bluuebunny/crossref_metadata_2025 huggingface dataset:
1262 Audit of MRI IAM (Internal Auditory Meatus) Requests at Darlington Memorial Hospital and Review of The Literature
Authors: Awni S , Zomorodian P , Maw J , Damodara M , Srinivasan R
Published: October 2021

Aim

To assess if the MRI IAM scans are being requested as suggested in NICE guidelines Draft 2017 for consultations. Educate and implement any changes if needed to minimise unnecessary investigations.

Method

Retrospective data collection of 1000 data. Variables included hearing loss (HL), tinnitus (T), dizziness (D) and other lateralized symptoms. Audiograms assessed for asymmetrical HL at decibel level ≥20 Db at a frequency of 0.5 kHz, 1.0 kHz, 2.0 kHz. MRI of IAM assessed if a cerebellar pontine angle (CPA) lesion was presented.

Results

853 (85.3%) met criteria. 16/1000 (1.6%) MRI showed CPA lesion. All 16 cases had unilateral sensorineural hearing loss (SNHL) and met NICE guidelines criteria.

Discussion

Limited value in the scanning of asymptomatic patients, those who do not fit audiometric guidelines, those bilateral symptoms or those with unilateral tinnitus without audiometric asymmetry. Very few studies were found in the literature in relation to symptoms associated with positive findings of CPA lesion. Our results indicate unilateral SNHL were linked with positive findings of MRI and it is similar findings in the literature. We recommend that patients who present with asymmetrical SNHL with this audiometric asymmetrical characteristic of 20Db or more will need an urgent MRI IAM as part of their diagnostic workup.
1309 Cochlear Implantation in Patients with Usher Syndrome: A Systematic Review of The Literature
Authors: Cornwall H L , Lam C M , Chaudhry D , Muzaffar J , Monksfield P , Bance M L
Published: October 2021

Introduction

Usher syndrome is a common cause of deaf-blindness characterised by progressive visual loss with congenital (types 1 and 2) or adult-onset (type 3) sensorineural hearing loss. Cochlear implantation is one of few effective options to enable patient access to useful sound. Auditory rehabilitation after cochlear implantation may be limited by deterioration of retinal function. Our objective was to evaluate the auditory outcomes of cochlear implantation in patients with Usher syndrome.

Method

Systematic review of Medline via PubMed, Ovid EMBASE, Web of Science, CENTRAL and clinicaltrials.gov was performed up to 30/03/2020, conducted in accordance with the PRISMA statement. Patient demographics, comorbidity, details of cochlear implantation, auditory and quality of life (QOL) outcomes were extracted and summarised. CRD 42020185102.

Results

32 studies reported over 215 cochlear implants in 186 patients with Usher syndrome, comprising subtypes 1 (56 patients), 2 (9 patients), 3 (23 patients), and not specified (98 patients). Where reported, cochlear implantation improved sound detection, speech perception, speech intelligibility, and patient-reported quality of life in the majority of patients with Usher syndrome.

Conclusions

Outcomes of cochlear implantation were comparable to those of patients without multiple sensory handicap. As clinical practice has evolved to emphasise early, bilateral implantation and access to oral education it is likely that these reported outcomes may underestimate contemporary implant outcomes among young children with Usher syndrome. To avoid multisensory deficits incurred by poor cochlear implant outcomes secondary to late implantation with Usher syndrome-related progressive visual loss, early implantation is crucial in the prelingually deaf Usher group.
1326 Otorhinolaryngology Education and Training Innovation: A Literature Review of the Academic Year 2019-2020
Authors: O'Hanlon J , McKenna J , Chan J
Published: October 2021

Aim

We aimed to summarise the literature on educational research and training in otorhinolaryngology during the academic year of 2019-2020.

Method

A literature search was conducted on Medline, Embase and Cochrane in accordance with PRISMA guidelines for ““(ENT or otorhino* or otolaryngo* or (ear, nose, and throat)) and (educat* or train or training or teach*)””. The search was conducted independently on 13/09/20 by two authors (JOH, JM), any discrepancy was further reviewed by a third author (JC). All original research papers published between 2019-2020 were included.

Results

68 papers were included in our study. Educational research this year shifted focus on how to combat the negative impact of COVID-19 on otorhinolaryngology teaching. Although many of the interventions created for postgraduate and undergraduate education have not been formally assessed, virtual electives for medical students were found to increase interest and knowledge in the specialty. Surgical simulation represented the most common teaching method reported aside from COVID-19. 3D models were used for emergency training with an aim to increase trainee exposure to an anterior neck abscess, retrobulbar haematoma and paediatric tracheostomy. 3D models were positively rated for face and content validity and gave statistically significant improvements in confidence for trainees.

Conclusions

The otorhinolaryngology training in 2019-2020 has changed massively due to the pandemic. Improving on virtual learning and adapting simulation training are the key to maintain a positive learning environment for medical students and doctors in the short term. Research on the effect of COVID-19 on otorhinolaryngology education and training will be the focus in 2021.
1402 Impact of COVID-19 on Nasal Fracture Presentation and Epidemiology: A Retrospective Comparative Case-series Study
Authors: Hassane A , Palaniappan S , Szostok M , Shakeel M
Published: October 2021

Aim

Nasal fractures (NF) are the most common ENT presentation and commonly managed in the clinic or A&E. With the recent COVID pandemic, this study aims to assess the difference in demographics, incidence and aetiology in NF since the start of the first lockdown (16/03/2020) as well as management of nasal fractures.

Method

Retrospectively, data collection on demographics, history and management over 5 years (2015-2020) for all patients presenting with symptoms of nasal fracture. Data was collected on password-protected Excel spreadsheet and subsequent statistical analysis performed using IBM SPSS Statistics.

Results

A total of 346 patients were identified of which 36 were diagnosed during the lockdown. Seventy-one percent were ≤40 years old and common aetiology recorded was assault (n = 85), sports (n = 85) and falls (n = 77). Mechanical fall was the common aetiology in older patients. Across gender, falls was the most common aetiology in females (37/94) and assault for males (72/246). Epistaxis (57%) and nasal congestion (31.8%) were most commonly reported symptoms. Before lockdown, Fifty-six percent of the cohort underwent manipulation of NF under local anaesthetic and no intervention needed in 39% while 58% underwent no intervention during the lockdown. No patients were readmitted in 30 days who were treated conservatively or with local anaesthetic during the lockdown.

Conclusions

This study showed that the most common cause of NF was sports and assault while during the lockdown, falls was the leading cause. More patients were managed conservatively during the lockdown with no 30-readmission showing that conservative management was as effective as management under local anaesthetic.
1629 The Risk of Malignancy in Cytologically Indeterminate Thyroid Nodules
Authors: Jones O , Blackabey V , Bhat N
Published: October 2021

Introduction

Fine needle aspiration (FNA) is the gold standard for the diagnostic assessment of thyroid nodules, with cytology stratified using the Thy classification (Thy 1-5). The management of cases where cytology is indeterminate (Thy-3) is challenging and subject to controversy. The current British Thyroid Association guidelines subclassify Thy-3 lesions into Thy-3a (atypia) and Thy-3f (follicular). Repeat FNA is generally recommended for Thy-3a specimens, whilst Thy-3f lesions should proceed to diagnostic hemithyroidectomy. The aim of this study was to determine the risk of malignancy in Thy-3a and Thy-3f lesions.

Method

This was a retrospective study of all patients who underwent FNA of a thyroid nodule from 01/01/2018 – 31/12/19. Those with Thy-3 cytology were identified and results correlated with final surgical histology.

Results

In total, there were 179 patients with Thy-3 cytology: 37 Thy-3a and 142 Thy-3f. The rate of malignancy was 21.6% (n = 8) for Thy-3a lesions and 20.4% (n = 29) for Thy-3f. When excluding microcarcinoma, the rates fell to 20.4% (n = 7) and 12.7% (n = 18) respectively. There was no statistically significant difference in malignant conversion between the two groups (p = 0.20).

Conclusions

This study does not demonstrate any statistically significant difference in the risk of malignancy between the Thy-3a and Thy-3f groups, suggesting that this subclassification does not add any additional utility to clinical decision making. Consideration should be given to the use of local malignant conversion rates to guide further management and pre-operative patient counselling in the Thy3 group.
1525 How Far Do Cultural Values Between First and Second Generational Medical Students Differ According to GMC Guidelines
Authors: Anwar S , Jha V
Published: October 2021

Aim

There are a disproportionately higher number of fitness to practise issues reported to the GMC within the BAME medic group than that any other ethnic group. This research seeks to compare differences in cultural nuances, if any, between second generation BAME medical students and whether there is an opportunity to address these within medical training.

Method

We conducted 4 qualitative one to one interviews of second generation medics (Those whose parents were not from the UK, but were themselves brought up in the UK) and medics who were both from the UK and whose parents had been brought up in the UK. An exploratory interview was conducted of what values were most important to the interviewees and how this affected their decision-making process. The interviewees were medical students from the University of Liverpool all of whom were in their clinical years between year 3-5. The interviewees were randomly chosen after expressing an interest in the research. A literature search across Pubmed and Scopus were conducted to help direct interview questions.

Results

The main themes interviewees reported impacting on decision making included difficulty of balancing cultures, the impact of religion on cultural values and personal professional values. When compared to the GMC guidelines, these values mostly aligned however there were some differences, mainly in communication and whistleblowing.

Conclusions

With an increasingly diverse workforce, there should be some further research conducted to address how the differences in culture affects decision making processes with the consideration of incorporation into medical training.
864 Adherence to British Hernia Society Standards in Consenting Practice for Inguinal Hernia Repair
Authors: Binnie C , Adedeji J , Noureldin K , Shamsiddonva A
Published: October 2021

Objectives

Evaluation of adherence to BHS Standards in IHRs Consent. Primary goal was the documentation of “Mesh” on clinic letter and consent form. Secondary points were the enlisted postoperative complications and advice given to reduce the risk of complications.

Introduction

Mesh repair is the gold standard for elective inguinal hernias. Recurrence rate is 1-3%. Chronic pain, for different causes, is documented in 10-15% (Most frequent complication).

Method

Retrospective study looked at first 100 patients, who were subjected to open inguinal hernia repair, in one year time. Patients under 18 years, history of previous repair and laparoscopic repair were excluded. The sample was reduced to 94, as 6 cases had untraceable and insufficient records

Results

Despite using mesh in all patients, it was not written in 11.7% of the consent forms and half of the clinic letters. Postoperative readmissions were 6.4% ,8.5% and 1.1% at week, month and year, respectively. The main causes were pain (1%), wound dehiscence (1%), hematoma (2%), and recurrence (1%). Overall complications rate after one year was 5.5%. Although recurrence and chronic pain are linked to hernia repair, they were not mentioned in 10% and 15%. In contrast, non-specific complications were documented in > 90%. Damage to cord structures and post-operative advice were found in 60% and 30%.

Conclusions

All grades surgeons were not adequately adherent to BHS, exposing the firm to negligence and complains. Preprepared forms and leaflets are advised to improve the quality of service, in respect to the GMC Domains.
577 Association Between the Use of Smokeless Tobacco and Cancer of Gingivobuccal Sulcus
Authors: Sahni D S , Bamania A , Ramsaha S
Published: October 2021

Background

Although oral cancer accounts for 2.1% of all cancer cases globally, it is surfacing as a major public threat in India. Oral cancer figures among three most common types of cancer in the Indian subcontinent, with an incidence rate of 30%. The increased availability and use of smokeless tobacco and betel quid in the recent years have further aggravated the situation. The scarcity of reports on the contribution of such risk factors in oral cancer incidence remains a prime concern. In this perspective, the association between smokeless tobacco and cancer of gingivobuccal sulcus was investigated.

Method

The medical records of 249 patients with cancer of gingivobuccal sulcus, attending the BRAIRCH, AIIMS, New Delhi, were retrospectively examined from 2009-2016. Demographic and clinical data including history of addictions (smoking, smokeless tobacco) were collected and patients were staged according to the 8thAJCC Cancer Staging (2017).

Results

Smokeless forms of tobacco were more prevalent among the patients (50.7%), in contrast to smoked tobacco (19.53%), while 29.77% were reported to consume both forms. A higher proportion of patients with smokeless tobacco addiction were diagnosed with advanced stages of cancer (56.9% in Stage III/IV). These rates were even higher (65.6%) in patients using both smokeless and smoked tobacco.

Conclusions

A strong association was observed between smokeless tobacco and gingivobuccal sulcus cancer, particularly in patients who kept the tobacco in the buccal vestibule after chewing, to suck, sometimesovernight. Elucidating the potential risk factors can be a key approach to design effective intervention programs to combat the growing pandemic of oral cancer in India.
69 The Experimental Methodology and Comparators Used For In Vivo Hernia Mesh Testing; A Ten-Year Scoping Review:
Authors: Whitehead-Clarke T , Karanjia R , Banks J , Beynon V , Parker S , Sanders D , Mudera V , Windsor A , Kureshi A
Published: October 2021

Aim

Before being marketed, hernia mesh must undergo in vivo testing, which often includes biomechanical and histological assessment. Currently there are no universal standards for this testing and methods vary greatly within the literature. A scoping review of relevant studies was undertaken to analyse the methodologies used for in vivo mesh testing.

Method

Medline and Embase databases were searched for relevant studies. 513 articles were identified, and 231 duplicates excluded. 126 papers were included after abstract and full text review. Data extraction was undertaken using standardized forms.

Results

Mesh is most commonly tested in rats (53%). 78% of studies involve the formation of a defect; in 52% of which the fascia is not opposed. The most common hernia models use mesh to bridge an acute defect (50%). Tensile strength testing is the commonest form of mechanical testing (63%). Testing strip widths and test speeds vary greatly (4-30mm and 1.625-240mm/minute respectively). There is little consensus on which units to use for tensile strength testing. Collagen is assessed for its abundance (54 studies) more than its alignment (18 studies). Alignment is not measured quantitatively. At least 21 histological scoring systems are used for in vivo mesh testing.

Conclusions

The current practice of in vivo mesh testing lacks standardisation. There is significant inconsistency in every category of testing, both in methodology and comparators. We would call upon hernia organisations and materials testing institutions to discuss the need for a standardized approach to this
321 The Darn Technique for Small (< 2 Cm Diameter) Midline Hernias
Authors: Pawlak M , Newman M , Beaux A. De , Tulloh B
Published: October 2021

Aim

Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias <1 cm. A darn is a tension-free repair where, in effect, a “mesh” is hand-woven across the defect in situ.

Method

Eligible patients undergoing this repair between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm at the widest point measured intra-operatively. Follow up was by telephone. Those who reported possible recurrence or other symptoms in the region of their repair were reviewed in person.

Results

47 suture-darn repairs were undertaken. Fifteen operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair.

Conclusions

The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.
425 The Impact Of COVID-19 On Hernia Surgery in The Lothian Region Of Scotland
Authors: Ewing A , Hodge K , McFadyen R , Grossart C , East B , de Beaux A
Published: October 2021

Aim

The COVID-19 pandemic resulted in a lockdown in South East Scotland on the 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown.

The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery.

Method

The Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020, and for the same time period in 2019. Data was collected on age, gender, location of the hernia, type of hernia repair and whether elective or emergency operation.

Results

The number of hernia repairs reduced dramatically between 2019 and 2020 (570 versus 149). The majority of this can be explained by a reduction in elective operating (488 versus 87). There was, however, also a reduction in the numbers of hernias repaired as an emergency over the same study periods (82 to 62). Lockdown in 2020 had the biggest effect on elective incisional hernia repair (74 versus 2).

Conclusions

The COVID-19 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. While the reduction in elective surgery has not resulted in an associated increase in emergency surgery over the study period, it is possible that if continuing reduced availability to elective hernia surgery continues in Lothian, the emergency hernia workload may increase.
827 Acute Appendicitis in An Amyand Hernia – A Case Report and Literature Review
Authors: Ahmad M , Fazili N , Chang T P , Abdalla H , Watfah J , Leo C. A
Published: October 2021

Introduction

An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73-year-old male patient presented with a two-day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy.

Method

We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970 to 2020.

Results

We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review.

Conclusions

Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intra-operative findings.
1598 Local Anaesthetic or General Anaesthetic: The Optimal Choice for Inguinal Hernia Repair
Authors: Mushonga K
Published: October 2021

Aim

Inguinal hernias occur when visceral tissue protrudes through the inguinal canal [1]. Around 20 million inguinal hernia repairs (IHR) are done annually worldwide and involve re-enforcement of the compromised wall of the inguinal canal using polypropylene mesh via open anterior approach or minimally invasive laparoscopy [2,3]. Despite gold standards in surgical approach, there’s no distinctively superior practice between local anaesthetic (LA) and general anaesthetic (GA). Therefore, the objective was to review IHR under both LA and GA and investigate which method is conductive to optimal patient outcomes.

Method

Systematically reviewed randomised control trials (RCTs) evaluating the benefits of LA over GA in IHR, by comparing factors such as post-operative nausea, urinary retention (UR), haematoma, wound infection (WI), pain, and operating time. PubMed was utilised for finding suitable studies, and data was obtained and summarised appropriately.

Results

Data assembled from RCTs evaluating benefits of LA over GA in IHR indicated no significant difference between groups when comparing nausea, UR, haematoma, WI and pain [4]. Supporting studies reviewing RCTs juxtaposing GA and LA in IHR elucidated no significant variance in operating time, haematoma and WI [5]. Patients did show less rates of UR, reduced pain scores and greater patient satisfaction under LA [5].

Conclusions

LA is used in specialised hernia clinics due to less cardiovascular risk however development of short-acting GA’s allows for suitability for day-case surgery. Future investigation is required taking into account factors like surgeon experience, patient anatomy and economic viability for a definitive gold standard.
1601 Trends in Investigation, Management and Patient Outcomes Following Emergency Presentation with Groin Hernia
Authors: Clyde D , Li L , Swan R , McLean R , Brown L
Published: October 2021

Aim

Groin hernias are associated with an increased morbidity and mortality following emergency presentations. This study aimed to review current practices regarding investigation and operative management of acute admissions of groin hernias in the North of England.

Method

Patients ≥18 years admitted as an emergency with femoral or inguinal hernias, between 2002-2016, across NHS trusts in the North of England were included. Data on demographics, investigations and operative interventions was collected. Outcomes of interest included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality.

Results

A total of 6165 patients were identified over 15 years: 4698 inguinal hernias and 1467 femoral hernias. 3904 (63.3%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.3% (2012-2016) (p < 0.001) and was associated with a reduced rate of surgical intervention (64.0% vs. 55.3%, p < 0.001). Bowel resection was higher amongst patients who underwent CT (16.6% vs. 6.4%, p < 0.001). Of those presenting with bowel obstruction, 11.7% required resection, 95.9% of these being small bowel. Bowel resection was associated with increased LoS (p < 0.001) and 30-day postoperative mortality (16.4% vs. 2.8%, p < 0.001). Laparoscopic repair, utilised in 177 procedures (4.5%), was associated with a shorter LoS compared to open repair (4.7 vs 5.5 days, p < 0.001) but no difference in mortality.

Conclusions

Emergency hernia repair, particularly cases requiring bowel resection, have high mortality rates. Pre-operative CT scanning is associated with reduced rates of operative intervention. Further research is required to assess the impact these changes have on surgical decision-making, and subsequent patient outcomes.
74 Does the SPIKES Protocol and Formal Teaching Increase Clinician Confidence When Breaking Bad News During the COVID Pandemic?
Authors: Olukoya O , Ishak P , Ali A , McLaughlan D
Published: October 2021

Background

Breaking bad news is often a daunting and complex task that we must all perform as part of our clinical duties. Given the current climate with the coronavirus, this task has unfortunately become an even bigger part of the day-to-day practice of many of us.

Aim

To establish how confident clinicians felt they were at breaking bad news, their familiarity with the SPIKES protocol and if they had a consistent approach they employed. Additionally, to ascertain if formal training in this, at any stage, corresponded to increased confidence with this task.

Method

A questionnaire was distributed to doctors and surgeons of all grades, primarily within the hospital. The questionnaire asked the responders how confident they felt at breaking bad news, how frequently they had to break bad news in an average month, if they had had any formal training in breaking bad news, and their familiarity with the SPIKES protocol.

Results

There were 58 responses. 60.4% had to break bad news 2 or more times in an average month. 86.2% had received formal training in breaking bad news. 60.3% felt confident or very confident. 53.4% had a consistent strategy and 58.6% were aware of the SPIKES protocol. 69% expressed they would like additional teaching with the SPIKES protocol.

Conclusions

Formal training does not guarantee knowledge of the SPIKES protocol or a consistent approach but has some impact on perceived confidence with the task. This task is, however, one most feel requires continued training to perform well.
227 Multiple Outbreak Of SARS-COVID-19 In Surgical Wards at The Tertiary Hospital
Authors: Karki B B , Mohammad S , Chung W , Eltweri A , Sauodi T , Dennison A , Garcea G
Published: October 2021

Background

Since the second surge of SARS-COVID-19 on 18th of September, additional several measures were introduced, and pathways created in order to execute safe surgical practices and protect both patients and staff from SARS-COVID-19. Despite these measures, there have been reported cases of outbreaks in various parts of UK amongst patients and clinical staff.

Method

Three outbreaks in the past 6 weeks (10, September 2020 to 21, October 2020) were reported in our surgical wards and we compiled the timing, initial source, number of affected individuals and immediate management steps taken.

Results

Following the first outbreak on wards, 28-day surveillance helped us understand responsible variants. Several staff members were found walking out of hospital, in groups once they had removed their PPEs. Communal lunching with inadequate social distancing, attending work with symptoms (albeit atypical for COVID), sharing cars to/from work or not wearing PPE correctly were highlighted in the subsequent investigations. The reduction in number of affected individuals during the last two incidents reflected a degree of efficacy of the implemented preventative measures, which were reviewed again following the subsequent incidents.

Conclusions

In the present climate, a robust and prompt response to outbreaks is required. Continual iteration with regards to the need for PPE, adequate social distancing and avoiding over-crowding in communal areas is paramount to reduce the probability of ward outbreaks and inter-professional transmission. Asymptomatic staff testing, particularly in high-risk areas could also be considered but would require adequate laboratory capacity and rapid turnaround of test results.
493 An Examination into The Impact of Sleep Deprivation on Surgeons
Authors: Antoniou V , Booth C C , Parry D
Published: October 2021

Background

Lack of sleep amongst surgeons is significant and worrying. It poses short- and long-term risks to surgeons’ health and negatively impacts patient outcomes. Previous studies have examined sleep deprivation amongst health care professionals. The aim of the present study was to examine impact in a specific population of surgical doctors.

Method

A questionnaire-based study completed in the anatomy department of King’s College London University. Surgical subjects spanned the United Kingdom. Subjects completed 14 questions regarding sleep habits. Data was compiled, calculating a sleep deprivation score.

Results

Valid responses were obtained from 66 surgical subjects of varying seniority. Mean age of subjects was 33.7 years old. 59.1% of subjects had rota commitments changing on a weekly basis. Average sleep amongst subjects amounted to 6.15 (± 1.26) hours per night. Daily sleep did not present differences dependent on seniority level (p = 0.186). 25.8% of subjects took >30 minutes to fall asleep. Our subjects woke 1.67 (± 1.21) times a night. Mean sleep deprivation score amongst our surgical population was 16.5 (± 4.26) demonstrating moderate negative impact on daily activities. 28.9% accumulated ≧20 sleep deprivation score demonstrating severe impact of sleep deprivation on life.

Conclusions

Our study has demonstrated reduced quantity and quality of sleep amongst our subject population. With protecting the health of both patients and surgeons in mind, we must place higher importance on improving sleep amongst surgical professionals.
1103 How to Report Noise in The Operating Theatre
Authors: Thompson N , Hampton T , Everett S , Krishnan M
Published: October 2021

Introduction

The reporting of operating theatre noise in the surgical literature dates back almost 50 years. The existing standards for noise and sound reporting in healthcare settings is heterogenous and there is a need for greater uniformity of reporting to support our growing understanding of the significance of communication and human factors on surgical performance.

Method

This presentation summarizes the existing Surgical and Acoustic Engineering industrial expertise to provide a narrative review of literature, grey reports and guidelines and then demonstrates appropriate reporting standards during Noise level recording in an operating theatre environment.

Results

We describe LAmax, LA90and LAeq expected levels. We compare our own theatre noise levels against these recommended standards for comparison. This presentation also suggests a suitable “ambient noise” (LAeq 65dB) level over which any communication devices or communication studies should benchmark when developing interventions to overcome noise in the operating theatre.

Conclusions

This paper proposes possible unified reporting standards and expected sound pressure levels against which future studies in this field could benchmark.
1227 The Impact of COVID-19 on the Wellbeing of Surgical Junior Doctors in a Tertiary Referral and Teaching Hospital
Authors: Griffin F , Heelan M , Kumar M
Published: October 2021

Introduction

Protecting the wellbeing of staff in the NHS is becoming ever more critical as we progress through this pandemic. We sought to identify the impact of the pandemic and changes in working pattern on wellbeing of doctors in training in a teaching hospital.

Method

Cross sectional study, with primary data collection using a web-based survey. Questionnaire was designed to identify issues relating to the personal wellbeing before and since the onset of the pandemic (Nov 2019-Feb 2020 vs March 2020- June 2020). Trainees in all surgical specialities were invited to participate.

Results

Thirty-six doctors responded. Across the timepoints there was a marked increase in reports of the following: constant fatigue (+500%), headaches (250%), loss of motivation (+500%), loss of interest in hobbies/friends (+566%), anger (+500%), loss of focus (+320%) and heightened emotional state (+700%). Almost 70% reported difficulty sleeping in the preceding month, with only 50% feeling they received adequate rest between shifts. Feelings of ‘too tired to drive’ increased by 216% with accidents or near misses increasing by 500%. Use of alcohol as coping mechanism increased by 500%, and comfort eating rose by 244%. 50% considered leaving their post.

Conclusions

These findings are significant and point to a dangerous trend if left unchecked. The causes of these outcomes are multi-factorial; changes to working patterns, cancellation of leave, redeployment, and anxieties around career progression were noted. The long-term health implications on the workforce should not be overlooked. This requires a collective response and action by employers, training and regulatory bodies and government.
1340 Is Displaying Mandated Information in Clinic Harming Patient and Society?
Authors: Herron J , Alleway P
Published: October 2021

Aim

The CQC has mandated certain pieces of information are displayed in a clinic and the staff know where to find them. This is in addition to the mandatory training that staff members undergo with increasing repetition. The UK Armed Forces is no exception to this, in addition wall space is often used as opportunistic education for patients.

Method

We counted the number of posters that were displayed in a CQC good, rated clinic, worked out the average cost to produce, produced a questionnaire of staff and patients to see how many times people engaged with the information and the carbon footprint of compliance. We looked timed how long it took for someone new to the clinic to spot the lifesaving information.

Results

140 items of literature took on average 65 minutes ±240 to produce, with an average of 9 pages per item ±190. Average cost was 10 pence per page when lamination was included, totalling £126. At 6000kg CO2/paper page and 1500kg CO2/laminate page, the total carbon footprint was 9,450,000 Kg CO2. Staff members engaged zero times with the literature and only one patient engaged. The time to spot the critical information in a clean room was 0.8 second, in a normal clinic room was 4.3 seconds.

Conclusions

Distractions can be detrimental in emergency situations and with human factors interplay this can cost people their lives. A 3.5 second delay may seem inconsequential but compounded could be devastating. The cost and Carbon footprint is extraordinary for little benefit.
249 Laparoscopic Assisted Enterolithotomy: A Viable Option in The Management of Gallstone Ileus
Authors: Angamuthu N , Alagaratnam S , D'Souza R , Varcada M
Published: October 2021

Introduction

Gallstone ileus (GSI) is a rare cause of small bowel obstruction in patients over the age of 65 years. We report a case of GSI treated successfully with a laparoscopic assisted enterolithotomy.

Case report

A 75-year-old female presented with two days of abdominal distension and vomiting with a non-peritonitic abdomen on examination. A computerised tomography scan demonstrated small bowel obstruction due to an obstructing stone in the distal ileum. Three port laparoscopy and small bowel assessment confirmed a solitary enterolith (4cms) in the distal ileum with upstream dilated loops. An infra-umbilical 6 cm midline incision was made and the localised bowel loop was delivered. An enterotomy was made proximal to the point of obstruction, stone retrieved, and a single layer interrupted closure was performed. Ten weeks post-operatively, patient had a virtual follow-up consultation and is doing well.

Conclusions

GSI often presents in elderly patients with multiple co-morbidities. A laparotomy with enterolithotomy is the initial treatment of choice with biliary intervention as a second operation, if needed, at a later date. Clearly, a conventional exploratory laparotomy in this cohort of patients carries a high risk and therefore the use of less morbid and less invasive procedure like laparoscopy should be considered. Although a total laparoscopic approach would require advanced laparoscopic skills particularly due to dilated bowel loops limiting the intra-abdominal space for suturing, a laparoscopic assisted approach as described above should be considered as a reasonable option within the remits of an emergency general surgeon.
290 Quality of Clinical Practice Guidelines for Laparoscopic Surgery: Systematic Review
Authors: Leung J , Leong J , Yeung K A , Hao D , Mclusky A , Kayani Y , Gurusamy K
Published: October 2021

Aim

Guidelines on laparoscopic surgery are essential for providing guidance to achieve safe and effective treatments. In this systematic review, we investigated the true extent of the grades of recommendation which were supported by evidence in the guidelines and whether this extent depended upon the quality of the guidelines.

Method

We searched PUBMED and EMBASE for laparoscopic surgical guidelines published between 1st March 2016 and 1st March 2019.To determine the extent of the grades of recommendation supported by evidence, we determined the disagreement in the grading between the guideline author and independent evaluation. We used the AGREE-II Tool ‘rigour of development’ and ‘clarity of presentation’ domains to assess the quality of guidelines. We performed a mixed effects generalised linear regression modelling using binary distribution and logit link in the GLIMMIX procedure of Statistical Analysis System (SAS) software.

Results

We analysed 1905 guideline statements from the 63 guidelines retrieved. The median of the scores for the ‘rigour of development’, ‘clarity of presentation’, the ‘editorial independence’ domains in the guidelines were 0.43, 0.72 and 0.63. The interquartile ranges were 0.094, 0.25 and 0.38. The ‘rigour of development’ domain was the only determinant of disagreement in the grades of recommendation guideline statements between the guideline authors and independent evaluation.

Conclusions

There is variation in the grades of recommendation in the guidelines. The ‘rigour of development’ domain can be used to predict quality of the guidelines. Guideline users should use the ‘rigour of development’ domain to assess the quality of the laparoscopic guidelines before developing local clinical policies.
486 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report
Authors: Tan M T , Akhter Rahman M M , Sasapu K
Published: October 2021

Introduction

Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis.

Presentation of the case

A- 9-year-old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management.

Discussion

The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment.

Conclusions

A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases.

Key Statement

Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.
1422 Are Blood Group and Antibody Screening Necessary Before Elective or Day Case Laparoscopic Cholecystectomy?
Authors: Bhambra T S , Pannu A , Jalal Q , Shah N , Rajput I
Published: October 2021

Aim

Laparoscopic cholecystectomy is generally safe with low rates of intraoperative bleeding. At present, there are no national guidelines on pre-operative blood group and antibody screening (G&S) for this procedure. The aim of this study is to establish the incidence of intraoperative haemorrhage requiring transfusion during laparoscopic cholecystectomy. This will indicate the necessity of routine preoperative G&S.

Method

Retrospective data collection of all patients having laparoscopic cholecystectomy at a large tertiary hospital from January 2015 to January 2020 (5 years). Patients having emergency procedures were excluded. The transfusion department records were used to identify any patients receiving a transfusion intraoperatively.

Results

2894 laparoscopic cholecystectomy procedures were performed over the 5-year period. 150 patients having emergency surgery were excluded. The final group consisted of 2744 patients. 1392/2744 (50.7%) patients were managed as a day case. 1352/2744 (49.3%) patients underwent elective surgery. 5/2744 (0.002%) patients received an intraoperative transfusion of blood products for the management of pre-existing haematological disorders.

Conclusions

No patients required transfusion for surgical haemorrhage. The small number of patients requiring transfusion were predictable because of clinical status. Our data is one of the largest series available. The results demonstrate that routine preoperative G&S is not justified. Instead, a selective approach would ensure high risk patients are appropriately screened. In event of vessel injury and major haemorrhage, O negative blood can be used. Furthermore, we estimate that elimination of a routine second G&S sample could have saved our institution approximately £5200 per year.
72 Increasing Radiotherapy Induced DNA Damage by Inhibiting Repair Proteins
Authors: Atkinson B , Wilson J
Published: October 2021

Introduction

Fanconi anaemia (FA) is a rare genetic disorder displaying higher incidences of head and neck squamous cell carcinoma (SCC). The surgical excision of these cancers is challenging and often supplemented with radiotherapy. One novel concept to improve survival rates is to increase the susceptibility of SCCs to radiotherapy. ATR is a protein responsible for homologous recombination repair (HRR) within the FA pathway and has been identified as a possible target for cancer therapy. Inhibition of ATR induces subsequent DNA damage. The primary objective of this study was to identify whether the inhibition of ATR can be achieved by exposing SCCs to mild hyperthermia. This novel concept aims to improve survival rates of patients with SCCs who require surgical excision and subsequent radiotherapy.

Method

By using a HRR assay it was possible to examine levels of DNA repair in various SCC cell lines following the exposure to radiation. These were compared to cells treated with heat, an ATR inhibitor and a mixture of both to determine whether heat reduces HRR.

Results

Repeated HRR assay’s showed SCC’s treated with heat, ATR inhibitor and a mixture of both before exposure to radiation underwent significantly lower levels of HRR compared to cells within the control.

Conclusions

Reduced HRR following exposure to heat increases the susceptibility of SCCs to radiotherapy. It is hoped that in combination with the surgical excision, this study will help to improve the outcomes of patients with head and neck carcinomas by improving the efficacy of radiotherapy.
270 A Retrospective Analysis of The Impaction Status of Mandibular Third Molars as A Risk Factor for Fractures of Angle or Condylar Region of The Mandible
Authors: Al-Harbawee A
Published: October 2021

Background

the position and angulation of mandibular third molars have both been found to influence the angle and condylar fractures. Objective: To identify whether there is an association between the depth and angulation of third molar impaction and the relative risk of fracture of the mandibular angle and condyle.

Method

Four-hundred and eighty-two panoramic dental radiographs were assessed for the period from January 2012 to June 2020. The study variables included the presence of mandibular third molars, position and angulation. The outcome variables were angle and condylar fractures.

Results

the mean age was 28.5 years (range 15-89) and 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted wisdom tooth (M3) ( p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with wisdom teeth classified as class II ( p = 0.026) and position B ( p = 0.05). In contrast, class I wisdom molars were more frequently associated with condylar fractures. With regards to the angulation of wisdom teeth, angles between 80 o – 100 o were highly correlated with angle fractures ( p = 0.020) whereas M3 angulations of 60 o – 80 o were related to condylar injuries (p = 0.025).

Conclusions

fractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I third molars were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80-100) and (60-80) respectively.
452 Dermal Filler Injection Leading to Facial Cellulitis: A Case Report
Authors: Baldock E , Devine C , Holden A , Colbert S
Published: October 2021

Background

Aesthetic medicine is a rapidly expanding field that is progressively becoming a normal part of society’s health and beauty regime. Hyaluronic Acid dermal filler injections are the second most widely performed aesthetic procedure, following Botulinum Toxin type A. Although serious complications are rare, they can have a detrimental impact on aesthetic outcome and general health. Infections following dermal fillers can be difficult to treat and have the potential to require hospital admission, intravenous antibiotics and surgical intervention.

Case description

We present a case of a 41-year-old female who suffered from facial cellulitis as a consequence of palpebro-malar groove dermal filler injections. The patient had 0.1ml of Monalisa dermal filler injected over her right malar prominence and suffered complications 6 days later, which eventually lead to the need for hospital admission on day 12 following the procedure for intravenous antibiotics. The management of this aesthetic procedure complication is outlined to highlight the risks and serious complications of these procedures.

Conclusions

Facial cellulitis is a rare adverse event following facial filler injection; however, it is an important risk factor to discuss during the consent process for these procedures. In addition, it is important that a highly trained and skilled professional performs these injections using a sterile non-touch technique due to the potential for serious complications and the anatomical proximity to vital structures.