bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data
Authors: Nghiem Son , Afoakwah Clifford , Scuffham Paul , Byrnes Joshua
Published: May 2021

Background

Despite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD).

Methods

We conducted a retrospective record-linkage cohort study of patients with diverse CVD in Queensland, Australia. We investigated the relationship between the risk of frailty, defined using the hospital frailty risk score (HFRS), and 30-day mortality, 30-day unplanned readmission, non-home discharge, length of hospital stay (LOS) at an emergency department and inpatient units and costs of hospitalisation. Descriptive analysis, bivariate logistic regression and generalised linear models were used to estimate the association between HFRS and CVD outcomes. Smear adjustment was applied to hospital costs and the LOS for each frailty risk groups.

Results

The proportion of low, medium and high risk of frailty was 24.6%, 34.5% and 40.9%, respectively. The odds of frail patients dying or being readmitted within 30 days of discharge was 1.73 and 1.18, respectively. Frail patients also faced higher odds of LOS, and non-home discharge at 3.1 and 2.25, respectively. Frail patients incurred higher hospital costs (by 42.7–55.3%) and stayed in the hospital longer (by 49%).

Conclusion

Using the HFRS on a large CVD cohort, this study confirms that frailty was associated with worse health outcomes and higher healthcare costs. Administrative data should be more accessible to research such that the HFRS can be applied to healthcare planning and patient care.
Prevalence, incidence and mortality of delirium in patients with COVID-19: a systematic review and meta-analysis
Authors: Shao Shih-Chieh , Lai Chien-Cheng , Chen Yi-Hung , Chen Yung-Chang , Hung Ming-Jui , Liao Shu-Chen
Published: May 2021

Background

Attention should be paid to delirium in coronavirus disease 2019 (COVID-19) patients, especially older people, since advanced age poses increased risk of both delirium and COVID-19-related death.

Objective

This study aims to summarise the evidence on prevalence, incidence and mortality of delirium in COVID-19 patients.

Methods

We conducted a comprehensive literature search on Pubmed and Embase from inception to 1 December 2020. Three independent reviewers evaluated study eligibility and data extraction, and assessed study quality. Outcomes were analysed as proportions with 95% confidence interval (CI). We also compared mortality differences in COVID-19 patients using odds ratio.

Results

In total, we identified 48 studies with 11,553 COVID-19 patients from 13 countries. Pooled prevalence, incidence and mortality rates for delirium in COVID-19 patients were 24.3% (95% CI: 19.4–29.6%), 32.4% (95% CI: 20.8–45.2%) and 44.5% (95% CI: 36.1–53.0%), respectively. For patients aged over 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 28.2% (95% CI: 23.5–33.1%), 25.2% (95% CI: 16.0–35.6%) and 48.4% (95% CI: 40.6–56.1%), respectively. For patients under 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 15.7% (95% CI: 9.2–23.6%), 71.4% (95% CI: 58.5–82.7%) and 21.2% (95% CI: 15.4–27.6%), respectively. Overall, COVID-19 patients with delirium suffered higher risk of mortality, compared with those without delirium (OR: 3.2, 95% CI: 2.1–4.8).

Conclusion

Delirium developed in almost 1 out of 3 COVID-19 patients, and was associated with 3-fold overall mortality. Our findings suggest that first-line healthcare providers should systematically assess delirium and monitor related symptoms among COVID-19 patients.
Detection of 4 quinolone antibiotics by chemiluminescence based on a novel Nor-Biotin bifunctional ligand and SA-ALP technology
Authors: Han Zhenyu , Sun Tieqiang , Xu Zehua , Fan Longxing , Yun Hanxuan , Ge Xuejiao , Liu Xiao , Liu Ying , Ning Bao'an
Published: May 2021

A simple and effective direct competitive chemiluminescence immunoassay for the detection of 4 kinds of quinolone antibiotics in milk was established using Nor-Biotin (biotin-modified norfloxacin [NOR]) bifunctional ligand and alkaline phosphatase–conjugated streptavidin signal amplification technology. The polyclonal antibody was obtained after the immunization of New Zealand White rabbits using norfloxacin-derived antigen. “Click chemistry” was used for the rapid and facile synthesis of the Nor-Biotin bifunctional ligand. After the optimization of the incubation time and reaction buffer, the direct competitive chemiluminescence assay method was developed and used for sensitive detection of 4 kinds of quinolone drugs (NOR, pefloxacin, ciprofloxacin, and danofloxacin). The IC50 of the 4 kinds of quinolone drugs ranged from 7.35 to 24.27 ng/mL, and the lowest detection limits ranged from 0.05 to 0.16 ng/mL, which were below their maximum residue levels, approved by the EU for treatment of food-producing animals. To demonstrate the applicability of the assay, artificially contaminated milk samples with the 4 quinolone drugs were analyzed. The mean recovery rates of the drugs ranged from 86.31% to 112.11%.
Semipinacol rearrangement of a bicyclo[7.2.0]undecane framework into a bicyclo[6.3.0]undecane skeleton: a model study on the biosynthesis of seiridiasteriscane A
Authors: Ishibashi Osamu , Nishiyama Mami , Kwon Eunsang , Hashimoto Masaru , Kuwahara Shigefumi , Enomoto Masaru
Published: May 2021

Seiridiasteriscane A is an asteriscane-type sesquiterpenoid bearing a trans-fused bicyclo[6.3.0]undecane skeleton. Although its biosynthesis has been proposed to involve a semipinacol rearrangement of a putative intermediary acetate bearing a bicyclo[7.2.0]undecane ring system (presumably derived from coisolated pestalotiopsin M) followed by epimerization of the resulting cis-fused seiridiasteriscane B, such a type of semipinacol rearrangement has never been reported so far. Our model study revealed that a 1-hydroxybicyclo[7.2.0]undecan-2-yl acetate underwent a smooth and stereospecific semipinacol rearrangement with the assistance of Et2AlCl to give the corresponding bicyclo[6.3.0]undecane-9-one. In addition, the resulting cis-fused 5,8-bicyclic ketone was partially epimerized to the corresponding trans-fused ketone by prolonged adsorption onto a silica gel plate. These results may support a recently proposed biosynthetic pathway of seiridiasteriscane A.
Discovery-defense strategy as a mechanism of social foraging of ants in tropical rainforest canopies
Authors: Antoniazzi Reuber , Camarota Flávio , Leponce Maurice , Dáttilo Wesley
Published: May 2021

Many hypotheses have been proposed to explain the coexistence of ants sharing similar food resources, including ecological trade-offs, however, these hypotheses have mostly been tested in ground-dwelling ant communities. For instance, the discovery-dominance trade-off hypothesis states that species with overlapping food resources differ in their ability to find and dominate resources. However, ant species may use different strategies to share food resources, including discovery-defense, in which the first species to arrive at a food resource maintains control of it. Here, we evaluated whether the discovery-dominance trade-off hypothesis, or the discovery-defense strategy could be a mechanism that promotes coexistence of ant species in the canopy of highly diverse tropical forest canopies. We evaluated the succession of ant species on 72 baits exposed on 24 trees during 13 observation periods (15–195 min) in the canopy of a tropical rain forest in Mexico. In general, we observed little variation in ant species composition (i.e., low β-diversity values) during the 195 min of bait exposure. Moreover, we found that ant species with the greatest ability to discover new food resources were those that dominated them. These findings empirically show that the discovery-defense strategy can be a social foraging strategy in rain forest canopy ants and reject the discovery-dominance trade-off. In short, our results highlight the importance of the discovery of a food resource in the canopy of a tropical rain forest, allowing it to be dominated.
Full-length de novo protein structure determination from cryo-EM maps using deep learning
Authors: He Jiahua , Huang Sheng-You
Published: May 2021

Motivation

Advances in microscopy instruments and image processing algorithms have led to an increasing number of Cryo-electron microscopy (cryo-EM) maps. However, building accurate models for the EM maps at 3–5 Å resolution remains a challenging and time-consuming process. With the rapid growth of deposited EM maps, there is an increasing gap between the maps and reconstructed/modeled three-dimensional (3D) structures. Therefore, automatic reconstruction of atomic-accuracy full-atom structures from EM maps is pressingly needed.

Results

We present a semi-automatic de novo structure determination method using a deep learning-based framework, named as DeepMM, which builds atomic-accuracy all-atom models from cryo-EM maps at near-atomic resolution. In our method, the main-chain and Cα positions as well as their amino acid and secondary structure types are predicted in the EM map using Densely Connected Convolutional Networks. DeepMM was extensively validated on 40 simulated maps at 5 Å resolution and 30 experimental maps at 2.6–4.8 Å resolution as well as an Electron Microscopy Data Bank-wide dataset of 2931 experimental maps at 2.6–4.9 Å resolution, and compared with state-of-the-art algorithms including RosettaES, MAINMAST and Phenix. Overall, our DeepMM algorithm obtained a significant improvement over existing methods in terms of both accuracy and coverage in building full-length protein structures on all test sets, demonstrating the efficacy and general applicability of DeepMM.

Availability and implementation

http://huanglab.phys.hust.edu.cn/DeepMM.

Supplementary information

Supplementary data are available at Bioinformatics online.
662 Tool-tissue Forces in Surgery: A Systematic Review
Authors: Khan D Z , Kafai Golahmadi A , Mylonas G , Marcus H
Published: May 2021

Introduction

Excessive tool-tissue interaction forces in surgery may result in tissue damage and intraoperative complications, while insufficient forces prevent the completion of the task.

Method

A systematic review of studies exploring tool-tissue forces applied during surgery was performed in accordance with PRISMA guidelines.

Results

45 studies discussing tool-tissue forces during surgical procedures or tasks were included. Mean forces per speciality were as follows: ophthalmology (0.04N), vascular (0.7N), neurosurgery (0.68N), cardiothoracic surgery (1.5N), general surgery (4.7N), otorhinolaryngology (8.5N), obstetrics & gynaecology (mean 8.7N), urology (9.8N) and orthopaedic surgery (210N). Senior surgeons applied 25% less force than novice surgeons, and feedback (haptic, visual or audio) reduced force application by 40% - across specialities and tasks. Nervous tissue required the least amount of force to manipulate (0.4N, n = 17), followed by epithelial (3.8N, n = 18), muscle (4.1N, n = 4) and connective tissue (45.8, n = 10). For manoeuvres, retraction-with-grasping recorded the highest forces (3.65N, n = 13), whilst vessel clamping recorded the lowest (0.5N, n = 2).

Conclusions

The measurement of tool-tissue forces is a novel but rapidly expanding field. Knowledge of the safe range of surgical forces will improve surgical safety whilst maintaining effectiveness. Measuring surgical forces may provide an objective metric for training and assessment. Development of smart instruments, robotics and integrated feedback systems will facilitate this.
677 Incidental Diagnosis of Metastatic Prostate Cancer by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) In the Absence of Pelvic Lymphadenopathy
Authors: Rahman S , Islam R , Hammadeh M , Reekhaye A
Published: May 2021

Metastasis pattern of prostate cancer varies widely; however, predominant affinity is towards regional lymph nodes. Mediastinal lymphadenopathy as the initial presentation, in absence of any pelvic lymph node involvement, remains extremely rare. Most patients are incidentally diagnosed and often have widespread metastatic disease on confirmation of diagnosis. A high index of clinical suspicion is necessary and routine clinical examination such as a digital rectal examination (DRE) can aid in earlier diagnosis and prompt clinical intervention can improve disease outcome. We present this case study of a 53-year-old patient who was incidentally diagnosed with metastatic adenocarcinoma of prostatic origin by TBUS-EBNA of hilar lymph nodes in the absence of pelvic lymphadenopathy.
78 A Lockdown Dilemma; Ingestion of Magnetic Beads Presenting as Right Iliac Fossa Pain and Sub-Acute Small Bowel Obstruction
Authors: Oyewole B , Sandhya A , Maheswaran I , Campbell-Smith T
Published: May 2021

A 13-year-old girl presented with a three-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice.

She represented six days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment as recommended by the radiology department.

Intra-operative findings revealed 200mls of serous fluid in the pelvis, normal-looking appendix, dilated stomach, and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetized the laparoscopic instruments.

A mini-laparotomy was performed with the extraction of fourteen magnetic beads and the repair of nine enterotomies.

Foreign body ingestion is a known cause of abdominal pain, which in some cases might mimic or even be the cause of acute appendicitis.

This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.
91 An audit of COVID-19 Awareness and Public Health Message Effectiveness in the Hospital Setting Over the Course of the Pandemic
Authors: Render L , Truss A , Waddington H , John S , Henderson C , Aldaraggi A , Page O
Published: May 2021

Introduction

An audit of healthcare workers investigated the effectiveness of Public Health England’s (PHE) information campaign across COVID’s timeline and assess knowledge between job roles.

Method

Data was collected across 3 cycles in 3 hospitals. A questionnaire assessed four domains: symptoms; spread; risk factors and the means to reduce transmission. PHE materials were shown before cycle 2 and respondents then subjected to the general campaign.

Results

253 responses were collected. Symptom recognition was 84%, increasing to 88% post-intervention, longer-term recognition remained high at 81% - including the new symptom of anosmia.

Identification of COVID’s means of transmission increased from 76% to 95% post intervention, risk factor recognition increased from 85% to 93% post-intervention. This fell to 74% later in the pandemic when recognised risk factors increased. Recognition of the new risk factors BAME status and BMI was 73% and 79% respectively in the final cycle.

Doctors had the highest number of pre-intervention correct answers for 3 domains and nurses gave the most incorrect answers for 3 domains pre-intervention.

Conclusions

We have shown the PHE message is being transmitted effectively. We have also shown an increase in hospital workers recognition of aspects of COVIDs characteristics that have since been verified in the literature.
190 Determinants of Psychological Well-Being in Healthcare Workers During the Covid-19 Pandemic: A Multinational Cross-Sectional Study
Authors: Goh E T , Denning M , Purkayastha S , Kinross J
Published: May 2021

Introduction

The Covid-19 pandemic has placed unprecedented pressures on healthcare systems globally, impacting working conditions, safety attitudes and the psychological well-being of healthcare workers. This cross-sectional study explores the prevalence and predictors of anxiety/depression amongst healthcare workers in the UK, Singapore, and Poland.

Method

From 22 March to 18 June 2020, healthcare workers from the UK, Singapore and Poland were invited to complete a self-administered questionnaire on psychological well-being. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Other components of the questionnaire include demographic information, Safety Attitudes Questionnaire (SAQ) measuring safety culture and the Oldenburg Burnout Inventory (OLBI) to measure burnout. Multivariate logistic regression was used to determine predictors of anxiety and depression.

Results

Of 3537 healthcare workers who participated in the study, 701 (20%) screened positive for anxiety and 389 (11%) for depression. Significant predictors of depression and anxiety include low SAQ score, nursing role, redeployment, burnout, and depression. There was significant overlap between anxiety and depression. The doctor role was protective.

Conclusions

Our findings demonstrate a significant burden of anxiety and depression amongst healthcare workers during Covid-19. These findings highlight the impact of Covid-19 on psychological well-being and suggests which groups would benefit from targeted support.
208 Assessment of The Impact Of COVID-19 On the Management of Patients with Neck of Femur Fractures in A Major Trauma Center In Wales
Authors: Solari F , Ansar Z
Published: May 2021

Introduction

Neck of femur (NOF) fractures form a significant proportion of trauma. Especially since they do not benefit from COVID-19 social isolation policies. Surgery and hospital admissions present risks to patients during the COVID-19 pandemic.

Method

Retrospective analysis of all NOF fractures from 24/3/20 to 26/6/20 in Morriston Hospital. Directly compared with 2019, allowing assessment of COVID-19’s impact.

Results

179 NOF fractures were admitted, 158 had an operation. Increased from 127 patients in 2019. Average time to surgery increased from 39 to 67 hours. There were operation delays for 98 patients, and non-operative treatment increased from 2 to 21 patients. Prompt orthogeriatric reviews completed in 80.4% patients in 2020, up from 72.5%. Prompt physiotherapy review increased from 66.9% to 74.6%. Mortality remained similar at 8.6% (2019) and 8.5% (2020). Average length of stay reduced; 17.4 to 11 days in 2020.

Conclusions

2020 saw increased waits for operations. There was reduction in length of stay and improved promptness of orthogeriatric and physiotherapy reviews. Increased non-operative treatment in 2020, reflecting decisions about risks and benefits of surgery in the pandemic. Mortality remained stable. This department improved some aspects of care, potentially due to pressures of COVID-19 heightening awareness of patient's needs.
228 Resilience, Mindset and Burnout of Healthcare Workers During the COVID-19 Pandemic
Authors: Lupi M , Maweni R , Foley R , Shirazi S , Machando D , Woods S , Vig S
Published: May 2021

Introduction

We investigated the impact of the Biopsychosocial challenges associated with the COVID-19 Pandemic on the Healthcare Workforce, exploring the impact on and relationship between Healthcare Workers’ Mindset, Resilience and Burnout.

Method

An electronic survey was distributed to Healthcare Workers through Professional Associations' websites and social media. The survey contained demographic questions, a Burnout Inventory, a General Resilience scale, a scale to assess for Resilience during the Pandemic, as well as an Adapted Dweck Mindset instrument to measure Mindset as related to Workplace Environment and Resilience. Univariate and multivariate analysis was undertaken to examine the relationship between these factors.

Results

1,370 healthcare workers completed the questionnaire. 58.5%, 25.4%, 28.5% reported having Burnout, Low General Resilience and Low COVID Resilience, respectively. Burnout was significantly associated with Fixed Mindset, Low General Resilience and Low COVID Resilience. Resilience Training was found to be protective for Burnout.

Conclusions

The COVID-19 Pandemic has led to a higher proportion of HCWs experiencing Burnout than previously reported. Our findings demonstrate that HCWs with Low Resilience and Fixed Mindsets are more likely to experience Burnout, suggesting that, in combination with improved institutional support, there is a role for personalised Resilience and Mindset Training, in helping reduce the proportion of HCW Burnout.
335 Planned Surgery in the COVID-19 Pandemic: A Prospective Cohort Study from Nottingham
Authors: Catton J , Banerjea A , Gregory S , Hall C , Crooks C , Lewis-Lloyd C , Marshall A , Humes D
Published: May 2021

Introduction

Globally planned surgical procedures were deferred during the current COVID-19 pandemic. We aim to report planned urgent and cancer case outcomes during the pandemic using a multi-disciplinary prioritisation group.

Method

Prospective cohort of patients prioritised by a multi-disciplinary COVID Surgery group undergoing urgent or cancer surgery at a NHS Trust from 1st March-30th April 2020. 30-day post-operative rates of PCR positive and suspected COVID-19 infections, 30-day mortality and COVID-19 related deaths are reported.

Results

During the period, 597 patients underwent surgery, median age 65-years (interquartile range 54-74) of which 86% (514/597) had a cancer diagnosis. 61% (362/597) had surgery at the NHS Trust whilst 39% (234/597) had surgery at Independent Sector hospitals. The COVID-19 incidence in the East Midlands was 193.7 per 100,000 population. 30-days following surgery, 1.3% (8/597) tested COVID-19 positive with all cases at the NHS site. 30-day mortality was 0.7% (4/597). Mortality following PCR positive COVID-19 diagnosis was 25% (2/8). Including PCR positive and suspected cases 3.0% (18/597) developed COVID-19 infection, 1.3% at the independent site compared to 4.1% at the NHS Trust (p = 0.047).

Conclusions

Rates of COIVD-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.
516 Patient Opinion on The Disruption Caused to Daily Life by Attending A Virtual Clinic Over A Face-to-Face Clinic Appointment in General Surgery During The COVID-19 Pandemic. A Retrospective Patient Feedback Study
Authors: Fanning S , Sturrock B , Palmer H , Hussain A , Carney C , Jaunoo S
Published: May 2021

Introduction

During the COVID-19 pandemic many hospitals adopted the use of virtual clinics to reduce in-person contact. We identified the need to assess patient’s opinion of the disruption caused to their lives by attending a virtual clinic appointment compared to a face-to-face appointment at a General Surgery department of a UK hospital.

Method

627 patients attended a virtual clinic in General Surgery between 25th March 2020 and 30th April 2020. Patients were selected using a random number generator; they were called and asked to complete a google survey which was sent via email. A shorter survey was also conducted over the phone for patients who did not have an email address.

Results

73 patients completed the online or telephone survey. 77.8% (n = 42) reported that they had no problems accessing the virtual clinic. 74.1% of patients (n = 40) agreed that virtual clinics caused less disruption to their daily life. 87.7% (n = 64) saved time by attending the virtual clinic. 67.1% (n = 49) saved two or more hours. 65.8% made a financial saving.

Conclusions

Patients found the clinic easy to access. Overall, the virtual clinics cause less disruption to patients’ lives than a face-to-face clinic appointment with notifiable savings in both time and money.
535 Private Trauma Lists: A Pragmatic Panacea During This Pandemic
Authors: Biggs A , Moore E , Zbaeda M , Shah K , Keightley A
Published: May 2021

Introduction

COVID-19 has disrupted the efficiency of hospitals nationwide. Ambulant trauma surgery was minimised to reduce risk of contracting COVID-19. Operating capacity significantly reduced and surgical training dramatically curtailed. Locally, a private hospital has been utilised as a green site with consultant-lead trauma lists. Our aim is to review the safety and efficiency of this service.

Method

Patients underwent pre-assessment, COVID-19 swabs and 7 days isolation pre and post-op. Staff also underwent swabbing. Prospectively data was gathered for all patients operated on at this site from 12/05/2020 to 20/08/2020. Records reviewed for readmission, complications and COVID status. A satisfaction questionnaire was sent to trainees who operated at this site.

Results

79 operations were completed during this period. 50 male and 29 female, average age 49, average ASA 2. No complications or COVID-19 infections were recorded. Mean time to theatre was 18 days. Delays to theatre led to 2 complications. 87% of trainees felt training was maintained.

Conclusions

Establishing a green site enabled efficient and safe management whilst still facilitating surgical training. This requires clear guidelines for staff and patients. We believe this model can help trauma service provision as the pandemic evolves.
598 Patients’ Knowledge and Compliance with Government Guidelines for COVID 19
Authors: Eskander J , Khallaf A , Zaki S , Elkawafi M , Makar R
Published: May 2021

Background

Since the outbreak of COVID-19; social distancing and recognized effective precautions were recommended by various governments to fight the viral spread.

Our aim was to assess the inpatient knowledge and compliance with the government guidelines during their hospital stay and at their discharge in two different NHS hospitals.

Method

The study took place in two hospitals: Berrywood hospital, UK and Countess of Chester hospital, UK. We invited inpatients to answer an anonymized questionnaire which was designed to include the contemporary government guidelines. We excluded patients with cognitive impairment and those who were not expected to be discharged within days.

Results

Out of 209 patients, 50% were male. Patients showed good awareness of the main symptoms of the virus (90%). However, A significant number of patients were not fully aware of the recommended precautions to minimize viral spread (28%) and the method of spread (43%). About 41% did not know the recommended safe distance.

Conclusions

Despite being aware of the main symptoms of COVID-19, a significant number of patients lack essential information needed to minimize the spread of the virus in the society and hospital. We recommend providing patients with information leaflets and direct advice on admission and discharge.
668 The Consequences to Emergency Surgery During COVID19 Pandemic in a UK District General Hospital in The North East of England
Authors: Evans R , Ng C
Published: May 2021

Aim

COVID19 pandemic has significantly affected surgical services. We aim to review its effects on our theatre output and risk of encountering COVID 19 cases.

Method

Serial record of operations performed locally were reviewed from start of UK COVID19 pandemic lockdown on 23rd March 2020 to 13th July 2020 after it was lifted. A weekly average by month of operations and the percentage of COVID19 cases diagnosed within 30 days of the procedure were noted.

Results

733 operations performed through this period. In March, 33 operations/week performed, 88.4% emergency and 7% diagnosed with COVID19. April, 31 operations /week performed, 95.9% emergency and 10.6% diagnosed with COVID19. May 46 operations /week performed, 94.5% emergency and 3.3% diagnosed with COVID19. June 56 operations /week, 80.9% emergency and less than 0.01% diagnosed with COVID19. By July 80 operations/week, 59.4% emergency and none diagnosed with COVID 19. Since testing capacity increased, only 6 of the 27 operated were diagnosed with COVID19.

Conclusions

There was initial reduction to non-emergency workload. However, this has gradually shifted as protocols are in place improve public confidence to return for surgical treatment. Mandatory admission testing allows early identification and remains essential for planning of services and protecting the workforce.
694 The Impact Of COVID-19 On Trauma Referrals to a National Neurosurgical Centre
Authors: Horan J , Duddy J , Gilmartin B , Nolan D , Corr P , Husien M B , Bolger C
Published: May 2021

Objective

To investigate the impact of COVID-19 on trauma referrals to a National Neurosurgical Centre.

Method

Retrospective analysis of a prospectively maintained database of all trauma referrals to the National Neurosurgical Centre at Beaumont Hospital, during the period March 1st – May 31st, 2019 and 2020. Patient characteristics including age, sex, alcohol use, anticoagulant/antiplatelet use and initial Glasgow Coma Scale were recorded. Patients were grouped by trauma aetiology and diagnosis.

Results

There were 527 and 437 trauma referrals in 2019 and 2020, respectively. Overall, there was a 17.1% reduction in trauma referrals between years. Traumatic brain injury, spinal injury and cranial fractures referrals reduced 25% (375 vs 283), 59% (32 vs 13) and 18% (39 vs 32) respectively from 2019 to 2020. Low energy falls below 2 metres were the most common mechanism of injury and accounted for 60 and 61% of referrals in 2019 and 2020. No reduction in road traffic collision (33 vs 34) and assault (40 vs 40) referrals were observed between years.

Conclusions

COVID-19 has had a significant impact on the volume and mechanism of trauma referrals to the National Neurosurgical Centre in Ireland, with falls below 2 metres the most common mechanism of trauma referral across both years.
709 Covid-19 Pandemic: Audit on The Management of Acute Cholecystitis
Authors: Asarbakhsh M , Lazarus N , Lykoudis P
Published: May 2021

Background

The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines.

Method

The audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included.

Result

24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis.

Conclusions

19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.
755 Elective Surgery in the COVID-19 Pandemic: Outcomes of 100 Consecutive Cases
Authors: Fisher R , Hadjittofi C , Ali Z , Antonas P , Parekh K , Seraj S , Thomas L , Uddin A , Lovett B
Published: May 2021

Introduction

The COVID-19 pandemic halted elective surgical activity. Basildon University Hospital established an elective Green Zone for COVID-19 swab negative patients who isolated for 14 days. This study reviewed the outcomes of the first 100 patients.

Method

A single-centre study was performed. Demographic and perioperative electronic data were supplemented with telephone follow-up for the first 100 Green Zone patients and analysed in Microsoft Excel.

Results

One hundred Green Zone patients underwent surgery between 21/05/2020 and 16/06/2020. The median age was 55 (14-88) years. 52% were female. Their operations were performed by General Surgery (39%), Gynaecology (17%), Vascular Surgery (14%), Oral Surgery (12%), ENT (9%), Urology (8%), and Pain Management (1%).

Preoperatively, 100% had a negative SARS-CoV-2 swab and one had CT evidence of mild resolving COVID-19. Two patients had postoperative SARS-CoV-2 swabs, both negative. Median length of stay was 0 (0-7) days. 84% responded to telephone follow-up at a median 25 (13-54) postoperative days, 69% of whom were asymptomatic There were no 30-day major complications (>Clavien-Dindo IIIa) or 90-day mortality.

Conclusions

Elective surgery can be safe during the COVID-19 pandemic, with appropriate measures in place. This has significant implications in the context of an ever-expanding NHS waiting list during a pandemic of uncertain duration.
822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital
Authors: Ahn K , Khan N , Desai N , Abdu M , Hiddema L , Odogwu S , Cheetham M , Pande R
Published: May 2021

Introduction

Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital.

Method

Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020.

Results

Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable.

Conclusions

Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.
828 Is Isolation Before Elective Surgery the Way Forward During The COVID-19 Pandemic?
Authors: James S , Lafaurie G , Hafeez R
Published: May 2021

Introduction

The COVID-19 pandemic is here to last, and services must adapt to enable elective surgery to continue. Surgery involves high-risk aerosol generating procedures, potentially harmful to staff and patients. The current NICE guidance is for the patient to self-isolate for 72 hours prior to surgery. A question persists: Is 72-hour isolation the way forward in elective general surgery?

Method

In a DGH centre, using an anonymous questionnaire, we prospectively collected data on isolation for 36 elective general surgery patients during the 72h isolation period. The data was analysed to assess the concordance with isolation as well as patient's satisfaction with the process.

Results

75% of patients were concordant with 72 hours of isolation pre-operatively. This was an increase from 35% when compared to patients questioned during the 14 day isolation period. The main factors contributing to isolation breech were visitors to the house and the mode of transport used to attend hospital.

Conclusions

The protocol is now for a COVID swab 72 hours pre-operatively followed by isolation until the operation. Our results show that still significant breaches in isolation remain and patients welfare is adversely affected during that period. Further research and consideration is needed to optimise the COVID isolation protocol.
841 The psychological impact of Foundation Interim Year 1 Placements on Final Year UK Medical Students Transitioning to Foundation Year One During the COVID Era
Authors: Durand-Hill M , Ike D I , Nijhawan A N , Shah A B , Dawson A , Awad W I
Published: May 2021

Introduction

During the COVID pandemic, the 2019-2020 cohort of final year students were invited to participate in Foundation interim Year 1 placements (FiY1). FiY1 aimed to ease transition to Foundation Year 1 doctor (FY1). We assessed the psychological impact of FiY1 on final year medical students.

Method

A cross-sectional survey was distributed to final year medical students in the UK between June 4th and July 4th, 2020. The survey contained the following domains: participant demographics, rationale for FiY1 participation, a checklist of the key safety principles for FiY1s, the Hospital Anxiety and Depression Scale and the Perceived Stress scale-4.

Results

107 final years responded to the survey. 72.0% (n = 77) of final year students surveyed were working as FiY1s. Final year students participating in FiY1 postings had reduced rates of anxiety (29.9% vs 43.4%, P = 0.186), depression (5.2% vs 20.0%, P = 0.018) and lower perceived stress levels (5.0 vs 7.2, P < 0.001). 19.5% (15/77) FiY1s reported working beyond their competency, 27.3% (22/77) felt unsupervised, but 94.8% (73/77) of FiY1s felt the post prepared them for FY1.

Conclusions

Students participating in FiY1 postings felt less stressed and depressed than those not participating in the scheme and the majority felt it was preparing them for FY1.
984 Hospital Transmission of COVID-19 in Trauma Surgery
Authors: Emerson H
Published: May 2021

Introduction

A single-site retrospective study identified a suspected cluster of hospital-acquired COVID-19 in trauma patients. The study aims to identify contributing factors in order to minimise future risk to patients and staff.

Method

A single-site retrospective cohort study including all T&O patients who underwent surgery with confirmed peri-operative COVID-19 infection. The primary outcome was 30-day mortality. Exposures investigated included diagnostic timing and theatre designation.

Results

92% of participants were not tested pre-operatively. 75% met the criteria for hospital acquired COVID-19. Only 2 patients were operated on in designated COVID-19 theatres. Two lists accounted for 50% of the T&O COVID-positive patients. Remaining patients on both lists were discharged without further testing. Local 30-day mortality rate (25%) was in line with the findings of the international COVIDSurg Study (23.8%). No further COVID-positive T&O cases identified since the introduction of blanket admission swabbing.

Conclusions

The majority of patients did not meet criteria for pre-operative testing. Thus, were not operated on in appropriately designated theatres despite unknown COVID status, increasing risk of cross-contamination. Complacency due to designation of “clean” and “dirty” wards, atypical presentation and bay nursing may have contributed to hospital transmission. Findings emphasise the importance of treating patients as COVID positive until proven otherwise.
21 Suture School: A Socially Distanced Surgical Education
Authors: Galloway R , Amar H , Panchalingham V
Published: May 2021

Introduction

Limited theatre exposure, cancelled practical teaching and placements abandoned due to COVID-19, has potential to damage the learning opportunities and experiences of medical students within surgery. We aimed to create and deliver an emergency small group teaching programme throughout the pandemic, targeted at increasing medical student confidence in basic surgical skills and inspiring interest in surgery.

Method

Multiple small-group teaching sessions were delivered to a cohort of 14 medical students recruited for work during the pandemic, whilst adhering to social distancing and sanitary measures. On completion of the programme and informal assessment of 11 surgical competencies, participants completed a follow up questionnaire to assess their improvement.

Results

70% reported improvement in 10 competencies and 30% across all 11 competencies. The greatest improvements were in abscess drainage and knot tying. 30% relayed increased interest in pursuing a surgical career. 80% were ‘more likely’ to attend theatres in future.

Conclusions

The teaching series facilitated increase in self-perceived confidence of students in basic surgical skills, whilst inspiring surgical interests. During challenging times, we must support learners to undertake activity that drives improvement in training for the wider benefit of health services. Innovative teaching programmes may reduce the impact of similar adversity in the future.
133 Neurosurgery Education in The Medical School Curriculum: A Scoping Review
Authors: Lee K S , Zhang J J Y , Alamri A , Chari A
Published: May 2021

Introduction

Worldwide, there is no specific medical school curriculum in neurosurgery despite a high burden of neurosurgical disease that is often assessed, investigated and managed by generalists. This scoping review was carried out to map available evidence pertaining to the provision of neurosurgery education in the medical school curriculum across the world.

Method

This review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.

Results

Ten studies were included. Six were from the United Kingdom, two from the United States, and one each from Canada and Ireland. Two studies evaluated perceptions of both medical students and practicing clinicians, five studies evaluated the perceptions of medical students and three studies reported perceptions of clinicians only. Three main themes were identified. Neurosurgery was perceived as an important part of the general medical student curriculum. Exposure to neurosurgery teaching was varied but when received, deemed useful and students were keen to receive more. Interest in a neurosurgical career amongst medical students was high.

Conclusions

There is a lack of a specialty-specific medical school curriculum and variability of medical students’ exposure to neurosurgery teaching exists. Our findings highlight the need to systematically assess specialty-specific teaching and determine adequacy.
189 Preliminary Results from an Innovative Surgical Research Group for Medical Students
Authors: Ng C H , Chin Y H , Nistala K R Y , Jain S R , Ow Z G W , Wong N W , Tham H Y , Lim W H , Chong C S
Published: May 2021

Introduction

Learning research in medical school can be daunting and difficult with many lacking appropriate guidance. Particularly, research in surgery can be difficult with most clinicians tied to long hours from clinical duties, leaving medical students lost to learn the ropes for medical research.

Method

We started a surgical research group in January of 2020 under a shepherd sheep model. Shepards were senior medical students who had previous experience in research and were provided resources from consultants on statistics and research designs. Thereafter, each Shepard were paired with junior medical students (sheep) and a resident to provide clinical background. Research was then carried out small teams with minimal guidance from consultants.

Results

To date, the group has published 11 articles (median impact factor: 2.41, range: 1.89 - 3.42), 3 articles in revision and 9 articles in review.

Conclusions

We provide preliminary evidence of a successful model for building medical student research in surgery. While current analysis was limited to meta-analysis and systematic review due to the availability of data, current expansion is currently underway to expand to observational studies.
379 The Critical Care Experience of Irish Surgical Non-Consultant Hospital Doctors, Are We Equipped to Assist During the Covid-19 Outbreak and Beyond?
Authors: Burke E , Balfe P
Published: May 2021

Introduction

The ongoing COVID-19 pandemic has presented unforeseen threats and stresses to healthcare systems around the world, most notably in the ability to provide critical care.

Aim

To assess surgical NCHD experience in providing critical care and working in an intensive care environment.

Method

An electronic survey was distributed amongst surgical trainees and then amongst individual surgical departments. Ten questions were included in the survey assessing the NCHD’s experience with aspects of critical care.

Results

39 respondents including 16 specialist registrars, 3 senior registrars, 11 registrars and 9 senior house officers. 18% of respondents had previous experience in anaesthetics or intensive care. 23% self-reported being competent in performing endotracheal intubation. 15% self-reported being competent in the use of CPAP and BiPaP, 5% did not know what these were. 20% self-reported being competent in the use of AIRVO. 15% self-reported being competent in placing central and arterial lines. 15% self-reported being competent in starting and adjusting inotropes/vasopressors. 49% reported completing a CCRISP or BASIC course. 85% felt that a rotation in anaesthesia should be a routine part of surgical training.

Conclusions

Whilst there is critical care experience amongst the surgical NCHD cohort there remains room for further development.
448 The Impact of Noise in the Operating Theatre: A Review of the Evidence
Authors: Mcleod R J W , Wilks L , Davies S , Elhassan H A
Published: May 2021

Background

Noise has been recognised to have a negative impact on performance and wellbeing in many settings. Average noise levels have been found to range between 51-79 dB in operating theatres. Despite this, there is little research investigating the effect of noise on surgical team functioning.

Method

A literature review to look at the impact of noise in the operating theatre was performed on MEDLINE which included the search terms ‘noise’ OR ‘distraction’ AND ‘technical skill’ OR ‘Surgical skill’ OR ‘Operating Room’. 10 of 307 articles identified were deemed relevant.

Results

8 of 10 studies found noise to be detrimental to communication and surgical performance, particularly regarding total errors and time to task completion. No studies found noise to be beneficial. Two studies found case irrelevant verbal communication to be a frequent form of noise pollution in operating theatres; this is both perceived by surgeons to be distracting and delays patient care. Noise was most harmful to trainees.

Conclusions

Noise and irrelevant verbal communications were both found to be harmful to surgical performance, surgeon experience and team functioning. The worsened effect on the trainee exposes an urgent need to address noise pollution in the training environment.