West Middlesex University Hospital Research Articles

Incorporation of vasa previa screening into a routine anomaly scan: A single center cohort study.

Vasa previa (VP), defined as unprotected fetal vessels traversing the membranes over the cervix, is associated with a high perinatal mortality when undiagnosed prenatally. Conversely, prenatal diagnosis with ultrasound and cesarean delivery before the membranes rupture is associated with excellent outcomes. However, controversy exists regarding screening for VP. In the UK, routine screening for VP is not recommended. The objective of this study was to report the incidence of VP and our experience in the detection of VP with a universal screening protocol at the time of the second-trimester fetal anomaly scan with third-trimester confirmation in an unselected population of pregnancies. We performed a single-center historical cohort study of all pregnant women who underwent routine second-trimester anomaly screening scans at West Middlesex University Hospital, London, UK, between 2012 and 2016. Over 5 years, every patient undergoing routine anomaly screening was evaluated for VP using a systematic protocol during their 20-week anomaly scan. Suspected cases of VP were rescanned in the third trimester by specialist sonographers with an interest in VP. The primary outcomes were the incidence and detection of VP. During the study period, 24 690 anatomy scans were performed. A total of 64 patients were identified as having potential VP at the second-trimester anomaly screening scan, of which 19 were confirmed by the specialist sonographer in the third trimester and at delivery. The screen positive rate was 0.26% (95% confidence interval [CI] 0.20%-0.32%). VP at birth was found in 19/24690 births (1:1299 [95% CI: 1:832-1:2030] births). Universal screening for VP using our protocol had a sensitivity of 100% and a specificity of 99.78% (95% CI: 99.72%-99.84%). The false-positive rate of the second-trimester screen was 0.18% (95% CI: 0.13-0.24). There were no false positives or false negatives at delivery. Of the 19 patients with confirmed VP, 17 had scheduled cesarean deliveries, and two required emergency deliveries due to antepartum hemorrhage. One baby died, giving a perinatal mortality of 5%. VP complicates approximately 1:1300 pregnancies. Routine screening for VP yielded a 100% detection rate. We suggest the inclusion of structured VP assessment in standard fetal anomaly screening programs.

913 Patient Satisfaction with Personalised Stratified Follow-Up After Treatment for Breast Cancer at West Middlesex University Hospital

Abstract Aim Personalised stratified follow up (PSFU) is a programme that ensures safe follow-up of breast cancer patients following treatment completion, avoids un-necessary appointments, whilst offering rapid access to clinicians when required. A protocol for PSFU was designed and the programme introduced to West Middlesex University Hospital in 2019. We aim to assess patient satisfaction with nurse-led end of treatment consultations. Method 200 Patients were enrolled from January 2019 to September 2021.The study was registered with the Clinical Governance department. All patients were initially contacted by telephone and later questionnaires were sent out either by post or using Google Docs via text messaging. Data was collected both from questionnaires and Somerset cancer registry platform and analysed using Microsoft Excel. Results Out of 200 patients, 150 were successfully contacted by telephone and sent questionnaires, with 68% response rate. This was largely electronic. 48% had video or phone consultations, with the rest attending in person. 90% thought they had sufficient time for discussion, with 82% feeling well informed regarding their management at the end of the consultation. 86% were satisfied or very satisfied with the consultation. 35% had their consultation within 3 months of completing treatment and 29% within 6 months. Conclusion Patients were largely satisfied with their end of treatment consultations. This was in spite of delays caused by the COVID-19 pandemic. Longer term follow up is required to determine satisfaction with the PSFU programme as a whole, and its efficiency.

Diagnostic Performance of a Noninvasive Breath Test for Colorectal Cancer: COBRA1 Study

Diagnostic Performance of a Noninvasive Breath Test for Colorectal Cancer: COBRA1 Study

551 Patient Satisfaction with Telephone Consultations in A One-Stop Breast Clinic During COVID-19 Pandemic

Abstract Aim Telemedicine has gained an important role in medical practice lately, particularly in the outpatient setting. In our unit, virtual consultations were previously used for results clinics only. However, the first wave of COVID-19 pandemic necessitated change of practice to address issues of triage, infection control, cancer target times, and decreased capacity in the face of maintained demand. New patients underwent a telephone consultation followed by a clinic visit one week afterwards to complete triple assessment. We aimed to assess patient satisfaction with the phone consultation and subsequent care. Method Patients referred from general practice to the Breast Unit at West Middlesex University Hospital, who had a telephone appointment in the period 15/04/2020 to 15/07/2020, were included. The study was registered with the Clinical governance department. Patients received text messages with anonymised links to an online survey and were contacted over the telephone to explain the survey. Results 219 successful phone calls were made to eligible patients, and 126 patients responded to the survey (57.5%). 78% felt that they were able to express all or most of their concerns over the phone. 86% spent less than 2 hours in clinic. 87% felt social distancing and safety measures were adequate. More than 75% were overall satisfied with their care. Conclusions We further discuss responses to this survey. Patients were largely satisfied; however, areas of improvement were identified, and changes need to be made to ensure telemedicine is used to its full potential and is appropriately incorporated in the post COVID-19 practice.

Validating a methodology to measure frailty syndromes at hospital level utilising administrative data

Identifying older people with clinical frailty, reliably and at scale, is a research priority. We measured frailty in older people using a novel methodology coding frailty syndromes on routinely collected administrative data, developed on a national English secondary care population, and explored its performance of predicting inpatient mortality and long length of stay at a single acute hospital. We included patient spells from Secondary User Service (SUS) data for those ≥65 years with attendance to the emergency department or admission to West Middlesex University Hospital between 01 July 2016 to 01 July 2017. We created eight groups of frailty syndromes using diagnostic coding groups. We used descriptive statistics and logistic regression to explore performance of diagnostic coding groups for the above outcomes. We included 17,199 patient episodes in the analysis. There was at least one frailty syndrome present in 7,004 (40.7%) patient episodes. The resultant model had moderate discrimination for inpatient mortality (area under the receiver operating characteristic curve (AUC) 0.74; 95% confidence interval (CI) 0.72-0.76) and upper quartile length of stay (AUC 0.731; 95% CI 0.722-0.741). There was good negative predictive value for inpatient mortality (98.1%). Coded frailty syndromes significantly predict outcomes. Model diagnostics suggest the model could be used for screening of elderly patients to optimise their care.

Nurses transform mouth care with oral hygiene plan

Two nurses on the stroke ward at West Middlesex University Hospital devised a single-use oral hygiene kit that hangs on patients’ bedsides

Management of Bone Health in Breast Cancer Patients Established on Aromatase Inhibitors

Purpose: (1) To audit compliance with national guidelines of screening, diagnosis and treatment of osteoporosis or osteopenia in breast cancer patients on aromatase inhibitors at the West Middlesex University Hospital (WMUH). (2) To model the effect of the introduction of adjuvant bisphosphonates at WMUH.

'I see myself as a conductor'.

North West Healthcare NHS Trust chief executive Dame Jacqueline Docherty has held a variety of posts during a nursing career that has spanned more than 40 years, including theatre sister and executive director of nursing. She was appointed chief executive at West Middlesex University Hospital in 2009, and has been in her current role since April 2015. In 2004, she was awarded a DBE for services to nursing and the NHS.

The role of MRCP in potential gallstone disease when the biliary tree is normal on initial imaging

Purpose Magnetic resonance cholangiopancreatography (MRCP) is increasingly used in the diagnosis of biliary abnormalities, particularly in stone disease. Studies of its role in the absence of a dilated biliary system on prior imaging have shown a low diagnostic yield and the aim of this study was to assess factors predictive of diagnostic outcome. Methods and materials A retrospective observational study of consecutive MRCPs (n = 375) from October 2010–June 2013 at West Middlesex University Hospital. MRCP findings were correlated with the presence of dilated or non-dilated biliary tree on initial imaging ultrasound scanning (USS)/computed tomography (CT), deranged liver function tests, abdominal pain and demographics. Multivariate logistic regression analysis was performed with SPSS statistical software. Results There were 243 female, 132 male patients (mean age of 62). The sensitivity of MRCP was 81% and specificity 80%. Multivariate analysis identified that age (p = 0.0253), jaundice (p = 0.0247) and abnormal index imaging (p = 0.0003) are statistically significant predictors of biliary tree abnormalities on MRCP. The c statistic for the multivariate analysis was moderately high at 0.665 (95% confidence interval [CI] 0.614–0.712, p < 0.001). Conclusion These data confirm the low diagnostic yield of MRCP in the absence of dilated biliary system on initial USS/CT. We propose there should be a specific rationale for performing MRCP when initial imaging is normal especially when bilirubin is normal. Magnetic resonance cholangiopancreatography (MRCP) is increasingly used in the diagnosis of biliary abnormalities, particularly in stone disease. Studies of its role in the absence of a dilated biliary system on prior imaging have shown a low diagnostic yield and the aim of this study was to assess factors predictive of diagnostic outcome. A retrospective observational study of consecutive MRCPs (n = 375) from October 2010–June 2013 at West Middlesex University Hospital. MRCP findings were correlated with the presence of dilated or non-dilated biliary tree on initial imaging ultrasound scanning (USS)/computed tomography (CT), deranged liver function tests, abdominal pain and demographics. Multivariate logistic regression analysis was performed with SPSS statistical software. There were 243 female, 132 male patients (mean age of 62). The sensitivity of MRCP was 81% and specificity 80%. Multivariate analysis identified that age (p = 0.0253), jaundice (p = 0.0247) and abnormal index imaging (p = 0.0003) are statistically significant predictors of biliary tree abnormalities on MRCP. The c statistic for the multivariate analysis was moderately high at 0.665 (95% confidence interval [CI] 0.614–0.712, p < 0.001). These data confirm the low diagnostic yield of MRCP in the absence of dilated biliary system on initial USS/CT. We propose there should be a specific rationale for performing MRCP when initial imaging is normal especially when bilirubin is normal.

PTU-306 The efficacy of mrcp in suspected gallstone disease when the biliary tree is normal on previous imaging: Abstract PTU-306 Table 1

Introduction Magnetic Resonance Cholangiopancreatography (MRCP) is increasingly used in the diagnosis of biliary abnormalities, particularly in stone disease. 1 However initial studies into its role in the absence of a dilated biliary system on initial imaging have demonstrated a low diagnostic yield. 2 The aim of this study was to further assess the role of MRCP when the biliary tree is non-dilated on index imaging. The factors associated with diagnostic yield in this setting are unclear. Method We performed a retrospective observational study of consecutive MRCP studies (n = 375) performed between October 2010 and June 2013 at West Middlesex University Hospital using electronic medical records. All MRCPs were reported by a consultant gastrointestinal radiologist. MRCP findings were correlated with the presence of dilated or non-dilated biliary tree on initial imaging (USS/CT), jaundice (bilirubin > 21 μmol/L), transaminitis (alanine transaminase >45 iu/L, aspartate transaminase >34 iu/L), raised alkaline phosphatase (>120 iu/L) and abdominal pain, and demographics including age and gender. Multivariate logistic regression analysis was performed using SPSS software. Results The study included 243 female and 132 male patients with a mean age of 62 (range 20–101) years. There were 153 patients with biochemical jaundice, 246 with a dilated biliary system and 129 with a non-dilated system. The sensitivity of MRCP was 81%, with a specificity of 80%. Multivariate analysis identified that age (p = 0.0253), the presence of jaundice (p = 0.0247), and abnormal index imaging (p = 0.0003), are statistically significant predictors of the finding of biliary tree abnormalities on subsequent MRCP (see attached Table 1). The c statistic for the multivariate analysis was only moderately high at 0.665 (95% CI 0.614–0.712, p Conclusion These data confirm there is a low diagnostic yield of MRCP in the absence of dilated biliary system on previous USS/CT. We propose that there should be a specific rationale for performing MRCP when initial imaging is normal, especially when the bilirubin is normal. Other clinical indices such as pain or abnormal liver chemistry (other than hyper-bilirubinaemia) are not independently predictive of positive finding on MRCP in our analysis. Disclosure of interest None Declared. References Shanmugam V, et al . Is magnetic resonance cholangiopancreatography the new gold standard in biliary imaging? Br J Radiol . 2005;78:888–893 Vadwhana B, et al . Is MRCP a useful investigation where the biliary tree is normal on previous imaging? Gut 2013; 62 (Suppl 1):A210

P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

The use of tranexamic acid results in decreased blood loss in patients undergoing primary lower limb arthroplasty

The use of tranexamic acid results in decreased blood loss in patients undergoing primary lower limb arthroplasty

“Eternal vigilance is the price of safety”: a case of inadvertent administration of oxytocin via epidural catheter

West Middlesex University Hospital, Dept of Anaesthesiology & Intensive Care, Isleworth, United Kingdom

PPO.36 The effect of HIV on pregnancy: A 9-year review of outcomes

BackgroundIn the UK, 2.2 per 1000 women giving birth have HIV.1 Routine antenatal screening and BHIVA guidelines1 recommending multidisciplinary input have reduced mother-to-child HIV transmission (MTCT). Antiretroviral therapy (ART) is...

Rubella Antibody Status of Patients Attending a South-West London Antenatal Clinic, 2007–2012

Mass vaccination with the measles-mumps-rubella (MMR) vaccine for children aged 12–15 months was introduced in 1988; schoolgirl vaccination was discontinued in 1996 and replaced by a second dose of MMR for preschool children and post-partum vaccination of susceptible women identified through antenatal testing. In the UK, declining uptake rates due to concerns about the MMR vaccine, and increasing numbers of cases in some European countries where rubella surveillance and preconceptional vaccination are inadequate, coupled with poor uptake rates, has started to show in the number of rubella-susceptible patients presenting at antenatal clinics (ANCs). In this study, samples were collected in serum separator tubes at the West Middlesex University Hospital (WMUH) ANC and sent to the laboratory. Rubella status was determined using a third-generation rubella IgG enzyme immunoassay. Any negative results were retested and confirmed using an alternative method. The concentrations were expressed as iu/mL (World Health Organization [WHO] standard). Over a five-year period, the number of rubella-susceptible patients increased from 4.1% to 6.8% of the total number of specimens tested. The current population susceptibility levels seem to be influenced by a number of factors: the target population, age at vaccination and the level of coverage, and exposure to wild virus.

PWE-033 The Incidence and Cost of Unexpected Hospital Attendance Following Elective Outpatient Flexible Sigmoidoscopy

IntroductionOutpatient flexible sigmoidoscopy is an increasingly utilised investigation shown to be effective in the detection and prevention of bowel cancer. The procedure is thought to entail a low risk of...

PWE-197 Is MRCP a useful Investigation where the Biliary Tree is normal on Previous Imaging?

IntroductionMagnetic Resonance Cholangiopancreatography (MRCP) is increasingly used in the diagnosis of biliary disease, especially in stone disease. It has a high sensitivity and specificity[1] [2]; however its role in the...

PTH-052 Microscopic Colitis Is Expensive To Diagnose: An Analysis Of The Utility Of Random Colonic Biopsies

IntroductionMicroscopic colitis is reported in up to 9.5% of patients with watery diarrhoea, and in almost 20% of those older than 701. The Joint Advisory Group on GI Endoscopy mandates...

PM.84 The Association Between Severity of Impaired Glucose Tolerance in Gestational Diabetes with Age, BMI and Ethnicity

IntroductionGestational diabetes (GDM) has been shown to cause adverse fetal outcomes including macrosomia, shoulder dystocia and stillbirth. The multinational Hyperglycaemia and Pregnancy Outcome (HAPO) Study has shown there is a...

PMO-044 Mortality post percutaneous endoscopic gastrostomy insertion: a root-cause analysis

IntroductionMeta-analysis has demonstrated a 19% 30-day mortality following Percutaneous Endoscopic Gastrostomy (PEG) insertion.1 The 2008 National Confidential Enquiry into Patient Outcome and Death (NCEPOD)2 retrospectively audited inpatient death, demonstrating poor...