Hospital Trust Research Articles

Cognitive processing biases associated with fear of childbirth

Fear of childbirth (FOC) is a phobic-like response concerning the prospect of giving birth. FOC can have negative implications for women during pregnancy and can impact their birthing experience. Cognitive processing biases (e.g., difficulty disengaging from threatening information, interpreting ambiguous information as threatening, and preferentially recalling threatening content) have previously been found to maintain general anxiety and low mood. To date, there has been no research assessing these attention, interpretation, and memory biases and their relationship with FOC in pregnant women. Accordingly, in this cross-sectional study, participants who were at least 12 weeks pregnant (n = 116), recruited through a local hospital trust, completed tasks assessing attention (emotional Stroop task), interpretation (scrambled sentences test), and explicit memory (recognition task) biases with materials including FOC-related content. They also completed three separate measures of FOC and measures of low mood, general anxiety, worry, and rumination. We found that a negative interpretation bias (but not attention or explicit memory biases) was associated with higher levels of FOC. These findings indicate that women presenting with higher FOC are more likely to demonstrate negative interpretation biases for ambiguous information relating to childbirth, which may inform research developing interventions to support women presenting with FOC.

Containment of carbapenem-resistant Enterobacterales colonisations and infections: Results from an integrated infection control intervention in a large hospital trust of northern Italy

We describe the results of an infection control intervention, implemented in 4 tertiary hospitals in Romagna, Italy, aiming at containing the spread of carbapenem-resistant Enterobacterales (CRE). The intervention consisted of rectal screening in patients at risk for CRE; pre-emptive contact precaution waiting for screening results; timely notification of CRE identification and concomitant computerized alert; contact precaution for confirmed CRE-positive patients. We performed an interrupted time series analysis to compare the incidence of CRE bacteraemia, of other CRE infections, and CRE-positive rectal swabs in the pre and postintervention period (January 2015-July 2017 and August 2017-June 2020, respectively). 4,332 CRE isolates were collected. Klebsiella pneumoniae was the most represented pathogen (n=3,716, 85%); KPC production was the most common resistance mechanism (n=3,896, 90%). The incidence rate of CRE bacteraemia significantly decreased from 0.554 to 0.447 episodes per 10.000 patient days in the early postintervention period (P=.001). The incidence rate of other CRE infections significantly decreased from 2.09 to 1.49 isolations per 10.000 patient days in the early postintervention period (P=.021). The monthly number of rectal swabs doubled in the postintervention period and there was a significant reduction trend of CRE-positive swabs, sustained over time (P<.001). The infection control intervention was successful in containing the spread of CRE infections and colonisations.

“Feedback is indeed a dainty dish to set before the Trust”: Comparing how online patient feedback is responded to and used across three hospital Trusts in England

“Feedback is indeed a dainty dish to set before the Trust”: Comparing how online patient feedback is responded to and used across three hospital Trusts in England

Impact of cost of Oncotype DX versus CanAssist Breast, an Indian prognostic test, in the management of node-negative early breast cancer in a single centre in India.

14 Background: It is well known that prognostication is important as not all women benefit equally from adjuvant chemotherapy, especially in HR+/HER2- early breast cancer (BC). Multiple publications have showcased the cost-effectiveness of Oncotype DX (ODX) in various countries. However, ODX remains out of reach for many patients in under-resourced geographies like Asia, Africa etc where healthcare insurance is not a norm. CanAssist Breast (CAB) is an affordable prognostic test developed on Indian patients. CAB couples the immunohistochemistry technique with an AI/ML-based prediction model to segregate patients as either low-risk or high-risk for distant breast cancer recurrence. CAB has been validated in the USA, Spain, Germany, Austria, Italy, and The Netherlands for predicting 5–10-year distant recurrences and has comparable low-risk accuracy with that of ODX/MammaPrint. In this abstract, we present real-world data about cost-analysis of the use of CanAssist Breast versus ODX in a single cancer care centre in Rajasthan, a state in Western India that has a per capita income of $ 1504 as against $ 68,400 in the USA. Methods: 124 patients with node-negative early BC were treated at a trust hospital in Jaipur, Rajasthan from 2020-2022. All the high-risk patients received chemotherapy at the treating clinician’s discretion. For the cost analysis model, the cost of chemotherapy drugs, hospitalization charges, and costs involved in managing short-term adverse events was compared for CAB and ODX. Treatment is provided at subsidized costs to the patients in this trust hospital. Results: The median age of this cohort was 55 years (35-78), with primarily T2 and G2 diseases. High-risk proportions were 27% and 17% (as per TAILORx) and by CAB and ODX respectively. The cost of ODX is 5.8 times higher than the cost of CAB. The cost savings per patient with CAB over ODX were US $ 3477 (Rs. 278161) in this trust hospital. Conclusions: This economic model shows that the use of ODX could impose an economic burden due to its cost. Use of CAB would lead to savings without comprising the patient’s health, as both tests have comparable performance.

How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study

ObjectivesTo investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as ‘actions that detract...

Domiciliary transcutaneous electrical stimulation in patients with obstructive sleep apnoea and limited adherence to continuous positive airway pressure therapy: a single-centre, open-label, randomised, controlled phase III trial

Hypoglossal nerve stimulation (HNS) for obstructive sleep apnoea (OSA) is a novel way to manage the condition. We hypothesised that in patients with OSA and limited adherence to continuous positive airway pressure (CPAP) therapy, domiciliary transcutaneous electrical stimulation (TESLA) would control sleep apnoea and provide health benefits. We undertook a single-centre, open-label, randomised, controlled phase III trial in patients with OSA (apnoea-hypopnoea-index [AHI] 5-35h-1), a BMI of 18.5-32kg∗m-2, and a documented lack of adherence to CPAP therapy (<4h∗night-1) at Guy's & St Thomas' NHS Foundation Trust (hospital), UK. Patients were randomly assigned (1:1) using minimisation (gender and OSA severity) to receive TESLA or usual care (CPAP) for at least 3 months; sleep study analysis was provided without knowledge of the assignment arm. The primary outcome was change in AHI at 3-months. The primary outcome and safety were analysed in the intention-to-treat population. Data are reported as median (interquartile range), unless otherwise explained. This trial is registered at ClinicalTrials.gov, NCT03160456. Between 6 June 2018 and 7 February 2023, 56 participants were enrolled and randomly assigned (29 patients in the intervention group and 27 in the usual care group). Patients were followed up for a median of 3.0 months (IQR 3.0; 10.0). The groups were similar in terms of age (55.8 (48.2; 66.0) vs 59.3 (47.8; 64.4) years), gender (male:female, 19:10 vs 18:9) and BMI (28.7 (26.4; 31.9) vs 28.4 (24.4; 31.9) kg∗m-2). The unadjusted group difference in the AHI was-11.5 (95% CI-20.7;-2.3) h-1 (p=0.016). Adjusted for the baseline value, the difference was AHI-7.0 (-15.7; 1.8) h-1 (p=0.12), in favour of the intervention. Minor adverse events were found in one of the participants who developed mild headaches related to the intervention. Domiciliary TESLA can be used safely and effectively in OSA patients with poor adherence to CPAP, with favourable impact on sleepiness and sleep fragmentation. Despite pandemic-related limitations of the amended protocol this trial provides the evidence that TESLA improves clinically meaningful outcomes over the observed follow up period, and the transcutaneous approach is likely to offer an affordable alternative for responders to electrical stimulation in clinical practice. British Lung Foundation, United Kingdom Clinical Research Collaboration-registered King's Clinical Trials Unit at King's Health Partners.

Svak skår på deltesten Tallhukommelse i WISC-V – en indikasjon på språklige vansker?

Background: WISC-V is the first Wechsler intelligence test that measures both the visual working memory and the auditory working memory. Both tests contribute to a combined Working Memory Index, but much of the research suggests that sensory modality plays an important role. Children with impaired phonological capacity and resulting reading, writing or language difficulties, often struggle with Digit Span without necessarily having problems with Picture Span. Psychologists are often more concerned with possible attention deficits than modality-specific problems, and may suspect ADHD in cases of impaired Digit Span. Method: In the project, 62 test protocols from children in the Child and Adolescent Psychiatry Unit at Vestfold Hospital Trust were analysed. They were assessed using Digit Span and Picture Span, and Conners CPT 3 was used to test attention deficit, in addition to the Norwegian test Språk 6-16 and Children’s Communication Checklist-2 to measure possible language-related problems. Results: Beyond shared variance between Digit Span and Picture Span, regression analyses showed that Digit Span was associated with language-related problems and not attention deficit problems, while Picture Span was associated with attention deficit. Implications: The clinical recommendation is to not interpret Digit Span or the Working Memory Index in isolation before considering modality differences. Impaired Digit Span should prompt clinicians to consider language-related problems, while impaired Picture Span may raise suspicion of more general attention deficits. Keywords: WISC-V, Digit Span, Working Memory, ADHD, language-related problems

Single-centre, non-randomised clinical trial at a tertiary care centre to investigate 1-year changes in social experiences and biomarkers of well-being after bariatric surgery in individuals with severe obesity: protocol for the Bariatric Surgery and Social Experiences (BaSES) study

IntroductionObesity is linked to increased loneliness and less enjoyment of social interactions. While bariatric surgery is the most effective treatment targeting severe obesity, there is limited understanding as to whether...

Changing outcomes of stem cell transplantation in primary immunodeficiencies: Results from a tertiary-care charitable trust hospital in Mumbai.

Hematopoietic stem cell transplantation in primary immunodeficiency disorders has come a long way since the first transplant in 1968. In India, pediatric stem cell transplantation long-term survival outcomes range from 62.5% to 75%, compared to 90% in high-income countries. We present single-center data of primary immunodeficiency transplants with immune-reconstitution evaluation after transplantation from a charitable trust hospital. Retrospective data of children transplanted for primary immunodeficiency disorders from March 2019 to March 2022 in a newly established transplant unit were collected. Data of pretransplant infections and comorbidities, surveillance for carbapenem-resistant Enterobacteriaceae, transplant characteristics, donor source, graft-versus-host disease, posttransplant infections, immune reconstitution, overall survival at 1 year, and immunodeficiency-free survival were collated. Twenty-one patients underwent transplantation for primary immunodeficiency disorders. The median age at transplantation was 3 years and 5 months (range, 7 months to 17 years). Seventy-five percent of the cohort had organ involvement, with lung being the most common organ involved, followed by central nervous system. Fifty-two percent of children had peritransplant infections, with most of them recognized at the pretransplant assessment. Among 20 of 21 children with engraftment, 94% had complete chimerism initially, with 33% developing mixed chimerism over time. The median duration of immunosuppression was 3 months after transplantation, and only 1 child required systemic graft-versus-host disease treatment for more than a year. Immune-reconstitution showed good T-cell recovery at 3 months and naive T-cell production at 6 months. There was no regimen-related or sepsis-related mortality. Overall survival of the cohort was 95% at 1-year follow-up. Immunodeficiency-free survival was 86% after a median follow-up of 20 months. Immunodeficiency-free and graft-versus-host disease-free survival can be achieved in the majority of children with primary immunodeficiencies using enhanced supportive care and the latest transplantation algorithms.

Severity of central sensitization in patients with chronic low back pain

Background: Low back pain develops into Chronic Low Back Pain (CLBP) due to the contribution of various psychosocial factors in approximately 10-20% of all patients. CLBP is classified into three groups namely neuropathic, nociceptive and central sensitization (CS). CS results in pain due to hyper-responsive nociceptive neurons and recruitment of sub-threshold or normal stimuli. Objective: To determine the frequency of central sensitization in patients with chronic low back pain Methods: A descriptive cross-sectional observational study was conducted on 388 patients with CLBP, aged between 18 to 44 years, using non-probability convenient sampling. Patients were recruited from Ghurki Trust and Teaching Hospital, whereas, adults with a history of spinal surgery within the last 12 months, use of NSAIDs/analgesics, and coexisting neurological, respiratory, cardiac, or rheumatic disorder were excluded. The participants were requested to fill the Central Sensitization Inventory (CSI) questionnaire which has a test-retest reliability of 0.817. Results: Out of 388 participants, 22.7% (n=88) of the participants demonstrated subclinical central sensitization. Mild central sensitization was reported by 33.0% (n=128) participants, 20.6% (n=80) demonstrated moderate central sensitization scores on the CSI. Whereas, severe central sensitization was found in 13.4% (n=52) participants and 10.3% (n=40) of the participants reported extreme central sensitization category based on their scores on the CSI. Conclusion: Mild central sensitization was reported frequently among patients with chronic low back pain.

Outcome of Suprachoroidal Triamcinolone Acetonide in Resistant Diabetic Macular Edema

One of the most frequent cause of central vision deterioration in people with retinopathy due to diabetes is diabetic macular edema. Suprachoroidal injections offer a novel way of delivery for the administration of corticosteroids that may have various benefits. Objective: To observe outcome of triamcinolone acetonide given by suprachoroidal route for the treatment of resistant diabetic macular edema. Methods: A descriptive case series study which was carried out at Department of Ophthalmology, Layton Rahmatullah Benevolant Trust Hospital Multan Road Lahore from July 14, 2021 till Jan 14, 2022. A total of 60 cases meeting selection criteria was taken after taking approval from hospital ethical committee. All injections were given by a single surgeon to avoid any related bias. 30-gauge 1cc insulin syringe was used in all cases. Results: The study included patients aged between 30 and 70 years, and the average age was 52.73 ± 10.99 years. There were 39(65%) male with 21(35%) female cases. The average central subfield thickness before and after one month was 593.62 ± 116.87 µm and 303.55 ± 31.29 µm with statistically significantly less mean central subfield thickness after 1 month, p-value less than 0.001. The mean visual acuity after correction before and after one month was 0.81 ± 0.16 and 0.45 ± 0.03 respectively, with statistically significantly less mean optimally corrected visual acuity after 1 month, p-value less than 0.001. Conclusions: It was found that suprachoroidal triamcinolone acetonide is useful in managing the central subfield and optimally corrected visual acuity in resistant diabetic macular edema.

A dietitian-led coeliac service helps to identify and reduce involuntary gluten ingestion with subsequent reduction in the frequency of repeat endoscopies.

Dietitian-led coeliac clinics have the potential to be a cost-effective way of monitoring patients living with coeliac disease (CD). The aim of this service evaluation was to explore the impact of a dietitian-led coeliac clinic on gluten-free diet (GFD) adherence and the frequency of endoscopies with repeat duodenal biopsies. Adults with biopsy-proven CD were transferred to a new dietitian-led coeliac clinic where data were collected from medical records and analysed using SPSS. GFD adherence was assessed by a specialist dietitian, specialist nurse, consultant gastroenterologists and a validated GFD adherence questionnaire. Repeat duodenal biopsy findings were compared with the most recent dietitian GFD adherence assessment. Project and ethics approval was granted by the hospital trust and affiliated university. Data from 170 patients (White: 51%, South Asian: 45%) are presented, with most being 35-64 years old (61%). Specialist dietitian assessments identified 67 (39%) of patients were adhering to the GFD, whereas prior gastroenterologist or coeliac nurse assessments identified 122 (72%) (p < 0.001) and the validated GFD adherence questionnaire identified 97 (57%) (p < 0.001). Dietitian assessments identified involuntary gluten consumption in 39/104 (38%) of those who self-reported GFD adherence, consequently avoiding the need for nine endoscopies with repeat duodenal biopsies once patients had received dietary education from the dietitian. On follow-up, within the dietitian-led coeliac clinic, significantly fewer patients consumed gluten involuntarily (14%, p < 0.001). In addition, a reduction in voluntary gluten consumption was observed from three to five to one to two times per month (p < 0.001) in 66 patients. The dietitian-led coeliac clinic helped to identify involuntary gluten ingestion, avoid repeat endoscopies with duodenal biopsies and was associated with significantly improved GFD adherence.

Storytelling and affiliation between healthcare staff in Schwartz Round interactions: A conversation analytic study

It is well known that the demands of working in healthcare can take a psychological toll on staff. Schwartz Centre Rounds are an intervention aimed at supporting staff wellbeing through providing a forum to talk about the emotional, social and ethical complexities of such work, employing facilitated storytelling and group discussion to try and achieve this. However, while prior research, through extensive interviews and surveys, has found Schwartz Rounds to be effective in fostering compassion and wellbeing amongst participants, the talk that occurs within Schwartz Rounds themselves has not been explored. One mechanism that has been considered in how Schwartz Rounds function is the creation of a ‘counter-cultural’, conversational space, suggesting the nature of the interactions themselves may be important in achieving their beneficial effects. Using conversation analytic (CA) methods, we examine Schwartz Rounds in the UK to address, at a detailed micro-level, how sequences of talk work to accomplish the key aims of this setting. Five separate one-hour Schwartz Rounds were recorded across three UK hospital Trusts, between January 2019 and February 2020. Our analysis addresses how panellists tell their stories in a way that emphasises the uniqueness of their experience but also provides a generalisable emotional ‘upshot’ and ‘stance’ for the audience to later respond to. We then focus in on how audience members are able to respond to these stories affiliatively, offering endorsements, generalisations and second stories. Drawing on prior CA literature examining support groups and psychotherapy, we consider how the format of Schwarz Rounds creates important opportunities for interpersonal affiliation in this context. Considering these interactional features alongside other research findings on Schwartz Rounds, we discuss how opportunities for interactional affiliation may be central to their success, with implications for how these interactions can be best facilitated.

Our health, our research. Identifying public health research priorities among children and youth in a multiethnic population: protocol for a community-based participatory health research priority survey

IntroductionEmphasis on public involvement (PI) in health research has increased in the last 20 years. However, there is limited literature on PI in planning and conducting population-based health research. This...

Transdiagnostic Associations between Anger Hostility and Chemokine Interferon-gamma Inducible Protein 10.

Many psychiatric disorders are linked to low grade systemic inflammation as measured by systemic cytokine levels. Exploration of cytokines and immune activity and their role in psychiatric symptoms may inform pathobiology and treatment opportunities. The aim of this study is to explore if there are associations between cytokines and psychiatric symptom clusters. Comparison between patients regularly using and those not using psychotropic medication is also conducted. This was a cross sectional naturalistic study with 132 participants from a general open inpatient psychiatric ward at the Nordland Hospital Trust, Norway. Serum levels of 28 different cytokines were assessed. Psychiatric symptoms the last week were assessed by a self-rating scale (Symptom check list, SCL-90-R) and grouped in defined clusters. Multiple linear regression model was used for statistical analyses of associations between levels of cytokines and symptoms, adjusting for possible confounding factors. We found a positive association (p = 0.009) between the chemokine interferon-gamma inducible protein 10 (CXCL 10; IP-10) and the anger hostility cluster. No associations were found between the other symptom clusters and cytokines. IP-10 and the anger hostility cluster were positively associated (p = 0.002) in the subgroup of patients using psychotropic medication, not in the subgroup not using psychotropic medication. Our analyses revealed a significant positive association between the symptom cluster anger hostility in SCL-90-R and the chemokine IP-10 in the subgroup of patients using psychotropic medications.

Delirium, neurofilament light chain, and progressive cognitive impairment: analysis of a prospective Norwegian population-based cohort

Previous population-based, longitudinal studies have shown that delirium is associated with an increased risk of dementia and cognitive decline. However, the underlying biological mechanisms are largely unknown. We aimed to assess the effects of delirium on both cognitive trajectories and any neuronal injury, measured via neurofilament light chain (NfL). In this analysis of a prospective, 2-year follow-up, cohort study of participants aged 65 years or older living in Sandefjord municipality, Norway, we included cohort participants who were receiving domiciliary care services at least once per week between May 12, 2015, and July 8, 2016. Individuals with a life expectancy of less than 1 week, with Lewy body dementia, with psychiatric illness (except dementia), or for whom substance misuse was the principal indication for domiciliary services were excluded. Participants had a comprehensive assessment at 6-month intervals for 2 years, which included the Montreal Cognitive Assessment (MoCA) and a blood sample for NfL to measure neuronal injury. All information on clinical diagnoses and medications were cross-referenced with medical records. During any acute change in mental status or hospitalisation (ie, admission to hospital), participants were assessed once per day for delirium with Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria. We also measured NfL from blood samples taken from participants who were acutely hospitalised. Between May 12, 2015, and July 8, 2016, 210 participants were eligible for inclusion and assessed at baseline (138 [66%] of whom were female and 72 [34%] of whom were male), 203 completed cognitive assessment, and 141 were followed up for 2 years. 160 (76%) of 210 had moderate or severe frailty and 112 (53%) were living with dementia. During the 2-year follow-up, 89 (42%) of 210 participants were diagnosed with one or more episodes of delirium. Incident delirium was independently associated with a decrease in MoCA score at the next 6-month follow-up, even after adjustment for age, sex, education, previous MoCA score, and frailty (adjusted mean difference -1·5, 95% CI -2·9 to -0·1). We found an interaction between previous MoCA score and delirium (β -0·254, 95% CI -0·441 to -0·066, p=0·010), with the largest decline being observed in people with better baseline cognition. Participants with delirium and good previous cognitive function and participants with a high peak concentration of NfL during any hospitalisation had increased NfL at the next 6-month follow-up. Mediation analyses showed independent pathways from previous MoCA score to follow-up MoCA score with contributions from incident delirium (-1·7, 95% CI -2·8 to -0·6) and from previous NfL to follow-up MoCA score with contributions from acute NfL concentrations (-1·8, -2·5 to -1·1). Delirium was directly linked with a predicted value of 1·2 pg/mL (95% CI 1·02 to 1·40, p=0·029) increase in NfL. In people aged 65 years or older, an episode of delirium was associated with a decline in MoCA score. Greater neuronal injury during acute illness and delirium, measured by NfL, was associated with greater cognitive decline. For clinicians, our finding of delirium associated with both signs of acute neuronal injury, measured via NfL, and cognitive decline is important regarding the risk of long-term cognitive deterioration and to acknowledge that delirium is harmful for the brain. South-Eastern Norway Health Authorities, Old Age Psychiatry Research Network, Telemark Hospital Trust, Vestfold Hospital Trust, and Norwegian National Centre for Ageing and Health. For the Norwegian translation of the abstract see Supplementary Materials section.

Patient-reported outcomes, weight loss, and remission of type 2 diabetes 3 years after gastric bypass and sleeve gastrectomy (Oseberg); a single-centre, randomised controlled trial

Little is known about the comparative effects of various bariatric procedures on patient-reported outcomes. We aimed to compare 3-year effects of gastric bypass and sleeve gastrectomy on patient-reported outcome measures in patients with obesity and type 2 diabetes. The Oseberg trial was a single-centre, parallel-group, randomised trial at Vestfold Hospital Trust, a public tertiary obesity centre in Tønsberg, Norway. Eligible patients were aged 18 years or older with previously verified BMI 35·0 kg/m2 or greater. Diabetes was diagnosed if glycated haemoglobin was at least 6·5% (48 mmol/mol) or by their use of anti-diabetic medications with glycated haemoglobin at least 6·1% (43 mmol/mol). Eligible patients were randomly assigned (1:1) to gastric bypass or sleeve gastrectomy. All patients received identical preoperative and postoperative treatment. Randomisation was done with a computerised random number generator and a block size of ten. Study personnel, patients, and the primary outcome assessor were blinded to allocations for 1 year. The prespecified secondary outcomes reported here were 3-year changes in several clinically important patient-reported outcomes, weight loss, and diabetes remission. Analyses were done in the intention to treat population. This trial is ongoing, closed to recruitment and is registered with ClinicalTrials.gov, NCT01778738. Between Oct 15, 2012 and Sept 1, 2017, 319 consecutive patients with type 2 diabetes scheduled for bariatric surgery were assessed for eligibility. 101 patients were not eligible (29 did not have type 2 diabetes according to inclusion criteria and 72 other exclusion criteria) and 93 declined to participate. 109 patients were enrolled and randomly assigned to sleeve gastrectomy (n=55) or gastric bypass (n=54). 72 (66%) of 109 patients were female and 37 (34%) were male. 104 (95%) of patients were White. 16 patients were lost to follow up and 93 (85%) patients completed the 3-year follow-up. Three additional patients were contacted by phone for registration of comorbidities Compared with sleeve gastrectomy, gastric bypass was associated with a greater improvement in weight-related quality of life (between group difference 9·4, 95% CI 3·3 to 15·5), less reflux symptoms (0·54, 0·17 to -0·90), greater total bodyweight loss (8% difference, 25% vs 17%), and a higher probability of diabetes remission (67% vs 33%, risk ratio 2·00; 95% CI 1·27 to 3·14). Five patients reported postprandial hypoglycaemia in the third year after gastric bypass versus none after sleeve-gastrectomy (p=0·059). Symptoms of abdominal pain, indigestion, diarrhoea, dumping syndrome, depression, binge eating, and appetitive drive did not differ between groups. At 3 years, gastric bypass was superior to sleeve gastrectomy in patients with type 2 diabetes and obesity regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, while symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups. This new patient-reported knowledge can be used in the shared decision-making process to inform patients about similarities and differences between expected outcomes after the two surgical procedures. Morbid Obesity Centre, Vestfold Hospital Trust. For the Norwegian translation of the abstract see Supplementary Materials section.

The role of doctors' assistants in reducing GP administrative workload at Maylands Healthcare.

Following the COVID-19 pandemic, the NHS is facing increasing pressures because of growing patient demand and hospital backlogs. With the number of GPs declining, the average number of patients per GP has increased. There are reports of hospital trusts and GP practices introducing doctors' assistants (DAs) to help with clinical and administrative tasks, which has reduced the workload of doctors. As the authors are not aware of any DAs working with GPs locally, Maylands Healthcare (14 000 patients) has introduced this new workforce model by assigning a DA to each clinician's worklist. To investigate the benefit of DAs in primary care in managing doctors' administrative workload. This qualitative study involved a questionnaire for DAs and doctors, exploring their views on the role of DAs. The DAs also completed a 5-day task diary in August 2022. Responses from six DAs and five doctors were analysed. The DAs completed 398 referrals. On average, each DA completed 66 referrals and 70 other tasks. The main tasks completed were referrals, investigations, transport, liaising with organisations including social services, and directly communicating with patients. Benefits reported by DAs included a reduction in doctors' administrative workload, enabling more time for consultations and supporting vulnerable patients. Doctors felt their administrative workload reduced by 30%, reporting benefits in time-efficiency, continuity of care, and managing patients with complex conditions. This study demonstrates that the introduction of DAs has helped to manage the administrative workload in primary care, improving efficiency, patient care, and safety.

A first census of skin cancer specialist nurses across UK secondary care trusts

BackgroundSkin cancer specialist nurses (SCSNs) support patients and work alongside healthcare professionals throughout the care pathway. Skin cancer management is rapidly evolving, with increasing and more complex treatment options now available, so the need for patient support is growing. While SCSNs are a major source of that support, the provision of SCSN resource across the UK has never previously been assessed. We therefore undertook a first SCSN census on 1st June 2021.MethodsAn electronic survey was disseminated to UK hospital trusts and registered skin cancer healthcare professionals. Responses were identifiable only by the respective trust name.Results112 responses from 87 different secondary care trusts were received; 92% of trusts reporting having at least 1 established SCSN post. Average SCSN staffing per trust was 2.4 (range 0–7) whole time equivalents, managing an average caseload of 83 (range 6–400) patients per week. SCSN workload had increased in 82% hospitals in the previous year and 30% of trusts reported being under-resourced. Most SCSN time was spent managing melanoma (as opposed to non-melanoma skin cancer) patients linked to surgical services. Regional variations existed, particularly associated with provision of lymphoedema services, nurse prescribing skills and patient access to clinical trials. The COVID-19 pandemic was associated with a marked increase in SCSN-led telemedicine clinics, but loss of training and education opportunities.ConclusionsSCSNs based in secondary care hospitals play a major role supporting both clinicians and patients throughout the care pathway. This first UK census confirmed that SCSN workload is increasing and in one third of hospital trusts, the work was reported to outstrip the staffing available to manage the volume of work. Regional variations in SCSN resource, workload and job role, as well as availability of certain skin cancer services were identified, providing valuable information to healthcare commissioners concerned with service improvement.

Cardiac troponin T, NT-proBNP and GDF-15 associate with future focal myocardial scar types, but not diffuse fibrosis assessed by cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust, Vestre Viken Hospital Trust, South-Eastern Norway Regional Health Authority, Roche Diagnostics provided reagents for hs-cTnT analyses Background In cardiovascular risk prediction, there is growing evidence that imaging and circulating cardiac biomarkers provide incremental prognostic value compared to single biomarkers or traditional risk factors. In patients with suspected or established cardiovascular disease (CVD), cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) associate with focal and diffuse fibrosis assessed by cardiac magnetic resonance (CMR) imaging. There is limited data on the associations between established and emerging circulating cardiac biomarkers with subsequent myocardial fibrosis in subjects without CVD recruited from the general population. Purpose Assess the associations between biomarkers of cardiac injury (cTnT), stress (NT-proBNP) and fibrosis and inflammation (growth differentiation factor-15, GDF-15), and subsequent focal and diffuse myocardial fibrosis assessed by CMR imaging. Methods We recruited 200 study participants born in 1950 from the general population. All participants were without known coronary artery disease or renal dysfunction. cTnT, NT-proBNP, and GDF-15 were measured in samples collected at baseline in 2012–2015, and CMR was performed 4–7 years later. Presence and type (ischemic/non-ischemic) of focal myocardial fibrosis were assessed by late gadolinium enhancement (LGE) imaging. Diffuse fibrosis was assessed by the extracellular volume (ECV) in the midventricular septum. Logistic regression analysis was used to examine relationships between log transformed concentrations of cardiac biomarkers and CMR parameters. Results The median age was 63.9 (63.4–64.5) and 52% were male (Table 1). cTnT was associated with presence of any LGE scar adjusted for common cardiovascular risk factors (OR 1.85, 95% CI 1.25–2.72), but this association was attenuated when left ventricular mass was added to the model (Table 2). NT-proBNP (OR 1.66, 95% CI 1.10–2.72) and GDF-15 (OR 4.45, 95% CI 1.29–15.27) were associated with presence of any LGE scar in the fully adjusted models (Table 2). cTnT (OR 1.90, 95% CI 1.06–3.39) and NT-proBNP (OR 2.72, 95% CI 1.29–5.76) were associated with ischemic scars. Only GDF-15 (OR 4.52, 95% CI 1.09–18.72) associated with non-ischemic scars in adjusted models. None of the biomarkers were significantly associated with ECV. Conclusion(s) In a general population cohort, biomarkers of myocardial injury and stress associate with ischemic type scars, but not diffuse fibrosis. GDF-15, an emerging circulating biomarker of fibrosis and inflammation, associates with non-ischemic type scars.