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Publication Cancer multidisciplinary teams in Africa : a narrative review of their role and availability(Springer, 2025-05-21) Sanni, Quadri Abiodun; Mohamed, Abdulkadir; Tsejime, James; Anyaegbu, Ejike Henry; Anifowose, Jubril O.; Wong, Kay'ien; Mechelen, Mia V.; South Warwickshire University NHS Foundation Trust; Southend University Hospital NHS Foundation Trust; Caterham School; The National Mathematics and Science College, Coventry; Urology; Surgery; Emergency Medicine; Medical and Dental; Sanni, Quadri A.; Mohamed, Abdulkadir; Tsejime, James; Anyaegbu, Ejike H.Multidisciplinary teams (MDTs) play a pivotal role in the care of cancer patients. With a progressive rise in the incidence of cancer diagnoses in the African subcontinent, there is an expectation that oncologic care should be standardized and fairly available, and central to this care is the establishment of a cancer MDT. This study aimed to explore the availability and role of oncologic MDTs in various centers in the African subcontinent. Data on Cancer MDTs were searched using keywords on PubMed, African Journal Online, and Google Scholar. Other relevant searches were conducted using the reference list of primary studies. There has been a 34% increase in the prevalence of MDT meetings among institutions in sub-Saharan Africa, spanning all regions of Africa, based on a survey conducted by the African Organisation for Research and Treatment in Cancer network in 2013 and repeated in 2021. Although there is an increase in the prevalence of MDT meetings in sub-Saharan Africa, spanning all regions of Africa, the mortality rate of cancer patients remains disproportionately high, with a mortality rate higher than that of Europe. Several centers across African countries do not have access to functioning oncologic MDTs, and those with access do have members frequently missing. Several factors mitigate against the establishment of cancer MDTs in Africa, including the lack of specialists, motivation of the healthcare staff, poor financial remuneration, and government policies. To ensure improved cancer care in Africa, efforts should be made to involve key stakeholders, including healthcare professionals, the government, and the private sector. Keywords: cancer center; healthcare outcomes; multidisciplinary discussion; multidisciplinary team; oncology care; sub-saharan africa.Publication A cross-sectional study on inequity and unmet needs in conducting systematic reviews (SRMA) and meta-analysis among medical students and junior doctors(Dove Medical Press, 2023-06-20) Manku, Bhagat; Saffari, Tiam Mana; Sandhu, Vinesh; Khajuria, Ankur; South Warwickshire University NHS Foundation Trust; Ohio State University, Columbus, USA; University College London; University of Oxford; Imperial College London; Surgery; Medical and Dental; Manku, BhagatBackground: Systematic reviews and meta-analyses allow a transparent, rigorous, and replicable analysis to summarize the results of multiple related studies and are considered top of the evidence-based medicine study hierarchy. The COVID-19 pandemic has shed light on the unmet educational needs of students worldwide, notably those from underprivileged backgrounds. This cross-sectional study aimed to ascertain students' and junior doctors' attitudes on their current knowledge, confidence and preparedness of appraising and conducting systematic reviews and meta-analysis internationally. Methods: A free online webinar was held in May 2021 by the senior author and a pre-event questionnaire was distributed. Responses collected were used for analysis anonymously to ascertain students' knowledge, experience, and confidence in preparing a systematic review and meta-analysis using a 1-5 Likert scale using IBM SPSS 26.0. Associations were examined using Chi-square and crosstabs analysis. Results: Out of 2004 responses from 104 countries included in the analysis, the majority of delegates were from lower middle-income countries and were not familiar with the PRISMA checklist (59.2% and 81.1% respectively of the total number of participants). The majority had never attended any formal training (83%) and felt their medical institute gave them minimal advice (72.5%) in preparing systematic reviews. Among those who had attended formal training, the proportion was significantly higher in those belonging to high and upper middle-income countries combined (20.3%) than lower and lower-middle-income countries combined (15%). Conclusion: This study highlights gaps that need addressing to enhance the knowledge of medical students and junior doctors performing systematic reviews and meta-analyses. Clear disparities are found in country income and the level of education. Future large-scale studies are needed to understand the rationale of working on online research projects and the opportunities available to medical students and junior doctors that may lead to medical curriculum changes. Keywords: inequity; medical education; meta-analysis; systematic review.Publication Evaluation of morbidity and mortality in iatrogenic colonic perforation during colonoscopy : a comprehensive systematic review and meta-analysis(Springer, 2024-11-08) Adebisi, Ajibola A.; Onobun, Daniel E.; Adediran, Adeola; Ononye, Reginald N.; Ojo, Ethel O.; Oluyi, Adedayo; Ojo, Ayotunde; Oputa, Stephen; Epsom and St Helier University NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; University of Ibadan, Nigeria; Glan Clwyd Hospital, Bodelwyddan; University Hospitals of Leicester; Maidstone and Tunbridge Wells NHS Trust; University of Nigeria, Enugu, Nigeria; Orthopaedics and Trauma; Medical and Dental; Onobun, Daniel E.; Ojo, Ethel O.This systematic review and meta-analysis explores the clinical and patient-specific factors contributing to increased morbidity and mortality following iatrogenic colonic perforation (ICP) during routine colonoscopy. A comprehensive search of Scopus, PubMed (Medline), Embase, and Google Scholar was conducted, reviewing studies published between 2010 and 2024. Data were synthesized through thematic analysis for qualitative data and meta-analysis for quantitative outcomes. This study found the overall perforation rate during colonoscopy to be between 0.019% and 0.66%. The average age of patients was 68.91 years. The mortality rate was approximately 11%. Older patients had a higher risk of perforation and an increased mortality rate. Therapeutic colonoscopy carries a significantly higher risk of perforation compared to diagnostic colonoscopy. Diagnostic colonoscopies were more likely to cause larger perforations, which, in turn, carry greater morbidity than smaller perforations. The most common sites of perforation are the sigmoid colon and the rectosigmoid junction. The leading causes of perforation include diverticulitis, malignancy, abnormal sigmoid anatomy, and inflammatory bowel disease. About half of the perforations were discovered during or immediately after the procedure. The most common surgical interventions were resection with primary anastomosis and Hartmann's procedure. Operators with limited experience were more likely to cause perforations and experience delayed recognition of the issue. The results suggest that both clinical and patient-specific factors play critical roles in determining outcomes for patients experiencing ICP during routine colonoscopy. Early detection, timely intervention, and operator experience are key to improving patient survival and reducing complications. Furthermore, the study highlights the need for ongoing research to refine patient selection criteria and enhance postoperative care protocols, particularly for high-risk populations such as the elderly and those with significant comorbidities. This review underscores the importance of heightened vigilance in colonoscopy procedures, especially among vulnerable populations. Future research should focus on improving diagnostic protocols and treatment strategies to minimize the risks associated with ICP and enhance patient safety in routine colonoscopy practices. Keywords: clinical factors; comorbidities; iatrogenic colonic perforation (icp); morbidity; mortality; operator experience; patient-specific factors; perforation severity; routine colonoscopy; surgical intervention.Publication Patients' perspective on day case breast surgery(Karger Publishers, 2015-01-15) Athwal, Ruvinder; Dakka, Mahmood; Appleton, Donna; Harries, Simon; Clarke, Dayalan; Jones, Lucie; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; Athwal, Ruvinder; Dakka, Mahmood; Appleton, Donna; Harries, Simon; Clarke, Dyalan; Jones, LucieBackground: This study assessed the views of patients undergoing breast surgery for breast cancer with a planned overnight stay, asking whether they would be happy to be discharged home on the same day of surgery. Methods: A structured questionnaire sent out in the 6 weeks following surgery was used to ascertain the patients' views. Results: The majority of patients undergoing mastectomy and axillary node clearance preferred an overnight stay, primarily for psychological reasons. Conclusions: Patients undergoing breast-conserving surgery were more prepared to go home on the day of surgery. Keywords: Breast cancer; Mastectomy; Psychosocial distress; Supportive care.Publication Quality of irritable bowel syndrome information on the internet(BMJ Publishing Group, 2015-06-22) El-Sheikha, J.; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; El-Sheikha, J.; Crossman, D.; Hayes, E.; Ramcharan, S.Conference abstract PWE-430 in the section 'Education and Training' of the 2nd Digestive Disorders Federation Conference, 22–25 June 2015, London, UK.Publication What is the correct prophylactic dose of tinzaparin in general surgical patients?(BMJ Publishing Group, 2015-06-22) El-Sayed, C.; Francombe, J.; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; El-Sayed, C.; Francombe, J.Conference abstract PWE-397 in the section 'Education and Training' of the 2nd Digestive Disorders Federation Conference, 22–25 June 2015, London, UK.Publication Enhanced recovery for laparoscopic colorectal resection : is there a role for transcutaneous electrical nerve stimulation?(BMJ Publishing Group, 2015-06-22) El-Sayed, C.; Singh-Ranger, D.; Aslam, I.; Khan, M.; Francombe, J.; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; El-Sayed, C.; Singh-Ranger, D.; Aslam, I.; Khan, M.; Francombe, J.Conference abstract PTU-167 in the section 'Neurogastroenterology: Functional Disorders, Motility and Clinical Physics' of the 2nd Digestive Disorders Federation Conference, 22–25 June 2015, London, UK.Publication Endoscopic muscosal resection of large coloerectal polyps in a district general hospital - is it safe and efficient?(BMJ Publishing Group, 2015-06-22) El-Sayed, C.; McArdle, K.; Chauhan, V.; Cheung, M.; Osborne, M.; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; El-Sayed, C.; McArdle, K.; Chauhan, V.; Cheung, M.; Osborne, M.Conference abstract PTU-014 in the section 'Endoscopy I' of the 2nd Digestive Disorders Federation Conference, 22–25 June 2015, London, UK.Publication Fournier's gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring(Oxford University Press, 2015-03-31) Sarmah, Piyush B.; Khan, Mashuk; Zilvetti, Miguel; City Hospital, Birmingham; South Warwickshire University NHS Foundation Trust; Worcestershire Royal Hospital; General Surgery; Medical and Dental; Khan, MashukFournier's gangrene (FG) requires prompt recognition and management. We report the case of a 68-year-old man who presented with extensive pain and purple discolouration from the right iliac fossa to perineum. Computed tomography demonstrated gas within the right hemiscrotum extending into the inguinal canal and right buttock, with a right pelvic fluid and air collection. At debridement necrotic fluid was arising from the superficial inguinal ring so laparotomy was performed, revealing a grossly inflamed appendix herniating into the inguinal canal; a right hemicolectomy was performed. Unfortunately, the patient went into cardiac arrest and passed away on the operating table. Histological analysis demonstrated acute-on-chronic inflammation involving the appendix. The condition where appendicitis is implicated in FG is usually due to retroperitoneal rupture and tracking into the perineal spaces. This is the first case reported of an inflamed appendix herniating into the inguinal canal and thus causing FG.Publication One Step Nucleic Acid amplification testing for CK19 : single copy number >5,000 copies/μL vs Total Tumour Load of 15,000 copies/μL(Elsevier, 2015-06) Atherton, Gavin; Tafazal, Habib; Amin, Verda; Dakka, Mahmoud; Khan, Mashuk; Harries, Simon; Jones, Lucie; Clarke, Dayalan; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Atherton, Gavin; Tafazal, Habib; Amin, Verda; Dakka, Mahmoud; Khan, Mashuk; Harries, Simon; Jones, Lucie; Clarke, DayalanBackground: The diagnostic criteria for OSNA proposes cut-off values of >5000 copies/μL of CK 19 mRNA as macro-metastases. Practice in our centre is to perform axillary node clearance (ANC) on patients with a copy number of >5000 in any node. A recent study has suggested an alternative method using the total copy number of all sentinel nodes (Total Tumour Load) with a cut-off of 15,000 copies/μL.Publication The use of SentiMag in identifying the sentinel lymph node : Warwick experience(Elsevier, 2015-06) Tafazal, Habib; Dakka, Mahmoud; Athwal, Ruvinder; Clarke, Dayalan; Jones, Lucie; Harries, Simon; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Tafazal, Habib; Dakka, Mahmoud; Athwal, Ruvinder; Clarke, Dayalan; Jones, Lucie; Harries, SimonIntroduction: SentiMag is a new system for the detection of the sentinel lymph node (SLN) in patients with breast cancer. The new technique uses 2 devices: a subcutaneous injection of a magnetic tracer into the breast and the use of a hand-held device (a magnetometer) to detect the SLN intra-operatively. We used SentiMag and compared it to the standard technique (radioisotope alone in our unit) used in breast cancer patients. We looked at the localisation rate of SLN detected with both the standard and the SentiMag technique.Publication One-step nucleic acid amplification : CK 19 copy number as a predictor of further axillary involvement(Elsevier, 2015-06) Tafazal, Habib; Atherton, Gavin; Amin, Verda; Dakka, Mahmoud; Park, Michael; Smith, Adrian; Harries, Simon; Jones, Lucie; Clarke, Dayalan; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Tafazal, Habib; Atherton, Gavin; Amin, Verda; Dakka, Mahmoud; Park, Michael; Smith, Adrian; Harries, Simon; Jones, Lucie; Clarke, DayalanIntroduction: In 2013, the National Institute of Clinical Excellence (NICE) endorsed the use of One step nucleic acid amplification (OSNA) in clinical practice. Our study aims to seek a correlation between the OSNA results, indicated by CK 19 mRNA copy numbers and the likelihood of non-sentinel axillary involvement in patients with macro-metastases.Publication Surgery for gallstone disease during pregnancy does not increase fetal or maternal mortality : a meta-analysis(AME Publishing, 2016-02) Athwal, Ruvinder; Bhogal, Ricky Harminder; Hodson, James; Ramcharan, Sean; South Warwickshire University NHS Foundation Trust; University of Birmingham; General Surgery; Medical and Dental; Athwal, Ruvinder; Ramcharan, SeanBackground: Pregnancy was traditionally considered a contraindication to cholecystectomy but is now becoming the favoured option for gallstone-related disease (GRD) during pregnancy. Methods: To assess if cholecystectomy during pregnancy increases the risk of preterm labour, fetal mortality and maternal mortality. PubMed and MEDLINE databases for the period from January 1966 through December 2013. Studies were both conservative and surgical intervention was utilised in the management of GRD were included. The results of the included studies were pooled using meta-analysis techniques. Results: Surgical intervention for GRD in pregnancy does not increase the risk of preterm labour, fetal mortality or maternal mortality. Conclusions: Cholecystectomy during pregnancy for GRD is associated with low complications for the fetus and mother and should be considered in all suitable patients. Keywords: Laparoscopic cholecystectomy; fetal mortality; gallstones; pregnancy; preterm labour.Publication Patient anxiety on the use of one step nucleic acid amplification (OSNA) during breast cancer surgery(SAGE Publications, 2016-01-25) Athwal, Ruvinder; Clarke, Dayalan; Harries, Simon; Jones, Lucie; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Athwal, Ruvinder Kaur; Clarke, Dayalan; Harries, Simon; Jones, LucieIntroduction: Assessment of the sentinel lymph node biopsy (SLNB) is used to stage the axilla in patients with breast cancer. There are a variety of methods to assess metastatic disease within the SLN. One-step nucleic acid amplification (OSNA) has a high sensitivity for detecting metastatic disease within the SLN and avoids the use of staged axillary surgery. However there remains a paucity of data within the literature on the psychological effects upon patients with the use of OSNA. Methods: All patients undergoing breast surgery (breast-conserving surgery or mastectomy) and assessment of the SLNB with OSNA from December 2011 to June 2012 were included in the study. A questionnaire was sent to patient within four weeks of surgery to assess their understanding and satisfaction with the OSNA procedure. Results: 60 patients responded to the questionnaire (83% response rate). All patients were female with a mean age of 63 years (range 38-71 years). 19 patients had positive SLNB as assessed by OSNA and all had ALND. 15 patients expressed pre-operative anxiety about having OSNA although 97% stated that they would be happy to undergo the same procedure again. Conclusion: Our study has identified the anxiety points that patients experience with OSNA based management and this will allow improved direct emotional support and provision of information. Keywords: Breast cancer; anexity; sentinel lymph node biopsy.Publication Short and medium-term outcomes for general surgery in nonagenarian patients in a district general hospital(Royal College of Surgeons of England, 2016-05-03) Hayes, A. J.; Davda, A.; El-Hadi, M.; Murphy, P.; Papettas, T.; South Warwickshire University NHS Foundation Trust; General Surgery; Medical and Dental; Hayes, A. J.; Davda, A.; El-Hadi, M.; Murphy, P.; Papettas, T.Introduction Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality. Methods A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes. Results A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003). Conclusions The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care. Keywords: Elderly; Morbidity; Mortality; Nonagenarian; P-POSSUM.Publication Acute scrotal swelling following perforated rectal carcinoma with abscess formation(Oxford University Press, 2016-06-06) Chauhan, Vishnusai; Newman, Matthew; Sinha, Rakesh; South Warwickshire University NHS Foundation Trust; Colorectal Surgery; Radiology; Medical and Dental; Chauhan, Vishnusai; Newman, Matthew; Sinha, RakeshA 59-year-old cachectic male was referred to the surgical outpatient department with intermittent haematochezia and a longstanding change in bowel habit with associated weight loss and anaemia. Following investigation, he was diagnosed with a large rectal tumour with multiple metastases. 7 days later, the patient presented again with fevers, bilious vomiting, abdominal pain and distension. On examination, he had a generally tender abdomen,= although no peritonism, but an enlarged, extremely tender hemiscrotum with no cough reflex. Imaging revealed a perforated rectum and subsequent abscess formation, which tracked via an unusual anatomical route to present as scrotal swelling.Publication Is there any relation between the value of CRP in the first post-operative day and the development of sepsis complications in elective colorectal resections?(Wiley, 2016-09-23) Rajjoub, Y.; Saffaf, N.; Peacock, M.; Cheltenham General Hospital; South Warwickshire University NHS Foundation Trust; Medical and Dental; Saffaf, N.Poster abstract P326 of the 11th Scientific and Annual Meeting of the European Society of Coloproctology, 28–30 September 2016, Milan, Italy.Publication Endoscopic stenting of acutely obstructing colorectal cancer : a 10-year review from a tertiary referral centre(Wiley, 2016-04-27) Padwick, Robert T.; Chauhan, Vishnusai; Newman, Matthew; Francombe, James; Osborne, Martin J.; Shrewsbury and Telford Hospitals NHS Trust; South Warwickshire University NHS Foundation Trust; University of Warwick; Colorectal Surgery; Medical and Dental; Chauhan, Vishnusai; Francombe, James; Osborne, Martin J.Background: Insertion of self-expanding metallic stents for obstructing colorectal cancer (CRC) is a potential alternative to emergency resection, but evidence regarding efficacy is inconclusive. We aim to assess local efficacy of stent insertion for obstructing CRC, and to establish whether the service could be offered regionally. Method: Retrospective patient data analysis using local paper notes and electronic records was performed. All patients underwent stent insertion for an obstructing CRC from April 2004 to March 2014. The main outcome measures were success of stent insertion, complications, further surgery and overall mortality. Results: Eighty-nine stent insertions were performed. Twenty-five were performed as a bridge to surgery, 49 due to advanced disease, 11 due to patient co-morbidity and four due to patient choice. Time from referral to stent insertion for emergency referrals was 1-360 h (median 23). Eighty-seven stents were successfully deployed. Perforation occurred in three patients and migration in nine patients. Twenty-one patients underwent planned surgery (time to surgery was 2-208 days, median 24), 14 patients underwent emergency surgery (time to surgery was 0-277 days, median 11). Forty-six patients have died since stent insertion (time to death was 0-42 months, median 6.04). Conclusion: Stent insertion for obstructing CRC is a viable alternative to emergency resection, with a low complication rate. Stent insertion may allow a proportion of patients to later undergo planned surgery. Stent insertion carries a lower peri-procedure mortality than emergency resection. An acute stent insertion service for obstructing CRC could potentially be offered at regional level in our Trust. Keywords: colorectal cancer; colorectal surgery; endoscopy; intestinal obstruction; stents.Publication Colonoscopy without sedation : patient factors alone are less likely to influence its uptake(Thieme, 2016-05-03) Iqbal, Nusrat; Ramcharan, Sean; Doughan, Samer; Shaikh, Irshad; South Warwickshire University NHS Foundation Trust; Queen Elizabeth the Queen Mother Hospital, Margate; Norfolk and Norwich University Hospitals NHS Trust; General Surgery; Medical and Dental; Iqbal, Nusrat; Ramcharan, SeanBackground and study aims: Conscious sedation during colonoscopy minimizes discomfort, improves polyp detection rates, and reduces technical failure, but carries medication-related risks and requires dedicated and costly recovery services. Sedation-free procedures may offer a safer alternative. We aimed to compare this group with those receiving sedation to determine differences in patient characteristics, cecal intubation rates, polyp detection rates, discomfort levels and safety in patients for whom anesthesia is high risk. Patients and methods: Prospectively collected data from all colonoscopies performed over a 1-year period at three district general hospitals were analyzed. Conscious sedation was offered to all patients and outcomes in those who refused were compared with outcomes in those who received sedation. Results: One hundred ninety-four of 1694 (11 %) colonoscopies were performed without sedation (61 % male, P < 0.001) but rates varied between hospitals. Of these, 55 % were American Society of Anesthesiologists (ASA) grade 3 or more and 5 % experienced moderate discomfort, compared to 40 % (P < 0.0001) and 10 % (P = 0.023) respectively of those receiving sedation. They were more likely to have indications of rectal bleeding or frequency of stool and less likely to have anaemia or macroscopic inflammation at colonoscopy. Complications, completion. and polyp detection rates were similar in both groups. Conclusions: Colonoscopy without sedation can be completed successfully in select patients without compromising comfort or polyp detection rates and is safe in those for whom anesthesia is high risk. It is therefore a safe alternative for clinicians concerned about sedation, but the findings suggest that hospital, rather than patient factors, may prevent its uptake.Publication Introduction of the new guidelines on the management of the axilla at Warwick Breast Unit, for women with breast cancer(Elsevier, 2016-11-26) Henderson, L.; Tafazal, H.; Harries, S.; Jones, L.; Clarke, D.; South Warwickshire University NHS Foundation Trust; Breast Surgery; Medical and Dental; Henderson, L.; Tafazal, H.; Harries, S.; Jones, L.; Clarke, D.Conference abstract 0994 of the Association of Surgeons in Training (ASiT) 40th Anniversary Conference, 18-20 March 2016, Liverpool, UK.