Royal Cornwall Hospital Trust Research Articles

P02 Evaluating antibiotic prescribing in pancreatitis: a single-centre retrospective case series

Abstract Background Procalcitonin (PCT) has been shown to safely reduce antibiotic use in respiratory tract infections but there is little evidence for other potentially infected body systems. A recent randomized controlled trial (RCT) demonstrated the safety and efficacy of PCT in reducing antibiotic use in patients with pancreatitis. Objectives We aimed to review antibiotic prescribing in patients with pancreatitis and to estimate the potential impact of PCT on rates of antibiotic prescribing at the Royal Cornwall Hospital Trust (RCHT). Methods Patient care episodes for pancreatitis between June 2022 and May 2023 were identified using pancreatitis ICD-10 codes. An audit tool was developed using the inclusion criteria used in the RCT. Electronic notes systems were used to collect the following: patient demographics, whether diagnostic criteria for pancreatitis were met, clinical specialty, pancreatitis severity, presence of necrosis, indications for antibiotics and course lengths. Results 121 patient care episodes were identified, of which 76 (63%) were analysed. Of these, 61 (80.3%) met the diagnostic criteria for pancreatitis and analysed; median age 57 (IQR 26), 28 (45.9%) female, 51 (83.6%) managed under surgeons and 10 (16.4%) under medicine. 15 (19.7%) patient episodes were excluded: 14 did not meet diagnostic criteria for pancreatitis and 1 on long term immunosuppression. 30 (49.2%) patients with a clinical diagnosis of pancreatitis were prescribed antibiotics; 5 (16.7%) for pancreatitis and 16 (53.3%) for extra-pancreatic indications: respiratory tract 3 (18.8%), cholecystitis 7 (43.8%), suspected cholangitis 1 (6.3%), other intra-abdominal infection 5 (31.3%). The indication for antibiotics was unclear in 9 episodes (30.0%). Of those prescribed antibiotics for pancreatitis, 4 (80%) were appropriately prescribed for suspected infected necrotic pancreatitis (patients with pancreatic or extra-pancreatic necrosis who deteriorate (physiologically or blood results) or fail to improve after 7-10 days), 1 (20%) was inappropriate. The overall rate of antibiotic prescribing in the PROCAP study were 31% in the PCT group and 47% in the usual care group (non-PCT); the rate of antibiotic prescribing in the usual care group was found to be comparable to our data (47.0% verses 49.2%). However, the majority of antibiotic prescriptions in our cohort were for extra-pancreatic infections, not pancreatitis. It is not possible to determine the proportion of antibiotics prescribed for pancreatitis in the PROCAP study and therefore we are unable to compare our findings. Conclusions Rates of antibiotic prescribing for patients at RCHT with pancreatitis are comparable to those in the PROCAP non-PCT guided treatment group which might suggest that adoption of PCT in our hospital could reduce antibiotic prescribing, as per the findings of the PROCAP study. Rates of antibiotic prescribing for pancreatitis at RCHT are low, with the majority of prescribing for extra-pancreatic indications, although the indication was unclear in approximately one third of episodes. The PROCAP study does not report rates of prescribing for pancreatitis which prevents estimating the impact of PCT on antimicrobial prescribing for pancreatitis at RCHT. Whether PCT has a role in reducing antimicrobial prescribing for patients with pancreatitis at RCHT is unclear.

Hyperparathyroid service evaluation at the Royal Cornwall Hospital Trust from 2013 to 2021

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

Detection of microRNA in urine to identify patients with endometrial cancer: a feasibility study

ObjectiveTo find dysregulated urinary microRNAs associated with endometrial cancer as a first step in finding a non-invasive new diagnostic biomarker. The second objective is to determine the correlation of urinary...

Body mass index and sexual function in women with gynaecological cancer.

To investigate the association between body mass index (BMI) and sexual functioning in gynaecologic cancer patients. To determine the association between socio-economic deprivation and sexual functioning. This is a prospective cohort study on women undergoing surgery for suspected or proven gynaecological cancer between September 2014 and February 2016 in the Royal Cornwall Hospital Trust. Patients were invited to participate by completing the Female Sexual Function Index (FSFI) at three time points: preoperative, 3months postoperative, and 1year postoperative. A semiparametric model of the FSFI score was used to establish the association between BMI and sexual functioning. A total of 257 patients were approached of which 166 patients were included. Fifty-two patients (33.8%) were overweight (BMI, 25-29.9kg/m2 ), 44 (28.6%) were obese (BMI, 30-39.9kg/m2 ), and a further 20 (13.0%) morbidly obese (BMI≥40kg/m2 ). Overweight and obese women reported improved sexual functioning compared with normal-weight women in endometrial, ovarian, and vulvar cancers. Among cervical cancer, worse sexual functioning was seen in women with an increased BMI; however, this was not significant. Younger age was associated with improved sexual function, and sexual functioning was better postoperatively for all patients compared with preoperatively. There was no evidence of relationship between deprivation and sexual functioning in gynaecological cancer patients. Higher BMI is associated with improved sexual functioning in endometrial, ovarian, and vulvar cancer; however, this was not seen in cervical cancer patients. There is no evidence of correlation between deprivation and sexual functioning.

Increasing rates for certification of visual impairment at Royal Cornwall Hospital Trust: An audit series

The audit series investigated how rates of Certification of Visual Impairment (CVI) at Royal Cornwall Hospital Trust (RCHT) performed when compared against Public Health England (PHE) indices. Our aim was to assess whether CVI rates could be improved by promoting clinician awareness. We collected CVI data for Sight Impairment (SI) and Severe Sight Impairment (SSI) from a prospective MS Excel database maintained at RCHT for all certifications between 1 August 2014 and 31 July 2016. Annual local certification rates were compared to regional and national rates using data from Public Health Outcomes Framework (PHOF) for glaucoma, age-related macular degeneration (ARMD), and diabetic eye disease. We found that overall rates of certification were above both those of the South West region and England; however, certifications for ARMD and glaucoma fell below the regional and national rates. Reasons for this may include variations in ethnicity, introduction of anti-vascular endothelial growth factor (anti-VEGF) agents, and/or the potential delay in CVI completion while under treatment for ARMD. We concluded that raising awareness among clinicians did not prove a satisfactory intervention to improve certification rates. In response to these findings, RCHT and a local charity, iSight Cornwall, have jointly funded an Eye Clinic Liaison Officer (ECLO) to enhance the certification process. This is expected to deliver immediate service improvement. Considerable overlap in dual diagnoses presents a problem in interpretation of CVI data, which could be targeted by the implementation of electronic certification.

Vapour, gas, dust and fume occupational exposures in male patients with rheumatoid arthritis resident in Cornwall (UK) and their association with rheumatoid factor and anti-cyclic protein antibodies: a retrospective clinical study

ObjectivesTo quantify exposure to vapour, gas, dust and fumes (VGDF) and smoking in male rheumatoid arthritis (RA) and investigate impact on rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) levels.DesignA...

148 - Service evaluation of stage III non-small cell lung cancer concurrent chemoradiotherapy treatment at Royal Cornwall Hospital Trust, Truro

148 - Service evaluation of stage III non-small cell lung cancer concurrent chemoradiotherapy treatment at Royal Cornwall Hospital Trust, Truro

Radiation-related toxicities and outcomes in endometrial cancer: are obese women at a disadvantage?

To assess the impact of body mass index (BMI) on radiotherapy toxicities in endometrial cancer patients. This was a retrospective cohort study of women diagnosed with endometrial cancer between January 2006 and December 2014 at the Royal Cornwall Hospital Trust. Women who received radiotherapy as part of their treatment, including external beam radiotherapy (EBRT) and/or vaginal brachytherapy were included. Radiation-related toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) guidelines. Toxicity outcomes were compared across BMI groups-non-obese (BMI<30kg/m2) and obese (BMI≥30kg/m2)-according to radiotherapy treatment received (EBRT, brachytherapy or a combination). Of a total of 159 women who received radiotherapy, 110 were eligible for inclusion in the study. Sixty-three women had a BMI<30kg/m2 and 47 women were obese. Obese women had poorer Eastern Cooperative Oncology Group performance status (P=0.021) and more comorbidities (P<0.001) compared to the non-obese group. Total (any) toxicity rates were 60.3, 72.7 and 52.0% for EBRT and brachytherapy (N=63), single-mode EBRT (N=22) and brachytherapy (N=25), respectively. BMI was not associated with the incidence of acute and late radiation toxicities in the different radiotherapy groups, and there were no differences in individual complications between the BMI groups. When comparing obese to non-obese women, obesity does not negatively impact the incidence of radiation toxicities in endometrial cancer. However, toxicities remain an important challenge as they are common and negatively influence the quality of life (QoL) of survivors. Future studies need to further explore the role of BMI and possible interventions to improve toxicities and QoL.

Exercise Programme in Endometrial Cancer; Protocol of the Feasibility and Acceptability Survivorship Trial (EPEC-FAST)

IntroductionObesity has been associated with impaired quality of life and poorer outcomes in endometrial cancer survivors. Lifestyle interventions promoting exercise and weight reduction have been proposed for survivorship care. However,...

Body mass index, physical activity and quality of life of ovarian cancer survivors: Time to get moving?

ObjectiveTo evaluate the association between body mass index (BMI), physical activity (PA) and the quality of life (QoL) of ovarian cancer survivors. MethodsWe performed a two-centre cross-sectional study of women who had been treated for ovarian cancer between January 2007 and December 2014 at the Royal Cornwall Hospital Trust and the Plymouth Hospitals NHS Trust. QoL was assessed using the EORTC QLQ-C30 and QLQ-OV28 questionnaires, and PA using the Godin Leisure Time Exercise questionnaire. ResultsIn total, 293 ovarian cancer survivors were invited to participate, of which 209 women (71.3%) responded. Thirty-five percent of women were overweight and 18% were obese, whilst only 21% met recommendations for PA. Obesity was associated with significantly poorer global QoL, physical, cognitive and social functioning, a poorer body image and more symptomatology. Sedentary behaviour was associated with poorer QoL scores including global QoL, physical, role, social and sexual functioning. After adjustment, BMI and PA both remained independently associated with QoL scores. ConclusionObesity and inactivity are associated with poorer QoL among ovarian cancer survivors. Future interventions promoting PA and weight loss should be evaluated as possible means to improve the QoL of this population.

P116. Effects of trastuzumab treatment on the patterns of survival and metastasis in Her-2 positive breast cancers

P116. Effects of trastuzumab treatment on the patterns of survival and metastasis in Her-2 positive breast cancers

P114. Acellular dermal matrix versus latissimus dorsi breast reconstruction: An investigation of the costs

P114. Acellular dermal matrix versus latissimus dorsi breast reconstruction: An investigation of the costs

Quality of life in ovarian cancer survivors: the influence of obesity.

In this study, we evaluated the effect of body mass index (BMI) on the quality of life of ovarian cancer survivors. Women diagnosed with ovarian cancer at the Royal Cornwall Hospital Trust between January 2008 and May 2013 were identified. Ovarian cancer survivors were invited to participate by completing the European Organization for Research and Treatment of Cancer QLQ-C30 (quality of life) questionnaire. Univariate and multiple regression analyses were used to determine associations between BMI and quality-of-life outcomes. A total of 176 ovarian cancer survivors were invited to participate, of which 133 were eligible for this study. In total, 81 ovarian cancer survivors (60.4%) completed the questionnaire, of which 26 responders (32.1%) were overweight (BMI, 25-29.9 kg/m²) and 27 (33.3%) were obese (BMI, ≥30 kg/m²). Increasing BMI was significantly associated with poorer quality-of-life outcomes in terms of physical functioning and emotional functioning, and this effect persisted for physical functioning after multiple regression analysis. Increasing BMI is associated with poorer quality-of-life outcomes in terms of physical and emotional functioning in ovarian cancer survivors. Further research is needed to evaluate the association between BMI and quality of life from diagnosis to survivorship to develop novel interventions.

Use of an electronic medical record system to improve antimicrobial stewardship

Antimicrobial resistance constitutes a growing global threat, driven in part by inappropriate antimicrobial prescribing [1]. Most hospitals implement antibiotic policies to promote antimicrobial stewardship. This audit examined the Royal Cornwall Hospital Trust (RCHT) Critical Care Department's compliance with the current standard defined in our local antimicrobial policy. This states that all antimicrobial prescriptions are to have an indication and review date recorded [2]. Sequential strategies to improve compliance were introduced prior to re-auditing the effects.

Cell salvage and leucocyte depletion filters

We read with interest the recent editorial ‘cell salvage induced hypotension and London buses’ concerning hypotension associated with the use of the leucocyte depletion filters [1]. At the Royal Cornwall Hospital Trust, we routinely collect blood for cell salvage at the time of caesarean section. We are currently recruiting to a study involving re-infusion of cell-salvaged-blood and following up women post re-infusion. At the time of caesarean section, the collected blood is washed and processed if there is enough in the collection bowl, or if there are clinical signs of blood loss. We consent women for a re-infusion of the cell-saved blood. All women who have their blood returned are monitored during the re-infusion and are followed up at three and six months postoperatively. At follow-up, a blood sample is taken to test for antibody formation. We have re-infused cell-saved blood to 70 patients. All these patients have received the re-infusion through a leucodepletion filter (Pall LeukoGuard® RS Filter; Pall Europe, Portsmouth, UK), and in all cases only one suction device was used. We have not observed any haemodynamic changes attributable to these re-infusions. However, we have not pressurised the bag or syringed the contents through the filter. We are aware that users have pressurised blood through the LeukoGuard RS filter without complication, although the manufacturer’s product instructions state: ‘use of this filter with a pressure cuff should comply with the recommendations of cell salvage equipment manufacturers’ instructions for use’. We have already demonstrated alpha-fetoprotein is significantly reduced post wash following cell-salvage, to levels well within the normal range for the general population, before passing through the filter. Heparin is also eliminated and whilst the washing process does not eliminate the presence of fetal squames, their significance in the circulation remains unknown [2]. Whilst the decision to re-infuse salvaged blood from a particular patient or patient group is a clinical one, the LeukoGuard RS filter has not been validated by the manufacturer for its ability to remove fetal squames from salvaged blood during re-infusion. Consequently, one cannot rely on the filter’s ability to remove these contaminants during re-infusion of salvaged blood and the filter is not currently endorsed for use for this purpose. The product instructions state that the filter is only validated and indicated for the removal of leucocytes, fat particles and microaggregates from intra-operative salvaged-blood intended for re-infusion. We found the LeukoGuard RS filter significantly reduced the presence of fetal squames with only two out of 34 cases testing positive after filtration [2]. Transfusion-induced hypotension is a recognised phenomenon and has been reported both with and without the use of bedside leucocyte removal filters. Although some publications have suggested that this is an event secondary to the use of leucocyte removal filters [3], a 9-year study of adverse transfusion reactions found an overall incidence of anaphylactic or anaphylactoid reactions of 1.3% (21 of 1613) and of these, nine had associated hypotension [4]. None of these reactions involved the use of bedside leucocyte removal filters. We recognise the limited flow achievable through a filter is a limitation when re-infusing cell-saved blood during hypovolaemic resuscitation. In such cases, we estimate and provide minimal volume resuscitation and transfusion of peri-operative allogenic blood, and subsequently commence slower re-infusion of cell-saved blood. In patients who decline allogenic blood, such as Jehovah’s Witnesses, we would consider removing the filter from the re-infusion. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.

West country upper GI cancer services must be centralised

They′ve resisted it for years, and had hoped that Professor Mike Richard′s eleventh hour intervention would validate their argument; but at the end of last month, campaigners had to resign themselves to upper gastrointestinal (GI) cancer services at the Royal Cornwall Hospital Trust (RCHT) being centralized to Derriford Hospital in Plymouth. In effect, this moves specialist upper GI cancer surgery services out of Cornwall and into the neighbouring county of Devon.

How do anaesthetic teams communicate in unique and dynamic circumstances?

1Institute for Clinical Education, Peninsula Medical School; 2Department of Anaesthesiology, Royal Cornwall Hospital Trust, Cornwall, UK

Diagnostic value and cost‐effectiveness of bronchial brushings in the diagnosis of bronchial malignancy

CytopathologyVolume 16, Issue 1 p. 52-53 Diagnostic value and cost-effectiveness of bronchial brushings in the diagnosis of bronchial malignancy J. Jewell, J. Jewell Department of Cellular Pathology, Royal Cornwall Hospital Trust, Truro, UKSearch for more papers by this author J. Jewell, J. Jewell Department of Cellular Pathology, Royal Cornwall Hospital Trust, Truro, UKSearch for more papers by this author First published: 13 February 2005 https://doi.org/10.1111/j.1365-2303.2004.00201.xCitations: 2 Jacqueline Jewell, Department of Cellular Pathology, Royal Cornwall Hospital Trust, Truro TR1 3LJ, UK. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume16, Issue1February 2005Pages 52-53 RelatedInformation