These results are compatible with those of previous randomised trials done in research settings, demonstrating that population-based colorectal cancer screening is feasible in Scotland and should lead to a comparable reduction in disease-specific mortality.

Objectives To review outcomes of massive transfusion protocol (MTP) activation and determine the impact of MTP implementation on blood bank use. Background MTP has been established to rapidly provide plasma and packed red blood cells in ratios approaching 1:1. Due to availability, MTP has been utilized in non-traumatic hemorrhage despite evidence of benefit in this population. Our hospital wide implementation of MTP was reviewed for propriety, outcomes, and effect on blood bank resources. Methods Retrospective cohort study of patients receiving transfusion after MTP activation from October 2009- 2011. Underlying medical conditions and baseline medication use were determined. In-hospital and 24-hour mortality were compared with evaluation for confounding by APACHE score and duration of MTP activation. Blood product use before and after MTP implementation was reviewed. Results MTP activation occurred in 62 trauma and 63 non-trauma patients. Non-trauma patients were older, had more underlying medical conditions, and higher APACHE scores compared to trauma patients. 24-hour mortality was higher in trauma compared to non-trauma patients (27.4% vs. 11.1%, p =0.02). There was no significant difference of in-hospital mortality. Transfusion ratio did not differ between trauma and non-trauma patients and was not associated with mortality even when MTP activation duration and APACHE score were considered. Hospital-wide blood product use did not change with MTP implementation. Conclusions MTP may be successfully used in trauma and non-trauma settings without significantly impacting overall blood product utilization. Inclusion of non-trauma patients into prospective studies of resuscitation with blood products is warranted to ensure benefit in these patients.

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Introduction Obesity is associated with an increased risk of colorectal cancer (CRC). Unlike the indirect measures such as BMI, CT-Body composition (CT-BC) allows for the assessment of both volume and distribution of adipose tissue. Therefore, the aim of this study was to examine the relationship between host characteristics, BMI, CT-BC measurements and the incidence of colorectal neoplasia. Methods Patients undergoing CT Colonography (CTC) as part of the Scottish Bowel Screening Programme, between July 2009 and February 2016, were eligible for inclusion. Data were collected including demographic data, clinicopathological variables and CT-BC measurements including skeletal muscle index (SMI), subcutaneous fat index (SFI) and visceral fat area (VFA). CTC, colonoscopy, and pathology reports were used to identify CRC incidence. Associations between demographic data, clinicopathological variables, CT-BC measurements, colorectal neoplasia and advanced colorectal neoplasia were analysed using univariate and multivariate binary logistics regression. Results 286 patients met the inclusion criteria. Neoplasia was detected in 105 (37%) of the patients with advanced neoplasia being detected in 72 (69%) of patients. On multivariate analysis sex (p < 0.05) and high VFA (p < 0.001) remained independently associated with colorectal neoplasia. On multivariate analysis a high SFI (p < 0.01) remained independently associated with advanced colorectal neoplasia. BMI was not associated with either colorectal neoplasia or advanced colorectal neoplasia. Conclusion When directly compared to BMI, CT derived fat measurements were more closely associated with the degree of neoplasia in patients undergoing colorectal cancer screening. In patients investigated with CT colonography, CT adipose measures may stratify the risk and grade of neoplasia.