bluuebunny/crossref_metadata_2025 huggingface dataset:
P19 An audit to improve ENT SHO confidence in using Floseal in the management of epistaxis
Authors: Ringrose T , Crossley E
Published: April 2021

Background

Departmental guidelines regarding the management of epistaxis were adapted to deal with the additional challenges presented during the Covid-19 pandemic. One of these adjustments involved the increasing use of haemostatic sealants such as Floseal in the management of epistaxis allowing reduced admission rates and hospital stay lengths for patients therefore reducing their risk of exposure to Covid-19.

Aims

To improve SHO’s confidence in using Floseal in the management of epistaxis.

Methods

A primary online survey was conducted to assess local ENT SHO’s confidence in making up and using haemostatic Floseal in the management of epistaxis. The SHO’s were then given teaching on how to make up Floseal and a poster including pictures was created. A secondary online survey was performed to re-audit the SHO’s confidence following this intervention.

Results

Of the 10 respondents, 3 had previous experience in using Floseal. Pre intervention the average confidence rating on a scale of 1 to 5 (5 – Most confident) in drawing up Floseal was scored at 2. Following teaching and implementation of the new poster the average confidence rating was scored at 4.4 (a 48% increase). From the respondents, 90% expressed that they found the poster useful and that they would also find further teaching on the use of Floseal beneficial in the future.

Conclusion

Teaching and creation of a clear stepwise poster including photographs improved ENT SHO’s confidence in drawing up Floseal. Ongoing education will be given to new juniors to ensure long-standing improvement.
P24 Audit reviewing viability of removing pre-operative Group and Save Tests prior to Transurethral Prostate Surgery during the COVID19 pandemic
Authors: Wong Nicholas
Published: April 2021

Introduction

COVID19 has stressed and stretched healthcare resources to the limit, thus the rational deployment of any resource should be necessary and of patient benefit. This retrospective audit aims to ascertain if a policy of two valid group and save tests prior to transurethral prostate surgery is necessary and if this resource can be redistributed safely during the ongoing pandemic.

Methods

A retrospective review of electronic patient records for patients that underwent transurethral prostate surgery from June 2017 to June 2018. During a single admission for surgery it was identified how many pre-operative group and save tests, and if a post-operative blood transfusion patients underwent.

Results

146 patients underwent transurethral prostate surgery between June 2017 to June 2018.

97 patients had two valid group and save tests prior to surgery. 49 patients did not have 2 valid group and save tests. 21 patients had expired tests, 20 had only one valid sample, and 8 had no group and save test at all.

No patient underwent a blood transfusion during their admission for transurethral prostate surgery.

Conclusion

This single centre study illustrates pre-operative group and save tests before transurethral prostate surgery are unnecessary as no patient required an associated blood transfusion during admission; and can safely be omitted. The clinical time and resource could be redirected elsewhere for greater patient benefit. £2855.00 of efficiency savings could be made foregoing unneeded group and save tests.

A policy omitting pre-operative group and save before transurethral prostate surgery will be implemented under COVID19 pandemic conditions and re-audited in 6 months.
P26 Barriers and Facilitators to Help-Seeking for Common Mental Disorders among University Students: A Systematic Review
Authors: Lui Joyce , Brown June
Published: April 2021

Background

High rates of mental health illness affect university students, most commonly depression and anxiety. Despite this, help-seeking behaviours are extremely low. This is the first systematic review aiming to summarise the barriers and facilitators to help-seeking for depression and/or anxiety among university students.

Methods

Three databases, EMBASE, MEDLINE and PsychINFO were searched for studies reporting barriers and facilitators to help-seeking for university students with depression and/or anxiety. In order to review data from both qualitative and quantitative studies, information on barriers and facilitators were coded into themes.

Results

Ten final papers were included; four qualitative and six quantitative. The most prominent barriers were self-reliance, stigma, physical barriers, poor awareness of mental health symptoms, poor knowledge of services and effectiveness, and symptom severity. Although there was significantly less research on facilitators, common facilitator themes were good mental health literacy and encouragement or pressure from others to seek help.

Conclusions

A recommendation from this review is the need to explore self-reliance as a barrier to help-seeking as this was the most commonly barrier, but a little researched area. Another recommendation is that more research is undertaken to investigate the facilitators to help-seeking. Clinical recommendations include using the internet to provide support and information on mental health disorders and services, implementing anti-stigma workshops in universities and integrating family members, partners, and friends into an individual’s mental health care. It is hoped that the findings from this review will be used to improve mental health services to address poor help-seeking behaviours among this student population.
P46 Effect of the COVID-19 pandemic on hip fracture patients in a Teaching London Hospital
Authors: Umarji Shamim , Sturley Rhonda , Tsinaslanidis Prodromos , Hing Caroline B
Published: April 2021

Introduction

Hip fractures are the commonest serious injury in older people, the commonest reason for older people needing surgery and the commonest cause of death following an accident. The NHFD is a national database whereby markers of care are recorded prospectively for patients over 60 years sustaining a hip fracture and requiring inpatient care, with a Best Practice Tariff linked to key performance indicators. The aim of this study was to review how care varied for patients sustaining a hip fracture during the COVID-19 pandemic compared to the equivalent time last year.

Methods

Using the NHFD we compared data from March – May 2019 to the same period in 2020 during the pandemic at St George’s Hospital. The study provides a snapshot of care during the pandemic.

Results

There were more admissions and more discharges during the pandemic. There was an increase in time to theatre and subsequent reduction in BPT. There was also an increase in non- operative treatment for these patients. 6 patients were confirmed COVID-19 positive, one of whom died. There was a reduction in time to ortho-geriatrician review and also a reduction in delirium review post-operatively. Length of stay was also reduced.

Conclusion

The COVID-19 pandemic had an effect on care provided to hip fracture patients. There was an increase in time and a deterioration in orthogeriatric review within 72 hours. The length of stay however improved due to improved focus on pathways and discharge processes. There was also a lower threshold to offer non- operative care wherever possible.
P47 Evaluating the Relationship of Pre-Assessment Host Systemic Inflammatory Response Biomarkers (Neutrophil Lymphocyte Ratio) to Post-Operative Infective Complication Risk in Colorectal Cancer Resection
Authors: Cooper Gordon , Knight Katrina , Bain Pamela , McLellan Morag , Torpiano Giuliana , Stewart Brian
Published: April 2021

Introduction

The host systemic inflammatory response (SIR) is prognostic in a wide variety of solid tumours, with a greater degree of inflammation being associated with a worse clinical outcome. Neutrophil Lymphocyte Ratio (NLR) is an established way to measure SIR in vivo. We aimed to establish whether preoperative NLR correlates with infective complications in patients undergoing colorectal cancer (CRC) resection.

Methods

Data was extracted retrospectively for all CRC resections over a 2 year period (2016-2018) at a single district general hospital. NLR was measured for each patient from bloods at the time of pre-operative assessment. Post-operative complications were recorded using the Clavien-Dindo classification and subsequently classified as infective and non-infective. A Two-tailed Mann-Whitney U test was used to evaluate the data from an online resource.

Results

Of the 131 patients, 49 had complications of which 20 were infective. Of total complications 58% were male and 35% were aged 75 years or older. Current or ex-smokers constituted 43% and 41 of the total patients had a BMI >30 kg/m2. Pre-assessment mean NLR was 2.3 in those without complications and 4.7 in those with any complication. A mean NLR of 5.4 was present in those with infective complications, p-value 0.026.

Conclusion

This study found that a raised NLR was present preoperatively in those who developed infective complications following CRC resection. This is a simple, readily available and cost-effective method of identifying patients at risk of complication. This ultimately may be useful in highlighting patients who would benefit from enhanced pre-operative optimisation. Further research to validate these findings in larger studies would seem warranted.
P49 Exploring medical student confidence in social media health advocacy through the lens of a pandemic
Authors: Veerappan Vigneshwar Raj , Begum Ruksana , Raja Abdullah , Quddus Tanjim , Senan Rahul
Published: April 2021

Introduction

Social media facilitates the rapid spread of information and misinformation to the public. Medical students as healthcare professionals in training have a responsibility to support public health advocacy. As such, it is important to understand whether medical students feel comfortable to use social media as a tool to promote public health. There is little literature evaluating this. The covid-19 pandemic gives us a unique opportunity to characterise this relationship.

Methods

This is a cross sectional survey-based study run by the student surgical society at Hull York Medical School. Data will be collected on confidence of medical students in receiving, appraising and resharing information on social media. The study will first be run as a single centre study. Following data collection and analysis, will be promoted to other student surgical societies across the UK to be run as a collaborative national study.

Results Primary Objective

How confident are medical students in receiving, appraising and resharing information they receive on social media?: Secondary Objective: Is there a relationship between years of training or postgraduate/undergraduate status and confidence in using social media amongst medical students? How often do medical students use social media as their primary source of information? Is there adequate education on how social media can be used to combat misinformation?: Conclusion: The covid-19 pandemic allows a unique opportunity to characterise the relationship between medical students, social media, and health advocacy. Understanding this relationship will help guide medical education to incorporate social media as an effective tool in healthcare.
P51 External Ventricular Drainage Insertion Audit
Authors: Lopuszko Aleksandra , McKenna  , Rosmarin Yordanov
Published: April 2021

Introduction

External Ventricular Drainage (EVD) is a neurosurgical technique used to lower the intercranial pressure while cerebrospinal fluid (CSF) flow is obstructed. The infection rate associated with the EVD insertion in the UK is 9.3%, with ventriculitis being the most common one. The aim of the audit was to compare our outcomes and infection rates and national standards and to implement an EVD Management protocol to improve patient outcome.

Methods

The data was collected from 43 patients, 98% of whom were emergency admitted cases. For all EVD procedures, silver coated catheters were used. The surgical factors such as the surgical team performance and the average operative time (1h 11min) were accounted for in the audit. The most common reason for EVD insertion was subarachnoid haemorrhage. Prophylactic antibiotics were administered in all cases before the surgery. 12% of the EVDs were used for Intercranial Pressure Monitoring.

Results

12% patients’ samples had catheter associated infections. The average EVD insertion period was 18 days. Leaks occurred in 11 cases (26%). 3 of them subsequently developed ventriculitis. White cell count result was over 10,000 cells per mm3 in 40% of patients.

Conclusions

Twice longer sampling time then the national average (8 days) increased the number of ITU transfers. The cause would be the use of out-of-date EVD type. However, the silver impregnated lines versus non-impregnated have a lower cerebrospinal fluid infection rate, the bolt connected EVDs would be more precise and decrease the rate of resuturing and hence decrease a chance of CSF infection.
P53 First Reported Case of Successful Non-Surgical Management for Acute Small Intestinal Obstruction Caused by Enterolith as A Rare Complication of Jejunal Diverticulosis
Authors: Quek Fang Fang , Tanase Andrew
Published: April 2021

Introduction

Enterolith ileus is a rare complication of jejunal diverticulosis, which in itself is a rare entity. Here we report a rare case of enterolith ileus as a complication of jejunal diverticulosis which is successfully managed conservatively.

Case Report

A 75-year-old female presented with a 7- day history of “gripey” abdominal pain with intermittent vomiting. She was able to pass flatus and had open bowel with small amount of loose stool. Patient was previously fit and well with no significant past medical history and had not undergone previous abdominal surgery. On admission, patient was in no acute distress and was afebrile. On examination, she had a very distended tympanic abdomen with left-sided tenderness but no palpable mass. Bowel sounds were present. Laboratory investigations revealed a white cell count of 22.6 x109/L, C-reactive protein of 26 mg/L and haemoglobin of 144 g/L. Abdominal X-rays revealed distended loops of small bowel indicating small bowel obstruction. CT images did not reveal pneumobilia which would be suggestive of gallstone ileus but showed intraluminal small bowel obstruction secondary to an enterolith in the terminal ileum. The scan also showed an inflamed jejunal diverticulum with fat stranding around but no perforation nor abscess was seen. The working diagnosis was acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum. Since no perforation nor abscess was noted, this patient was treated conservatively. Patient recovered uneventfully and was discharged with an MRI scheduled in 4-6 weeks for follow-up. The follow-up MRI was completely normal and patient has recovered uneventfully with conservative management.

Discussion

Acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum is rare. However, it is important to diagnose jejunoileal diverticulosis timely as they may lead to acute complications which can be life- threatening and may even cause death.

Conclusion

Many cases have reported jejunoileal diverticulosis being overlooked or misdiagnosed for other acute abdominal conditions. It is important to have a clinical awareness of this condition as although rare, it can lead to life-threatening complications.
P86 PANC Study - Pancreatitis: A National Cohort Study
Authors:   PANC Study Group
Published: April 2021

Introduction

Pancreatitis is a common, yet complex, surgical presentation with an incidence of approximately 56 cases per 100,000 people per year in the UK. The management of pancreatitis can vary significantly between different regions, hospitals or clinicians despite a number of national and international guidelines. Historic regional studies in the UK have shown management to be suboptimal with regards to time to diagnosis, higher dependency care or dynamic CT for severe cases and time to definitive treatment of gallstones.

Aim

We aim to assess current variation in practice in the management of patients diagnosed with early acute pancreatitis. This will identify areas for future research need, and give the groundwork for a potential future model of ambulatory care in a select subgroup of patients.

Study design

Pancreatitis: A National Cohort Study (PANC Study) is a multicentre, prospective cohort audit which will be conducted through trainee-led research collaboratives in Spring 2021. All patients >18 years, presenting with a diagnosis of acute pancreatitis by modified Atlanta classification, will be included during the 2-month collection period. Data will only be collected for the first 30-days from presentation. The data collected will include patient demographics, admission observations and investigations, aetiology, management and complications and will be anonymised and uploaded onto an online platform for analysis.

Conclusions

Management of pancreatitis has not been previously assessed nationally in the UK. Obtaining data on population characteristics, management choices and patient outcomes will allow for resource planning so that the service provision reflects local and national population needs.
P89 Patient reported comorbidity is not a reliable data source: a systematic review of the literature
Authors: Lin Chung Mun Alice , Ng Nathan , Orman Alexander , Clement Nicholas D , Deehan David J
Published: April 2021

Introduction

There is currently an increased demand for elective orthopaedic surgery. However, due to the ever-growing financial, time and resource limitations, there is a pressing need to identify those who would benefit most from surgery but with the lowest risk of complications. Comorbidities are a fundamental factor in this decision and the traditional way to ascertain this is through medical record data abstraction during pre-operative assessment. However, this can be time consuming and expensive. We therefore set out to establish whether patient reported comorbidities are reliable as a principal source of information.

Method

Searches were performed on PubMed and Medline, and citations independently screened. Included studies were published between 2010 to 2020 assessing the reliability of at least one patient reported comorbidity against their medical record or clinical assessment as gold standard. Cohen’s kappa coefficient values were grouped into systems and a meta-analysis performed comparing the reliability between studies.

Results

Meta-analysis data showed poor-to-moderate reliability for diseases in cardiovascular, musculoskeletal, neurological and respiratory systems as well as for malignancy and depression. Endocrine diseases showed good-to-excellent reliability. Factors found to affect the concordance included sex, age, ethnicity, education, living alone, marital status, number or severity of comorbidities, mental health and disability.

Conclusion

Our study showed poor-to-moderate reliability for all systems except endocrine, consisting of thyroid disease and diabetes mellitus, which demonstrated good-to-excellent reliability. Although patient reported data is useful and can facilitate a complete pre-operative overview of the patient, it is not reliable enough to be used as a standalone measure.
P94 Pre-Operative Fasting in Surgical Patients at Good Hope Hospital – Reducing incidents of unnecessary prolonged fasting periods in patients undergoing surgery
Authors: Kamath Anjali
Published: April 2021

Patients are often fasted from food and liquid for unnecessarily long periods of time prior to surgery. There is often misunderstanding amongst patients and even members of staff as to what exactly is meant by the pre-operative fasting rules, specifically the meaning of ‘clear fluids’. Prolonged fluid fasting can result in significant distress to adult and children patients through feelings of thirst, hunger and anxiety. Prolonged fasting can also negatively affect insulin resistance and severe cases of hypoglycaemia and hypovolaemia.

A questionnaire was handed out to elective surgical patients over a month period between September and October 2019. Data was then collated and compared to the 2011 ESA Guidelines standard where 100% of patients should be fasted appropriately. Results were presented and a poster was created which will be distributed at pre-operative assessment clinic and displayed in clinical areas and the day-case unit.

68 responses to the questionnaire were collected. The results showed that 58% of patients received both written and verbal advice about pre-operative fasting. However, 42% of patients stated they received no information about being able to drink clear fluids until 2 hours prior to their operation and therefore fasted from fluids for longer than required.

In conclusion there was still disparity between what exactly was meant by ‘clear fluids’ and many did not realise the list included coffee and tea without added milk. The next steps would be to implement clear posters outlining correct fasting rules and reinforce education to healthcare staff about this matter. Patients are often fasted from food and liquid for unnecessarily long periods of time prior to surgery. There is often misunderstanding amongst patients and even members of staff as to what exactly is meant by the pre-operative fasting rules, specifically the meaning of ‘clear fluids’. Prolonged fluid fasting can result in significant distress to adult and children patients through feelings of thirst, hunger and anxiety. Prolonged fasting can also negatively affect insulin resistance and severe cases of hypoglycaemia and hypovolaemia.
P104 Orion xTask: Improving neurosurgical workflow using an electronic tasks system
Authors: Koh Chan Hee , Nathan Arjun , Goacher Edward , Fernandez-Mendez Rocio , Owen Nicola , Martin Michael , Davies Benjamin Marshall , Joannides Alexis
Published: April 2021

Introduction

The dominant form of communication within hospitals remains the antiquated paging system. Pitfalls to pagers include: overwhelming volume of non-urgent bleeps; inability to prioritise at the point-of-bleep; no written record of communication - potentially compromising patient safety.

Orion xTask, an electronic tasks system, was implemented at Cambridge neurosurgery in April 2019 to mitigate some of these pitfalls.

Methods

Bleep logs, covering 2-months before and 4-months after xTask implementation with total 3181 bleeps, were obtained. xTask data for the same period (total 4195 electronic requests) was exported. Bleep response times for neurosurgery and for other specialties without xTask were collected. Questionnaires were distributed to nursing and medical staff.

Results

Daily averages of 14.4 in-hours and 23.7-out-of-hours electronic requests were made. The exception to greater out-of-hours utilisation was the ward without a dedicated doctor, where requests peaked in the morning. Prescription was most commonly requested (49%), followed by clinical review (17%).

There were daily averages of 13.0 in-hours and 8.3 out-of-hours bleeps. Changes in bleep volume with xTask implementation were inconsistent: Calls to ward bleeps decreased (p = 0.044), but increased to the on-call (p = 0.042).

Bleep response times, and (bleeped-)job completion times were significantly quicker for neurosurgery than for other specialties (p < 0.001).

Nursing and doctors’ feedback was overwhelmingly positive, with agreement that xTask improves patient safety. xTask scored particularly highly on “Improves Communication”, “Improves Record Keeping” and “Useful Out-of-Hours”. Doctors indicated that xTask also “Helps Prioritisation” and “Facilitates Educational Opportunities”.

Conclusion

The feedback and pattern-of-use indicates that Orion xTask successfully mitigates some of the pitfalls of pagers, thereby improving patient safety.
P108 Service Evaluation - the impact and lessons learnt from the COVID-19 pandemic on a UK burns centre
Authors: Phillips Georgina , Talwar Cyrus , Makaranka Stanislau , Collins Declan
Published: April 2021

The COVID-19 pandemic has dramaticallyimpacted healthcare provision in the UK and burns services have had to adapt to ensure the continuityof a safe care. As we return to " normalit y" we reflect on lessons learnt from our response to this pandemic.

A service evaluation was performed from patient notes between March 23rd and May8th 2020 and an anonymoussurveygiven to patients attending outpatient appointments.

258 patients were referred to our burns service and 148 patients completed the survey. Eleven burns were caused bytreatment or prevention of COVID-19. Patients delayed seeking medical attention due to concern of catching COVID-19 (36% adults, 8% children). There was a delayin referral of 17 patients despite them fulfilling the referral criteria. Infection rates were higher following delayed presentation (21% vs 6%). The majorityof burns were managed conservatively (237/258). Dressing changes were performed at home by32% of patients. The outreach team treated 22 patients.

During the pandemic telemedicine has improved the efficiencyof outpatient burn care and outreach nurses have enabled treatment of vulnerable patients. More must be done to raise public awareness of preventable causes of burn injuryand to reassure them to seek help when burns occur.
P117 Surgical management of Ureteropelvic Junction Obstruction (UPJO) in Neonates amid COVID-19 pandemic; Review of Literature and a Cohort Study in Iran
Authors: Sherafat Alireza , Ashraf Mohammad Ali , Ahmadian Sarina , Sarian Arni , Ramezannezhad Elham , Foroutan Hamid Reza , Hiradfar Mehran
Published: April 2021

Introduction

The current study presents a systematic review of literature on surgical management of ureteropelvic junction obstruction (UPJO) alongside an ongoing cohort study of neonates presenting with high grades of hydronephrosis due to UPJO requiring urgent treatment in a developing country amid the COVID-19 pandemic. The aim of this study is to investigate the efficacy and cost effectiveness of laparoscopic-assisted pyeloplasty.

Methods

Patients’ demographics, clinical presentations and treatment outcomes are recorded. The cohort is classified into 3 groups based on type of surgical treatment offered including open, laparoscopic and laparoscopic-assisted pyeloplasty. All patients admitted with grade 3-4 hydronephrosis due to UPJO are included. Patients with UPJO as part of a complex multisystemic syndrome are excluded. Literature review was conducted from 2000/1/1 to 2020/1/1 to include all original research papers on surgical management of UPJO. The age group was limited to neonates (under 1 year-old).

Results

32 articles were included in the review. 20 papers (62.5%) recommended open pyeloplasty, 10 papers (31.3%) recommended laparoscopic pyeloplasty and 2 papers (6.25%) recommended laparoscopic-assisted pyeloplasty. The cohort study is currently recruiting patients treated by the 3 surgical approaches.

Conclusion

The majority of studies are focusing on open pyeloplasty. However, as more surgeons are going through the learning curve of laparoscopic pyeloplasty, the trend is towards more laparoscopic management in the future. It is important to discover the advantages of laparoscopic-assisted approach as a new technique to improve the outcome and shorten the hospital stay amid the COVID-19 pandemic.
P119 The association of hand and wrist injuries with other skeletal injuries in multiple trauma patients in a UK Major Trauma Centre
Authors: Tsinaslanidis Prodromos , Smith Toby O , Brown Oliver S , Tsinaslanidis George , Umarji Shamim , Hing Caroline B
Published: April 2021

Background

There are 20,000 major trauma cases in England annually yet the association with concomitant upper limb injuries is unknown. Injuries of the hand and wrist can cause serious functional impairment, decreased quality of life and confer a significant economic burden to healthcare systems. The aim of this study was to determine the incidence, injury pattern and association of hand/wrist injuries with other injuries and the ISS score in multiple trauma patients in the UK.

Methods

A single centre retrospective cohort study was performed at a level one trauma centre. Trauma Association & Research Network (TARN) eligible patients during a 5-year period were included.

Results

A total of 107 patients were included in this study. Seventy patients had an ISS<15 and 37: had an ISS>15. The majority were male (70.1%) and the mean age was 45 Years. Hand and wrist injuries were the second most common injury found in 26.2% of patients.

There was a significant association between hand/wrist injuries and lower limb injuries (p = 0.04) and pelvic injuries (p = 0.02). The association between hand and wrist injuries with ISS score was found to be not significant (p = 0.82).

Conclusion

Hand and wrist injuries should be screened for in multiply injured patients with a pelvic or lower limb injury.
P121 The development of Core Outcome Sets and Common Data Elements in clinical neurosciences: a scoping review
Authors: Bandyopadhyay Soham , Horsfall Hugo Layard , Chari Aswin , Kolias Angelos G
Published: April 2021

Background

Core Outcome Sets (COS) are a consensus-based agreed minimum set of outcomes that should be measured and reported in all studies within a research field. Common Data Elements (CDEs) are the minimum data points that should be collected regarding the characteristics of population, condition and intervention. The use of COS and CDEs minimises research wastage by increasing the cross-comparison and meta-analysis of study findings.

Objective

The primary objective was to collate and describe the current process of developing core outcome sets and common data elements in published research pertaining to clinical neurosciences. The secondary objective was to identify the clinical neuroscience subspecialties that have developed COS and CDEs, the countries of origin of authors, and the process through which COS and CDEs were developed.

Design

A search between 2000-2020 of the top 40 Impact Factor neurosurgical and neurological journals was conducted. A scoping review was performed in accordance with the PRISMA-ScR Checklist.

Results

Our search returned 169 papers, of which 35 were eligible for inclusion in the present study. The USA published the majority of papers (20/35). The papers mostly related to neurosurgery (30/35), with the most common neurosurgical sub-specialty being traumatic brain injury (14/35) and subarachnoid haemorrhage (10/35). There is an increasing publication trend over time, with 12 papers published in 2019. COS and CDE development is an international collaborative process, with authors from a number of different countries. Five papers were systematic reviews conducting with the intention of COS/CDE development. 27 papers reported CDE development and 2 papers reported COS development (aphasia and non-specific low back pain). The COS development papers utilised international consensus meetings and adhered to international development statements.

Conclusions

COS and CDEs are an essential research tool to reduce research wastage and ultimately improve patient outcomes through homogenous outcome reporting, aligned with patient-derived outcomes. COS and CDEs are increasingly being developed within clinical neurosciences.
P123 The effect of having volunteers and face masks present at hospital entrances on the wearing of face masks and hand washing
Authors: Stanier Paul B , Lochab Savneet K , Grice John E , Stanier Paul B
Published: April 2021

Background

The spread of COVID-19 has put inpatients lives at risk and increased stress on hospital. Simple, cost effective measures such as mask wearing and hand hygiene have been shown to reduce the spread of droplet borne viruses. Compliance with these measures is variable and when performed improperly, reduce efficacy.

Objective

In this paper we aim to determine whether the provision of masks at hospital entrances and the use of volunteers to ensure correct mask wearing and hand hygiene can improve compliance with infection prevention measures for COVID-19.

Method

Visitor and staff compliance with mask wearing and hand hygiene measures were observed with and without the presence of masks and volunteers at hospital entrances at a District General Hospital.

Results

A total of 519 people were observed entering the hospital. Mask wearing went from 71% to 99% (P = <0.001) with the addition of volunteers. Provision of masks increased mask wearing from 56% to 97% (P = <0.001). Hand hygiene was improved from 9% to 84% (P = <0.001) with the presence of volunteers.

Discussion

A statistically significant improvement in hand hygiene and correct mask wearing was seen with both the presence of volunteers at hospital entrances and with the provision of masks. This is a relatively small study with heterogenous cohorts of staff and visitors. However, these results appear to indicate that use of volunteers and provision of masks at entrances may improve the compliance with the measures that been shown to reduce the in-hospital transmission of COVID-19.
P130 Timing of nasogastric tube insertion and risk of postoperative pneumonia: international, prospective cohort study
Authors:   EuroSurg Collaborative,   EuroSurg Collaborative
Published: April 2021

Introduction

This study aims to assess whether Prophylactic NGT insertion was associated with reduced rates of pneumonia, in comparison to Reactive NGT after colorectal surgery.

Methods

Pre-planned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January and April 2018 were included. Those receiving NGT were divided into three groups, based on the timing of the placement: Routine (at the time of surgery); Prophylactic (after surgery, before vomiting); and Reactive (after surgery, after vomiting).

Pneumonia within 30 postoperative days was considered as primary outcome measure and it was compared between the three groups using multivariable regression analysis.

Results

4,715 patients were included in the analysis. 1,536 (32.6%) received an NGT corresponding to 926 (60.3%) Routine, 461 (30%) Reactive and 149 (9.7%) Prophylactic. 200 patients (4.2%) developed pneumonia (No NGT: 2.7%; Routine NGT: 5.2%; Reactive NGT: 10.6%; Prophylactic NGT: 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the Prophylactic and Reactive NGT groups (OR: 1.03, 95% CI: 0.56 – 1.87, p = 0.932).

Conclusion

In patients who required NGT insertion after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery in comparison to reactive insertion.
P137 Virtual support for the newly formed stoma
Authors: Wright Francesca , Alford Natasha , McDonald Sophie , Okocha Michael
Published: April 2021

Background

214 stomas were created between January 2019 and January 2020 at our Tertiary Colorectal Centre. We surveyed patients to identify desirable features for a mobile stoma support application to mitigate potential challenges of limited in-person review.

Objective

The aim is three-fold: To survey stoma patients, identify literature on mobile applications supporting stoma patients and evaluate available stoma support applications.

Methods

A survey of 60 newly formed stoma patients focused on mobile application support. A systematic search, following the PRISMA checklist, determined the use of mobile applications in supporting stoma patients. A comprehensive search of mobile applications on IOS and Android stores was performed.

Results

79% of patients under 70 years old, and 58% of patients over 70, were interested in using a mobile application. 45 patients wanted an application that could photograph their output. Output and soft tissue management were the most cited reasons for contacting the stoma care nurse. The literature search yielded 196 publications; 4 studies met the eligibility criteria. One study found self-efficacy of stoma care improved after the app-based intervention. One stoma mobile application met the inclusion criteria: ‘Ostobuddy osto companion’; features include measurement of output volume, photography and diary keeping. 21 fluid intake applications included features to customise water input and record fluid history.

Conclusion

Mobile applications can ease strain on services whilst improving care. This study indicates, a mobile application including a stoma output diary and photography would be well received by patients and could improve self-efficacy and care of the stoma.
P138 What are medical students’ perceptions of human factors in simulated learning events: a thematic analysis
Authors: Tebbett Alex , Jennings Jo , Bannon Chris , Brown Mike , Khan Qasim , Shuker Ben , Shanmugam Rathinavel , Ranganathan Mohan
Published: April 2021

Introduction

Human factors, such as communication skills, are imperative to good patient care. In post-simulation debriefs we discuss these non-technical skills with medical students regularly, but do we have a good appreciation of what the terms mean to them, or what aspects of behaviour, good or bad, they focus on?

Method

Six human-factor sheets were developed to guide the students in their analysis of events in simulated scenarios. The sheets focused on one of: communication, teamwork, decision making, task management, situational awareness, or a final overview. A brief introduction to each factor was given as well as examples of good practice. The students were encouraged to record in writing what aspects of the scenario went well, and what could be improved, for a chosen skill. These sheets were then collected at the end of the session, with the students’ consent, for anonymous analysis. Data collection commenced last month and will run until December, with an estimated inclusion of about 100 students from two universities. The data will be analysed using thematic analysis performed by multiple researchers.

Discussion

If we can understand what aspects of these non-technical skills are considered important to our students early on in their career we can better tailor our teaching, both in simulation and in the clinical environment, to foster better performance throughout their training. By understanding what our students perceive, analyse, and internalise we can also reflect on our own practice and interactions to consider how we project as role models to our future colleagues.
P139 Women's Health Care during COVID-19
Authors: Rimmer Michael P , Al Wattar Bassel A , Barlow Catriona , Black Naomi , Carpenter Ciara , Conti-Ramsden Frances , Dalton John A W , Davies Rhianna , Davies Rebecca , Dunlop Cheryl , Guyett Elvena , Jamison Laura , Karavadra Babu , Kasaven Lorraine , Lattey Katherine , Long Emma , Macmahon Caroline , Navaratnam Kate , Nijjar Simrit , O’Brien Stephen , Ojukwu Obi , Parnell Laura , Raglan Olivia , Ramcharn Meera , Riches Jenny , Stocker Linden Jane , Wong Siew Chee , Wyeth Charlotte
Published: April 2021

Introduction

The coronavirus disease 2019 (COVID-19) pandemic is disrupting health services worldwide. Women's health care is often acute and in continual demand, with poor health outcomes seen in women's health in particular in the recent Ebola and Swine flu epidemics. Regrettably, early reports globally and in the UK have shown a rise in the stillbirth rate. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic.

Methods

We undertook an interview-based national survey of junior doctors in obstetrics and gynaecology in women’s healthcare units in the National Health Service using the network of the UK Audit and Research Collaborative in Obstetrics and Gynaecology. We sought responses on general training, labour ward care, antenatal and postnatal care, benign gynaecology and gynaecology oncology services.

Results

We received responses from 148/155 units (95%) contacted. Most completed speciﬁc training drills for managing obstetric and gynaecological emergencies (89/148, 60.1%) and two-person donning and dofﬁng of personal protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19-speciﬁc protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148,70.8%). Most units suspended elective gynaecology services (131/148, 88.5%). The 2-week referral pathway for oncological gynaecology was not affected in half of the units (76/148,51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%)

Discussion

Women's health care services have responded well to the acute phase of the COVID-19 pandemic, however further planning is required for the long term.
V12 VIRTUAL: Virtual InteRacTive sUrgicAl skiLls classroom – A Randomized Controlled Trial Proposal
Authors: Nathan Arjun , Fricker Monty , Hanna Nancy , Asif Aqua , Patel Sonam , Georgi Maria , Hang Kien , Sinha Amil , Mullins Will , Lamb Benjamin , Sridhar Ashwin , Kelly John , Collins Justin
Published: April 2021

Introduction

High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction and feedback. They may optimise resources and increase accessibility, facilitating larger-scale training whilst producing a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method

72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will receive virtual classroom training. The assessed task will be to place three interrupted sutures with hand tied knots. Pre- and post-intervention Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will be measured. Feasibility and accessibility will also be assessed.

Results

Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine relative performance.

Conclusion

To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual BSS classroom training as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient virtual BSS training programs during the COVID-19 pandemic and in the future.
Inhibitory control in children with tic disorder: aberrant fronto-parietal network activity and connectivity
Authors: Jurgiel Joseph , Miyakoshi Makoto , Dillon Andrea , Piacentini John , Makeig Scott , Loo Sandra K
Published: April 2021

Chronic tic disorders, including Tourette syndrome, are typically thought to have deficits in cognitive inhibition and top down cognitive control due to the frequent and repetitive occurrence of tics, yet studies reporting task performance results have been equivocal. Despite similar behavioural performance, individuals with chronic tic disorder have exhibited aberrant patterns of neural activation in multiple frontal and parietal regions relative to healthy controls during inhibitory control paradigms. In addition to these top down attentional control regions, widespread alterations in brain activity across multiple neural networks have been reported. There is a dearth, however, of studies examining event-related connectivity during cognitive inhibitory paradigms among affected individuals. The goal of this study was to characterize neural oscillatory activity and effective connectivity, using a case–control design, among children with and without chronic tic disorder during performance of a cognitive inhibition task. Electroencephalogram data were recorded in a cohort of children aged 8–12 years old (60 with chronic tic disorder, 35 typically developing controls) while they performed a flanker task. While task accuracy did not differ by diagnosis, children with chronic tic disorder displayed significant cortical source-level, event-related spectral power differences during incongruent flanker trials, which required inhibitory control. Specifically, attenuated broad band oscillatory power modulation within the anterior cingulate cortex was observed relative to controls. Whole brain effective connectivity analyses indicated that children with chronic tic disorder exhibit greater information flow between the anterior cingulate and other fronto-parietal network hubs (midcingulate cortex and precuneus) relative to controls, who instead showed stronger connectivity between central and posterior nodes. Spectral power within the anterior cingulate was not significantly correlated with any connectivity edges, suggesting lower power and higher connectivity are independent (versus resultant) neural mechanisms. Significant correlations between clinical features, task performance and anterior cingulate spectral power and connectivity suggest this region is associated with tic impairment (r = −0.31, P = 0.03) and flanker task incongruent trial accuracy (r’s = −0.27 to −0.42, P’s = 0.0008–0.04). Attenuated activation of the anterior cingulate along with dysregulated information flow between and among nodes within the fronto-parietal attention network may be neural adaptations that result from frequent engagement of neural pathways needed for inhibitory control in chronic tic disorder.
High neutrophil/lymphocyte ratio at cancer diagnosis predicts incidence of stroke in cancer patients
Authors: Kawano Tomohiro , Sasaki Tsutomu , Gon Yasufumi , Kitano Takaya , Kanki Hideaki , Todo Kenichi , Shimamura Munehisa , Matsumura Yasushi , Huang Ao , Hattori Satoshi , Mochizuki Hideki
Published: April 2021

Although cancer increases the incidence and severity of ischaemic stroke, there is no reliable method for predicting ischaemic stroke in cancer patients. To evaluate the prognostic capacity of the neutrophil-to-lymphocyte ratio at cancer diagnosis for predicting the incidence of ischaemic stroke, we used a hospital-based cancer registry that contained clinical data from all patients treated for cancer at Osaka University Hospital between 2007 and 2015. The neutrophil-to-lymphocyte ratio was calculated after dividing absolute neutrophil counts by absolute lymphocyte counts. These counts were obtained within 1 month after cancer diagnosis. The primary endpoint was new-onset ischaemic stroke within 2 years after cancer diagnosis. Of the 18 217 included cancer patients (median age: 65.2 years), 69 (0.38%) had ischaemic stroke. Unadjusted Cox regression analysis stratified by cancer site demonstrated that each 1-unit increase in the neutrophil-to-lymphocyte ratio was associated with a significant 7.2% increase in the risk of an ischaemic stroke event (95% confidence interval 1.041–1.103, P < 0.001). Survival tree analysis and the Kaplan–Meier method suggested that patients with and without atrial fibrillation who had increased neutrophil-to-lymphocyte ratios had a higher risk of ischaemic stroke. Multivariate Cox proportional hazard models, adjusted for cancer site and stage, revealed that patients with high neutrophil-to-lymphocyte ratios (>15) had higher ischaemic stroke risk than patients with low neutrophil-to-lymphocyte ratios (<5). This was true among cancer patients both with (hazard ratio 11.598; 95% confidence interval 0.953–141.181) and without (hazard ratio 7.877; 95% confidence interval 2.351–26.389) atrial fibrillation. The neutrophil-to-lymphocyte ratio at cancer diagnosis is associated with the incidence of ischaemic stroke among cancer patients and might thus be useful for identifying patients at high risk of ischaemic stroke, allowing us to guide future preventive interventions.