Management of alcohol-abusing patients presenting with intracapsular hip fractures is controversial. The aim of this study was to compare the management and outcome of working-age alcohol-abusing patients with similar-aged controls. Patients were identified from a prospectively collected database of trauma admissions. Full case notes were available for 78 patients under 65 of age presenting with a displaced intacapsular fracture at a teaching hospital between 1998 and 2002. Thirty seven patients had evidence of alcohol abuse. Alcohol-abusing patients presented to hospital later (p = 0.05), underwent surgery a median of 18 hours later (p = 0.011) and required a longer post operative stay (p = 0.003) compared to non-abusers. Despite this, the results of internal fixation were comparable. There was no significant difference between alcohol-abusers and non-abusers in rates of avascular necrosis (6.9% vs 9.7%; odds ratio 0.69, 0.11-4.47) or revision surgery (0.21 vs 0.10 procedures/ patient; odds ratio 1.49, 0.30-7.33). The high rates of alcohol abuse in this low-velocity trauma population suggest such patients are at increased risk of osteoporosis. Routine screening for osteoporosis should be considered in working-age alcohol abusers. After subcapital fracture, reduction and internal fixation is an acceptable treatment in this sub-group of patients.

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Introduction Neoadjuvant long course chemo-radiotherapy (LCCR) is the standard of care for locally advanced rectal cancer. In June 2013 this institution implemented preoperative MRI post LCCR in an attempt to improve the R0 resection rate. The aims of this projects were to audit the compliance with the new policy and to assess whether it had an impact on the R0 resection rate. Method All patients who underwent resection after LCCR between June 2013 and February 2017 had their clinical notes audited to assess compliance with the standard ‘all patients who have undergone LCCR should receive MRI imaging of the rectum unless clinically contraindicated’. To assess effectiveness of the intervention the R0 resection rate of patients who had received the preoperative MRI was compared to those who had not between the period January 2008 and February 2017. The data was entered and stored onto a larger departmental database so that it could be used in future for other projects. Result 33 out of 88 (37.5%) of eligible patients received post LCCR MRI rectum prior to resection although a further two patients had a preoperative CT scan. The R0 resection rate in patients who had pre-operative MRI was 88% compared to 89% in those who did not (p=1). Conclusion The rate of patients who received pre-operative MRI following LCCR was 37.5%. Whilst this shows significant room for improvement, data collected regarding effectiveness of the intervention shows that it makes no difference to R0 resection rate. Take-home message Pre-op MRI following LCCR does not improve R0 resection rate in locally advanced rectal cancer.

Introduction Dehydration is a common problem amongst colorectal cancer patients who are defunctioned with loop ileostomy. This is known to lead to significant morbidity including acute kidney injury, hospital readmission and non-commencement or non-completion of chemotherapy. This institution plans to run a trial looking into preventing this with oral rehydration salts and formed a patient and public involvement (PPI) group to inform trial design and assess patient opinion on importance of this area of research. Method Five patients were recruited to the PPI group and a recorded semi-structured group interview was conducted. Patients were invited to try the rehydration salts and asked questions related to trial design and importance of research. The recording was transcribed and thematically analysed by the primary researcher. A consultant surgeon was present to ensure any medical issues raised were dealt with correctly. Result Three participants had experienced problems with their stoma. The main themes identified were; social embarrassment, behaviour modification, high outputs of stomas, fear of non-closure. The participants were unaware of dehydration related complications but felt that they were of high importance when provided with relevant information. Participants tasted the oral rehydration salts and expressed preference for mixing them with fruit flavoured squash. No specific barriers were identified in participation and patients were highly motivated to engage with the proposed study. Conclusion Patients are motivated and believe this to be a worthwhile area of research. Daily double strength rehydration salts are an acceptable intervention with few barriers to participation. Take-home message Dehydration in patients defunctioned with loop ileostomy is a significant cause of morbidity. Patients are highly motivated to engage in research into preventing this and find daily double strength rehydration salts is an acceptable intervention.