Knowledge Hub @ Bedfordshire Hospitals NHS FT
The Knowledge Hub, managed by the Danielle Freedman Library is a digital repository - a central location for Bedfordshire Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.
The Knowledge Hub replaces the academic report previously published by Research & Development.
Some items are added to the repository automatically by the library team, if you do not find your item or you would like more information about submitting your work to the Knowledge Hub please contact library@besdft.nhs.uk
Recent Submissions
Item SP6.4 - Were QR codes to distribute information to patients following a consultation beneficial in a clinical setting?(2024)Abstract Aims To investigate whether the use of QR codes to distribute information from brochures online would be accepted and preferred by patients compared to physical paper brochures; If paper waste can be reduced - fewer brochures being printed and discarded and hence eco-friendly and cost effective Methods Benign breast conditions were chosen for this project and QR codes generated with specific URLs for each booklet linked to a scannable QR code. At the end of clinical consultation, the Consultant invited and guided patients to scan the QR code brochure specific for their symptoms. 60 patients, from October 2022 to March 2023 were invited to take part in this original study, as a part of their consultation, with their responses gathered and analysed. Results 60 patients completed the feedback form with a 100% response rate. The age range was 20 to 70 (mean age = 45 years), of which 76.7% were aged under 50 years, and 96.7% were female. The majority (78.3%) preferred accessing an electronic leaflet via a QR code instead of a paper leaflet, and 88.3% found it easier to access information online via the QR code over other methods to access websites. Conclusions The majority of the patients were satisfied/very satisfied with the use of QR codes to access the online brochures. Although this was a simple study, it provides the basis to design a larger trial with a standardised methodology procedure, so that we can draw meaningful results from appropriate statistical analyses. Topic: consultationcost effectivenessconsultantsfeedbackinternetpamphletsbreast disease, benignurl Issue Section: Abstract > Short Paper Collection: BJS Foundation JournalsItem VS 01 - BN Chronic loop gastrojejunostomy volvulus masquerading as a Crohn’s stricture(2024)Abstract Background A video presentation of a case of chronic loop gastrojejunostomy volvulus masquerading as a Crohn's stricture. Method 61 year old female with a previous loop gastrojejunostomy and subsequent ileocaecal resection for Crohn's related pyloric stenosis and terminal ileal stricture. Acute worsening of post-prandial pain and vomiting 5 years later, re-investigation revealed a stenosed gastrojejunostomy thought to be Crohn's related. Results Intraoperative volvulus of the gastrojejunostomy was demonstrated related to traction forces resulting in the migration of the duodeno-jejunal flexure to the right of midline. The gastrojejunostomy was revised to a Roux-en-Y configuration with relief of mechanical obstruction. Conclusion An ileocaecal resection may create unexpected traction forces Topic: crohn's diseasegastrojejunostomyroux-en-y anastomosisconstriction, pathologicintraoperative carepainpostprandial periodtractionvomitingpyloric stenosisileumjejunumintestinal volvulusgastric bypass, roux-en-y Issue Section: Abstract > Videos Presentation Session Collection: BJS Foundation JournalsItem BS SO20 - The impact of Ethnicity and Social Deprivation on Weight Loss following Roux-En-Y Gastric Bypass Surgery(2024)Abstract Background Long-term weight loss and weight regain are markers of success following bariatric surgery. The aim of this study was to determine whether there are differences amongst various ethnic and social deprivation groups in terms of weight loss following Roux-En-Y Gastric Bypass (RYGB) at 24 months post-surgery. Method Data from a single high-volume UK Bariatric centre (Luton & Dunstable Hospital) were analysed. Relevant variables such as patient demographics, weight and Body Mass Index (BMI) at surgery, were included. Failure to lose sufficient weight was defined as failure to lose ³20% TBWL at 24 months post-surgery. Results A total of 1,427 patients underwent RYGB during this time, of whom 80.2% were female. The median age was 48 years old (IQR: 39-55) and the median BMI was 44.7Kg/m2 (IQR: 40.6-50.1). At 24 months post-surgery, 39.3% of patients had failed to lose 20% TBWL. Multivariable analyses demonstrated that the most socially deprived patients were less likely to achieve a TBWL of ³20% at 24 months post-surgery (OR: 0.71 95% CI: 0.56-0.89, p=0.023) as were those from Black (OR: 0.69, 95% CI: 0.50-0.83, p=0.019) and Asian backgrounds (OR: 0.73, 95% CI: 0.61-0.88, p=0.013) compared to patients from a White background. Conclusion Ethnicity and social deprivation serve as key indicators of predicting weight loss at 24 months following bariatric surgery. These findings suggest the possible need for tailored care and treatment strategies to optimise long-term outcomes for diverse populations. Understanding these differences is crucial for developing personalized treatment plans and improving the efficacy of bariatric surgery across various ethnic groups. Future research should focus on identifying the underlying causes of these disparities and evaluating interventions to mitigate them. Topic: body mass index procedureweight reductiondemographyethnic groupsurgical procedures, operativesurgery specialtybariatric surgerygastric bypass, roux-en-ycare planhealth disparityasiansocial deprivation Issue Section: Abstract > Short Oral Presentations > Bariatrics Collection: BJS Foundation JournalsItem BS SO18 - Small bowel intussusception after Roux-en-Y gastric bypass: A case report and review of literature(2024)Abstract Background Small bowel obstruction after RYGB for obesity can occur due to various common causes like internal hernia and adhesions. One of the rare complications of RYGB is retrograde intussusception of jejunum at the common channel. Since it does not present with typical symptoms of small bowel obstruction, it is often challenging to consider it as differential diagnosis at initial presentation. Also, managing the intussusception at non bariatric centres could prove difficult due to location of it in the common channel, which will require understanding of orientation of alimentary and biliary limbs as well as reconstruction after resection of the intussusception. Method We collected the details of our patients admission episode from a different centre where she was admitted initially to understand the clinical behaviour of the condition. Also, we conducted a systematic search of literature databases like PubMed, Embase, CINAHL, ProQuest Dissertations & Theses using MeSH terms and keywords Intussusception, Retrograde intussusception, J-J intussusception, Intestinal Obstruction, Small bowel obstruction, Bowel obstruction, Obesity, Morbid obesity, Gastric Bypass, Roux-en-Y gastric bypass, Jejunojejunostomy, Jejuno-jejunostomy, Gastric by-pass, RYGB, Roux-en-Y. Data were extracted on to Excel sheet for analysis. Results The search yielded 41 case reports. Patients were operated in most instances except in seven cases where they had multiple episodes. The average age of presentation was 38 mostly in females and few instances being during pregnancy including our patient. Intussusception happened between 5 to 360 months after the initial operation with the average time after the operation being 66 months. Pain was the principal mode of presentation without classical symptoms of bowel obstruction. There were few instances of coffee ground vomiting. CT was the diagnostic modality in almost all cases. Recurrence was invariable when not managed with resection. Conclusion Small bowel intussusception after RYGB occurs retrogradely and does not present with classical symptoms and signs of small bowel obstruction. It can be reliably diagnosed with CT abdomen. Of note, medical management and no-resectional surgical management results in recurrence of this condition. Topic: obesitypregnancycoffeesmall bowel obstructionadhesionsage of onsetdifferential diagnosislimbgastric bypassintestinal obstructionintestine, smallintussusceptioncreation of jejunostomyobesity, morbidpainreconstructive surgical proceduressurgical procedures, operativevomitingdiagnosisjejunummedical subject headingsbariatric surgerygastric bypass, roux-en-yabdominal ctmedical managementembasejejunojejunostomyinternal hernia Issue Section: Abstract > Short Oral Presentations > Bariatrics Collection: BJS Foundation JournalsItem P15 Screening and prevalence of MASLD-associated liver fibrosis in a bariatric cohort – a pilot study in a Tier 3 weight management service(2024)Abstract Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is a well-recognised cause of advanced liver disease for which obesity is a predominant risk factor. Patients with BMI >35 have access to obesity/bariatric services but evidence regarding optimal screening for progression to MASLD-related liver fibrosis in this cohort is lacking. Our pilot study describes a novel, joint Bariatric-Hepatology pathway within a Tier 3 weight management service aiming to establish a screening pathway for liver fibrosis in an asymptomatic population. Method Retrospective review of the records of patients screened for liver fibrosis using FIB-4 on a Tier 3 weight management programme. Patients subsequently underwent vibration-controlled transient elastography (VCTE) according to FIB-4 score, and VCTE scores were stratified based on BAVENO VII consensus. Results Data was collected on 1015 patients encompassing 941 ‘low risk’ (92%), 69 ‘medium risk’ (7%), and 5 ‘high risk’ (1%) based on standardised FIB-4 cutoffs. Of the ‘low risk’ group, 18 patients underwent VCTE (mean age 45; mean HbA1c 45.8; mean BMI 47) and within this sub-group, liver stiffness measurement (LSM) was >8kPa in 7/18 (39%) and >15kPa in 3/18 (17%). Notably, only 2/18 (11%) had HbA1c >48. Of the ‘medium risk’ group, 28 patients underwent VCTE (mean age 55.8; mean HbA1c 49.3; mean BMI 49.2) and within this sub-group, liver stiffness measurement (LSM) was >8kPa in 20/28 (71%), >15kPa (assumed compensated advanced chronic liver disease (cACLD)) in 13/28 (46%) and >25kPa (assumed clinically significant portal hypertension (CSPH)) in 5/28 (18%). Of those with assumed cACLD, mean HbA1c was 70.5 and 11/13 (85%) had at least two additional metabolic risk factors. Of the ‘high risk’ group, all patients who underwent VCTE (n=3) had scores in the cACLD range and 1/3 had assumed CSPH. Discussion A joint Bariatric-Hepatology pathway was successfully implemented in a Tier 3 weight management pathway identifying a high prevalence of unrecognised liver disease and prompting pre-bariatric assessment and Hepatology input. As expected, the majority of patients with liver fibrosis had metabolic risk factors. ‘Medium risk’ FIB-4 had a high positive predictive value in our cohort compared to existing literature. In comparison, ‘low risk’ FIB-4 (projected to exclude advanced liver fibrosis in ~90% of patients) had a poor negative predictive value in our cohort (61%). Existing evidence suggests that FIB-4 alone is insufficient in high-risk clinical conditions including obesity and diabetes with high false negative rates which was correlated by our findings. Combining non-invasive tests might reduce misclassification.
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