Abstract Background Urinary incontinence (UI) is an under-reported and treatable condition, associated with reduced quality of life. The Integrated Care programme of Older Persons (ICPOP) supports people with complex care needs in their home. There is no available research on the rate of UI among the ICPOP population. This study aimed to assess UI in this group. Methods A convenience sample of 100 patient records selected randomly from an ICPOP serving approximately 30,000 people from 2017 to present were retrospectively reviewed; including patients charts, Comprehensive Geriatric Assessments (CGAs) and outpatient letters. As part of the CGA each person was assessed for UI on domiciliary visit. Irish geriatric medicine trainees were surveyed to assess their self-reported confidence assessing and treating UI. Results Of the 100 patients CGAs reviewed, 62% were female. 11% had UI reported on their referral to ICPOP. 56% reported UI during their CGA. Only 18% of those with UI had UI generated on to their problem list. Of those patients with UI, polypharmacy (≥5 medications) was noted in 89%. 77% of those with UI were on a medication associated with worsening UI, while only 18% of those with UI were on a treating medication for UI. 25% had their UI assessed at clinic, including 7% who were referred onwards to urology for management of their UI. 80% of geriatric medicine trainees said that they did not feel confident managing UI and 100% said they would like to receive further teaching on UI. Conclusion CGA is an excellent method for identifying UI. This data suggests that UI is more prevalent among the ICPOP as compared with an inpatient population and the general population in the same age group. Further specialist teaching is needed to improve trainee confidence in this area.

Abstract Background There is increasing awareness of the need to inform public-facing services, and in particular police services, on dementia awareness so as to meet the differing needs of those living with dementia. While there have been programmes in Ireland such as the Dementia Elevator course, no specific course to date has been implemented for the Garda Síochána. Our experience in a pioneering Integrated Care Programme for Older People (ICPOP) team indicated a need to develop a course. We report on the feedback of community and probationary Gardaí to a dementia awareness course. Methods Questionnaire survey on 26 participants in course based on existing dementia support framework, and feedback from Gardaí at ICPOP steering group. Results The results indicated a positive (100%) (strongly agree/agree) response to: (a) application of knowledge learned, (b) content organised and easy to follow, (c) good quality of training, (d) trainers were knowledgeable, (e) adequate time given for questions and discussion and (f) participation and interaction encouraged. Overall rating of the course was 100% excellent. Useful feedback was given on improving the course—more up to date videos, and more cross organisational communication. Conclusion Police forces have a particularly important role in encountering people living with dementia, and a limited number of international reports exist on their implementation. The finding of this course development and survey point to a useful role for expanding dementia awareness training across the Gardaí at a national level, and consideration of delivery to all first-responders.

Abstract Introduction Lack of home ownership is associated higher rates of mental and physical ill-health and death1. According to longitudinal data in Ireland, 92% of persons aged 75 and over own their homes outright with approximately 8% living in rented accommodation2. We sought to compare characteristics of a cohort of patients open to our Integrated Care for Older Persons (ICOP) team with this national Irish dataset. Method A convenience sample of 50 patients reviewed by the ICOP team in a University Teaching Hospital was analysed. Data was anonymised and stored via encrypted key. Analysis was performed using SPSS v.27. Results The average age was 82.5 (±8.1) with 70% women in the sample. There was a lower prevalence of home ownership in this group of patients than the national norm (66% vs 92%) ie 34% were living in rental accommodation, majority Local Authorities. Those living in Local Authority accommodation had lower overall time spent in full time education than those who owned their own home (9.3 ± 3.1 vs 11.5 ± 3.3 p = 0.013), they were more likely to require external assistance with finances (54.5% v 88.2% p = 0.026) and less likely to have a Will (63.6% vs 35.2% p = NS) or EPOA (33.3% vs 23.5% p = 0.053) established. There was no significant difference in age, CFS, MMSE, Waterlow or polypharmacy rates between these groups. Discussion This report highlights a divergence between community dwelling older adults referred to ICOP teams and national standard data. Targeted social work interventions should be operationalised to assist financially vulnerable older adults. 1: Marmot M, Geddes I, Bloomer E, Allen J, Goldblatt P. The health impacts of cold homes and fuel poverty. London: Friends of the Earth. 2011. 2: Orr, J, Scarlett S, Donoghue, O, McGarrigle, C. Housing conditions of Ireland’s older population. Implications for physical and mental health, 2016. Available from https://tilda.tcd.ie/publications/reports/pdf/Report_HousingConditions.pdf

Abstract Background Covid-19 impacted older peoples’ confidence and mobility. Restrictions from March 2020 on our cohort of patients (> 65 years) reduced movement and social interactions leading to deconditioning and brain health implications. In our falls assessment service the clinical nurse specialist conducts a multifactorial assessment. We aimed to see if a difference existed in assessments of similar cohorts of patients’ pre and post restrictions. Methods A retrospective review of assessment measures for patients attending the falls service between October – December 2019 and 2021. Measures compared included gender, age, Fear-of-Falling (FOF), Timed Up and Go (TUG), Fracture Risk Assessment tool (FRAX), Vitamin D levels, grip strength and Body Mass Index (BMI). Results Twenty-two patient charts were reviewed from 2019 and 2021. Both years had similar female and male patient data reviewed (14/22 female 2019, 15/22 female 2021). FOF was noted in 38% (8/21) of patients in 2019, versus 45% (10/22) in 2021. In 2021 the average age of our patient cohort had decreased by three years. The TUG average time increased by 2 seconds in 2021 (median time decreased by 2.5 seconds). The major osteoporotic average percentage decreased in 2021 by 1.1%, (median drop 9%), the hip fracture percentage decreased by 2.5% in 2021 (median drop 10.5%). The average vitamin D level decreased by 1mmol in 2021 (median decreased 54mmol), while BMI average increased by 2kg/m² (median increased by 6kg/m²). The average grip strength results in 2021 dropped by 11.5kg (median decreased by 10.5kg). Conclusion Potential trends are observed in this data. We intend to examine a larger timeline/number of patients to be able to validate these findings, particularly FOF.

Abstract Background An important consequence of population ageing has been the increasing number of older adults who live alone. According to TILDA data, older adults with the lowest levels of education tend to experience most social isolation and there is a strong association between living alone and loneliness. We sought to compare the cohort of patients open to the Integrated Care for Older Persons (ICPOP) team in a University Teaching Hospital serving a community area of approx. 300,000 population, to this national dataset. Methods A convenience sample of 174 patients who underwent comprehensive geriatric assessment via domiciliary visit between July 2021-May 2022 by was analysed. Data was anonymised and analysis was performed using SPSS v.27. Results The average age was 81.5 (±8.1) with 63% women in the sample. Eighty-five older adults i.e. 49% of the sample either lived alone or spent more than 21 hours alone per 24-hour period. Compared to those who live with someone, those who lived alone had higher rates of likely depression as determined by Geriatric Depression Score (6.6 vs 4.8 p=0.007). They were also likely to have less educational attainment, as determined by years spent in full time education (11.81 vs 10.42 42 p= 0.0016) and those living alone had overall less central heating in their homes than those not living alone (64/85 vs 81/89 p=0.0109). There were no significant differences in the rates of polypharmacy, falls, dementia and home ownership between groups. There were higher levels of frailty in the group living with someone than those living alone as determined by Clinical Frailty Scale (6.14 vs 5.23 p<0.001). Conclusion A high proportion of patients seen by our ICPOP team live alone and have complex care needs that require an innovative, multidisciplinary approach. Financial vulnerability in this group is likely to compound isolation and loneliness.

Background Colorectal cancer is one of the leading causes of cancer-associated morbidity and mortality worldwide. The local anti-tumour immune response is particularly important for patients with stage II where the tumour-draining lymph nodes have not yet succumbed to tumour spread. The lymph nodes allow for the expansion and release of B cell compartments such as primary follicles and germinal centres. A variation in this anti-tumour immune response may influence the observed clinical heterogeneity in stage II patients. Aim The aim of this study was to explore tumour-draining lymph node histomorphological changes and tumour pathological risk factors including the immunomodulatory microRNA-21 (miR-21) in a small cohort of stage II CRC. Methods A total of 23 stage II colorectal cancer patients were included. Tumour and normal mucosa samples were analysed for miR-21 expression levels and B-cell compartments were quantified from Haematoxylin and Eosin slides of lymph nodes. These measures were compared to clinicopathological risk factors such as perforation, bowel obstruction, T4 stage and high-grade. Results We observed greater Follicle density in patients with a lower tumour T stage and higher germinal centre density in patients with higher pre-operative carcinoembryonic antigen levels. Trends were also detected between tumours with deficiency in mismatch repair proteins, lymphatic invasion and both the density and size of B-cell compartments. Lastly, elevated tumour miR-21 was associated with decreased Follicle and germinal centre size. Conclusion Variation in B-cell compartments of tumour-draining lymph nodes is associated with clinicopathological risk factors in stage II CRC patients.

ABSTRACTBackgroundColorectal cancer is one of the leading causes of cancer-associated morbidity and mortality worldwide. The local anti-tumour immune response is particularly important for patients with stage II where the tumour-draining lymph nodes have not yet succumbed to tumour spread. The lymph nodes allow for the expansion and release of B cell compartments such as primary follicles and germinal centres. A variation in this anti-tumour immune response may influence the observed clinical heterogeneity in stage II patients.AimThe aim of this study was to explore tumour-draining lymph node histomorphological changes and tumour pathological risk factors including the immunomodulatory microRNA-21 (miR-21) in a small cohort of stage II CRC.MethodsA total of 23 stage II colorectal cancer patients were included. Tumour and normal mucosa samples were analysed for miR-21 expression levels and B-cell compartments were quantified from Haematoxylin and Eosin slides of lymph nodes. These measures were compared to clinicopathological risk factors such as perforation, bowel obstruction, T4 stage and high-grade.ResultsWe observed greater follicle density in patients with a lower tumour T stage and higher germinal centre density in patients with higher pre-operative carcinoembryonic antigen levels. Trends were also detected between tumours with deficiency in mismatch repair proteins, lymphatic invasion and both the density and size of B-cell compartments. Lastly, elevated tumour miR-21 was associated with decreased follicle and germinal centre size.ConclusionVariation in B-cell compartments of tumour-draining lymph nodes is associated with clinicopathological risk factors in stage II CRC patients.What does this paper add to the literature?This study demonstrates the variability of tumour draining lymph node morphological features in stage II CRC patients. This provides new scope for biomarker discovery in stage II CRC patients which is a research priority for this patient group.

ANZ Journal of SurgeryVolume 89, Issue 12 p. E570-E571 IMAGES FOR SURGEONS Segmental dilatation following side-to-side isoperistaltic strictureplasty in Crohn's disease: a note of caution Brendan Desmond MB BCh BAO, Brendan Desmond MB BCh BAO orcid.org/0000-0003-2717-5583 Department of General Surgery, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this authorAshok Gunawardene MBChB, BSc, Ashok Gunawardene MBChB, BSc orcid.org/0000-0003-1032-3455 Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand Department of Surgery and Anaesthesia, University of Otago, Wellington, New ZealandSearch for more papers by this authorBen Griffiths MBChB, FRACP, Ben Griffiths MBChB, FRACP Department of Gastroenterology, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this authorJohn Keating MBBS, FRCS, FRACS, John Keating MBBS, FRCS, FRACS Department of General Surgery, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this author Brendan Desmond MB BCh BAO, Brendan Desmond MB BCh BAO orcid.org/0000-0003-2717-5583 Department of General Surgery, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this authorAshok Gunawardene MBChB, BSc, Ashok Gunawardene MBChB, BSc orcid.org/0000-0003-1032-3455 Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand Department of Surgery and Anaesthesia, University of Otago, Wellington, New ZealandSearch for more papers by this authorBen Griffiths MBChB, FRACP, Ben Griffiths MBChB, FRACP Department of Gastroenterology, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this authorJohn Keating MBBS, FRCS, FRACS, John Keating MBBS, FRCS, FRACS Department of General Surgery, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this author First published: 04 March 2019 https://doi.org/10.1111/ans.15001Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume89, Issue12December 2019Pages E570-E571 RelatedInformation

Ms M is a 38 year female who has a history of severe endometriosis. She underwent resection of pelvic endometriosis, parital cystectomy and an anterior resection and loop ileostomy due to a rectosigmoid stricture. Post operative gastrograffi showed a patent anastomosis. The patient presented electively for closure of the ileostomy three months later. Under general anaesthesia, the patient was examined and it was found that the colorectal anastomosis was completely occluded. This article presents a novel procedure using a colonoscope with a cutting snare, Hegar’s dilators and a Controlled Radial Expansion (CRE) balloon to reopen the lumen.

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PURPOSE: Colorectal cancers may be adherent to the urinary bladder. To achieve oncologic clearance of the cancer, en bloc bladder resection should be performed. This study describes the multicenter experiences of en bloc bladder resection for colorectal cancer in the major New Zealand public hospitals. METHODS: A retrospective database of patients undergoing surgery for colorectal cancer adherent to the bladder between 1984 and 1999 was constructed. Data was analyzed for age, gender, disease stage, and outcome (local recurrence and survival). RESULTS: Fifty-three patients were identified: International Union Against Cancer and American Joint Committee on Cancer Stage 1 = 0; Stage 2 = 23; Stage 3 = 22; Stage 4 = 6; unknown = 2. Forty-five had en bloc partial cystectomy performed, four en bloc total cystectomy, and four had the adhesions disrupted and no bladder resection. The most common site of the primary colorectal cancer is sigmoid colon, with local invasion into the dome of the bladder. All patients who did not have en bloc resection developed local recurrence and died from their disease. Mean follow-up was 62 months. The extent of bladder resection did not seem important in determining local recurrence. CONCLUSIONS: En bloc resection of the urinary bladder should be performed if the patient is to be offered an optimal oncologic resection for adherent colorectal cancer. The decision to perform total rather than partial cystectomy should be based on the anatomic location of the tumor. Because the sigmoid is usually the primary site, most patients will not have received preoperative radiation. Therefore, postoperative radiotherapy may reduce local recurrence in these patients.

Reversal of a loop ileostomy is not infrequently associated with wound infection and delayed wound healing. This in turn may lead to a disappointing scar. A simple modification to the technique of stoma construction simplifies wound closure, reduces the rate of wound morbidity, and improves the cosmetic result.

AIM:This study describes the outcome of patients with rectal cancer treated in four New Zealand public hospitals before the advent of specialised colorectal units in order to provide a baseline against which any changes in management can be measured.METHODS:A retrospective review of case notes of patients who underwent resection of rectal cancer with curative intent over a period of 7-10 years up to 1995 in Christchurch, Wellington, Nelson, and Masterton Public Hospital's, was undertaken. Patients were identified from hospital records using a combination of methods (pathology data bases, clinical case mix data, operating logs and audit data). Metastatic disease was considered to be present if confirmed on histology or the clinical course of the patient was consistent with metastatic disease. Patients were excluded if there was perioperative evidence of metastatic disease or if they had transanal excision. Previously published results from Auckland and Dunedin Hospitals are compared.RESULTS:524 patients with rectal cancer were identified who had undergone surgery with curative intent in the four hospitals. The overall permanent stoma rate was 37%. The overall 30-day mortality was 2.9%, five-year survival was 63% and local recurrence at five years was 26%.CONCLUSION:While low perioperative mortality and good long-term survival were achieved, there were high rates of local recurrence. These data are a baseline against which the impact of new approaches to curative resection for rectal cancer can be measured.

Aims. To determine the prevalence of constipation and faecal incontinence in the community.Methods. A 20-question multi-field postal questionnaire was sent to 1500 adults (over 18 years) randomly selected from the electoral roll in the Canterbury region. Questions detailed frequency of bowel function, time spent at the toilet, incidence and severity of faecal incontinence, constipation, and the effect of disordered bowel function.Results. Of 1500 questionnaires, 717 (48%) were returned (male: female 388:329). The median age was 46 years (range 18-70). 24 (4%) had self-reported gastrointestinal disease. There was a median frequency of seven bowel motions per week (BM/wk) (range 1 to 70) with 89% having between two motions a day and one every two days. Faecal incontinence affected lifestyle in 58 (8.1%). Incontinence of solid stool at least once a month occurred in 70 (9.8%), of liquid stool in 91 (12.7%), of gas in 459 (64%), while 12 (2%) regularly wore a pad. Those with self-reported gastrointestinal disease had a significantly higher (p<0.05) bowel motion frequency (17 vs 7 BM/wk) and median faecal incontinence score (2.5 vs 0). Laxatives were used by 4.9% of the population, while 26.2% increased fibre to avoid constipation.Conclusions. The normal frequency of bowel motions (+.- 2SD) was 2-17 per week. Faecal incontinence affecting life style affected 8.1%, while constipation requiring regular laxative use affected 4.9% of people. There is acceptance in the community that a moderate degree of bowel dysfunction is normal. Stool frequency and faecal incontinence scores can be used to predict those most likely to have organic gastrointestinal disease.

ANZ Journal of SurgeryVolume 71, Issue 2 p. 124-126 Low anterior resection and colonic J-pouch in the treatment of adult Hirschsprung’s disease J. P. Keating, J. P. Keating *University Department of Surgery, Wellington School of Medicine, ‡ Department of Pathology, Hutt Hospital, Lower Hutt, Wellington and †University Department of Surgery, Christchurch Hospital, Christchurch, New ZealandSearch for more papers by this author* F. A. Frizelle, F. A. Frizelle *University Department of Surgery, Wellington School of Medicine, ‡ Department of Pathology, Hutt Hospital, Lower Hutt, Wellington and †University Department of Surgery, Christchurch Hospital, Christchurch, New ZealandSearch for more papers by this authorH. D. Brasch, H. D. Brasch *University Department of Surgery, Wellington School of Medicine, ‡ Department of Pathology, Hutt Hospital, Lower Hutt, Wellington and †University Department of Surgery, Christchurch Hospital, Christchurch, New ZealandSearch for more papers by this author J. P. Keating, J. P. Keating *University Department of Surgery, Wellington School of Medicine, ‡ Department of Pathology, Hutt Hospital, Lower Hutt, Wellington and †University Department of Surgery, Christchurch Hospital, Christchurch, New ZealandSearch for more papers by this author* F. A. Frizelle, F. A. Frizelle *University Department of Surgery, Wellington School of Medicine, ‡ Department of Pathology, Hutt Hospital, Lower Hutt, Wellington and †University Department of Surgery, Christchurch Hospital, Christchurch, New ZealandSearch for more papers by this authorH. D. Brasch, H. D. Brasch *University Department of Surgery, Wellington School of Medicine, ‡ Department of Pathology, Hutt Hospital, Lower Hutt, Wellington and †University Department of Surgery, Christchurch Hospital, Christchurch, New ZealandSearch for more papers by this author First published: 20 December 2001 https://doi.org/10.1046/j.1440-1622.2001.02037.xCitations: 2 J. P. Keating, Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand. Email: surgjk@wnmeds.ac.nz Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume71, Issue2February 2001Pages 124-126 RelatedInformation

Colorectal DiseaseVolume 3, Issue 2 p. 138-140 Closure of difficult vaginal fistulas using the gracilis muscle J. P. Keating, J. P. Keating Colorectal Surgeon, Wellington School of Medicine, Mein Street, Newtown, Wellington, New Zealand.Search for more papers by this author J. P. Keating, J. P. Keating Colorectal Surgeon, Wellington School of Medicine, Mein Street, Newtown, Wellington, New Zealand.Search for more papers by this author First published: 07 July 2008 https://doi.org/10.1111/j.1463-1318.2001.00216.x Ghislain DevroedeMD Centre Universitaire de Santé de l’Estrie, Campus Fleurimont, Service de Chirurgie Générale, 3001-12e Avenue Nord, Fleurimont (Québec), Canada, J1H 5N4. E-mail: ltessier@courrier.usherb.ca Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume3, Issue2March 2001Pages 138-140 RelatedInformation