ObjectiveIBD prevalence is estimated to be rising, but no detailed, recent UK data are available. The last reported prevalence estimate in the UK was 0.40% in 2003. We aimed to establish the current, and project future, prevalence in Lothian, Scotland.DesignWe conducted an all-age multiparameter search strategy using inpatient IBD international classification of disease (ICD-10) coding (K50/51)(1997–2018), IBD pathology coding (1990–2018), primary and secondary care prescribing data (2009–2018) and a paediatric registry, (1997–2018) to identify ‘possible’ IBD cases up to 31/08/2018. Diagnoses were manually confirmed through electronic health record review as per Lennard-Jones/Porto criteria. Autoregressive integrated moving average (ARIMA) regression was applied to forecast prevalence to 01/08/2028.ResultsIn total, 24 601 possible IBD cases were identified of which 10 499 were true positives. The point prevalence for IBD in Lothian on 31/08/2018 was 784/100 000 (UC 432/100 000, Crohn’s disease 284/100 000 and IBD unclassified (IBDU) 68/100 000). Capture–recapture methods identified an additional 427 ‘missed’ cases (95% CI 383 to 477) resulting in a ‘true’ prevalence of 832/100 000 (95% CI 827 to 837).Prevalence increased by 4.3% per year between 2008 and 2018 (95% CI +3.7 to +4.9%, p<0.0001). ARIMA modelling projected a point prevalence on 01/08/2028 of 1.02% (95% CI 0.97% to 1.07%) that will affect an estimated 1.53% (95% CI 1.37% to 1.69%) of those >80 years of age.ConclusionsWe report a rigorously validated IBD cohort with all-age point prevalence on 31/08/2018 of 1 in 125, one of the highest worldwide.

Background and aims Multiple adalimumab (ADA) biosimilars are now approved for use in IBD; however, effectiveness and safety data remain scarce. We aimed to investigate long-term outcomes of the adalimumab (ADA) biosimilar SB5 in IBD patients following a switch from the ADA originator (SB5-switch cohort) or after start of SB5 (SB5-start cohort). Methods We performed an observational cohort study in a tertiary IBD referral centre. All IBD patients treated with Humira® underwent an elective switch to SB5. We identified all these patients in a biologic prescription database that prospectively registered all ADA start and stop dates including brand names. Data on IBD phenotype, CRP, drug persistence, ADA drug and antibody levels, and faecal calprotectin were collected. Results 481 patients were treated with SB5, 256 in the SB5-switch cohort (median follow-up: 13.7 months [8.6-15.2]) and 225 in the SB5-start cohort (median follow-up: 8.3 months [4.2-12.8]). 70.8% of the SB5-switch cohort remained on SB5 beyond one year; 90/256 discontinued SB5, mainly due to adverse events (46/90) or secondary loss of response (37/90). In the SB5-start cohort, 81/225 discontinued SB5 resulting in SB5-drug persistence of 60.3% beyond one year. No differences in clinical remission (p=0.53), CRP (p=0.80), faecal calprotectin (p=0.40) and ADA trough levels (p=0.55) were found between baseline, week 26 and week 52 following switch. Injection site pain was the most frequently reported adverse event. Conclusion Switching from ADA originator to SB5 appeared effective and safe in this study with over 12 months of follow-up.

Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.

The NHS Cancer Plan sets out targets for the diagnosis and treatment of cancer. Ideally, there should be a maximum of a 2-week wait from a referral for suspected cancer to an outpatient appointment. A fast track referral system has been established nationally, with general practitioners given guidelines as to appropriate referrals. In the South Essex region, we audited all such referrals using this system for a 12-month period and also all new patients diagnosed with head and neck cancer during the same period. We found that 71% of patients diagnosed with cancer were not referred using the fast track system and that only 15% of patients who were referred by the fast track system were subsequently found to have cancer. For patients with cancer who were referred using standard letters, the time from referral to initial consultation was generally much longer than the recommended period of 2 weeks. We conclude that improvements in utilizing the fast track system need to be made if it is to bring about an improvement in early diagnosis of head and neck cancer. As things stand, it may actually be detrimental for most cancer patients.

Background & Aims Vedolizumab is an anti-a4b7 monoclonal antibody that is licensed for the treatment of moderate to severe Crohn’s disease and ulcerative colitis. The aims of this study were to establish the real-world effectiveness and safety of vedolizumab for the treatment of inflammatory bowel disease. Methods This was a retrospective study involving seven NHS health boards in Scotland between June 2015 and November 2017. Inclusion criteria included: a diagnosis of ulcerative colitis or Crohn’s disease with objective evidence of active inflammation at baseline (Harvey–Bradshaw Index[HBI] ≥5/Partial Mayo ≥2 plus C-reactive protein [CRP] >5 mg/L or faecal calprotectin ≥250 µg/g or inflammation on endoscopy/magnetic resonance imaging [MRI]); completion of induction; and at least one clinical follow-up by 12 months. Kaplan–Meier survival analysis was used to establish 12-month cumulative rates of clinical remission, mucosal healing, and deep remission [clinical remission plus mucosal healing]. Rates of serious adverse events were described quantitatively. Results Our cohort consisted of 180 patients with ulcerative colitis and 260 with Crohn’s disease. Combined median follow-up was 52 weeks (interquartile range [IQR] 26–52 weeks). In ulcerative colitis, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 57.4%, 47.3%, and 38.5%, respectively. In Crohn’s disease, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 58.4%, 38.9%, and 28.3% respectively. The serious adverse event rate was 15.6 per 100 patient-years of follow-up. Conclusions Vedolizumab is a safe and effective treatment for achieving both clinical remission and mucosal healing in ulcerative colitis and Crohn’s disease.

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The National Service Framework (NSF) for Diabetes highlights the importance of sharing decision making with patients when helping them to adopt and maintain a healthy lifestyle. It was felt that this shift in focus with the development of a more patient-centred approach would require the teaching of new skills to health care professionals. The Communication Skills Unit in Cardiff worked with the local Diabetes Unit to design a training programme that allows professionals to develop their skills in behaviour change counselling. The nurse specialists in the Diabetes Unit were very involved in talking to patients about lifestyle issues, and yet they had little or no previous communication skills training.A pilot course was designed, in which four audiotaped simulated consultations were conducted before and after two seminars led by an expert in behaviour change counselling. The consultations were carried out in six nurses' normal clinical settings to ensure a truer representation of a normal consultation. The results showed that initially most participants were using a didactic and nurse-centred approach when offering lifestyle advice. Following the course, all the nurses were using skills that were more aligned with behaviour change counselling, and interviews afterwards revealed that the course was acceptable and enjoyable. This pilot study provides the rationale for paying closer attention to practitioner skill acquisition before examining the efficacy of behaviour change counselling for improving lifestyles among those with chronic diseases like diabetes.

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