bluuebunny/crossref_metadata_2025 huggingface dataset:
P22 Are Elderly Patients at Increased Perioperative Morbidity and Mortality from Oesophagectomy for Oesophageal Cancer? A Systematic Mapping Review and Meta-Analysis
Authors: Gujjuri Rohan R , Elhadi Muhammed , Umar Hamza , Subramanya Manjunath S , Evans Richard P T , Kamarajah Sivesh K , Griffiths Ewen A
Published: April 2021

Introduction

Oesophagectomy is being increasingly performed in an ageing population that is observing a concomitant growth in the life expectancy. However, the risks are poorly quantified, and this study aims to review current evidence to further quantify the postoperative of oesophagectomy in the elderly population compared to younger patients.

Methods

A systematic electronic search was conducted for studies reporting oesophagectomy in the elderly population. Meta-analysis was performed using random-effects modelling to compute odds ratios (OR) and 95% confidence intervals (CI). Primary outcome was overall complications and secondary outcomes included anastomotic leaks, cardiac complications, pulmonary complications, overall and disease-free survival. Meta-regression was performed to identify study-, hospital- and patient-level factors confounding study findings.

Results

This review included 37 eligible studies involving 61,723 patients. Increasing age was significantly associated with increased rates of overall complications (OR: 1.67, CI 95%: 1.42 – 1.97), cardiac complications (OR: 1.62, CI 95%: 1.10 – 2.40), pulmonary complications (OR: 1.44, CI 95%: 1.11 – 1.87) and decreased 5-year overall survival (OR: 1.36, CI 95%: 1.11 – 1.66) and 5-year disease-free survival (OR: 1.66, CI 95%: 1.40 – 1.97). Rates of anastomotic leaks showed no difference between elderly and younger patients (OR: 1.06, CI 95%: 0.71 – 1.59).

Conclusion

Postoperative outcomes such as overall complications, 5-year overall survival and disease-free survival appear to significantly worse in all age cut-offs in this meta-analysis. Sarcopenia and frailty act as better predictors of postoperative outcomes than chronological age. This study confirms the preconceived suspicions of increased risks in elderly patients following oesophagectomy and will aid future pre-operative counselling and informed consent.
P27 Bedside teaching from a distance; surgical education in the COVID era, a randomised control trial
Authors: Feeley A , Carroll A , Hehir D
Published: April 2021

Introduction

The COVID pandemic resulted in a shutdown of facilities and resources globally. With drastic changes in the provision of services available in the health sector, so too were medical students’ provision of learning. With the onslaught of COVID and the need for ongoing learning resources for students, novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required was devised using a virtual platform to compliment current pedagogical approaches.

Methods

This was a randomised control trial to evaluate the perceived use of remote learning in place of surgical bedside teaching in the COVID-19 era. Medical students in a regional hospital were recruited and randomised to undergo the bedside teaching in person or receive the teaching virtually through a Xpert eye, smart glasses to facilitate connections remotely. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits and limitations.

Results

Feedback demonstrated greater engagement, satisfaction, involvement and learning (p < 0.01) in the bedside teaching group. Content analysis yielded three main themes; Interpersonal content, technological features, and provision of content. Students reported the virtual teaching was an acceptable alternative in the current climate of social distancing and reduced patient access.

Conclusion

The current pandemic poses a risk to adequate patient exposure to patient centred learning. Teaching sessions received remotely are an acceptable alternative in the current climate of reduced clinical access, however bedside teaching remains the preferred method of learning.
P30 Can non-allergy health workers safely delabel reported penicillin allergies using an antibiotic allergy assessment tool? - A multicentre study
Authors: Owens Rhys , Sandoe Jonathan , Whyte Andrew , West Robert , Slatter Mandy , Stonell Rebecca , Powell Neil
Published: April 2021

Background

False penicillin allergy labels can be potentially hazardous to patients. Most penicillin allergy labels can be safely removed following risk stratification and formal drug challenge. These de-labelling strategies have been limited to specialist allergy and infectious disease services.

Aims

To determine whether non-allergy specialist health-care workers can use an antibiotic allergy assessment tool (AAAT) to correctly phenotype and manage reported penicillin allergy.

Method

Non-allergy health-care workers in three UK hospital were emailed online questionnaires and asked to assign the allergy phenotype and management recommendation for eight vignettes of real cases reporting a penicillin allergy using the AAAT. In one hospital participants were randomised into two groups: one group was directed to use the AAAT whilst the second group had no decision tool. Participants were assigned an average score for correct allergy phenotype, management and a major error rate.

Results

Use of the AAAT across the eight vignettes significantly improved the average score for assigning correct phenotype (6.7 vs 5.2 p < 0.001), management choice (7.1 vs 5.7 p < 0.001), and major error rate (0.6 vs 1.6 p < 0.001). Participant performance with the AAAT was generalizable across all three hospitals. Despite use of the AAAT 35-40% of participants made at least one major error.

Conclusion

The AAAT significantly improved health worker performance in phenotyping and choosing correct management for reported penicillin. However, even with the AAAT, there remains a risk of potentially hazardous management choices highlighting the need for formal allergy training to expand penicillin allergy assessment services.
P32 Changes in medical education due to COVID-19
Authors: Kabbani Jade , Kabbani Jamil
Published: April 2021

Introduction

The Coronavirus pandemic (COVID-19) has greatly impacted medical education, resulting in changes to teaching, examinations and research opportunities. We explored changes across these areas, evaluating their impact on medical education.

Methods

Pubmed was searched using the terms “medical education”, “COVID-19”, and “changes”, yielding 174 results. Relevant results were assessed to determine perceived impact on medical education, categorised as changes to teaching, examinations, and research opportunities.

Results

Changes to teaching included the introduction of virtual learning, with in-person lectures replaced by recordings or livestreams to facilitate remote teaching. Perceived advantages included increased flexibility, although drawbacks include increased reporting of loneliness. With social-distancing measures limiting the number of individuals allowed in theatre, opportunities for surgical experience have been greatly reduced. Online assessments have largely replaced traditional written examinations, with the introduction of new mediums in order to assess “soft-skills”, as demonstrated by virtual OSCE examinations. However, the efficacy of such mediums has yet to be demonstrated. Despite large volumes of COVID-19-related studies, research as a whole has been negatively affected by restrictions in both funding and research-related hiring, as well as pauses on many clinical trials.

Conclusion

COVID-19 has resulted in significant changes to medical education, including greatly accelerating the incorporation of technology in medical teaching. These novel adaptations may be permanently incorporated into curriculums due to possible benefits in flexibility. However, these changes are not without drawbacks, including reduced opportunities for research and surgical experience.
P35 Co-producing surgical patient information during COVID-19
Authors: Venn Mary L ,   on behalf of CovidSurg Collaborative
Published: April 2021

Introduction

Patients preparing for surgery are understandably fearful due to the threat of COVID-19. With rapid release of surgical research, we wanted to ensure patients can access the right evidence to make informed decisions. We describe an innovative, digital, patient and public involvement (PPI) strategy designed to engage surgical patients with COVID-19 research as it is released, by producing accessible resources.

Methods

We established a Patient Advisory Group (PAG) to co-produce patient information about having surgery during the pandemic, and the risks of perioperative SARS-CoV-2, using information from the CovidSurg international surgical cohort studies.

Results

The PAG were keen for patients to understand the high risks of mortality and serious breathing complications associated with perioperative SARS-CoV-2. They wanted detailed information about what patients can do to stay safe and about the measures hospitals are taking to keep them safe. What patients wanted to know was not always what surgeons presupposed.

We co-produced patient resources with separate versions for dyslexia and learning disabled patients. We published 18 translations within a few weeks and hosted them in purpose-built web pages. We generated PAG-approved lay summaries to share our original research findings with patients.

Conclusion

Patients quickly adapted to engage in digital PPI activities during pandemic lockdown conditions. Collaborative working via teleconferencing and shared screens is a productive, inclusive and convenient way to rapidly develop patient information. Clinicians should invite critique and can expect patient engagement to enhance the content and acceptability of patient resources.
P41 Development of a Montgomery compliant consent discussion aide memoire leading to the establishment of a 'remote consent clinic'
Authors: Priestman Elena , Anderson Joseph , Curtis Alex , Kelly Andrew
Published: April 2021

In response to the Montgomery ruling and increasing costs due to improper consenting, specialties such as spinal surgery have implemented consent clinics performed between the conventional initial consultation and day of surgery. However, as this new process can be cost and labour intensive, providing the clinic remotely has been proposed as a way of streamlining this service.

This review aims to develop a Montgomery-compliant checklist that provides practical considerations on conducting a remote consent clinic, with scope to integrate this initially into orthopaedic practice.

Two literature searches were conducted with the first establishing previous study in remote consent clinics and the second determining the feasibility and financial viability of providing a remote clinic against a face-to-face clinic.

The initial analysis revealed remote consent clinics as a relatively novel area of research. However, both literature searches suggested improvements in both patient recall and understanding in remote consenting, further enhanced by additional resources. Moreover, remote clinics are more efficient and cost-effective while still maintaining high patient satisfaction; outcomes are further improved by delegating this service to alternative staff members. Patients also benefit from the complete erasure of travel times and associated costs. Additionally, in the era of COVID-19, it limits patient exposure allowing hospitals to provide safer services.

Consent clinics, when performed remotely, are a cost-effective and efficient tool to minimise negligence claims while maximising patient satisfaction. In line with the digitisation of healthcare, it also allows for a COVID-appropriate service. Nevertheless, to ease the transition, a practical checklist has been developed.
P44 Direct and Combined Revascularization Versus Indirect Revascularization in the Treatment of Moyamoya Disease: A Systematic Review and Meta-Analysis
Authors: Lee Keng Siang , Zhang John J Y , Teo Mario , Steinberg Gary K
Published: April 2021

Introduction

There is currently no definite consensus regarding the surgical treatment of moyamoya disease (MMD). This study aimed to compare direct and combined versus indirect bypasses with regard to perioperative complications in pediatric and adult patients with MMD.

Methods

Systematic searches of Medline, Embase and Cochrane Central were undertaken. Primary outcome measures analyzed included perioperative complications defined as any major adverse events within 30 days after bypass surgery.

Results

2490 studies were identified. 20 reporting 2982 patients were eventually included in our meta-analysis. Pooled mean age was 37.5 years (95%CI:33.5–41.5) and 7.4 years (95%CI:4.1–10.7) in adult and pediatric patients respectively. For adult patients, perioperative stroke rate was comparable between direct/combined bypass and indirect bypass (OR = 1.26 [95%CI:0.81–1.96], p = 0.300 for indirect bypass). For pediatric patients, perioperative stroke rate was comparable between direct/combined bypass and indirect bypass (OR = 2.43[95%CI:0.74–7.94], p = 0.143 for indirect bypass). No difference was found in perioperative mortality between direct/combined bypass and indirect bypass for adult patients (OR = 1.16[95%CI:0.07–19.00], p = 0.915 for indirect bypass). There was no difference in perioperative mortality between direct/combined bypass and indirect bypass (OR = 1.39 [95%CI:0 –Inf], p = 1.00 for indirect bypass) in pediatric patients. There was no significant difference in perioperative neurological deficit rates between direct/combined bypass and indirect bypass (OR = 1.27[95%CI:0.68–2.39], p = 0.451 for indirect bypass).

Discussions/Conclusions

Our meta-analysis provides statistical evidence suggesting that both direct and indirect bypasses can be equally effective in preventing stroke, with similar rates of perioperative complications in pediatric and adult patients.
P48 Exploration of variation in Management of Acutely Symptomatic Hernia – results from the MASH practice survey
Authors: Spence O , Proctor V , Sayers A , Green S , Burns F , Smart N , Lee M
Published: April 2021

Introduction

There is minimal evidence to guide the emergency management of groin and abdominal wall hernia. The aim of this project is to understand current variations in clinical practice across the UK when managing common types of acutely symptomatic hernia.

Methods

A survey of clinical practice was developed to explore the management of acutely symptomatic abdominal wall hernia (ASH) including groin (GH), umbilical (UH), and incisional hernia (IH). The survey captured respondent characteristics. It explored preferences in the management of each type of ASH, including factors related to treatment and repair strategy. Surgeons at ST3+ level with a UK practice were invited to participate through Twitter and collaborative networks.

Results

In total, 144 responses were received (response rate 26%). Of these, 62 (43.1%) were Consultant Surgeons, 105 (72.9%) did not have a specialist hernia practice, and 95 (66%) did not follow specific guidelines for emergency hernia repair. There was variation in investigations used e.g. CT required for IH (91%) but less for GH (34.7%) and UH (47.2%). Open repair was preferred in all settings. For GH with ischaemic bowel 76 (52.8%) would suture repair vs. 67 (46.5%) who would use a mesh (64.2% permanent synthetic) this is similar for IH, where 59 (41%) chose suture vs. 71 (49.3%) mesh, although 61.9% favoured biologic mesh for IH. Suture repair was preferred for UH with ischaemic bowel (69.4%).

Conclusion

The survey demonstrates variation in treatment of ASH. Areas which require further exploration include use of mesh and laparoscopy in the emergency setting.
P65 Improving the experiance of teaching for foundation doctors in a busy general surgery department
Authors: Condie N , Quinn M A , Arvind N
Published: April 2021

Introduction

In the national training survey undertaken by the GMC in 2019 the general surgery teaching programme at North Bristol Trust scored 35.24 for local teaching; significantly lower than the national average. We aimed to introduce a teaching programme for foundation doctors on their general surgery rotations to help them meet the objectives set out by The UK Foundation Programme curriculum and gain further insight into general surgery and the roles of allied healthcare professionals.

Methods

A survey consisting of Likert scale and open ended questions was distributed to foundation doctors at the start and end of their foundation programme placements from August to December 2019. During this period a general surgery teaching programme was introduced consisting of once weekly sessions led by allied healthcare professionals and once weekly consultant led sessions.

Results

The number of foundation doctors agreeing with the statement ‘I think the General Surgical Unit is a good training and learning environment for foundation doctors rose by 33% (59% to 92%). There was an increase of 59% (24% to 83%) in the number of foundation doctors who felt they had good educational opportunities during their general surgical attachment.

Conclusion

The implementation of a general surgery teaching programme involving specific consultant-led sessions and sessions led by allied healthcare professionals (bariatric specialists, amputation counsellors, palliative care specialists) is invaluable to foundation doctors. It retains the interest of surgically and non-surgically inclined foundation doctors and is an essential element of a general surgical placement in a teaching hospital.
P66 In what way does skin of colour representation in undergraduate dermatology education influence medical students’ clinical experiences?: A national, collaborative, mixed-methods study
Authors: Gandhi Suraj , Duncan Lois , Maseland Tashi , Walker Nicola , Bandyopadhyay Soham
Published: April 2021

Introduction

The pandemic has highlighted health inequalities in the UK, with Black and Asian ethnic groups experiencing higher mortality than White ethnic groups. Alongside this, a wider recognition of societal inequalities has lead to a drive for increased racial representation in medical school curricula. This is especially relevant to dermatology, where skin colour has clear effects on the presentation of important conditions. It has been hypothesised that delayed diagnosis and consequent worse outcomes may result from physicians’ unfamiliarity with the appearance of dermatologic presentations on skin-of-colour (SoC). We propose a national, cross-sectional, mixed-methods study using student collaboration aiming to understand how SoC representation in undergraduate dermatology teaching influences medical students’ clinical experiences.

Methods

The study will involve three phases, delivered in part by student collaborator at each institution: first, a national online survey of final year students from 34 UK medical schools to investigate their recollections of SoC representation in their dermatology teaching. Second, a survey of faculty members at each medical school to investigate how SoC representation is incorporated into the broader design of their institution's dermatology teaching. Finally, a series of online focus groups to explore students’ ideas about the influence of SoC representation in dermatology education on their clinical experiences with patients of varied skin tones.

Proposed Impact

Our findings may help inform the timely and effective provision of diverse SoC representation in undergraduate medical education and, more broadly, demonstrate the usefulness of collaboratively-acquired, student-generated data in guiding the future development of medical school curricula.
P72 Knowledge and application of the guidelines on intravenous fluid therapy in adult post op surgical patients amongst junior doctors in maidstone and tunrnbridge wells (mth) nhs trust
Authors: Onyekachi Ekowo , Cynk Mark
Published: April 2021

Introduction

Foundation Year doctors and Senior House officers are commonly made responsible for fluid prescriptions. Errors could lead to significant poor outcome for the patient.

Methodology

A total of 36 FY1s and SHOs were asked 8 questions to check their knowledge of the guideline for intravenous fluid therapy in adult surgical patients (GIFTASUP). Following this, a retrospective analysis of fluid prescriptions received by 37 patients who had elective colorectal surgeries was analysed over a 3-month period to see if the fluids received met the GIFTASUP guideline and see how this affected the outcome of the patients.

Results

33(92%) of doctors studied are not aware of any guidelines for fluid prescription post operatively. 38(22%) of prescriptions made exceeded 2500mls in 24 hours. Ileus was significant amongst those patients who received fluid volumes more than 2500 mls in 24 hours (p = 0.045). Also, all 4 patients who had pneumonia received fluid volumes exceeding 2500mls in the days preceding the pneumonia. In addition, the length of hospital stay was 15 days and 9 days in those with fluids volumes greater than 2500mls and less than 2500mls in 24 hours, respectively.

Conclusion

Majority of the Foundation year doctors in MTH are not aware of post-operative fluid guidelines which resulted in errors in the prescriptions made. This is associated with pneumonia, ileus and prolonged length of hospital stay.
P73 LEARN: uroLogical tEAching in bRitish medical schools Nationally - a national retrospective multi-centre audit of urology teaching across British medical schools
Authors: Ng A , Cambridge W A , Jayaraajan K , Lam C M , Light A , Asif A , Chan V W S , Matthews M G , Clement K , Kulkarni M , Bhatt N R , Khadhouri S , Kasivisvanathan V
Published: April 2021

Introduction

Urological conditions account for approximately 25% of acute surgical referrals and 10-15% of general practitioner appointments. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology that must be covered during undergraduate medical training. However, its uptake nationally remains unknown. This project aims to assess undergraduate urology teaching across UK medical schools.

Methods

A targeted advertising drive using social media, medical school societies, websites and newsletters was performed over 4 weeks. Collaborators are responsible for recruiting survey respondents (year 2 medical students to foundation year 1 (FY1) doctors). Survey respondents will complete a REDCap survey retrospectively assessing their urology teaching to date. The primary objective is to compare current urology teaching in medical schools across the United Kingdom with the BAUS undergraduate syllabus.

Results

Currently, 522 collaborators have registered from 36 medical schools nationally. Of these collaborators, 6.32% (33/522) are FY1s and 93.68% (489/522) are medical students. Each collaborator will be responsible for recruiting at least 15 survey respondents to be eligible for PubMed-indexed collaborator authorship.

Conclusion

LEARN has recruited successfully to date, with all collaborators from the medical student and FY1 cohort. With the role of collaborators to further recruit survey respondents, LEARN will provide the most representative and thorough evaluation of UK undergraduate urological teaching to date. It will provide evidence to support changes in the medical school curriculum, and allow re-evaluation of the current national undergraduate BAUS syllabus.
P78 MedEd Collaborative: a new research collaborative to promote medical education research
Authors:   MedEd Collaborative (Writing Group):, Byrne Matthew H V , Ashcroft James , Alexander Laith , Wan Jonathan C M , Harvey Anna , Schindler Nick , Brown Megan E L , Burford Bryan , Vance Gill
Published: April 2021

Introduction

In response to the disruption to medical education caused by COVID-19, there is a need for wide-scale robust medical education research and the generation of research capacity for the future. Trainee research collaboratives have demonstrated they can nurture the research skills of students and trainees while delivering high quality research outputs. However, we have been unable to identify a permanent medical education research collaborative for trainees and students.

Methods

We started the MedEd Collaborative in September 2020 to fill this gap, consisting of a trainee- and student-led medical education research collaborative supported by senior medical education experts and clinicians.

Results

Our vision is to increase engagement of students and trainees in high-quality medical education research that informs practice. The MedEd Collaborative will engage students and trainees in medical education research by completing at least one national multicentre study per year, the first being the COVID Ready 2 study. This is a national cross-sectional survey of the educational impact of medical student volunteering during the COVID-19 pandemic.

Conclusions

We anticipate the MedEd collaborative will: increase exposure to medical education research, thereby increasing the number of medical students and trainees aiming to pursue an academic medical education career; provide training in medical education research methodologies, such as qualitative analysis; improve the quality of medical education research outputs from students and trainees; encourage collaboration between medical schools and deaneries; and provide support to other trainee research collaboratives that aim to explore education research in their own specialties.
P79 Medical students’ mood adversely affected by COVID-19 pandemic: An interim analysis from the SPICE-19 prospective cohort study of 2075 medical students and interim foundation doctors
Authors: Bandyopadhyay Soham , Georgiou Ioannis , Baykeens Bibire , Gillespie Conor S , de Andres Crespo Marta , Bashir Mohammad Talha , Handa Ashok , Saunders Kate E A
Published: April 2021

Background

Currently, we can only speculate on what the effects of the COVID-19 pandemic have been on medical students and interim foundation year doctors. In order to support them appropriately both now and, in the future, it is imperative that we understand the impact it has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought.

Methods

A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate. The data analysis was carried out as detailed a priori in the protocol.

Findings

A total of 2075 individuals participated in the SPICE-19 survey from 33 medical schools. There was a significant (p < 0.0001) decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic. Social distancing and more time at home/with family were the factors that negatively and positively respectively impacted the mood of the greatest number of participants. All areas of life included in the survey were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university. Participants were mainly seeking support with exam preparation, course material, and financial guidance.

Discussion

Medical and foundation schools need to prepare adequate and effective support. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce. When medical students return to their universities, there is likely to be need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance.
P81 Mental Health Presentations to a UK Tertiary Children’s Emergency Department during the Covid-19 Pandemic in 2020 compared to 2019
Authors: Groome Rachel , Jain Neha , Henderson Sally , Green Michelle , Hand Catriona , Cuellar Bianca
Published: April 2021

Introduction

Observational study exploring the differences between the number and severity of mental health presentations to a Children’s Emergency Department over a 2-month period during the Covid-19 Pandemic (2020) compared to the same months in 2019. Additionally, exploration of the possible impact of the introduction of a hotline giving clinicians access to 24/7 Children’s and Adolescent Mental Health Services (CAMHS) advice.

Methods

Identification of mental health presentations in children ≤ 16 years from coded admission data. Data collected included basic demographics, presenting complaint, final diagnosis, mental health Risk Assessment Matrix (RAM) outcome and timings of review, referral and discharge.

Results

141 cases were examined (2019 - n = 79, 2020 - n = 62). During the Covid-19 pandemic 18.9% (n = 10) scored high on the RAM and 64.2% (n = 34) scored moderate whilst in 2019, 17.2% (n = 11) scored high on the RAM and 69.4% (n = 38) scored moderate. 2019 data saw 25.3% (n = 20) discharged directly compared to 37.1% (n = 23) in 2020.

In 2020, 26 (42.6%) of CAMHS reviews were via telephone compared to nine (12.3%) in 2019. Overnight (20:00-08:00), in 2019, there were 37 (46.8%) presentations, 86.5% (n = 32) of which required admission and in 2020 there were 36 (58.1%) where 75.0% (n = 27) required admission.

Conclusion

A higher number of presentations was not seen in the CED despite the potentially adverse psychological effects caused by enforced isolation due to Covid-19. The provision of a 24/7 hotline may have contributed to clinician’s decision to discharge, aiding a higher number of out of hours discharges.
P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study
Authors: Gwilym B , Waldron C , Thomas-Jones E , Pallmann P , Preece R , Brookes-Howell L , Milosevic S , Edwards A , Twine C , Massey I , Burton J , Harris D , Samuel K , Dilaver N , Day S ,   The Vascular and Endovascular Research Network (VERN), Bosanquet D
Published: April 2021

Introduction

Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools?

Methods

A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media.

Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools.

Results

PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients.

Discussion

This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.
P93 Pre-operative assessment and management of open tibia fractures at a Major Trauma Centre (MTC): a review of cases over a one-year period
Authors: Khajuria Apoorva , Saeed Abu , Ward Jane
Published: April 2021

Introduction

Despite perianal abscess being a common presentation, certain aspects of its management remain controversial, especially the routine use of intra-operative swab cultures.

Methods

A retrospective review of patients that underwent incision and drainage procedures for a perianal abscess over a six-month period was undertaken.

Results

Over 6 months, 50 patients were identified. The male to female ratio was 3:1 and median ASA score was 1. Only 6/50 patients presented with recurrent abscess and 1 patient had history of inflammatory bowel disease. On the basis of operative findings, 39 patients (78%) had uncomplicated abscess (not associated with cellulitis, sinus or fistula); swab cultures were performed in 26 (67%) of these patients. All patients were discharged on the same day; microbiology reports did not impact the treatment and no patients were followed up in clinic post-operatively or presented with recurrence. The number of unnecessary microbiology swabs undertaken in this cohort equates to approximately 52 unnecessary swabs a year. The cost of one swab is £10.10p, which means £520 could potentially be saved annually.

Conclusion

Routine intra-operative swab cultures do not impact management decisions, add to unnecessary costs and therefore should not be undertaken in uncomplicated or first presentation of peri-anal abscesses.
P96 Project Consent: Introducing EIDO leaflets to improve patient experience
Authors: Lythgoe M P , Condie Natalie
Published: April 2021

Introduction

With increased litigation and media attention around the consent process it is vital we ensure patients understand what their operation entails prior to surgery. North Bristol Trust has recently started using EIDO consent leaflets; currently used in 50% of NHS hospitals . Our aim was to calculate how many patients received EIDO healthcare consent leaflets and whether this affected their experience of the consent process.

Method

Questionnaires made up of Likert scale and open ended questions were distributed to patients undergoing Upper GI surgery on the day of their operation. The questionnaire explored whether patients received an EIDO leaflet pre-operatively, their understanding of the risks and benefits and their satisfaction with the consent process. The Wilcoxon signed-rank test was used to compare responses from the included patients.

Results

12 patients received EIDO leaflets during their pre-operative consultation, six did not. Compared with those that did not, patients who received a leaflet had a better understanding of the risks (p = 0.002), benefits (p = 0.008) and details of the operation (p = 0.005) and were happier with the consent process (p = 0.02).

Conclusion

Including EIDO leaflets in the consent process helps ensure patients making an informed decision and improves the smooth running of theatre lists. We are currently introducing EIDO consent leaflets throughout general surgery for emergency operations and when sending out dates of elective operations. We aim to review the use of these leaflets as the consent process becomes increasingly difficult due to COVID 19 and the lack of face to face interaction.
P106 Robotic Roux-en-Y gastric bypass: A systematic review to examine reporting of a surgical innovation
Authors: Robertson H , Huttman M , Dixon L , Macefield R , Hossaini S , Scroggie D ,   on behalf of the RoboSurg collaboration
Published: April 2021

Introduction

Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric procedures, and robotic methods are increasingly used. Perceived benefits of robotic surgery include improved visualisation and ergonomics, fewer complications, and shorter hospital stay. Rigorous processes that facilitate the safe transition of surgical innovations such as robotic RYGB into clinical practice are currently lacking. This may place patients at risk, and lead to research waste. The IDEAL Collaboration has produced guidance on the reporting of surgical innovations, but it is not known how robotic RYGB has been reported. This project aims to summarise technique description, governance arrangements and outcome reporting in robotic RYGB.

Methods

A systematic review is being conducted, using PRISMA guidance. A search of Embase, Ovid Medline, the Cochrane Library and Web of Science was performed to identify primary studies reporting outcomes of robotic RYGB. Data will be extracted on study characteristics, governance and ethical arrangements, descriptions of technique, and outcomes. The data will be evaluated in relation to IDEAL principles.

Results

The literature search yielded 1012 studies; 754 remained after de-duplication. Following screening by abstract, 229 full texts were screened. 67 studies will undergo extraction of data. A descriptive summary of the data will be presented, with a critique of the findings.

Conclusion

This study will summarise and appraise how robotic RYGB has been reported. This will contribute towards the development of a standardised and methodical process for the introduction of surgical innovation into clinical practice.
P111 SMILE: Sustaining Medical Education In a Lockdown Environment. Student perceptions of a free online access medical education platform as an adjunct to the traditional undergraduate curriculum during lockdown
Authors: Pascoe John , Foster Paul , Quddus Muntasha , Kosti Angeliki , Guest Francesca , Stevens Sian , Bamford Richard , Coulston James
Published: April 2021

Introduction

The coronavirus outbreak has had significant impact on medical students worldwide. SMILE is a free online access medical education (FOAMed) platform. SMILE delivered 200 lectures during lockdown with up to 1400 students per session from both UK medical schools and 33 abroad. Here we discuss student perceptions to SMILE during lockdown

Method

An electronic survey was used to collect information from students who had utilised the platform during lockdown. This examined access to learning, impact on their mental health during lockdown and the differences between FOAMed and more traditional based campus lecture based learning.

Results

1306 students responded to the anonymous survey with 94% of students stating SMILE had been “extremely useful” or “very useful” at supplementing learning during covid.

71% of students stated lockdown had affected their stress levels and 44% reported deterioration in their mental health. >80% felt SMILE improved stress levels by adding structure and providing motivation.

Students attended 4.3hours/week of university teaching, vs 7.9hours/week by SMILE. Positives included: anonymity, making 80% more likely to both ask and answer questions, the informal approach, ease of access and enthusiastic teachers. Negatives included time differences and technical issues such as poor Internet.

98% stated they would be interested in future SMILE projects post lockdown

Conclusions

SMILE addressed challenges identified during an unanticipated transition towards the online provision of medical education on an international scale.

Students found SMILE lectures effective, accessible and safe, supporting FOAMed as part of the “new normal” post lockdown
P113 Starting a research collaborative in the midst of a pandemic – the Humberside experience
Authors: Totty J , Hitchman L , Wilkins A , Loubani M ,   on behalf of the CASSH Research Collaborative
Published: April 2021

Introduction

The COVID-19 pandemic severely impacted research activities. Large international research collaboratives have successfully produced high quality COVID-related research. We aimed to investigate factors that influence trainee engagement in collaborative research and quantify engagement in our local area to propose methods to ensure all trainees have the opportunity to take part in impactful research.

Methods

This is a mixed methods study consisting of a survey to trainees regarding their experiences in research and an assessment of engagement in COVID-related research. The survey was circulated to undergraduates and trainees of all grades in February 2020.

Results

Engagement with the survey was poor, with a < 10% return rate. 43% of respondents stated that they had no experience of research. Engagement with collaborative research was popular, with responders declaring involvement with at least 7 other collaboratives. Reasons for participating in research were improving patient care (23%), producing high quality research (19%) and CV building (19%). Barriers included perceived lack of time (23%) and lack of knowledge about research (23%).

The CASSH collaborative co-ordinated the local response to COVIDSurg, COVIDSurg|Cancer and the COVER study, involving 20 trainees contributing data on 368 patients.

Conclusions

All research collaboratives rely on the enthusiasm of participants in order to succeed. We have presented some of the motivators and barriers to participation in our region and outlined how we have built on national projects to improve engagement on a local level. Further projects are planned to capitalise on this improved engagement.
P126 The FLIP study – Fluid resuscitation In Pancreatitis
Authors: Moir John , Tingle Sam , Hawthornthwaite Emma , Robinson Stuart , French Jeremy ,   NOSTRA
Published: April 2021

Introduction

Acute pancreatitis is a common condition encountered in emergency general surgical presentations. The severity of this condition can range from mild, whereby symptoms settle with simple conservative measures, to severe and potentially life threatening in up to 20% of cases. Intravenous fluids are the cornerstone of management in these patients, however there is very little guidance and poor quality evidence within the research literature regarding optimal intravenous fluid administration. The aim of this study is to establish current clinical practice within the North East of England regarding the rate of intravenous fluid administration in acute pancreatitis and the effect this has on patient morbidity and mortality.

Methods

This project is a prospective multi-centre snapshot audit of patients presenting with acute pancreatitis over a one month period, with 30 days follow up. Inclusion criteria are patients aged 18 or above with acute pancreatitis. Data will be collected on intravenous fluid administration in the first 72 hrs following admission in addition to demographics and severity scoring. The primary outcome measure will be admission to HDU/ITU with key secondary end-points including 30-day mortality, length of stay, radiological evidence of pancreatic necrosis and evidence of organ failure.

Results

The results of this study will be prepared in accordance with guidelines set by the STROBE: (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Data will be collected and analysed with appropriate statistical tests using SPSS. Statistical significance will be defined as a p value of ≤ 0.05

Conclusion

Data collection will be completed in early 2021 with analysis and write up planned for early in the new year. Pending the results of phase one, an RCT will be designed to determine the optimal rate of intravenous fluids for improved patient outcome.
P128 The implications of SARS-CoV-2 on a Cardiothoracic unit
Authors: Luckwell Rhys
Published: April 2021

Introduction

The effort to prevent healthcare systems becoming overrun during the 2020 COVID-19 pandemic has come at the cost of delaying operations and with that bringing difficult risk analysis to help decide which operations should go ahead. With COVID-19 being a novel disease there is limited evidence for guidance on this issue. We have previously presented work highlighting the high risk of mortality associated with a perioperative cardiothoracic patient becoming COVID-19 positive and thus decided to implement a series of changes to departmental perioperative practice. This work presents these interventions and compares the infection and the mortality rate with those before the intervention was put in place.

Method

Two retrospective loops were performed. Pre intervention, 5/3/20 – 20/4/20, and post intervention, 21/4/20- 23/6/20. Inclusion criteria: patients who had received cardiothoracic surgery at University Hospital of Wales within 4 weeks of the positive COVID-19 PCR (1st loop n = 53, 2nd loop n = 40). Exclusion criteria included re-admissions from greater than 4 weeks (n = 2). Interventions included 14 day pre op isolation, a strict multifaceted screening regime, reverse barrier nursing and delaying operations if diagnostic uncertainty.

Results

9/51 patients from the pre intervention loop and 2/40 from post intervention loop tested +ve for COVID-19. The pre intervention mortality was 5/9 and post intervention mortality was 0/2.

Conclusion

Our data suggest that simple changes to perioperative practice can decrease the transmission of COVID-19 during this period. Thus, allowing surgical services to run at a reduced risk
O2 Facilitating engagement in surgical research through a virtual systematic review network: The RoboSurg Collaborative
Authors: Jones Conor S , Dada Mo , Dewhurst Max , Dewi Ffion , Pathak Samir , Main Barry G , Blencowe Natalie S ,   on behalf of the RoboSurg Collaborative
Published: April 2021

Introduction

For students and trainees, COVID-19 has restricted opportunities for training and development. We sought to develop a virtual network to facilitate remote engagement and training in surgical research during COVID-19.

RoboSurg aims to conduct a series of systematic reviews, to summarise and critique the reporting of studies of robot-assisted surgery across seven upper gastrointestinal procedures.

Methods

A protocol was developed based on previously published work. Searches were undertaken to identify studies evaluating robotic pancreas, liver, oesophagus, stomach, gallbladder, bariatric and anti-reflux surgery. Participants were identified through social media and collaborative research networks. Abstracts were screened for inclusion by two participants. Data extraction is completed by teams of collaborators, entered into a bespoke REDCap database and verified by senior team member. Changes are logged, with rationale and feedback provided to collaborators and reviewed by a third reviewer to assess consistency. Results of each review will be summarised in narrative syntheses.

Results

A total of 134 collaborators have registered, with 73 active participants. Collaborators range from second year medical students to surgical registrars across the UK. To date, 9444 abstracts and 1653 full texts have been screened with 422 eligible articles identified. Data extraction for two systematic reviews, including 193 articles, has been completed using this approach.

Conclusion

RoboSurg has developed a network and methodological framework for the remote conduction of complex systematic reviews, which can be utilised to engage and train students and trainees in surgical research.