Background: Assess the effectiveness and safety of combination laxative therapy containing milk of magnesia, liquid paraffin and sodium picosulphate (Cremaffin-Plus®) in management of constipation, in patients with anal fissure/haemorrhoids/obstructive defecation syndrome (ODS). Methods: Patients visiting study site with complaints of constipation secondary to anal fissures/haemorrhoids/ODS, intended to receive combination laxative therapy (as per physicians' discretion), were enrolled. Primary objectives were to assess the change in number of bowel movements per day and stool consistency; secondary objectives were to assess change in straining, physician global efficacy assessment, quality of life (PAC-QOL score), Constipation Symptoms (CSS), Fecal Incontinence Score (FIS), Patient Assessment of Constipation Symptoms (PAC-SYM) score, along with the Modified Longo Score (MODS) for ODS from baseline to end of 4 weeks. Safety, tolerability and treatment adherence were also assessed. Results: About 32 patients (anal fissure:19, haemorrhoids:5, ODS:8) met inclusion criteria. Significant improvement in stool frequency was observed in all patients pooled together (p=0.016); group wise, statistical significance was noted in patients of anal fissures. Stool consistency was improved in all patients pooled together (p<0.001); group wise, significant improvement was seen in patients of anal fissure and ODS. There was a significant improvement in straining noted in all patients pooled together (p=0.002). Significant reduction (p<0.001) was noted in all the symptom scores (CSS, FIS, PAC-SYM and PAC-QOL) from baseline to 4 weeks in all patients. About 51.44% reduction in MODS score was noted in patients with ODS. Conclusions: Improvement in stool frequency, consistency and straining was noted in all patients with constipation (with fissure/haemorrhoids/ODS) treated with Cremaffin-plus for 4-weeks, improving the quality of life. All patients showed good therapy adherence with better safety and tolerability profile.

ProblemAvailability of advanced radiotherapy technology to treat cancer is limited in regional Australia. At Central West Cancer Care Centre, the utilisation rate of intensity‐modulated radiotherapy and volumetric modulated arc therapy was significantly lower compared to other NSW public health services. Stereotactic ablative body radiotherapy treatment was not available at Central West Cancer Care Centre.DesignTo increase the intensity‐modulated radiotherapy/volumetric modulated arc therapy utilisation rate and to make stereotactic ablative body radiotherapy treatment available through quality improvement projects with multi‐disciplinary collaboration.SettingCentral West Cancer Care Centre is part of Western NSW Local health District. Central West Cancer Care Centre has two linear accelerators for delivering intensity‐modulated radiotherapy, volumetric modulated arc therapy and stereotactic ablative body radiotherapy treatments, and a computed tomography simulator with 4D computed tomography capability.Key measures for improvement Intensity‐modulated radiotherapy/volumetric modulated arc therapy utilisation rate increases to > 65% Stereotactic ablative body radiotherapy available to Central West Cancer Care Centre patients Strategy for changeA multi‐disciplinary active of team radiation oncologists, medical physics specialists and radiation therapists developed an implementation plan for each treatment technique.Effect of changeThere was a significant increase in use of advanced techniques. The impact on patients included the following: Fewer side effects and improved control of disease as the advanced techniques directed the dose to the tumour and reduced the radiation dose to organ at risk. Treatment completed sooner than conventional radiotherapy, as the required dose required fewer trips to the hospital. Rural and remote patients were not required to travel to a metropolitan centre to have stereotactic ablative body radiotherapy treatment. Lessons learntStrong commitment from a trained team and a collaborative approach is important for the implementation of advanced technology in regional centres.