SPARC 2018 Internationalisation and collaboration : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2018 SPARC conference. This year we not only celebrate the work of our PGRs but also the launch of our Doctoral School, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 100 presenters, the conference truly showcases a vibrant PGR community at Salford. These abstracts provide a taster of the research strengths of their works, and provide delegates with a reference point for networking and initiating critical debate. With such wide-ranging topics being showcased, we encourage you to take up this great opportunity to engage with researchers working in different subject areas from your own. To meet global challenges, high impact research inevitably requires interdisciplinary collaboration. This is recognised by all major research funders. Therefore engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Trends of Over-the-Counter and Prescribed Medication Use During Pregnancy: A Cross-Sectional Study

Amal A Alyami,1 Manal M Alem,2 Shereen R Dorgham,3 Sahar A Alshamandy4 1Obstetrics & Gynecology Hospital, King Saud Medical City, Riyadh, Saudi Arabia; 2Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Obstetrics and Women’s Health Nursing Department, College of Nursing, Minia University, Minya, EgyptCorrespondence: Manal M Alem, Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi Arabia, Email [email protected]: Globally, unjustified medication use during pregnancy, a critical phase in human life, is a threat that compromises the safety of both, the mother and the child. We aim to investigate the prevalence of over-the-counter (OTC) or non-prescription and prescription medication use during pregnancy in women from the city of Riyadh, Saudi Arabia, the level of prior knowledge, and the sources of their information about medication hazard/safety.Methods: A cross-sectional study was performed using a self-administered questionnaire for 287 pregnant women visiting King Saud Medical City (KSMC) – outpatient departments for routine antenatal care during 3 months (1st Mar– 31st May 2021). The questionnaire was developed by Navaro et al with 4 sections: socio-demographic data, medication use during pregnancy, level of knowledge, and relevant sources of information.Results: The participants had a mean age of 32.21 years ± 6.41 (SD), and gestational age of 23.67 weeks ± 8.47. About 76.66% of them reported using medication during their current pregnancy: predominantly prescribed (86.36%). Women who used medication during pregnancy were slightly older; the mean difference was 1.97 years (95% CI 0.23– 3.71) (P=0.027). Women living in an urban environment as compared with rural had a higher prevalence of medication use (79.01% vs 52%) (P=0.002). Overall, 58.19% reported using non-prescribed medications during pregnancy, with analgesics as the most frequently used class (70.30%). The mild nature of the illnesses and availability of an old prescription and information from pharmacists were the main reasons for self-medication. About 40.77% denied receiving any information about medication use during pregnancy.Conclusion: The prevalence of the medication use during pregnancy in our population is alarmingly high. Analgesics were the most frequently used. Lack of adequate information from treating physicians appears to be contributory to self-medication during this critical time.Keywords: nursing, antenatal care, pregnancy care, prescription medication, non-prescription medications, over-the-counter, fetal health and development, self-medicatio

Prevalence and Associated Factors of Vitamin D Deficiency in High Altitude Region in Saudi Arabia: Three-Year Retrospective Study

Mostafa Abdelsalam,1,2 Eman Nagy,2 Mohamed Abdalbary,2 Mona Abdellatif Alsayed,1,3 Amr Abouzed Salama Ali,4 Reham Metwally Ahmed,1 Abdulbadie Saleh M Alsuliamany,1 Ali H Alyami,5– 7 Raad MM Althaqafi,8 Raghad M Alsaqqa,9 Safaa Ibrahim Ali,10 Bakar Aljohani,11 Ahmed Abdullah Alghamdi,12 Faisal A Alghamdi,9 Adnan A Alsulaimani1 1Internal Medicine Department, Alameen General Hospital, Taif, Saudi Arabia; 2Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 3Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Mansoura Medical District, Family Medicine Hospitals, Ministry of Health, Mansoura, Egypt; 5Department of Surgery, Ministry of the National Guard – Health Affairs, Jeddah, Saudi Arabia; 6Department of Surgery, Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 7Department of Orthopedics, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 8Orthopedic Surgery Department, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia; 9College of Medicine, Taif University, Taif, Saudi Arabia; 10General Medicine Faculty, Sechenov University, Moscow City, Russian Federation; 11Neuroradiology, AlHada Military Hospital, Taif, Saudi Arabia; 12College of Medicine, Al-Baha University, Al Baha, Saudi ArabiaCorrespondence: Eman Nagy, Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt, Email [email protected]: Vitamin D has many functions in the human body, and its deficiency is associated with skeletal and non-skeletal diseases. Vitamin D deficiency (blood level of 25 (OH) vitamin D < 20 ng/mL) has been reported worldwide, including Kingdom of Saudi Arabia (KSA). Its prevalence and associated factors vary according to KSA. Therefore, this study aimed to explore the prevalence and risk factors of vitamin D deficiency in the Taif region of KSA.Methods: This retrospective study included patients who attended outpatient clinics at the Alameen General Hospital from 2019 to 2021. Demographic, clinical, and laboratory data were collected using a hospital software system.Results: The study included 2153 patients and vitamin D deficiency was diagnosed in 900 (41.8%) of whom were diagnosed with vitamin D deficiency. It was more common in males (P=0.021), younger age (< 0.001), and in patients without comorbidities. There was a positive correlation between 25 (OH) vitamin D levels and blood cholesterol, high-density lipoprotein, calcium, and vitamin B12 levels. In the binary logistic regression analysis, age was the most significant predictor (P< 0.001), followed by the absence of thyroid disease (P=0.012) and asthma (P=0.030).Conclusion: Vitamin D deficiency is common in the Saudi population despite sunny weather in KSA. It is more prevalent among males, younger individuals, and those without comorbidities such as thyroid diseases and asthma.Keywords: vitamin D, prevalence, risk factors, KSA, calciu

Knowledge and practice of using airway pressure release ventilation mode in ARDS patients: a survey of physicians

Background: Limited data is available on awareness and clinical management of the airway pressure release ventilation (APRV) mode of ventilation for acute respiratory distress syndrome (ARDS) patients among physicians who work at in adult critical areas. This study aimed to assess the knowledge and current practice of using APRV mode with ARDS patients and identify barriers to not using this mode of ventilation among physicians who work in adult critical areas in Saudi Arabia. Methods: Between November 2022 and April 2023, a cross-sectional online survey was disseminated to physicians who work in adult critical areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results: Overall, 498 physicians responded to the online survey. All responders (498, 100 %) reported that APRV is indicated in patients with ARDS, but 260 (52.2 %) did not know if there was an institutionally approved APRV protocol. Prone positioning was the highest recommended intervention by 164 (33.0 %) when a conventional MV failed to improve oxygenation in patients with ARDS. 136 (27.3 %) responders stated that the P-high should be set equal to the plateau pressure on a conventional ventilator while 198 (39.8 %) said that P-low should be 0 cmH2O. Almost half of (229, 46.0 %) responders stated that the T-high should be set between 4 and 6 s, while 286 (57.4 %) said that the T-low should be set at 0.4–0.8 s. The maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, just over half (257, 51.6 %) believed that the maximum allowed P-high setting should be 35 cmH2O. One third of the responders (171, 34.3 %) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cmH2O. However, 284 (36.9 %) thought that the T-high should be gradually increased to reach a target of 10 s. Most responders (331, 66.5 %) felt that the criteria to switch the patient to CPAP would be to have an FiO2 ≤ 0.4, P-high ≤10 cm H2O, and T-high ≥10 s. Lack of training has been the most common barrier to not using APRV by 388 (77.9 %). Conclusion: There is a lack of consensus on the use of APRV mode, probably due to several barriers. While there were some agreements on the management of ventilation and oxygenation, there were variations in the selection of the initial setting of APRV. Education, training, and the presence of standardized protocols may help to provide better management