the local investigator) than on dasatinib (D7/406, 1.7%; I71/406, 17.4%) but more patients on the dasatinib arm discontinued due to intolerance (D123/406, 30.3%; I68/406, 16.7%). More patients went on to transplant in the imatinib arm than in the dasatinib arm (D 6/406, 1.5%; I 30/406 7.6%) and in the imatinib patients undergoing transplant the reason for first line treatment failure was disease progression in 5/30 and suboptimal molecular response in 11/30. Using an intention to treat analysis cumulative incidence of MR3 and MR4 on first line therapy within 5 years was higher in the dasatinib arm than the imatinib arm (MR3: D 83.0%, I 63.0% - difference 20.0%, p<0.0001; MR4: D 77.5%, I 57.2% - difference 20.3%, p<0.0001).At 24 months the complete cytogenetic response rate was D 42.6%, I 31.8% - difference 10.8%, Chi-square test p=0.001.At 5 years the probability of treatment failure-free survival was higher with dasatinib than imatinib(D60.9%, I52.9% - HR: 0.73 (95%-CI:0.59-0.90), p=0.004) but there were no significant differences in event free survival (D91.0%, I89.0% - HR:0.80 (95%-CI:0.51-1.25), p=0.319) or overall survival (D91.9%, I91.2% - HR: 0.90 (95%-CI:0.56-1.47), p=0.690). IPCW modelling results will be presented at the meeting.The overall rate of pleural effusion over 5 years in the dasatinib arm was 36.0% with a higher incidence in older patients. 13 patients developed their first pleural effusion after 3 years on study. Conclusions. In SPIRIT 2 we observed a higher molecular and cytogenetic response rate and also a higher pleural effusion rate with dasatinib but a higher treatment failure rate with imatinib often because investigators were concerned about sub-optimal PCR responses. More imatinib-treated patients proceeded to transplant. There were no statistically significant differences in event free survival (the primary endpoint) or overall survival. Imatinib remains a highly effective first line therapy though subgroup analyses are planned to explore whether dasatinib may have advantages in particular clinical scenarios. DisclosuresO'Brien:Bristol Myers Squibb: Research Funding; CTI: Other: Chair of Independent Data Monitoring Committee; National Institute for Health and Care Excellence (NICE): Other: Chair of Technology Appraisal Committee. Osborne:Servier: Honoraria; Pfizer: Honoraria; Takeda: Honoraria; MSD: Honoraria; Roche: Honoraria; Novartis: Honoraria. Bell-Gorrod:Bristol-Myers Squibb: Consultancy; Merck EDM Serono: Consultancy; PharmaMar: Consultancy; Novartis: Consultancy; GlaxoSmithKline: Consultancy. Latimer:Pfizer: Consultancy; BMS: Consultancy; Merck: Consultancy; Astra Zeneca: Consultancy; Bluebirdbio: Consultancy; Janssen: Consultancy. Apperley:Incyte: Honoraria, Speakers Bureau; BMS: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau. Byrne:Novartis: Consultancy, Speakers Bureau; BMS: Consultancy, Speakers Bureau. Pocock:Kent & Canterbury Hospital: Employment. Copland:Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Clark:Ariad/Incyte: Consultancy; Pfizer: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; Novartis: Consultancy, Research Funding.

A Case report on the diagnosis and management of florid cemento-osseous dysplasia with cystic degeneration over 14 years

Introduction: A 42-year-old female presented to the maxillofacial department at Kent and Canterbury Hospital with a hard swelling buccal and lingual to lower right first molar and periapical radiolucency.

Diagnostic quality of Labial gland biopsies in the diagnosis of Sjögrens syndrome in EKHUFT

Introduction: Biopsies of the Labial gland are invasive, key to establishing a definitive histological diagnosis in Sjögrens syndrome. Insufficient sampling and inaccurate reporting risks unnecessary morbidity. Inspite of this no consensus on the diagnostic criteria currently exists. Following consultation with the East Kent Hospitals University Foundation Trust (EKHUFT) head and neck lead histopathologist, a standard was devised where 6 or more minor salivary gland lobules were required to be deemed of sufficient diagnostic quality, and a focus score of 1 or more (1 focus score is 1mm2with more than 50 lymphocytes) as diagnostic of Sjögrens syndrome. Between 11/12/2011-28/10/2014 an initial retrospective audit of our trust (population of 759,000) established that biopsies and reporting were of insufficient diagnostic quality, with many failing to comment on the focus score or number of lobules.

An investigation into denture loss in hospitals in Kent, Surrey and Sussex.

Background The loss of dentures for inpatients can have a detrimental effect on their well-being. Self-respect and dignity become compromised along with their ability to eat meals and communicate clearly, and long-term recovery.Aim This investigation aimed to identify the reported number of dentures lost in hospitals and the financial reimbursements given by trusts to replace them.Method Information on reported denture loss and reimbursement was collected in 12 trusts throughout Kent, Surrey and Sussex.Results Eleven out of 12 trusts returned data about how many dentures were lost in their hospitals, between them 695 dentures were reported lost over five years (2011-16). Seven trusts reported financial reimbursements for dentures losses; results showed £357,672 was reimbursed over six years (2010-16), the highest amount reimbursed for a single denture was £2,200.Conclusion The results indicate that denture loss is a problem in hospitals that contributes to the financial burden for the NHS. Consideration needs to be given by hospitals to find ways to reduce the number of dentures lost every year.

Trainees removed from Kent hospital due to lack of consultant supervision

Health Education England (HEE) has recommended the removal of trainees from the Kent and Canterbury Hospital because of a lack of consultant supervision. Trainees at the hospital, which is run by the East Kent Hospitals University NHS Foundation Trust, were receiving inadequate education and training, HEE said. It said that 42 of the 76 trainees at the hospital should be moved to the trust’s other two acute hospitals—the William Harvey Hospital, Ashford and Queen Elizabeth The Queen Mother Hospital, Margate—to continue with their training. In a statement HEE said that it had been working with the trust to improve the quality of education and training in the minor injuries …

Abstract P240: Clinical Outcomes in Patients With Takotsubo’s Cardiomyopathy Who Have Undergone Cardiac Catherterization at Presentation vs. Those Who Have Not: A Two Community Based Hospitals Experience

Background: Diagnosis of Takotsubo’s Cardiomyopathy (TC) remains a challenge due to similar presentation to acute coronary syndrome. Coronary catheterization (CC) proven clean coronaries is important to diagnose TC. However, it is not uncommon that CC is occasionally delayed due to unstable medical condition and/or high risk for CC. We hypothesized that patients with TC had similar outcomes whether they underwent CC at presentation or were diagnosed using non-invasive imaging techniques. Methods: Retrospective chart review of data from Memorial Hospital of Rhode Island and Kent Hospital, two community based hospitals, from June 2008 to March 2016 was done. Thirty nine adult patients &gt; 18 years of age admitted to the intensive care unit or medical floor with chest pain, shortness of breath, elevated troponin, EKG changes, and new non-regional wall motion abnormalities or reduce ejection fraction, with suspected TC were enrolled. Patients were divided into 2 groups based on diagnostic approach of TC: Baseline echo findings suggestive of TC with EF improvement at follow up (non-CC) vs. clean coronaries by CC. Outcomes of the two groups were compared using Chi-square analysis, analysis of variance (ANOVA) and Mann-Whitney Test appropriately. Results: Out of 39 patients, 20 underwent CC while 19 did not. Mean age was not different between the 2 groups (69.1±11.8 vs. 62.4±14.0, p= NS) but CC group had more females (95 %, 19 of 20 vs 68.4%, 13 of 19; p=0.031). Most common chief complaint at the time of admission in both groups was shortness of breath (60.0%, 12 of 20 vs 68.4%, 13 of 19; p=0.548). Admission heart rate was significantly higher in non-CC vs. CC patients (102.3± 19.3 vs 85.4±85.4; p=0.007). Third troponin was higher in non-CC group (1.926 ± 2.667 vs 0.775± 1.378, p=0.017). All other admission and in-hospital findings and drug management in both groups were similar. Both CC and non-CC groups had comparable outcomes: intubation (15%, 3 of 20 vs 21.1%, 4 of 19) , heart failure (21.2 %, 4 of 20 vs 15.8%, 3 of 19), shock (0 %, 0 of 20 vs 5.3% 1 of 19 ), stroke (5 %, 1 of 20 vs 0%, 0 of 19), death (5.3 % 1 of 20 vs 5.3% 1 of 19 ), recovery (65%,13 of 20 vs 52.9 % 10 of 19) p=NS for all. ICU admission (42.1%, 8 of 20 vs 52.6%, 10 of 19; p=NS) and length of stay (8.21±7.82 days vs 5.75±5.67 days; p=NS) was not significantly different between the 2 groups. Both groups showed analogous improvement in ejection fraction (21.92 ± 13.96 vs 20.63 ± 13.21; p= 0.835) on a follow up Echo done within 2 weeks to 6 months. Conclusion: This study shows no difference in outcomes between TC patients diagnosed with CC or TTE on admission. However, CC should still be done on admission for diagnosis of TC until large non-invasive diagnostic imaging modalities (such as myocardial perfusion echocardiogram) trials show high specificity for diagnosis of TC.

Laparoscopic colectomy in a district hospital: the single surgeon can be safe

Background: Several outcome measures have been identified for colorectal surgery and published in the literature. This study sought to compare outcomes of high volume laparoscopic colectomy by a single surgeon in a district hospital with outcomes from tertiary referral centres.Methods: This was a retrospective review of elective laparoscopic colectomy by a single laparoscopic general surgeon in a district hospital over a 51-month period using a prospectively maintained database. The key outcome measures studied were length of hospital stay, conversion to open, anastomotic leak, wound infection, re-admission and 30-day mortality.Results: 187 elective laparoscopic colectomies were performed at the Kent and Canterbury Hospital between July 2008 and October 2012. The median patient age was 69 years (range 22–90 years). Median length of hospital stay was 4 days (range 1–48 days). Anastomotic leak occurred in 4 (2.1%) patients. Seven (3.7%) patients underwent conversion to open surgery. Re-admission occurred in 4 (2.1%) patients for small bowel obstruction (1), wound infection (1), anastomotic leak (1) and colo-vaginal fistula (1). There was one post-operative death from severe chest infection (0.5%). These results are similar to those published by tertiary referral centres.Conclusions: This study of outcomes at a district hospital shows that the outcome reported from laparoscopic colorectal surgery in tertiary referral centres is reproducible at the district hospital level by a single surgeon with a high operative volume.

‘Being part of a patient study was an excellent example of co-production’

When Brian Gracey was asked to be involved in a study as a patient representative from Barts Health NHS Trust, in conjunction with East Kent Hospitals University NHS Foundation Trust, he took on the roles of co-researcher and chair of the patient and carer advisory group. Involving patient and carers was a major factor in establishing empathic relationships with the study participants.

ECG-based PICC tip verification system: an evaluation 5 years on.

In 2011, the vascular access team at East Kent Hospitals University NHS Foundation Trust safely and successfully incorporated the use of electrocardiogram (ECG) guidance technology for verification of peripherally inserted central catheters (PICC) tip placement into their practice. This study, 5 years on, compared the strengths and limitations of using this ECG method with the previous gold-standard of post-procedural chest X-ray. The study was undertaken using an embedded case study approach, and the cost, accuracy and efficiency of both systems were evaluated and compared. Using ECG to confirm PICC tip position was found to be cheaper, quicker and more accurate than post-procedural chest X-ray.

Comparing the diagnostic accuracy of ultrasound in the community and in the hospital setting for urinary calculi: A retrospective cohort study

Objective: The objective of this article is to test whether there is a significant difference in diagnostic accuracy between hospital and community-based ultrasound (US) for the detection of urinary calculi in the United Kingdom (UK). Materials and methods: A 30-month, single-blind, retrospective cohort study of all patients referred to Kent and Canterbury Hospital urology multidisciplinary meeting for suspected urinary calculi was conducted. Only those investigated with US and non-contrast computed tomography (NCCT, the gold standard) for their calculi were included. Concordance of US and NCCT was stratified by US location: i.e. either the hospital or community setting (e.g. the latter via general practitioners (GPs) or independent radiographers). Fisher’s exact test was subsequently utilised to test for any significant difference between these two patient groups. Results: Of 2464 patients referred, 257 had both ultrasound and NCCT in their diagnostic workup. Of these, 150 and 107 patients had their US performed in hospital and community settings, respectively. No significant difference in the accuracy of US was detected between the two groups for the detection of urinary calculi when compared with NCCT. Conclusion: US carried out by independent radiographers and GPs in the community is just as accurate as US carried out by hospital sonographers for the detection of urinary calculi in the UK. Greater use of community US for the diagnosis of urinary calculi may promote greater patient/GP satisfaction and reduce hospital attendance without loss of diagnostic accuracy.

Handbook of orthodontics, second edition

Handbook of orthodontics, second edition

Development of risk models for the prediction of new or worsening acute kidney injury on or during hospital admission: a cohort and nested study

BackgroundAcute kidney injury (AKI) is a common clinical problem with significant morbidity and mortality. All hospitalised patients are at risk. AKI is often preventable and reversible; however, the 2009 National Confidential Enquiry into Patient Outcome and Death highlighted systematic failings of identification and management, and recommended risk assessment of all emergency admissions.ObjectivesTo develop three predictive models to stratify the risk of (1) AKI on arrival in hospital; (2) developing AKI during admission; and (3) worsening AKI if already present; and also to (4) develop a clinical algorithm for patients admitted to hospital and explore effective methods of delivery of this information at the point of care.Study designQuantitative methodology (1) to formulate predictive risk models and (2) to validate the models in both our population and a second population. Qualitative methodology to plan clinical decision support system (CDSS) development and effective integration into clinical care.Settings and participantsQuantitative analysis – the study population comprised hospital admissions to three acute hospitals of East Kent Hospitals University NHS Foundation Trust in 2011, excluding maternity and elective admissions. For validation in a second population the study included hospital admissions to Medway NHS Foundation Trust. Qualitative analysis – the sample consisted of six renal consultants (interviews) and six outreach nurses (focus group), with representation from all sites.Data collectionData (comprising age, sex, comorbidities, hospital admission and outpatient history, relevant pathology tests, drug history, baseline creatinine and chronic kidney disease stage, proteinuria, operative procedures and microbiology) were collected from the hospital data warehouse and the pathology and surgical procedure databases.Data analysisQuantitative – both traditional and Bayesian regression methods were used. Traditional methods were performed using ordinal logistic regression with univariable analyses to inform the development of multivariable analyses. Backwards selection was used to retain only statistically significant variables in the final models. The models were validated using actual and predicted probabilities, an area under the receiver operating characteristic (AUROC) curve analysis and the Hosmer–Lemeshow test. Qualitative – content analysis was employed.Main outcome measures(1) A clinical pratice algorithm to guide clinical alerting and risk modeling for AKI in emergency hospital admissions; (2) identification of the key variables that are associated with the risk of AKI; (3) validated risk models for AKI in acute hospital admissions; and (4) a qualitative analysis providing guidance as to the best approach to the implementation of clinical alerting to highlight patients at risk of AKI in hospitals.FindingsQuantitative – we have defined a clinical practice algorithm for risk assessment within the first 24 hours of hospital admission. Bayesian methodology enabled prediction of low risk but could not reliably identify high-risk patients. Traditional methods identified key variables, which predict AKI both on admission and at 72 hours post admission. Validation demonstrated an AUROC curve of 0.75 and 0.68, respectively. Predicting worsening AKI during admission was unsuccessful. Qualitative – analysis of AKI alerting gave valuable insights in terms of user friendliness, information availability, clinical communication and clinical responsibility, and has informed CDSS development.ConclusionsThis study provides valuable evidence of relationships between key variables and AKI. We have developed a clinical algorithm and risk models for risk assessment within the first 24 hours of hospital admission. However, the study has its limitations, and further analysis and testing, including continuous modelling, non-linear modelling and interaction exploration, may further refine the models. The qualitative study has highlighted the complexity regarding the implementation and delivery of alerting systems in clinical practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Audit of the diagnosistic quality of labial gland biopsies in the diagnosis of sjögrens syndrome in east kent hospitals university NHS foundation trust between November 2011–November 2014

Audit of the diagnosistic quality of labial gland biopsies in the diagnosis of sjögrens syndrome in east kent hospitals university NHS foundation trust between November 2011–November 2014

Audit on hyponatraemia in a West Kent Hospital experience

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

PWE-441 Colonoscopy procedures with and without sedation and pain scores: Abstract PWE-441 Table 1

<h3>Introduction</h3> Retrospective data collection to compare pain scores during colonoscopy procedures performed with and without sedation in both Bowel cancer screening programme (BCSP) and Non bowel cancer screening programme (Non BCSP) patient groups. <h3>Method</h3> Data collected retrospectively for all patients who underwent colonoscopy procedures at East Kent Hospitals NHS Trust from August 2014 to October 2014. Data collected from Unisoft in endoscopy department before C02 was introduced. Total number of colonoscopy procedures performed 1903 over 3 month period. 179 patients excluded because of incomplete endoscopy reports including comfort scores. Total number of patients included 1724. Number of patients in Non BCSP group and BCSP group were 1565 and 159 respectively. Pain score completed post colonoscopy procedure. Patient pain scores were recorded from 0–3 (no discomfort, minimal discomfort (One or two episodes of mild discomfort, well tolerated), moderate discomfort (More than two episodes of discomfort, adequately tolerated), Extreme or significant discomfort). <h3>Results</h3> Non BCSP (Non Bowel Cancer screening programme) Group <b>a) Sedated patients</b>1136 (72.58%), Male: female (486:650), Average age and Standard deviation (61.66, 13.4) <b>b) Unsedated patients</b>429 (27.42%), Male: female (277:152), Average age and standard Deviation (71.5, 4.95) BCSP (Bowel cancer screening Programme) Group <b>a) Sedated patients</b>104 (65%), (Male: female 49:55), Average age and standard deviation (72.5, 3.53) b) <b>Unsedated patients</b>55 (35%), (Male: Female 45:10) Average age and standard deviation (67.1, 0.71) Pain scores for sedated and unsedated patients in Non BCSP and BCSP groups are shown in Table 1below <h3>Conclusion</h3> Unsedated colonoscopy is a safe, effective and well tolerated procedure in the right patient. Male gender is predominant in patients underwent colonoscopy without sedation in both BCSP and Non BCSP. Nearly 1/3^rdof patients in symptomatic Non BCSP and BCSP group completed the procedure without sedation without more discomfort than those received sedation (although this may reflect different groups of patients). Despite the used greater intervention in bowel cancer screening patients after pain scores with and without sedation were similar to the symptomatic group. <h3>Disclosure of interest</h3> None Declared.

Andrew James Johnson

Andrew James Johnson (“Andy”) qualified with distinction. He undertook specialist training at the Brompton Hospital and in Edinburgh. Appointed to the Kent and Canterbury Hospital in 1983, his impact was...

The Impact of High Surgical Volume on Outcomes From Laparoscopic (Totally Extra Peritoneal) Inguinal Hernia Repair.

Laparoscopic hernia repair is characterised by a steep learning curve for the surgeon, and proficiency and outcomes are dependent on experience. The aim of this study was to compare laparoscopic totally extra peritoneal (TEP) inguinal hernia repair outcomes conducted by a single surgeon as experience changed over time. Clinical records of 100 consecutive patients who underwent laparoscopic TEP inguinal hernia repair (n=113 hernias) at Kent and Canterbury Hospital by a single laparoscopic surgeon over a four-year period were reviewed for postoperative outcomes. Outcomes were compared with a previous cohort of patients undergoing TEP repair in the preceding three years. One patient experienced chronic postoperative pain, but there were no recurrences, wound infections, haematomas, or conversions compared to three recurrences, three conversions to open operations, one haematoma, and one episode of postoperative pain in the preceding period. Laparoscopic TEP inguinal hernia repair can be further improved with surgical proficiency and high surgical volumes.

Ronald Charles King

After house jobs at Barts, and two years as a demonstrator in physiology at the medical school, Ronald Charles King (“Ronnie”) spent a year as instructor and research assistant in...