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  An Audit Of Oxygen Prescribing Practices In Respiratory Wards Of A Tertiary Care Hospital In Nottinghamshire, Uk.

  Cheema, Ahmed Afrasiyab (Journal of Ayub Medical College, Abbottabad : JAMC, 2024-10)

  Background: This audit primarily assesses compliance with the British Thoracic Society guidelines (BTS) for oxygen prescriptions in the Respiratory Department at King's Mill Hospital. The results of this audit aim to guide the strategies to improve the oxygen prescription practices in the Trust. Methods: We collected the data on oxygen prescriptions, from the electronic prescribing system, of all the patients admitted in the three respiratory wards of King's Mill Hospital over the period of one week. This data was then recorded and analysed using Audit management and Tracking© (AMAT). Results: The overall compliance score to BTS guidelines for oxygen prescription was 12.2%. Out of the 152 patients, only 8 (5%) had oxygen therapy prescribed and a target oxygen saturation range was identified. No patient had an identifiable oxygen delivery method on their prescription. Conclusions: The current practices of oxygen prescription at the respiratory department of King's Mill Hospital are suboptimal. These findings highlight the risk of serious potential consequences and the opportunity to implement safe prescribing measures for oxygen, like other prescribed medications.
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  The predictive role of symptoms in COVID-19 diagnostic models: a longitudinal insight

  Heer, Amardeep (2024-01)

  To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
• Telemedicine in diabetic retinal screening: pre- and post-COVID-19 challenges a new perspective

  Zafar, Azhar (2024-10)

  Telemedicine in ophthalmology has been around for decades and has been successful with its use in diabetic retinal screening in countries like the UK (with the introduction of the UK National Diabetic Eye Screening Programme in 2003). However, most telemedicine, in the field of diabetic retinopathy, has largely been reliant on human graders for triage purposes. With the advent of COVID-19, patients with chronic conditions, such as diabetes, were disproportionately affected. The pandemic also caused significant rise in patients on waiting lists. Before the pandemic, there have been studies illustrating the use of artificial intelligence (AI) to analyse images obtained from patients screened for monitoring of their diabetic retinopathy. The image analysis by AI and deep-learning algorithms offers insight into the future of screening in diabetes. The transition, from the use of human graders in teleophthalmology to the use of AI-based image analysis has the potential to screen a wider cohort of patients, thereby tackling waiting lists awaiting screening which has lengthened since after COVID-19. It is therefore vital to understand the role of AI in screening diabetic retinopathy patients, from a patient-acceptability, cost-effectiveness and reliability perspective as, this offers potential answers to streamline the screening process further.
• Retrospective study on pain management pathway for patients with suspected renal/ ureteric colic in a U.K. accidents and emergency department: A quality improvement project.

  Garg, G; Anto, M (F1000Research, 2024-09)

  Competing Interests: No competing interests were disclosed. Background: In acute settings around the globe, renal/ureteric colic remains one of the most common diagnoses for patients presenting with loin-to-groin pain. Even though management spans from medical expulsive therapies to surgical options, pain as a significant component of a patient's presentation must be dealt with quickly, decisively, and safely, as it can be excruciating and its effects on overall health are dire. This study aimed to explore compliance with the National Institute for Health and Care Excellence (NICE) guidelines for pain management in patients with suspected renal/ureteric colic. It includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs), intravenous paracetamol, and opioids as first-, second-, and third-line analgesics, respectively, and does not offer antispasmodics. In the event of deviations from the standard, the aim was to put in corrective measures, followed by re-exploration of compliance with patient care. Methods: This study involved a single healthcare facility with the study type being retrospective before interventions and prospective after interventions. In the first cycle, we retrieved and analysed 78 patients records whom had been suspected to have renal/ureteric colic between July and September 2022. The inclusion criteria were documented complaints of "flank/loin-to-groin pain" and diagnosis prior to performing diagnostic tests. We surveyed the first-, second-, and third-line painkillers issued, and whether an antispasmodic was given. We collected and entered data into a Microsoft Excel file and correlated it with NICE standards. Having found deviations from the standard, we conducted interventions, allowed time for clinicians to adapt, and re-explored compliance using patient case records [n=58] between February and May 2023. Results: In the 1 st cycle, 78 patients were suspected of having renal/ureteric colic. M: F = 1.2:1. Non-contrast computerized tomography of the kidney ureters and bladder (NC-CTKUB) confirmed 87% of patients with stones and 3% had no stones. NC-CTKUB was not performed in 9% of patients because they were young, and urinalysis showed no microscopic hematuria. One patient had discharged against medical advise before the NC-CTKUB was performed. Compliance with the NICE pain management guidelines for suspected renal/ureteric colic was full in 23% of cases but unsatisfactory in 78% of cases. In the 2 nd cycle, M: F = 1.5:1, NC-CTKUB was not re-audited, as the first cycle study yielded excellent results, and our action plan resulted in an NICE pain management compliance rate of 56%. Although our interventions resulted in improvements of more than twice the initial results, work still needs to be performed. Conclusion: Clinicians' ability to correctly diagnose renal/ureteric colic is remarkable. However, the pain management compliance rate indicates room for improvement. This may be due to the limited awareness of the NICE guideline or the fact that the clinical team has an affinity for certain analgesics compared to others. We propose the need to consider select variables to existing standard guidelines to enhance compliance for improved patient care. (Copyright: © 2024 Ojo C et al.)
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  'Low' faecal immunochemical test (FIT) colorectal cancer: A 4-year comparison of the Nottingham '4F' protocol with FIT10 in symptomatic patients

  Bailey, James A; Morton, Alastair J.; Jones, James; Chapman, Caroline J; Humes, David J; Banerjea, Ayan (2024)

  Aim: The aim of this work was to evaluate colorectal cancer (CRC) outcomes after 'low' (sub-threshold) faecal immunochemical test (FIT) results in symptomatic patients tested in primary care. Method(s): This work comprised a retrospective audit of 35 289 patients with FIT results who had consulted their general practitioner with lower gastrointestinal symptoms and had subsequent CRC diagnoses. The Rapid Colorectal Cancer Diagnosis pathway was introduced in November 2017 to allow incorporation of FIT into clinical practice. The local '4F' protocol combined FIT results with blood tests and digital rectal examination (DRE): FIT, full blood count, ferritin and finger DRE]. The outcome used was detection rates of CRC, missed CRC and time to diagnosis in local 4F protocols for patients with a subthreshold faecal haemoglobin (fHb) result compared with thresholds of 10 and 20 mug Hb/g faeces. Result(s): A single threshold of 10 mug Hb/g faeces identifies a population in whom the risk of CRC is 0.2%, but this would have missed 63 (10.5%) of 599 CRCs in this population. The Nottingham 4F protocol would have missed fewer CRCs 42 of 599 (7%)] despite using a threshold of 20 mug Hb/g faeces for patients with normal blood tests. Subthreshold FIT results in patients subsequently diagnosed with a palpable rectal tumour yielded the longest delays in diagnosis. Conclusion(s): A combination of FIT with blood results and DRE (the 4F protocol) reduced the risk of missed or delayed diagnosis. Further studies on the impact of such protocols on the diagnostic accuracy of FIT are expected. The value of adding blood tests to FIT may be restricted to specific parts of the fHb results spectrum.Copyright © 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

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