Tag Archives: Plain English abstracts

FIT visual abstract

Guest Plain English summary: Worried about symptoms of bowel cancer? A simple stool test may help.

Kai Sheng Saw, Chen Liu, William Xu, Chris Varghese, Susan Parry, Ian Bissett

Have you ever worried if you or a loved one has bowel cancer? Bleeding from the rectum, changing bowel habits, unexplained weight loss, abdominal pain and bloating are symptoms associated with bowel cancer, warranting a visit to the doctors. However, studies have demonstrated that presence of these symptoms are poor predictors of colorectal cancer diagnosis.(1)

Currently, when these symptoms are raised with your doctor, it is very likely that the next step would be a colonoscopy or colonography. This involves clearing your bowel with bowel preparation laxatives for the test, and the discomfort of having a medical instrument inserted into one’s back passage. These colonic investigations also carry small but significant procedural risks.

The faecal immunochemical test, or FIT, is a simple and non-invasive test for patients who present to their doctors with symptoms concerning for bowel cancer. It is stool test that can reliably detect minute amounts of human blood in faeces that is not always visible to the naked eye. Most bowel cancers bleed to varying degrees into the colon and mix with faeces. FIT has been widely used in bowel cancer screening programmes but surprisingly it is only with COVID constraining access to healthcare that interest to expand its clinical use for patients with bowel cancer symptoms has taken hold.

We hypothesised that the FIT test could measure the amount of blood in faeces of patients presenting with concerning symptoms and categorise them into different colorectal cancer risk groups to help doctors determine the need for and urgency of recommending further invasive colonic investigation.

At the end of August 2021, we looked at over 9600 relevant academic publications on this topic, selected 15 high quality studies that were best designed to answer the question and combined their results for further analysis.

Our analysis showed that at the lowest possible detectable faecal blood by FIT (≥2 microgram Hb/g faeces), a positive FIT test would detect approximately 96 out of 100 colorectal cancers. In two of the largest studies conducted in the UK (2, 3), up to 63% of patients who under current standards would undergo an invasive colonic investigation because of reported symptoms, would be able to avoid one. 

When settings are adjusted to be in line with current National Institute for Health and Care Excellence (NICE) recommendations (≥10 microgram Hb/g faeces), a positive FIT test would pick up approximately 88 out of 100 colorectal cancers. If one has a negative FIT test at this setting, it is estimated that approximately only 1 in 243 patients undergoing invasive colonic investigation would have a cancer detected, meaning by contemporary practices, 242 patients would undertake the risk of a colonoscopy despite not having bowel cancer. (2,3)

Conversely, if FIT detects higher levels of blood in faeces (such as at ≥100 or ≥150 microgram Hb/g faeces), approximately 1 in 3 patients will have bowel cancer diagnosed. 

For patients with symptoms, these results indicate that when very low levels of blood are detected in stool by FIT, the chances of having bowel cancer are adequately low, hence invasive investigation may be avoided. Conversely, if relatively higher levels of blood are indicated by FIT, the probability of an existing bowel cancer is very high and urgent colonic investigation would be ideal to detect and treat the cancer as soon as possible.

No test is perfect. The currently accepted gold standard, colonoscopy, is estimated to miss 5 in 100 cancers.(4) With the correct settings, our analysis suggests that FIT approximates this diagnostic accuracy while being non-invasive, accessible and cheap.  While colonic imaging tests have an irreplaceable role in the diagnosis of bowel cancer, it may be more optimal for patients, clinicians, and health care systems to rationalise the use of colonoscopy and colonography to avoid delays in diagnosis and treatment for those who are deemed to be at highest risk of bowel cancer.

There are more intricacies related to this question and areas requiring further research, hence, for more information, we invite you to read our Open Access article that was recently published in BJS

References

1.         Vega P, Valentin F, Cubiella J. Colorectal cancer diagnosis: Pitfalls and opportunities. World J Gastrointest Oncol. 2015;7(12):422-433.

2.         D’Souza N, Georgiou Delisle T, Chen M, Benton S, Abulafi M, Group NFS. Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study. Gut. 2021;70(6):1130-1138.

3.         Turvill JL, Turnock D, Cottingham D, Haritakis M, Jeffery L, Girdwood A, et al. The Fast Track FIT study: Diagnostic accuracy of faecal immunochemical test for haemoglobin in patients with suspected colorectal cancer. British Journal of General Practice. 2021;71(709):E643-E651.4.         Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection–systematic review and meta-analysis. Radiology. 2011;259(2):393-405.

Hernias in children

Guest blog in plain English: Hernias in children

Nathalie Auger, Francesca del Giorgio, Annie Le-Nguyen, Marianne Bilodeau-Bertrand, Nelson Piché

University of Montreal Hospital Research Centre, Montreal, Quebec, Canada

Are women who have inguinal hernias more likely to have a child with an inguinal hernia? Have you ever wondered why a child may develop an inguinal hernia? Inguinal hernias affect about 4% of children1,2, but the reasons why are very unclear. An inguinal hernia occurs when intestinal tissues push through a weak spot in the abdominal wall. Most children with inguinal hernias are thought to have developed this disorder while still in their mother’s womb1,3. Yet there has been little attention to the possibility that the characteristics of mothers could predict which children will develop inguinal hernias while growing up.

We studied whether women who were previously diagnosed or treated for an inguinal hernia were more likely to have a child with an inguinal hernia. To test our research question, we analyzed the health status of 795,590 children from the province of Quebec, Canada4. We collected information from their mothers including her age, pregnancy complications, diseases she may have had in the past, and whether she was ever treated for an inguinal hernia. We closely followed her child over time to find out if the child was ever hospitalized for an inguinal hernia between birth and 13 years of age. We used regression methods to determine how characteristics of the mothers were associated with the chance of having an inguinal hernia in the child, and made sure that we controlled for confounders that could lead to incorrect measurements.

Our findings were very enlightening. We confirmed that mothers with a history of inguinal hernia were more likely to have a child who develops an inguinal hernia. But we found that the risk was higher for daughters than sons. Girls whose mothers had an inguinal hernia were 5 times more likely to themselves have an inguinal hernia. Additionally, mothers with connective tissue disorders such as rheumatoid arthritis or lupus were more likely to have sons with inguinal hernias. The figure illustrates just how strong some of the associations were.

These results suggest that the characteristics of a mother may affect a child’s chance of having an inguinal hernia. The likelihood of having an inguinal hernia also depends on if the child is a girl or a boy. Some of this difference may be because the development of inguinal hernias in boys is not the same as in girls. But it is also possible that there is a genetically sex-linked component. Finally, the relationship between maternal connective tissue diseases and the risk of inguinal hernia in boys suggests that connective tissue architecture may be involved as well.

Although more research is needed to confirm these findings, doctors and patients should be aware that children with abdominal symptoms who have a mother with a history of an inguinal hernia or connective tissue disorder may themselves be more likely to have an inguinal hernia. For more information, we invite you to read our study that was recently published in British Journal of Surgery4.

References

1          Azarow K, Cusick R. Pediatric Surgery [Internet]. The Surgical clinics of North America, Vol. 92. 2012. Available from: http://www.sciencedirect.com/science/article/pii/S0039 610912000680 [accessed 11 February 2021]

2          Lao OB, Fitzgibbons RJ, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surgical Clinics of North America 2012; 92: 487–504.

3          Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatric Clinics of North America 1998; 45: 773–789.

4          Auger P, Del Giorgio F, Le-Nguyen A, Bilodeau-Bertrand M, Piché N. Pediatric hernias and hydroceles. British Journal of Surgery 2021.

Plain English Summary: How the first COVID‐19 wave affected UK vascular services

Global overall mean service reductions, worldwide response, and service reduction scores in the UK and the Americas
Global overall mean service reductions, worldwide response, and service reduction scores in the UK and the Americas

The COVID-19 pandemic has impacted healthcare around the world. Patients who have vascular disease (problems with their arteries or veins), are at high-risk of having complications if they develop COVID-19. This is because patients with vascular disease usually have many medical problems. Some of them are also elderly and might be frail. We do not know how the COVID-19 pandemic might have affected the care of patients with vascular disease. 

The COVER study is an international study trying to assess how the COVID-19 pandemic changed the medical care of patients with vascular disease. The first part of the COVER study was an internet survey. In this survey, doctors and healthcare professionals were asked questions (every week) about the care of vascular patients at their hospital. The results were published in this article.

The results showed that the COVID‐19 pandemic had a major impact on vascular services worldwide. Most of the 249 hospitals taking part from 53 countries, reported big reductions in numbers of operations performed and the types of services they could offer to patients with vascular disease. Almost half of the hospitals stopped doing routine scans to detect artery problems and a third had to stop all clinics in the height of the pandemic. There were major changes in the resources available to treat blocked leg arteries. Most non-urgent operations, especially for vein problems, were cancelled.

In the months during recovery from the pandemic peaks, there will be a big backlog of patients with vascular disease needing surgery or review by vascular specialists.

Surgical research in Plain English

Randomized controlled trial of plain English and visual abstracts for disseminating surgical research via social media

BJS started with the aim of of being a medium through which surgeons “can make our voice intelligibly heard”, according to Sir Rickman Godlee, President of the Royal College of Surgeons of England in 1913.

The aim of a recently published paper in BJS was to increase the engagement (defined compositely as the total number of replies, retweets, or likes on Twitter) of clinicians and patients in the communication of surgical research – part of the core values of BJS.

Ibrahim et al. showed in the Annals of Surgery that visual abstracts increased engagement on Twitter in their case-control study, but plain English summaries have not previously been studied in the context of surgical research. Plain English summaries are becoming a real priority for funders (e.g. NIHR), as well as for clinical practice (BMJ, AoMRC). Patients are involved in the development of research, and need to have access to it.

This was a three-arm, randomized controlled trial with crossover of two intervention arms. Manuscripts that were eligible for inclusion were randomly allocated to three arms and disseminated via Twitter. The arms were standard tweets, plain English abstracts & visual abstracts.

Visual abstracts are a simplified graphical summary of a study’s scientific abstract. Plain English abstracts were developed according to NIHR INVOLVE ‘make it clear’ guidance and edited to satisfy a minimum readability index.

The primary outcome was online engagement by the public within 14 days of dissemination. The secondary outcome was online engagement by healthcare professionals.

The results can be seen in the visual abstract, with more details available in the paper. Overall: visual abstracts attracted a greater number of total engagements than plain English abstracts, and engagement by members of the public was low across all abstract types.

Note that this study only looked for the potential benefits from the point of view of the journal – not data from the perspective of patients, although a Twitter poll suggested that there was an appetite for informing the public about the findings of research studies.

More work needs to be done in collaboration with the public to understand how and in what format they prefer to engage with surgical research. We need to avoid soundbites of results, and instead provide a balanced & educated interpretation, to help to counter the avalanche of false information to which the public is exposed.