bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.TU.79Assessed and Discharged - An Audit of Discharge Summaries Completion During On-Calls
Authors: Ma Jennifer , Oyewole Bankole , Belgaumkar Ajay
Published: October 2021

Aim

Effective health care provision is heavily dependent on timely, reliable transfer of patient information. Failure of this communication between professionals could result in redundancy of tests, delay in treatment, which may in turn endanger patient safety. The NHS Standard Contract requirements state discharge summaries should be completed within 24 hours of hospital assessment and discharge. Discharge summaries for patients who were reviewed but not admitted have been observed to be poorly completed during on-calls and this audit aims to clarify this.

Method

On-Call Patient Lists between 1 December to 14 December 2020 were studied retrospectively. Patients who were assessed by the on-call surgical team but not admitted were included in the audit. Patients referred to other specialties were excluded. Hospital electronic system was reviewed for electronic records from the encounter including clinical note or discharge summary.

Results

In total, 47 patients were identified during the 2 week- period. 40/47 patients were referred from AE and 9 of these patients were discharged from AE directly. 3 of the patients had a clinical note or discharge summary completed on the hospital electronic system.

Overall, 18 of the 47 (38.3%) patients had a clinical note or discharge summary on the electronic system, with 6 (12.8%) of them being recorded as discharge summaries.

Conclusion

The overall completion of discharge summaries for this group of patients was poor. Awareness of this failing and the importance of professional communication should be highlighted with the juniors during surgical meeting to improve compliance.
EP.TU.156Frailty in the Emergency General Surgical Cohort, could we being doing more?
Authors: Hunter Ross
Published: October 2021

Aims

Frailty, a state of diminished diminished physiological capacity to deal with external stimuli, is being seen ever increasingly in the aging emergency general surgical cohort. Length of hospital stay, morbidity and mortality are shown in the literature to dramatically increase in the frail population. Outcomes in this cohort are shown to improve significantly with specialist frailty input from geriatricians, physiotherapy and occupational therapy teams. The authors aimed to assess the burden of frailty in emergency surgical admissions in a District General Hospital, and the frailty specialist care these patients received.

Methods

A snapshot survey of all acute surgical admissions during a single 24 hour period was performed. Frailty was defined as a Rockwood Clinical Frailty Scale score of 5 or above. The management of these patients was then compared to national standards and recommendations made on how the treatment of the clinically frail could be improved upon.

Results

73% of patients in the sampled cohort (19/26) were found to be clinically frail. Only 2 (10%) of these patients had been reviewed by the frailty specialist teams within the hospital. Following implementation of recommendations, namely an improved referral system, reminders within initial clerking paperwork and raising departmental awareness, specialist input was shown to increase threefold to 32% (10/31) within the same patient group.

Conclusions

A significant cohort of emergency general surgical patients are classified as clinically frail. Optimal care for these patients involves a multidisciplinary approach, the uptake of which can be increased significantly with intra-departmental education and increased awareness.
EP.TU.184A story of a successful hunt for long-lost needles
Authors: Ibrahim Ban , Chowdhury Sabyasachi , Dordea Matei
Published: October 2021

Introduction

There are various case reports of intraluminal foreign body following a clear history of ingestion commonly presenting in paediatrics or in patients with a psychiatric background.

Case presentation

We present a rare cause of unusual foreign bodies evident within the abdomen, radiologically. There was no history of ingestion nor insertion.

70-year-old male has been suffering from chronic abdominal pain, presented to the emergency department with acute lower abdominal pain. He had previous splenectomy with distal pancreatectomy 23 years ago and laparotomy (adhesiolysis) 5 years back. He sought medical opinion on several occasions whereby, based on his intricate surgical history, adhesions were a possible culprit. This admission with acute pain warranted a thorough review of past history and a closer radiological investigation. These showed historical presence of sewing needles for 3 years.

Conclusion

Foreign body can manifest as acute reactions with inflammatory response, however if not removed can cause scarring and chronic pain as seen in this case. Although evident in radiological images over period of pain recurrence, this was not identified as a cause. We emphasize the need for direct communication between surgical and radiological teams in an unusual case scenario like these, to prevent incidence of symptoms from foreign bodies.
EP.TU.260Retained appendiceal tip and abdominal wall appendicolith - a rare combination of post appendicectomy complications
Authors: Dey Abhishek , Symons Nicholas
Published: October 2021

Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately.

An 29 year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis.

On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed.

The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief.

This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.
EP.TU.270Improving Treatment Escalation Plan (TEP) Completion Rate for General Surgical Patients
Authors: Yii Eric Yuen Ing , Bradley Alison
Published: October 2021

Aims

Treatment Escalation Plan (TEP) is essential for recognition of patients’ ceiling for care in the event of clinical deterioration. It should be clearly documented to ensure continuity of care, especially during Covid-19 pandemic. This audit aims to evaluate and improve the TEP filling rate for general surgical patients.

Methods

A prospective data collection was performed for one week in July 2020 in general surgical wards. Data on patients’ gender, age, presence of DNACPR form and date of TEP completion were collected from patients’ clinical notes. Data was analysed using SPSS statistic software. Educational posters were displayed in the ward and presentation was done to emphasise the importance of TEP documentation. Second audit cycle was done in August 2020 to assess for improvement in TEP filling rate.

Results

In the first cycle, 60 patients were included with a mean age of 60. Only 11.7% patients had TEP form filled in with a mean delay of 2.7 days since admission. In the second cycle, 57 patients were included with a mean age of 66. 28.1% patients had TEP form documented with a mean delay of 1.7 days. This has shown a 140% improvement in completion rate of TEP form and 59% reduction in the delay in TEP documentation.

Conclusions

TEP is essential to ensure that patients received optimal care when their condition deteriorate. Simple intervention such as educational posters will help to improve the TEP completion rate. However, continuous auditing is required to ensure improvement in TEP documentation for surgical patients.
EP.TU.356Can day case elective operating lists provide efficient training opportunities for general surgical trainees?
Authors: Coulson Rachael , Gilmore Catherine , Sheridan Catherine , Murray Anna , McCain Scott , McAllister Ian
Published: October 2021

Introduction

During the COVID-19 pandemic there has been a reduction in trainee hands-on learning opportunities due to curtailment of elective workload. Our study aims to assess the impact of non-consultant led operating on theatre list efficiency.

Methods

Prospective data collection over an eight week period of consecutive elective day case hernia lists at a newly established regional centre of excellence for day surgery. Specifically recording of key time points in surgical cases including time ready, knife to skin, last suture and exit theatre. This was achieved using the Theatre Management System (TMS).

Results

46 patients underwent open unilateral elective inguinal hernia repair. 54% (N = 25) of cases were trainee led. Median trainee time was 53 minutes, vs 51 minutes for consultant led procedures; no significant difference (p > 0.05).

Conclusion

Day case elective hernia lists can be efficient training opportunities for general surgical trainees. Our results demonstrate that trainee-led operating in this setting have not resulted in significantly increased surgical time or operative theatre inefficiency. It is widely acknowledged there is benefit to training in performing the same technical skill within a short time frame.
EP.TU.364Intravenous fluid prescribing – common pitfalls and suggestions for improvement
Authors: Makhort Alexei , Ma Jennifer , Ng Stephanie
Published: October 2021

Aim

Intravenous fluids are no doubt most prescribed treatments in surgical practice. It is also an area where junior doctors’ performance is commonly found deficient. There appeared to be a gap in general knowledge of fluid and electrolyte management. Our audit aims to assess the competency of surgical juniors in fluid prescribing as compared to recommendations set out by GIFTASUP 2011. FY1s have also been asked to complete a survey on fluid and electrolyte management.

Method

We included all adult surgical inpatients (28) admitted over one week to our DGH who were started on IV fluids for maintenance only. We retrospectively audited their prescription charts and medical notes. FY1's in the department have been also asked to fill out a short survey testing their knowledge on fluid and electrolyte requirements. Following this, we held a tutorial on fluid management of surgical inpatients for FY1's. We also made fluid management algorithm available in SAU for reference.

Results

Data was tabulated and outcomes compared with CG174 guidance. Cycle 1 showed poor compliance with only about 50% patients being prescribed appropriate intravenous fluid volumes. FY1’s completing the survey scored 54% on average. Often previous fluid prescription was copied. Cycle 2 showed some improvement in appropriate volumes and choice of maintenance fluids prescribed, and better survey score of 64%. There was also improvement on the understanding of daily fluid and electrolyte requirement from the FY1 cohort.

Conclusions

We suggest implementing varied educational approach to improve on fluid prescribing and patient outcomes in hospital.
EP.TU.371The introduction of standardised ward round notes in the Acute Surgical Unit
Authors: Johns Jonathan , Rahman Atiqur , Pearson Katherine , Howse Frances , Berry David
Published: October 2021

Introduction

A standardised approach to note-keeping has been shown to improve patient care and experience.

Aims

This repeated audit cycle assesses the compliance with the introduction of a standardised proforma.

Method

Data collection was prospective. Round 1 (n = 83) after introduction of a ward round proforma, Round 2 (n = 94) following result analysis / education, Round 3 (n = 62) following proforma changes.

Results

(% Compliance with proforma)

Conclusions

Some improvements were seen in Round 2. A notable improvement was observed in EDD and CFD when a tick box option was implemented in Round 3. Successful implementation of a standardised note-keeping requires repeated analysis, education and modification of the proforma.
EP.TU.393Management of Suspicious Neoplastic Rectal Lesions in Octogenarians by a Specialist Early Rectal Cancer MDT
Authors: Altaf Kiran , Gahunia Sukhpreet , Sochorova Dana , Andrews Timothy , Sarkar Sanchoy , Ahmed Shakil
Published: October 2021

Aims

To assess management of early rectal cancers in octogenarians going through a regional Small and Early Rectal Cancer MDT observing oncological outcomes, morbidity, mortality and quality of life after treatment

Methods

Consecutive octogenarian patients treated via the SERC MDT between Dec 2013 and Dec 2019 were examined retrospectively from a prospectively maintained database. Patients underwent transanal endoscopic microsurgery (TEMS), endoscopic submucosal dissection (ESD), contact radiotherapy or hybrid combinations. Patient demographics were recorded and outcomes assessed including pre and post-operative oncological staging, morbidity, mortality, length of stay and FISI scores

Results

85 patients were assessed. 38 had TEMS, 40 had EMR, ESD or hybrid procedures and 7 had contact radiotherapy. Of the 38 patients who underwent TEMS, there was minor morbidity in 5 patients, one cancer recurrence and no cancer related mortality. FISI scores pre- and post-procedure were markedly different with deterioration in control of flatus and mucus, but no faecal incontinence. Of the 40 patients who underwent EMR, ESD or hybrid procedures, 2 had minor morbidity and 3 had adenocarcinomas detected requiring further treatment

Conclusions

Management of octogenarians with early rectal cancer via a specialist MDT provides a safe option with minimal morbidity and no mortality in a subgroup of patients who would otherwise constitute a high risk cohort for surgical intervention. A deterioration in continence in this group highlights the need for careful counselling of patients to achieve the optimal balance between oncological outcomes and quality of life
EP.TU.414Development and introduction of a multi-modal Major Trauma Ward nursing course
Authors: Knight Chris , Smith Stella
Published: October 2021

Introduction

In 2018, the National Major Trauma Nursing Group (NMTNG), published a set of competencies for nurses working on Major Trauma Wards (MTW). They recommended that nurses evidence their knowledge and skills to this framework and that local education packages are created to support this.

Methods

Nurses working on the MTW completed a survey to self-assess their competency and level of knowledge against the NMTNG framework. An intensive, in-house, 2-day pilot course was designed for nurses, incorporating lecture-based teaching, practical skills and simulation. The content was fully mapped against the NMTNG key competencies, and also addressed the survey responses and local policy. Nurses were then asked to repeat the survey following the course.

Results

5 nurses and 2 student nurses attended the pilot course. The majority of attendees (4/7) had been working on the major trauma ward for over 6 months and none had previously completed any nationally accredited major trauma training. Following the course, an improvement in self-assessed knowledge was recorded across all aspects of the competency framework. The highest percentage increase in knowledge was 76% in maxillo-facial trauma and the mean increase across all areas was 48% (range 20-76%).

Conclusion

Attendance at the course significantly increased the nurses self-perceived knowledge and competency in all key areas. Feedback will be used to further develop the course and an associated mentorship scheme, ensuring all nurses working within Major Trauma will have access to ward-based, major trauma specific education.
EP.TU.480Novel virtual near-peer surgical teaching for foundation doctors
Authors: Hughes Andrew , Choi Sarah , Olabisi Oluwafisayo , Torkington Jared
Published: October 2021

Aims

Studies have shown that new medical graduates feel unprepared for their role as clinicians. Courses and teachings have been cancelled due to COVID-19. Our aim was to assess demand for surgical teaching and provide a new surgical course delivered virtually to fill this gap.

Methods

FY1 doctors from a large teaching hospital were invited to fill in a questionnaire to assess their preparedness for surgical specialties and subsequent appetite for near-peer teaching. The findings were used to create a virtual surgical teaching course. A post-course questionnaire was distributed to assess the success of the course.

Results

Fifteen FY1 doctors completed the questionnaire. 73% (11) felt they had not had sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on managing surgical patients in foundation training. None felt ‘very confident’ managing patients peri-operatively. None felt ‘very confident’ managing surgical complications. 66.7% (10) and 53.3% (8) said they had not had any teaching from SHOs or SpRs respectively. Of those who had, 66.7% (4) and 85.7% (6) found it ‘very useful’. 100% (15) said they would be interested in surgical teaching delivered by CSTs. Twelve FY1 doctors completed the post-course feedback. 83% (10) found the course ‘extremely useful’ and relevant to their surgical ward based jobs.

Conclusion

FY1s are not confident in managing surgical patients on the wards. There is a demand for surgical teaching for FY1s. Virtual lunch-time teaching is an effective way to encourage and continue surgical teaching throughout the pandemic.
EP.TU.493Attitudes of Irish General Surgery trainees to Robotic-Assisted Surgery
Authors: Ramjit Sinead , O'Connell Lauren , Donlon Noel , Neary Paul , O'Riordain Diarmuid , Hafeez Adnan
Published: October 2021

Background

While the use of robotic-assisted surgery is now mainstream for procedures such as robotic prostatectomy, its role in general surgery is less well established. Access to training in robotics for general surgery trainees in the Republic of Ireland is variable. Further, there is no data on attitudes of Irish trainees towards the role of robotics. We aimed to establish attitudes of Irish general surgery trainees towards the perceived utility of robotic surgery as well as access and satisfaction with training.

Methods

A survey was disseminated to trainees in the Republic of Ireland enrolled in a General Surgery training scheme via email and social media. Data collected included stage of training, intended subspecialty, interest in developing robotic skills, previous exposure to robotic surgery, satisfaction with current access to robotic training and opinion on formally incorporating training in robotics into the general surgery curriculum.

Results

The response rate was 44.8%. Of these, 83% reported interest in training in robotics and 69% anticipated using the technology regularly in consultant practice. Previous exposure to robotic-assisted surgery was significantly predictive of interest in developing the skillset (p = 0.014). Over 71% of trainees reported that they were not satisfied with access to robotic training. Of those satisfied with access, 40% felt there was a role for incorporating robotic training into the curriculum, compared to 68% of those dissatisfied.

Conclusion

Irish general surgery trainees perceive robotic-assisted surgery to be highly relevant to their future practice. There is an unmet need to provide additional training in the skillset.
EP.TU.4973 year oncological outcomes of robotic-assisted versus laparoscopic rectal cancer resections – a single centre experience
Authors: O'Connell Lauren , Ramjit Sinead , Nugent Tim , Neary Paul , Hafeez Adnan , O'Riordain Diarmuid
Published: October 2021

Background

Robotic-assisted minimally invasive surgery (MIS) for rectal cancer is a relatively new technique. Studies to date suggest that short term outcomes including TME quality, margin status, lymph node retrieval and 30-day morbidity and mortality are equivalent in robotic-assisted and laparoscopic MIS for rectal cancer. By contrast, there is a paucity of data on the medium and long-term oncologic safety of robotic-assisted comparative to laparoscopic surgery for rectal cancer.

Methods

A retrospective review was conducted of all robotic-assisted (n = 31) and laparoscopic (n = 23) rectal cancer cases performed at our institution between January 2016 to December 2018. Inclusion criteria were patients scheduled electively for a laparoscopic or robotic-assisted resection of rectal cancer (anterior resection or abdomino-perineal resection). Patients with distant metastases at presentation, those who proceeded to surgery as an emergency and those with a non-colorectal primary were excluded from analysis.

Results

A total of 54 (n = 54) cases met the inclusion criteria and were included in the final analysis. The median follow-up was 34 months. Of the 54, 21 patients received neoadjuvant chemoradiotherapy prior to definitive surgery.

No significant difference was detected in local recurrence rates (p = 0.5), overall survival (p = 0.7) or disease-free survival (p = 0.8) between the robotic-assisted and laparoscopic cohorts.

Conclusion

In this series, robotic-assisted rectal cancer resections were associated with equivalent medium term oncological outcomes as laparoscopic procedures.

However, given the small numbers in this cohort, outcomes from larger scale datasets will be required to confirm these results.
EP.TU.505Does a foundation interim year one post improve confidence in general surgery in a tertiary centre?
Authors: George Jayan , Mathew Alok , Botsford Edward , Al-Mukhtar Ahmed
Published: October 2021

Aims

1. Understand the confidence levels of current foundation year one (FY1) doctors.

2. Understand whether a foundation interim year one (FiY1) post improves confidence.

Methods

FY1s were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

28.6% (30/105) of FY1s completed the survey.

20% (6/30) did not undertake a FiY1 post but 80% (24/30) did.

Confidence levels were similar between FY1s who had a FiY1 post and those that did not for: dealing with acute general surgical patients, non-specific abdominal pain, appendicitis and prescribing fluids for maintenance as well as resuscitation.

Confidence levels were higher for FY1s who did not have a FiY1 post compared to those that did in managing those with hepatobiliary disease.

Confidence levels were lower for FY1s who did not have a FiY1 post compared to those that did in scrubbing for theatre, speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown.

Conclusions

FY1s who have had a FiY1 post in a tertiary centre have more confidence in most areas but not all. This data shows the value of the FiY1 post however work needs to be done to improve the experience to the role.
EP.TU.517Is a foundation interim year one post better for improving confidence in the care of the dying in general surgery in a tertiary centre or a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Botsford Edward , Ardley Rohan , Al-Mukhtar Ahmed
Published: October 2021

Aims

1. Understand the confidence levels of current foundation year one (FY1) doctors who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH).

2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH.

Methods

FY1s were surveyed throughout August – December 2020. Six questions used Likert scales (1 to 5: not at all confident to very confident) over some common palliative themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

16.7% (4/24) from a DGH and 83.3% (20/24) from a TC had a FiY1 post.

Confidence levels were higher for FY1s who had a FiY1 post in a TC than a DGH in managing pain control, psychological distress, spiritual health.

Confidence levels were higher for FY1s who had a FiY1 post in a DGH than a TC in dealing with social issues, speaking to the family of a patient in the last days of life.

Conclusions

FY1s who had a FiY1 post in a TC had better confidence in three areas as opposed to a DGH in two areas. The experience of the FiY1 should be more standardised to ensure the growth of confidence across all areas identified in the survey.
EP.TU.524Does a foundation interim year one post improve confidence in the care of the dying of general surgical patients in a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Ardley Rohan
Published: October 2021

Aims

1. Understand the confidence levels of current foundation year one (FY1) doctors.

2. Understand whether an interim foundation year one (FiY1) post improves confidence.

Methods

FY1s were surveyed throughout August – December 2020. Six questions used Likert scales (1 to 5: not at all confident to very confident) over some common palliative themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

28.6% (8/28) of FY1s completed the survey.

50% (4/8) did not undertake a FiY1 50% (4/8).

Confidence levels were higher for FY1s who did have a FiY1 post compared to those that did not in managing pain control, psychological distress, spiritual health, social issues, speaking to family and the patient in the last days of life.

Conclusions

FY1s who had a FiY1 post had greater confidence levels than those that did not in a district general hospital. This data suggest the value of the FiY1 post however work needs to be done to improve the experience to the role.
EP.TU.526Is a foundation interim year one post better for improving confidence in general surgery in a tertiary centre or a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Botsford Edward , Ardley Rohan , Al-Mukhtar Ahmed
Published: October 2021

Aims

1. Understand the confidence levels in caring for general surgical patients of current foundation year one (FY1) doctors in who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH).

2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH.

Methods

FY1s doctors were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

20% (6/30) from a DGH and 80% (24/30) from a TC

Confidence levels were higher for FY1s who had a FiY1 post in a TC as opposed to a DGH in dealing with acute general surgical patients, appendicitis and scrubbing in theatre.

Confidence levels were the same in both a TC and DGH for FY1s in managing those with hepatobiliary disease, prescribing fluids for resuscitation and maintenance as well as speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown.

Conclusions

FY1s who had a FiY1 post in a TC had better confidence levels in more areas as opposed to a DGH. The experience of the FiY1 post should be more standardised to ensure the growth of confidence across all areas identified in the survey.
EP.TU.533A rare clinical presentation of Goblet Cell Adenocarcinoma of the appendix: Recommendations for safe & effective management
Authors: Ramsamy Ganeshan , Slack Zoe , Tebala Giovanni
Published: October 2021

Background

Goblet cell carcinoma (GCC) is a rare mixed neoplasm arising from the appendix, consisting of glandular and neuroendocrine tissue. It typically presents in adults with a mean age of 55-65 years old. Diagnosis is usually incidental via histopathological examination after 0.3% to 0.9% of all appendicectomies. Literature remains sparse on classification and prognosis of GCC, and cases documented in younger patients.

Aims

To highlight an interesting clinical presentation and intra- and post-operative management of GCC. To increase awareness for future practice when managing patients with GCC.

Methods

A 37 year-old male presented with left sided abdominal pain, constipation and fresh rectal bleeding. Computed Tomography demonstrated extensive SMV thrombus causing small bowel ischaemia. On the Intensive Care Unit, he underwent thrombolysis through a Transjugular Intrahepatic Porto-Systemic Shunt. A few days later, he developed bowel obstruction, necessitating a small bowel resection secondary to an ischaemic stricture. 9 months later, he presented with clinical signs of appendicitis. After an uneventful appendicectomy, he was diagnosed with GCC upon histopathological examination of the specimen.

Results

The patient made an uneventful post-operative recovery. A multidisciplinary team (MDT) decision was made to perform a completion right hemicolectomy, with histology confirming pT3N1M0 GCC. Adjuvant chemotherapy with 5-Fluorouracil was started.

Conclusion

This case highlights GCC with a preceding clinical course not yet published in the literature. It stresses the importance of the MDT in managing GCC. Although primarily diagnosed histologically, a clinical suspicion of GCC of the appendix is worth considering in pro-thrombotic patients.
EP.TU.560Improving surgical handover by implementing a dynamic handover sheet
Authors: Stienstra Roxane , Wilson Michael , Kynaston James
Published: October 2021

Aim

Safe and effective handover is paramount to ensuring good patient care and patient safety. The aim of this study was to identify key issues with the current handover sheets and implement a new comprehensive sheet aimed to improve quality of handover and reduce safety issues within a busy DGH general surgery department.

Methods

A prospective dynamic study was performed. Retrospective data was obtained by sending out questionnaires to all junior and senior staff. The questionnaire aimed to assess key issues with the original handover sheets and collect qualitative data of perceived safety and efficiency. A dynamic handover sheet was developed using Microsoft Excel and Microsoft Visual Basic. After 2 months of using the new handover sheet, repeat questionnaires were sent out to assess its impact.

Results

There were 26 responses to the pre-intervention and 14 to the post-intervention questionnaire. 14/26 (54%) reported safety issues, mainly patients being missed at weekend ward rounds or missing handovers from elective teams. Post introduction of the comprehensive sheet 6/14 (43%) reported safety issues, mostly related to user error. Subjective list accuracy improved from 59.0% to 65.3% and accuracy for weekend wardrounds improved from 58.4% to 61.3%. Subjective efficiency of the list improved from 52.5% to 71.5%.

Conclusion

The new, dynamic handover sheet has led to an overall improvement in safety and efficiency of handover. An easy to understand instruction sheet has been designed to further improve usability and to ensure a lasting effect to mitigate against the inherent risk of junior doctor change-over.
EP.TU.582Impact of enteral prophylactic antibiotic course on the trends of inflammatory markers following laparoscopic colorectal cancer surgery
Authors: Najdawi Amal , Rao Ahsan , Razzaq Humayun , Dworkin Michael
Published: October 2021

Introduction

The study aimed to assess the effect of oral prophylactic antibiotic (OAB) with mechanical bowel preparation (MBP) on the serial measurement of postoperative inflammatory markers and clinical outcomes of the patients undergoing laparoscopic colorectal cancer resection surgery.

Methods

A retrospective data collection was carried out from January 2019 to March 2020 for the patients undergoing laparoscopic colorectal cancer resection. Daily measurements of inflammatory markers were obtained upto 7 days following surgery. The measurements of inflammatory markers were compared between patients who received a 1 week course of OAB along with MBP to those who only received MBP.

Results

There were a total of 110 patients that were divided into 2 groups: patients who received OAB and MBP (n = 44, 40%) and those who had MBP only (n = 66, 60%). There was no significant difference between the patient characteristics and preoperative staging of the cancer between the 2 groups. The overall length of stay was significantly lower in the patients who received OAB (9.09 days [SD 7.94] vs. 6.63 days [SD 4.96], P 0.02). The patients with OAB and MAP had persistently and significantly low levels of white blood cell count, CRP, and neutrophil count throughout the postoperative period as compared to those who only had MBP.

Conclusion

The study demonstrated reduction in serial measurement of inflammatory markers throughout postoperative stay for the patients receiving preoperative OAB. The use of OAB helps in physiological recovery of the patient by reducing the inflammatory process postoperatively.
EP.TU.590Making the cut – Tailoring an undergraduate surgical teaching programme a QI project
Authors: Koo Hui Fen , Huttman Marc , Boardman Charlotte , Saunders Michael
Published: October 2021

Aims

This project set out to improve the quality of surgical teaching for final year students on a DGH placement. A four-week programme was introduced and regular modification was undertaken through systematic gathering of feedback. The sessions developed were interactive question-based tutorials, suturing, and on-call simulation with common F1 scenarios.

Methods

Material was developed and piloted based on topics the facilitators felt were poorly taught as students. Feedback was gathered by questionnaire after each session comparing the student’s confidence before and after, along with suggestions for improvement. This process was repeated through all six rotations.

Results

A total of 95 questionnaires were completed. Average confidence increased from 52% to 77%. The programme was expanded based on suggestions to include orthopaedic examinations and plastic surgery. The tutor pool was increased to include more foundation doctors to ensure sustainable weekly delivery.

Examples of how suggestions were implemented include:

Conclusions

The success of the teaching programme was evident through positive feedback and good student attendance. By playing to the strength of foundation trainees as recent graduates, the programme complemented content-based teaching from more senior colleagues with sessions targeting practical F1 skills and exam specific needs of students. Early piloting also meant ability to constantly adapt the programme to enhance its benefit to the students.
EP.TU.634Role of Colonoscopy in left colon diverticulitis
Authors: Oweis Rami , Gulnaz Nadia , Jaral Farhan , Oommen Chitakattil
Published: October 2021

Aim

Methods

Result

Conclusions
EP.TU.637To Resect or Not to Resect? Incidental Meckel’s Diverticulum at Colon Cancer Resection
Authors: Mishra Shashwat , Martin Graham , Chowdhury Ashim , Aravind Biju
Published: October 2021

Case

An 85-year-old man underwent elective resection for a large proximal transverse colon tumour. At the time of this open extended right hemicolectomy, a Meckel’s diverticulum was identified in the ileum, but not resected considering the age and character of the diverticulum. However, on the sixth post-operative day, he developed small bowel obstructive symptoms which required a reoperation. It was found that the cause of obstruction was identified as a long pedunculated Meckel’s diverticulum wrapped 15 centimetres proximal to the anastomosis. Considering the general condition of the patient and co-morbidities, resection of the Meckel’s diverticulum and loop ileostomy was performed. The patient has now recovered and is being followed up in the community awaiting stoma reversal.

Background

Occurring in 2% of the population, Meckel’s diverticulum is the most common congenital gastrointestinal malformation. Complications of a Meckel’s diverticulum include obstruction, haemorrhage, perforation, diverticulitis and intussusception. Most complications manifest in childhood and are less likely to occur in adults. The indication for resection of incidental Meckel’s diverticula in an adults is still debated amongst surgeons.

Discussion and Conclusion

This case demonstrates an unfortunate scenario of a post-operative complication from an abnormality detected at the time of the index surgery. A recent systematic review has shown that evidence in literature remains controversial for resection in asymptomatic Meckel’s Diverticulum. There are even scoring systems to facilitate decisions in such situations. This case offers an interesting perspective where morbidity may have been reduced if resection was undertaken.
EP.TU.639Daily Next of Kin Updates in the Intensive Care Unit: A Crucial Message in Effective Communication
Authors: Afify Sarah , Mohamud Halima , Popoola Adebusola
Published: October 2021

Aim

The Society of Critical Care Medicine has stated that next of kin (NOK) should be updated daily to inform and support family members of patients in the ICU.

We aimed to determine whether daily NOK updates of surgical patients were performed routinely by ICU doctors and to explore any associated difficulties.

Method

A retrospective audit of 132 patient records from surgical ICU admissions between September and October 2020 was reviewed to assess frequency of NOK updates. A concurrent survey was circulated amongst ICU doctors to assess the self-reported frequency of NOK updates and perceived challenges.

Results

Daily NOK updates were carried out in 61.2% of cases. On admission, NOK were contacted in only 19.4% of cases and only 4.7% of NOK were contacted on step-down days. Conversations were documented in 65% of contacts.

The survey was completed by 20 ICU doctors, 60% stating they always carried out updates. High workload was a contributory factor for not performing updates. 60% found it challenging to speak to NOK.

Conclusion

Although NOK updates are occurring there is scope for improvement. We assume from our study that the parent surgical teams will inform NOK of patients being admitted to ICU; however, this should be better communicated to ICU staff to ensure that updates for these patients are not being overlooked.

A nominated doctor or nurse is recommended to ensure NOK updates are performed. Juniors should be provided with a forum to discuss and learn from challenging conversations.
EP.TU.642An ANTTiclimax for Antiseptic Non-Touch Technique? A Survey of Junior Doctor Awareness
Authors: Afify Sarah , Shabbir Sehrish
Published: October 2021

Aim

Hospital acquired infections are a significant problem, costing the NHS an estimated £1 billion per year and impact on the health and safety of patients. Antiseptic non-touch technique (ANTT) has repeatedly been demonstrated as a method to reduce this burden but there is often a lack of understanding of this topic. We investigated the extent of junior doctors’ knowledge of ANTT during invasive procedures and the precautions that are taken in practice.

Method

This study utilised information from the World Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare, NICE guidelines on Infection Prevention and Control and local protocols to create a questionnaire assessing the following domains; general knowledge, hand washing, procedural and post-procedure actions. This was distributed to junior doctors in the ICU.

Results

A total of 20 participants were assessed from foundation trainees to registrar level. 55% understood the acronym ANTT, whilst 45% did not.

A staggering 85% of participants were not aware of Trust ANTT key principles. 70% of respondents were not aware of WHO and local guidelines relating to ANTT for invasive procedures. 95% of participants did wash their hands prior to invasive procedures and 90% post-procedure.

95% of participants stated they would benefit from a formal teaching session on ANTT.

Conclusion

These results indicate little comprehension of ANTT with reference to both national and local guidelines. Mandatory online and formal education should be integrated into compulsory induction sessions of new staff Trust-wide.
EP.TU.659Comparison of Gallbladder Tissue Tensile Strength between Thiel Embalmed Cadavers and Living Patients
Authors: Chan Deona Mei Lam , Rossolatos Kostantinos , Brown Stuart , Alijani Afshin , Kulli Christoph
Published: October 2021

Aim

Formalin-embalmed cadavers have traditionally been used as an integral part of anatomy teaching and surgical training. Cadaveric tissue can, however, be compromised by distorted appearance, shrinkage, rigidity and unnatural colouration. The Thiel embalming process produces more ‘life-like’ specimens and it could be postulated that these may be more suitable for surgical training. This study aimed to provide quantifiable and repeatable measurements for the mechanical tissue properties of Thiel embalmed cadavers.

Methods

Four gallbladders were removed from Thiel Embalmed cadavers and eleven from living patients during laparoscopic cholecystectomies. The specimens were prepared into a uniform ‘hour-glass’ shape. The cadaveric specimens were loaded onto the Instron tensometer and the patient specimens were loaded onto a portable hand-held tensometer. The samples were extended until complete tensile failure occurred allowing measurement of the tissues’ tensile strength and strain.

Results

Nine samples were obtained from the four Thiel embalmed gallbladders and 27 samples yielded from the 11 living patients’ gallbladders. The mean ultimate tensile strength of the Thiel samples was 2.16 ± 0.91 MPa compared with 2.24 ± 1.40 MPa in the living patient group (p = 0.85). The Thiel embalmed cadaveric samples had a lower measured mean strain than the living patient gallbladders of (123 ± 33% vs. 233 ± 91%, p < 0.01).

Conclusion

This study demonstrates that, while tissue strength is well preserved, there may be some differences in how the tissues feel, related to differences in elongation during handling in Thiel embalmed gallbladder tissue.
EP.TU.660The rate of interval colorectal cancer within 5 years of a negative colonoscopy at a district general hospital
Authors: Alqallaf Abdullah , Grant Aimee , Lavelle Corina , Chandran Palanichamy
Published: October 2021

Aims

Interval colorectal cancer is defined as cancer that has developed within a short interval of a diagnostic test that did not detect a cancer. Many authors define this interval as five years, though more complex definitions of interval cancer have been proposed. Our aim was to determine what percentage of colorectal cancers diagnosed at our hospital had a negative colonoscopy within the 5 years prior to their diagnosis.

Methods

We obtained details of all colorectal cancers diagnosed between 2017-2019 at our department. We then surveyed the endoscopy system to detect the patients who had a negative colonoscopy within the 5 years prior to their diagnosis, to calculate what percentage of cancers diagnosed within that period were interval cancers.

Results

Between 2017-2019, 539 patients were diagnosed with colorectal cancer. Age at diagnosis varied widely from 21 to 107, and 310 (57.5%) of patients were male. Seventeen patients had a negative colonoscopy within 5 years (though two of these were planned repeat procedures within a few months of the index ‘negative’ colonoscopy). We can therefore calculate the rate of interval cancer at 3.1% between 2017-2019.

Conclusions

The aetiology of interval colorectal cancer has been attributed to patient/tumour factors (right colon and female sex) and technical factors (adenoma detection and caecal intubation rate). Though the rate of interval cancer at our department seems pleasingly low compared to the literature, we plan to investigate the risk factors that might be at play: are biological factors to blame or can our endoscopy service be improved?
EP.TU.672Privacy and security in surgical communication: Is Signal app the future?
Authors: Cheah Hock Ping , Quah Samantha , Wong Kenneth
Published: October 2021

Aims

Electronic communication amongst surgical team members improves the team's ability to care for patients. Security and privacy of patient data are significant concerns. Recent controversy involving private data collection with WhatsApp has led to many users changing to other forms of messaging apps to protect user privacy. The aim of this study is the analyse the efficiency and effectiveness of the Signal messaging app in a research setting in Australia.

Methods

Members of our research group comprising three junior doctors and a supervising consultant surgeon used the Signal app as our main method of communication to discuss matters relating to our various research projects. No patient details were discussed in the messaging app.

Results

A total of 234 personal and 148 group messages were sent during the study period in a group and personal message setting. Most messages including picture files sent were received within one minute by the recipient. We did encounter a 24 hour period where Signal encountered some technical difficulties and some messages did not go through.

Conclusion

Signal messaging app is a good alternative to WhatsApp messaging app with better user privacy protection. With more user uptake on Signal app, it has the potential to be used for clinical care as Signal also provides end-to-end encryption to protect patient privacy.
EP.TU.693A rare case of anal melanoma: An entity to be aware of
Authors: Dhaif Ahmed , Boyle Cameron , Lowe Katherine , Paterson Rosemary , Gumber Ashutosh
Published: October 2021

Aims

Anal melanoma is a rare but aggressive malignancy representing a small percentage anorectal cancers. We report a rare case incidentally detected during bowel screening.

Methods

A 74-year-old female presented for endoscopy after a positive qFIT. She was asymptomatic. During endoscopy, perianal examination revealed a jet black naevus of approximately 3x3cm from 9 to 12’O clock position, overlying the perianal body, involving anal margin to the posterior vagina. General physical, abdominal and rectal examinations were unremarkable.

During colonoscopy, a benign polyp was removed from the sigmoid colon. She underwent examination of rectum and vagina under general anaesthetic, and incisional biopsies were obtained. Histopathology confirmed an invasive, superficial spreading malignant melanoma, with a Breslow thickness of 1.5mm and Clark Level IV invasion. Staging CT scans did not reveal metastasis.

Following loco-regional MDT discussion, a combined colorectal and plastic surgery was offered. She underwent wide local excision from the posterior vaginal fourchette to the anal canal, bilateral perforator flap reconstruction, and defunctioning sigmoid loop colostomy.

Results

There were no intraoperative complications. She recovered well post-operatively. After histopathology, her tumour was staged as pT2b, N0, M0. She did not require further treatment post-operatively as per MDTdiscussion. No disease recurrence has been detected yet with 30 months follow up, and she is awaiting reversal of colostomy.

Conclusions

Prognosis is generally poor in anal melanoma. This case report adds to the limited literature and emphasizs that despite no consensus on management, early detection and surgical resection offers the best chance for favorable outcomes.