Background Azathioprine (AZA) is a recognised treatment option for maintaining remission in IBD patients. Myelotoxicity and abnormal liver function tests may present at any stage of therapy, therefore ECCO advises practitioners to check full blood count, liver and kidney function tests at 3-monthly intervals for patients established on therapy. During the COVID-19 pandemic, UK guidance suggested reducing blood test monitoring to a minimum safe frequency to facilitate ‘shielding’ of vulnerable patient groups. Patients established on treatment at St Mark’s Hospital for more than 12 months, on stable doses were deemed eligible for extended blood monitoring intervals of 6-monthly. The aim of this audit was to assess the impact of this extension on patient safety, by measuring outcomes against locally agreed standards. Methods All patients on AZA were identified using the pharmacy dispensing system and patient information software for blood test results, clinic letters and notes. Outcomes for patients who had extended blood monitoring were collected retrospectively including monitoring calls to the IBD advice line and any hospital admissions associated with therapy. Subsequent blood test results were also captured. Results A total of 92 patient records were identified and analysed. Table 1 shows the achieved compliance (%) to the audit standards compared to the target compliance (%). 54% of patients (n=50) received medication that lasted beyond the standard 12-week validity of a blood test, i.e. had extended blood monitoring. Of those 50 patients, 43 were eligible for extended blood monitoring (86%). From 50 patients with extended blood monitoring, one patient had elevated alanine aminotransferase levels which improved after a one-week treatment break. Another patient called the IBD advice line reporting nausea and abdominal cramps due to treatment and was advised to split the dose and monitor for side effects. No patients were admitted to emergency care or hospital due to deranged blood test results or adverse effects from their medication. Conclusion Overall the findings suggest that the temporary relaxation of blood monitoring did not adversely affect patient safety. For more comprehensive results, it would be prudent to repeat the audit using a larger sample size; however the audit has established a baseline at a time of unprecedented changes in the workplace, which will be useful in guiding future practice.
Objectives: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). Methods: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007 Objectives:The authors have investigated the use of advanced transvaginal sonography (TVS) techniques to identify the features of this neoplastic entity pre-operatively, in order to possibly predict the extent of its required surgical treatment. Methods: All patients in this continuous ongoing investigation who were histologically diagnosed with AEH or EC were examined sonographically, using three dimensional ultrasound (3D U/S) with Power Doppler Angiography (PDA) from April 1, 2015 to the present. All of these patients underwent a subsequent surgical procedure with the resulting histology surgically obtained to be compared with those pre-operative ultrasound findings. Results: The identified sonographic features of the cases enrolled in this study were compared with the intraoperative and post-operative pathologic findings. With the results of only 12 patients thus far, the ultrasound findings predicted the minimum EC staging 100 % of the time. Deep myometrial invasion (≥50%) and cervical stromal invasion were specifically identified and which is naturally associated with the surgical staging of EC. Conclusions: This ongoing investigation seeks to validate the findings of Alcazar and those of Karlsson, to sonographically identify the features of this oncologic condition, so as to properly predict its optimal surgical treatment. The clinical importance of this should be recognised, for the impact it can have on patient care, in that there is often difficulty in properly obtaining the diagnosis of this entity (EC) when it presents as Postmenopausal Bleeding (PMB Visualising endometrial blood flow by Doppler imaging was thought to be useful to distinguish cancer from other endometrial lesions. The aim of this study was showing the efficacy of SMI on diagnosing endometrial cancer compared with ordinary Doppler way. Methods: From September 2015 to February 2017, we enrolled 27 endometrial cancer patients who visited our hospital, and 83 patients without cancer as a control group. Endometrial thickness was measured by transvaginal ultrasonography, Toshiba Aplio 300. Endometrial blood flows were obtained by ordinary Doppler way, colour Doppler image, advanced dynamic flow and PDI, and SMI. We compared age, endometrial thickness and the detection rate of endometrial blood flow between these two groups, and the capability of visualising endometrial blood flow, small branching vessels, and blooming artefact among cancer group. Results: The mean age of endometrial cancer group was 57.8 ± 11.4 years ol...
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