George Eliot Hospital NHS Trust
George Eliot Hospital NHS Trust provides a range of elective, non-elective, surgical, medical, women’s, children’s, diagnostic and therapeutic services to a population of more than 300,000 people. The hospital opened in 1948. The hub of the Trust is located on the outskirts of Nuneaton and its services cover a large footprint, including north Warwickshire, south west Leicestershire, and north Coventry. The Trust also provides a range of community services, delivered across Coventry, Warwickshire and Leicestershire. George Eliot Hospital NHS Trust is committed to supporting research to provide the very best care for its patients. This community collects together the research outputs of the Trust. The research outputs are arranged under the organisational structure of the Trust.
Sub-communities within this community
Recent Submissions
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How well do endoscopic morphological and histopathological characteristics correlate in colonic polypectomy reporting?Abstract P384 of the ESCP 17th Scientific & Annual Meeting, 21-23 September 2022, Dublin, Ireland.
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Anaesthesia for caesarean section in a parturient with systemic mastocytosisAbstract P.175 of the Obstetric Anaesthesia Annual Scientific Meeting 2022, Newport, 5-6 May.
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Myeloproliferative neoplasia masquerading as idiopathic intracranial hypertension: a case reportAbstract P113 of the European Neuro-Ophthalmological Society (EUNOS) 15th Meeting, Birmingham, 20-23 June 2022.
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Review on interferon beta: from cells to clinical usageIntroduction: Interferon (IFN) was first introduced by Isaacs and Linddeman in 1957. It referred to a factor that could cause inhibition in the growth of the live influenza virus. Interferons are intracellular proteins that are involved in many cellular processes such as growth, proliferation, differentiation, metabolism of the extracellular matrix, apoptosis, and regulating immune responses. There are different intereferones. Amog them, interferons-beta (IFN-β) is a natural cytokine produced by immune cells in response to biological and chemical stimuli. Signal transduction of IFN-β is initiated throughout a heterodimeric receptor complex that is composed of IFNAR1 and IFNAR2 which leads to expression of various proteins via the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway as well as other pathways. In addition to antiviral effects of IFN-β, it has been shown to have therapeutic effects in some autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and lupus. It has recently been shown that the use of IFN-β in combination with other antiviral compounds may be effective in treatment of Covid-19. In this review the various topics about IFN-β are investigated such as signalling pathways, biological functions, therapeutic effects, and side effects of IFN-β therapy.
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Appropriate utilisation of the ReSPECT process in George Eliot Hospital, UKPoster abstract P138 from the European Resuscitation Council conference 2022.
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Introduction of under 40s clinic to reduce pressures of the 2 week wait targets in a district general hospitalAbstract P074 from The Association of Breast Surgery Conference 2022.
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Peri-operative care of a rare case of Ogilvie's syndrome after lower segment caesarean sectionAbstract 076 from the Association of Anaesthetists Winter Scientific Meeting 2022, 13-14 January 2022.
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Ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency: initial tertiary experience from southwestern GreeceLetter to the Editor regarding an initial tertiary experience from southwestern Greece of ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency.
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Hyperthermic intraperitoneal chemotherapy with mitomycin C versus oxaliplatin after cytoreductive surgery for the treatment of peritoneal metastases of colorectal cancer originBackground: Mitomycin C and oxaliplatin are considered the main chemotherapeutic agents used in the context of hyperthermic intraperitoneal chemotherapy (HIPEC) after the performance of cytoreductive surgery for peritoneal metastases of colorectal cancer origin. However, there is lack of a generally accepted consensus regarding the optimal choice between them as upfront chemo-therapetic agent. Our paper aims to summarize in a comprehensive manner the available evidence, while individualised schemes with targeted therapies are under development. Methods: We conducted a comprehensive, narrative review of the literature including all previous studies until 03/2022, which reported perioperative and/ or oncological outcomes after the use of mitomycin C and/ or oxaliplatin as main hyperthermic chemotherapy agents after cytoreductive surgery for colorectal peritoneal metastatic disease. Results: Data from a total of 23 single-agent and 13 comparative studies were included in our review. Despite the demonstrated safety profile of both chemotherapeutics, the heterogeneity of the included studies, their retrospective nature and the absence of relevant randomized trials prohibits the drawing of safe conclusions regarding the superiority of one of the two agents. However, it seems that perioperative morbidity is less with oxaliplatin-based HIPEC, while mitomycin C appears as a more cost-effective option. Conclusions: Selection of the optimal intraperitoneal chemotherapy agent for peritoneal metastases of colorectal cancer origin after the completion of cytoreductive surgery is still a matter of debate, with significant institutional variation. Further randomized clinical trials between the two commonest HIPEC agents are required, assessing the differences in perioperative outcomes, oncological outcomes, healthcare-associated costs and patients' quality of life. Keywords: chemotherapy; cytoreduction; hyperthermia; mitomycin; oxaliplatin.
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Is the increase in emergency colorectal cancer presentation directly related to the after effects of the pandemic?Poster abstract from the ESCP 17th Scientific & Annual Meeting, 21 - 23 September 2022, Dublin, Ireland.
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Machine learning prediction of early postpartum prediabetes in women with gestational diabetes mellitusBackground Early onset of type 2 diabetes and cardiovascular disease are common complications for women diagnosed with gestational diabetes. About half of the women with gestational diabetes develop postpartum prediabetes within 10 years of the index pregnancy. These women also have double the risk of developing cardiovascular disease than women without a history of gestational diabetes. Currently, there is no accurate way of knowing which women with gestational diabetes are likely to develop postpartum prediabetes. This study aims to predict the risk of postpartum prediabetes in women diagnosed with gestational diabetes. Methods We build a sparse logistic regression-based machine learning model to learn key variables significant for the prediction of postpartum prediabetes, from antenatal data with maternal anthropometric and biochemical variables as well as neonatal characteristics of 607 UK women diagnosed with gestational diabetes. We evaluate the performance of the proposed model in addition to other more advanced machine learning methods using established metrics such as the area under the receiver operating characteristic curve and specificity for pre-determined values of sensitivity. We use K-L divergence and information graphs to evaluate and compare different thresholds of classification for targeted screening options in resource-constrained settings. We also perform a decision curve analysis to study the net standardized benefit of our model compared to the universal screening approach. Results Strikingly, our sparse logistic regression approach selects only two variables as relevant but gives an area under the receiver operating characteristic curve of 0.72, outperforming all other methods. It can identify postpartum prediabetes in women with gestational diabetes using the Rule-in test with 92% specificity at an optimal probability threshold of 0.381 and using the Rule-out test with 92% sensitivity at an optimal probability threshold of 0.140. Conclusion We propose a simple logistic regression model, which needs only the antenatal fasting glucose at OGTT and HbA1c soon after the diagnosis of GDM, to predict, with remarkable accuracy, the probability of postpartum prediabetes in women with gestational diabetes. We envision this to be a practical solution, which coupled with a targeted follow-up of high-risk women, could yield better cardiometabolic outcomes in women with a history of GDM.
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Unexpected DiagnosisA 74-year-old man presented to the ER with an eight-month history of shortness of breath, cough, anorexia, and weight loss. He had emigrated from sub-Saharan African to the USA, where he was diagnosed and treated for coronary artery disease, heart failure, and stroke; was hospitalized several times; and underwent hernia surgery. Despite the complex care that he received in the USA for many years, the diagnosis of AIDS was continually missed for years, and the patient was eventually diagnosed at the age of 74.
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Cerebellar cavernomaIntroduction A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They're sometimes known as cavernous angiomas, cavernous haemangiomas or cerebral cavernous malformation. A case report of a young male with cavernomas is reported. Methods A 37-year-old man was referred to the ambulatory care unit from the accident and emergency department with a 2-day history of visual disturbance and dizziness. Clinical examinations of all systems were normal including neurologic examination which did not reveal any focal neurological signs. Routine haematology and biochemistry blood tests were all normal. Initially, a computed tomography of the brain was requested which showed no definite acute abnormality, but a small focus of high attenuation present within the left middle cerebellar peduncle may represent a small cavernoma. Further assessment with magnetic resonance imaging was suggested. The patient was then admitted to the acute medical unit for further investigations and workup. Results and discussion An MRI of the brain was performed and revealed multifocal cerebral microhaemorrhages of variable sizes spread randomly throughout the supra- and infra-tentorial compartments of the brain with no predilection for the deep structures (basal ganglia/thalami) to suggest chronic hypertensive encephalopathy. Cavernoma are less common in males at this age, which makes our case more unique. Conclusion A detailed history (personal and family) are key to detect such malformations in young patients, which also helps physicians be aware of its related complexities and further management. Conflict of interest statement None declared.
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Implementing a smoke-free hospital site policyTurning an entire hospital site into a smoke-free environment sounds like a daunting project but good communication and careful preparation can lead to success.
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MiddlemarchNo abstract
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38 The alphabet strategy for diabetes management; a patient centred, evidence-based checklist approach for reducing complications and healthcare costsBackground The International Diabetes Federation estimates 430million cases of diabetes globally. The National Diabetes Audit highlights significant gaps in attainment of national targets, which can result in diabetes-related complications including heart disease, stroke, and retinopathy. The latest report highlighted; - Type-1 diabetes: only 17.1% achieved good glycaemic control, BP and cholesterol targets - Type-2 diabetes: only 39.5% achieved these targets Method The Alphabet Strategy is an evidence-based care plan to manage patients with diabetes. Created at George Eliot Hospital, and included GPs; Nurses, Specialist Doctors and patients. The strategy allows healthcare professionals to provide a personalised care plan to all patients including a specialised plan for patients observing Ramadan. Results The strategy resulted in significant improvements in glycaemic control, blood-pressure, cholesterol, eye and foot examinations, and guardian drug uptake. Locally, we had the best attainment of targets out of 22 regional Clinical Commissioning Groups. The National Impatient Diabetes Audit highlighted lower admission rates and disease-related complications. Discussion The Alphabet Strategy philosophy follows our ‘POETIC’ vision; Patient-Centred, Public-Health driven, Professionally Inspired Outcome-based, Evidence-based, Team-focused, Integrated across services, Cost efficient, Dissemination is ongoing; over 50 teaching workshops and diabetes care events based on The Alphabet Strategy, including the BMJ Masterclass by Professor Patel. The care plan is part of the Sound Doctor diabetes care educational programme, approved by QISMET (Quality Institute for Self-Management, Education and Training). Conclusion We have learnt that a ‘POETIC’ approach works well. Implementing the strategy can lead to earlier detection of disease-related complications and better patient outcomes.
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Multiple synchronous intestinal tumorsLetter to the Editor reporting the case of an 83-year-old woman with synchronous primary cancers of terminal ileum, sigmoid and upper rectum.
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High fat intake leads to acute postprandial exposure to circulating endotoxin in type 2 diabetic subjectsObjective: To evaluate the changes in circulating endotoxin after a high-saturated fat meal to determine whether these effects depend on metabolic disease state. Research design and methods: Subjects (n = 54) were given a high-fat meal (75 g fat, 5 g carbohydrate, 6 g protein) after an overnight fast (nonobese control [NOC]: age 39.9 ± 11.8 years [mean ± SD], BMI 24.9 ± 3.2 kg/m(2), n = 9; obese: age 43.8 ± 9.5 years, BMI 33.3 ± 2.5 kg/m(2), n = 15; impaired glucose tolerance [IGT]: age 41.7 ± 11.3 years, BMI 32.0 ± 4.5 kg/m(2), n = 12; type 2 diabetic: age 45.4 ± 10.1 years, BMI 30.3 ± 4.5 kg/m(2), n = 18). Blood was collected before (0 h) and after the meal (1-4 h) for analysis. Results: Baseline endotoxin was significantly higher in the type 2 diabetic and IGT subjects than in NOC subjects, with baseline circulating endotoxin levels 60.6% higher in type 2 diabetic subjects than in NOC subjects (P < 0.05). Ingestion of a high-fat meal led to a significant rise in endotoxin levels in type 2 diabetic, IGT, and obese subjects over the 4-h time period (P < 0.05). These findings also showed that, at 4 h after a meal, type 2 diabetic subjects had higher circulating endotoxin levels (125.4%↑) than NOC subjects (P < 0.05). Conclusions: These studies have highlighted that exposure to a high-fat meal elevates circulating endotoxin irrespective of metabolic state, as early as 1 h after a meal. However, this increase is substantial in IGT and type 2 diabetic subjects, suggesting that metabolic endotoxinemia is exacerbated after high fat intake. In conclusion, our data suggest that, in a compromised metabolic state such as type 2 diabetes, a continual snacking routine will cumulatively promote their condition more rapidly than in other individuals because of the greater exposure to endotoxin.
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B419 Patient outcomes following hip fracture surgery using intrathecal 2% prilocaine alongside peripheral nerve blocksBackground and Aims Regional anaesthesia has increasingly become the mode of anaesthesia for hip fractures in view of the frail, elderly multiple comorbid populations who usually succumb to this significant injury. Bupivacaine is often the choice for spinal anaesthesia however, local anaesthetics like 2% Prilocaine (Prilotekal®) are gaining popularity in recent years due to their fast offset and better side effects profile. We analysed patient outcomes using intrathecal Prilocaine alongside peripheral nerve blocks and Eleveld modelled target-controlled infusion (TCI) 1% Propofol for sedation. Ethical committee approval was deemed unnecessary by our audit and research department as patients receive short-acting spinal anaesthesia with blocks routinely. Methods Data from 84 patients who received intrathecal 2% Prilocaine alongside ultrasound-guided peripheral nerve blocks (Femoral and Lateral cutaneous nerve of thigh) and Elevled TCI Propofol sedation were analysed. We recorded the day 1 post-op systolic blood pressure, pre and post-operative pain score, length of stay and 30-day mortality. Results We noted that no patient required additional analgesia in recovery, no admissions to intensive care and 30-day mortality was found to be 4%, which is better than the UK national average. The mean length of stay in the hospital was found to be 18 days. Conclusions We observed that intrathecal Prilocaine combined with nerve blocks is a reliable technique in hip fracture surgery, offers haemodynamic stability and could improve overall survival. Further study of the use of short-acting intrathecal agents is required in comparison to traditional methods.
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B100 “Dream” tubeless opiate free anaesthesia achieved with peripheral nerve blocks for knee replacement surgery – an observational studyBackground and Aims Perioperative opioids mainstay analgesia for Knee replacement surgery.Spinal opioids cause urinary retention, itchiness and vomiting.Cumulative opioid consumption causes increase CRP and fibrinogen levels- acute phase reactants. High opiate use cause physical dependence hence we planned Tubeless opiate free anaesthesia to fulfill our DREAM((Drink, Eat, Analgesia, Mobilise) . Methods Prospective Study done in 24 Patients undergoing elective Knee replacement surgery . Low dose spinal Bupivacaine heavy 0.5% 2.4 mls.No intrathecal opiates and Urinary Catheters not inserted. Adductor cana l (Figure 1) at apex of femoral triangle(FT)- 15 mls Ropivacaine 0.375%. Genicular blocks - SM,SL,IL-15 mls, IPACK (Figure 2&3) - above condylar level- 12 mls( max total dose Ropivacaine 3mg/kg ). Intraoperative analgesia was Paracetamol, Parecoxib and Mgso4. Tourniquet used for all. Results In patients with Nerve blocks patients length of stay was reduced by 2 days.Median Motor recovery time 3 hours. No Urinary catheter was required in opiate free group. Opiates requirement was reduced in post operative period Tubeless “DREAM “ was achieved postoperatively (No IV , Oxygen tubes & urinary catheters required). Only patients with high Preoperative pain scores asked for further pain relief 24 hrs postoperatively & 16 patients didn’t require opiates. Conclusions Opiate free Anaesthesia gives better results for enhanced recovery in post operative knee replacement patients. Ultrasound guided Adductor canal/IPACK blocks indicated to spare intrathecal opiate and postoperative opiate requirements. DREAM for Knee replacement patients can be realised . Our mission was to wean patients from preoperative opioids. Our technique of RA is the mainstay in achieving that. ( Ethical committee approval granted audit number 841_341 Georgeeliothospital )