Postoperative surveillance after surgery for colorectal liver metastasis: a cross-sectional study

INTRODUCTION

Colorectal liver metastases (CRLM) are associated with a high recurrence rate after surgery. There is paucity of high-quality evidence regarding the nature and overall benefit of surveillance after hepatectomy for CRLM. As part of a broader programme of research, this study aimed to assess current strategies for surveillance after liver resection for CRLM and outline surgeons' opinions regarding the benefit of postoperative surveillance.

METHODS

An online survey was sent to clinicians performing surgery for CRLM at tertiary hepatobiliary centres in the UK.

RESULTS

There were responses from a total of 23 centres (88% response rate); 15/23 centres used standardised surveillance protocols for all patients. Most centres followed patients up at six months, but there is variation in postoperative surveillance at 3, 9, 18 and beyond 60 months. Patient comorbidities, indeterminate findings on imaging, margin status and assessment of recurrence risk were identified as the major factors influencing personalised surveillance strategies. There was clear clinician equipoise regarding the costs and benefits of surveillance.

CONCLUSION

There is heterogeneity in postoperative follow-up for CRLM in the UK. High-quality prospective studies and randomised trials are necessary to elucidate the value of postoperative surveillance and identify optimal follow-up strategies.

55 Laparoscopic Cholecystectomy Consent Form Analysis Audit

Aim

To assess consent forms in the new urgent laparoscopic cholecystectomy theatre (ESAC) list in the University Hospital of Wales. With procedure-specific consent forms becoming more regularly utilised, we assess the need for them in our Trust.

Method

We prospectively assessed the consent forms of the first 20 patients who were enrolled in ESAC. We measured the complications list against national standards to assess completeness, including any use of abbreviations and the overall legibility. To complete our assessment and for posterity, we called each patient and gave them an official questionnaire to ensure their understanding before, during and after surgery.

Results

We found that of the complications included in the ESAC consent forms, there was a high degree of variability. For example, 75% contained ‘bile leak’ and 55% ‘post-cholecystectomy syndrome’; both named examples in national guidelines. Additionally, while the vast majority were legible, 50% of the consent forms utilised abbreviations in their written sections. Lastly, patient understanding surrounding the details of the operation was sound, with the majority correctly identifying their surgery, what it entailed and what they were expected to do post-operatively. However, just over half were able to provide a moderately detailed list of the associated complications that may have occurred.

Conclusions

That the trust would benefit from a procedure-specific consent form (PSCF) to provide exhaustive information on procedure details, complications, and their rates, as well as mortality rates. Additionally, this would eliminate issues of legibility and usage of abbreviations. We anticipate that it will also improve patient understanding.

Administrative Data Research Northern Ireland (ADR NI)

BACKGROUND

The Administrative Data Research Northern Ireland (ADR NI), is a partnership between academia and the local statistics agency to advance the access to and use of administrative data in Northern Ireland. These goals are currently being advanced by undertaking a series of demonstrator Strategic Impact Projects developed to provide input to departmental areas of research interest and the current draft Programme for Government.

APPROACH

ADR NI does not currently operate as a data repository but will negotiate access to and link subsets of administrative data from other departments and agencies as required for specific and approved projects. It is, however, anticipated that this model will broaden with the creation and retention of large linked datasets that could be used to address questions across a range of policy areas. At present accredited researchers can access the anonymised data only from within the safe setting situated in Belfast, although consideration is being given to using the Office for National Statistics Secure Researcher Service to access data more widely within the UK. ADR NI is currently being used to inform policy in a wide array of areas including health, education, environmental and urban planning.

DISCUSSION

ADR NI continues to develop and change. The growing confidence amongst data owners which has been supported by new and facilitating UK legislation has increased the willingness and ability to share and link administrative data. However, the associated logistical and administrative processes for accessing data will need further streamlining so that the timelines become more efficient and predictable. The evidence for the potential utility of research based on administrative data to influence policy continues to grow.

CONCLUSION

Over the last decade we have demonstrated to data owners and the different publics that it is safe and acceptable to link administrative data for public benefit. The evolution and maturation of the ADR NI progresses apace and we continue to learn from developments in our sister organisations throughout the UK and throughout the world. We look forward to greater access to and use of administrative data both within Northern Ireland and across the UK.

Knowledge, Attitudes and Practices of Non-Consultant Hospital Doctors In The Immediate Post-Fall Period

Aim The aim of this study is to determine the knowledge, attitudes and practices of Non-Consultant Hospital Doctors (NCHDs) in the immediate post-fall period. Methods A survey study design was employed using an online questionnaire of all NCHDs in SVUH comprising 15 questions that blend dichotomous, multiple choice, scaled and open-ended questions to determine knowledge, attitudes and practices of NCHDs across three constructs; injury management, falls prevention and fracture prevention. Descriptive statistics was used to analyse data. Results There was a 40% response rate (n=105). The respondents reported dissatisfaction with their standard of falls assessment training (mean 4/10). Between 60-70% of NCHDs do not routinely determine hip trauma, joint tenderness, syncope, use of anti-coagulants, visual symptoms, amnesia or vomiting. Half of respondents (n=57) rarely or never rationalised medications. The main reasons for this are lack of knowledge of alternatives (63%), time constraints (65%), benefits outweighing the risks (80%) and reluctance to interfere with care of another medical team (86%). Only 9% always consider a bone health review. Discussion A targeted education programme in the areas of hip assessment, neurological assessment, syncope management, medication rationalisation and bone protection is warranted.

The premarket assessment of the cost-effectiveness of a predictive technology "Straticyte™" for the early detection of oral cancer: a decision analytic model

INTRODUCTION

Approximately half of oral cancers are detected in advanced stages. The current gold standard is histopathological assessment of biopsied tissue, which is subjective and dependent on expertise. Straticyte™, a novel prognostic tool at the pre-market stage, that more accurately identifies patients at high risk for oral cancer than histopathology alone. This study conducts an early cost-effectiveness analysis (CEA) of Straticyte™ and histopathology versus histopathology alone for oral cancer diagnosis in adult patients.

METHODS

A decision-analytic model was constructed after narrowing the scope of Straticyte™, and defining application paths. Data was gathered using the belief elicitation method, and systematic review and meta-analysis. The early CEA was conducted from private-payer and patient perspectives, capturing both direct and indirect costs over a five-year time horizon. One-way and probabilistic sensitivity analyses were conducted to investigate uncertainty.

RESULTS

Compared to histopathology alone, histopathology with Straticyte™ was the dominant strategy, resulting in fewer cancer cases (31 versus 36 per 100 patients) and lower total costs per cancer case avoided (3,360 versus 3,553). This remained robust when Straticyte™ was applied to moderate and mild cases, but became slightly more expensive but still more effective than histopathology alone when Straticyte™ was applied to only mild cases. The probabilistic and one-way sensitivity analyses demonstrated that incorporating Straticyte™ to the current algorithm would be cost-effective over a wide range of parameters and willingness-to-pay values.

CONCLUSION

This study demonstrates high probability that Straticyte™ and histopathology will be cost-effective, which encourages continued investment in the product. The analysis is informed by limited clinical data on Straticyte™, however as more data becomes available, more precise estimates will be generated.

Are Volunteering and Caregiving Associated with Suicide Risk? A Census-based Longitudinal Study

Background

This record linkage study explores the suicide risk of people engaged in caregiving and volunteering. Theory suggests opposing risks as volunteering is associated with better mental health and caregiving with a higher prevalence and incidence of depression.

Methods

A 2011 census-based study of 1,018,000 people aged 25–74 years (130,816 caregivers and 110,467 volunteers; 42,099 engaged in both). All attributes were based on census records. Caregiving was categorised as either light (1–19 hours/week) or more intense (20+ hours/week). Suicide risk was based on 45 months of death records and assessed using Cox proportional hazards models with adjustment for and stratification by mental health status at census.

Results

More intense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18); volunteering with better mental health (OR 0.87; 95%CIs 0.84, 0.89). The cohort experienced 528 suicides during follow-up. Both volunteering and caregiving were associated with a lower risk of suicide though this was modified by baseline mental ill-health (P = 0.003), HR 0.66; 95%CIs 0.49, 0.88 for those engaged in either activity and with good mental health at baseline and HR 1.02; 95%CIs 0.69, 1.51 for their peers with poor mental health. There was some indication that those engaged in both activities had the lowest suicide risk (HR 0.34; 95%CIs 0.14, 0.84).

Conclusions

Despite the poorer mental health amongst caregivers they are not at increased risk of suicide. The significant overlap between caregiving and volunteering and the lower risk of suicide for those engaged in both activities may indicate a synergism of action.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Do women who intermittently attend breast screening differ from those who attend every invitation and those who never attend?

Objectives

Analysis of screening uptake usually dichotomizes women into attenders and non-attenders, though many women respond positively to some but not all invitations. This paper studies these intermittent attenders.

Methods

A cohort of 8,571 women invited for consecutive breast screens in the Northern Ireland Breast Screening Programme were followed in a study linking screening and census records. Multivariate logistic analysis was used to analyze the characteristics of those who attended both times (consistent), once (intermittent or ‘one-time only’), or not at all (non-attenders).

Results

Overall, 15.5% of women attended once and 13.4% were non-attenders. Non-attenders were characteristically disadvantaged (as measured by social renting, car access, and employment status), less likely to be married, and more likely to be healthy. One-time attenders were younger, and suffering poor health, though there was no association with either social renting or employment status. Privately rented accommodation and city living was associated with both one-time attendance and non-attendance.

Conclusions

One-time attenders are an important and distinct subgroup of screening invitees in this analysis. Their distinct characteristics suggest that transitory factors, such as change in marital status, ill-health, or addressing difficulties through change of residence are important. These distinct characteristics suggest the need for different approaches to increase attendance, among both intermittent attenders and those not attending at all.