Background Blood platelet measurement is a widely available and inexpensive test that is performed routinely. Platelets are thought to act by inducing inflammation and play a role in clotting and antimicrobial defence. A postoperative rise in the platelet count (thrombocytosis) is often dismissed as an incidental finding, but there is growing evidence to suggest that it may act as an indicator to underlying pathology. It correlates with significant pyogenic infections as well as multiple malignancies. In addition to this, recent research indicates that thrombocytosis may be a useful prognostic indicator for postoperative outcomes in patients with malignancies. In patients undergoing surgery for gastric cancer, a combination of platelet count and neutrophil-to-lymphocyte (NLR) ratio collected preoperatively was shown to correlate with postoperative survival. Objective To evaluate whether there is a positive correlation between pre- and postoperative thrombocytosis and the risk of complications following colorectal surgery. Methods This was a retrospective observational study based in Morriston Hospital, Swansea. Patients undergoing elective colorectal surgery for an 18-month period between 2014 and 2016 were included. Data on patient demographics, pre- and postoperative platelet count, the first date at which the highest platelet count was recorded, length of stay, type of operation, and postoperative complications using the Clavien-Dindo classification was obtained from the theatre booking software (TOMS) and Welsh Clinical Portal. Pearson's chi-square test was used for the analysis of the categorical variables. Results Of the 201 patients studied, 75 (37%) had postoperative thrombocytosis (platelets ≥ 500 × 109/L, range 501–1136), 120 (59%) had postoperative normocytosis (platelets < 500 × 109/L, range 107–499), and 6 (2.9%) patients were excluded due to insufficient data. Peak platelet level was seen at a median of 8 days postoperatively but ranged from days 1 to 49. In patients with thrombocytosis, the mean time to peak platelet count was 9.5 days and ranged 1 to 49 days. 101/195 (52%) patients had a Clavien-Dindo III/V postoperative complication: 63% patients with postoperative normocytosis and 24% with postoperative thrombocytosis. In the thrombocytosis group, 16/75 (21%) were found to have postoperative pelvic collections compared to 1/120 (0.8%) of the normocytic patients. The total percentage of medical complications (44% versus 20%, p = 0.006) and surgical complications (64% versus 15.8%, p = 0.0001) was higher in the thrombocytosis group compared to the normocytosis group. Conclusion In this retrospective study, thrombocytosis was shown to have a positive correlation with postoperative medical and surgical complications. An elevated platelet count in the postoperative period should alert the clinician to a developing complication. We recommend that further studies with a larger sample size would test the specific associations with individual complications.

"Abstract: This article is based on the writer’s doctoral research undertaken in 2007. It examines the experience of managing a Gestalt training department, the complexities of that role and the tensions that arise from it. A multiplicity of roles and agendas are discussed together with the tasks that can be seen to be part of the role. How suited a psychotherapist is to be a manager is considered together with leadership style and the use of power and authority. The importance of the selection, support, and development of the psychotherapist/ manager for the education of future professionals is highlighted. Key words: manager, psychotherapist, training, tensions, support, role."

IntroductionA service review of the upper GI 2 WW referrals locally showed a 20% annual increase in the UGI referrals from 2013 to 2015. The cancer pick up rates were static at 4.5% with the vast majority of patients discharged back to their GP after a normal gastroscopy.1 The review also showed a 43% re-referral rate back to gastroenterology after a normal gastroscopy leading to an increase in the outpatient volumes and hence a delay in the delivery of care to those patients.MethodsWe piloted a dedicated consultant taking a lead to vet all UGI referrals and to channel them in to a simple (straight to gastroscopy) or complex (clinic first) pathway. All complex pathway patients were reviewed in clinic and investigated appropriately if required.ResultsOf the 619 UGI 2 WW referrals received over a 3 month period between August to October 2015, 153 (25%) patients were reviewed in dedicated complex pathway clinics (2 clinics/week). The cancer pick up rate increased to 8% (12) with 60% (7) being UGI (oesophagus (6) and stomach (1)) and 40% Non-GI cancers (ovarian, lung and endometrial cancers). 15% of these patients had a diagnosis requiring ongoing secondary care follow up (more than one follow up appointment) for conditions such as strictures, coeliac disease and eosinophilic oesophagitis etc. 42% (65) had a clinically significant diagnosis that required advice and guidance to GP for community follow up. 82% were discharged back to primary care after one follow up appointment.ConclusionThere was an 80% increase in the cancer pick up rate as compared to our previous direct to test pathway. We believe daily clinician vetting of referrals and upgrading to a clinic first pathway contributed to a higher rate of cancer detection. There were non GI cancers detected which would have been missed with a gastroscopy only service. The prompt clinic follow up in secondary care for patients with significant yet benign diagnoses together with advice and reassurance prior to discharge for others should eventually lead to a reduction in the re-referral rate whilst maintaining the high quality delivery of care.Reference1 Kapoor N, Bassi A, Sturgess R, et al. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005;54:40–5.Disclosure of InterestNone Declared