bluuebunny/crossref_metadata_2025 huggingface dataset:
328 Renal Cell Carcinoma (RCC) Metastasis to the Coracoid Process
Authors: Patel M. , Wignakumar A. , Deshpande A.
Published: February 2022

A 51-year-old man was diagnosed with renal cell carcinoma (RCC) of the left kidney seven years ago. The tumour was staged as T2N0M0 and the patient underwent an uncomplicated open left radical nephrectomy. The RCC was classified as clear cell and he was kept on biannual renal surveillance thereafter.

Six years after the nephrectomy, the patient had reported a 5-month history of worsening pain and globally restricted movement in their right shoulder. A palpable mass on the coracoid process was noted. MRI imaging had shown a 27x30x17mm lesion suggestive of an expansile osseous mass in the coracoid process. An ultrasound guided biopsy was performed for definitive characterisation. Histology had reaffirmed that the lesion was in fact metastatic clear cell carcinoma in keeping with the patient’s renal primary. CT chest/abdomen/pelvis and NM-Bone SPECT CT scanning had shown no other sites of metastasis. A marginal resection of the lesion was performed with a good macroscopic clearance.

The common sites within the skeleton implicated in RCC include the spine, pelvis and femur. Tumours of the coracoid process are exceedingly rare. From the literature, only four cases of metastasis to the process have been noted: two from breast carcinoma, one from hepatocellular carcinoma and the other from basal cell carcinoma. Thus, this case denotes an extraordinary presentation for a metastasis of RCC many years after the nephrectomy. Furthermore, it emphasises the criticalness of regular follow-up and early intervention as delays could lead to systemic metastasis and a poorer prognosis.
337 Are Surgical Trainees Reviewing Their Post-Operative Patients in Cardiothoracic Surgery?
Authors: Ijaz A. , Hunter S. , Sadeque S.
Published: February 2022

Aim

Operating surgeons should review their post-operative patients regularly. They are responsible for decision-making on further management and planning discharge. Trainee surgeons who have operated should be reviewing their patients and encouraged to make independent decisions to develop their clinical judgement and responsibility for patient care. There are no specific guidelines on the number of recommended reviews in the post-operative patient

Method

40 patients taken from cardiothoracic operating lists. Patients selected where the documented 1st operator was not a consultant. This was done using operative notes recorded on Infoflex. Operation date, type of operation, total days as inpatient, discharge date and number of days reviewed by the 1st operator were recorded. The results were presented to both consultants and registrars locally and an open discussion was held to make improvements. The audit was repeated 6 months later.

Results

Average inpatient stay post-operatively was comparable: 6.4 vs 6.9 days. There was a significant increase: 2.7 vs 0.6 days of average reviews by the lead operator. 9% to 39% increase. In phase 1, only 42% of patients were reviewed at all by the lead operator. In phase 2, this increased to 100%.

Conclusions

Open discussion and joint planning between consultants and registrars has led to an improvement in surgical trainee engagement in post-operative management. There is still scope for further improvement on documentation and communication with the on-call consultant. On multiple occasions the patients were reviewed but this was not documented or communicated with the consultant.
338 Medical Student Engagement with Surgery and Research During the COVID-19 Pandemic: Supporting the Future Workforce for Post- Pandemic Surgical Recovery
Authors:   Student Audit and Research in Surgery (STARSurg) Collaborative
Published: February 2022

Introduction

Medical students have lost invaluable exposure to surgery and research during the COVID-19 pandemic, resulting in missed opportunities and mentorship essential to career decision-making. This study aimed to explore the impact of COVID-19 pandemic and the influence of regional educational events on student engagement with surgery and academia.

Method

A series of virtual regional events on academic surgery were delivered in 2021 across the UK and Ireland. Attendees completed post-event feedback, including questions on their experience of engagement with surgery and research during the pandemic, and the impact on career interests. 5-point Likert scales were used to assess agreement (from 1 [“strong disagreement”] to 5 [“strong agreement”]). Data were summarised using mean and standard deviation (SD), and mean differences (MD) compared using parametric tests.

Results

Of ∼850 attendees across 31 events between January and May 2021, 393 students responded. The pandemic had made engagement with surgery (mean: 3.95, SD: 1.01) and research more challenging (mean: 3.79, SD: 1.03). Those undecided on a surgical career reported a significantly larger increase in knowledge (MD: 0.42, 95% CI: 0.25–0.59, p<0.001) and intention to consider a surgical career (MD: 0.41, 95% CI: 0.26–0.56, p<0.001) after the event, than those who had already decided.

Conclusions

Accessible opportunities are needed to combat the lack of surgical and research experience caused by the pandemic. Concrete efforts at grass-root and national levels are required to continue encouraging a representative and research-active surgical workforce.
339 Single Use Flexible Scopes in Percutaneous Renal Surgery
Authors: Olaitan O. , Pinnamaraju P. , Nemade H. , Pai A.
Published: February 2022

Introduction

Flexible nephroscopy is performed at the end of percutaneous nephrolithotomy (PCNL) to confirm stone clearance. Flexible cystoscopes are commonly used to perform nephroscopy through the PCNL tract, however reusable scopes can provide limited optics due to procedural factors such as renal bleeding and scope factors such as fibre-optic damage. The Ambu® aScope™ 4 Cysto (AmbuScope) is a single-use disposable, video flexible cystoscope which has been solely used in the outpatient setting for bladder visualisation. We describe the first experience of the single use scope in nephroscopy during PCNL.

Method

Retrospective data was collected and analysed in a 6-month period from 13 consecutive patients undergoing PCNL using the AmbuScope for flexible nephroscopy. Stone free rates on nephroscopy, post-op complications, surgeons’ useability scores and theatre staff opinions were collated.

Results

All procedures were completed without complication or scope malfunctions. One patient died 27 days post operatively from urosepsis and osteomyelitis: unrelated to the single use scope. All other cases had an uncomplicated recovery. Surgeon useability scores rated the scope as easy (40%) or very easy (60%) to access, very user friendly (100%) and had good (20%) and very good (80%) image quality. 60% of respondents preferred to use the Ambu® aScope™ over the reusable scope. The single scope was found to be more cost-effective at £135 compared to £166 for reusable scopes.

Conclusions

This study is the first to show that single use scopes are safe, user friendly and cost effectively used during percutaneous nephroscopy.
343 Medical Teaching in the Covid Era: The Rise of the Webinar
Authors: Baig A. , Parwez R. , Rahman S. , Itum H. , Khoudir M.
Published: February 2022

Background

Since the emergence of COVID-19, virtually the whole world has been forced to into lockdown and adapt to a way of life not seen in living memory. Although pandemics are not new, nor will this likely be the last, the modern era has one major advantage that our ancestors did not have: the internet.

Through the usage of modern technology and the internet, we have been able to continue our professional lives through a virtual medium through programs like Zoom. As part of this virtual shift, medical teaching is also mainly online. A QI study was conducted on webinars.

Aim

To determine whether medical students and junior doctors find online teaching to be an effective medium of learning, as well as to determine the advantages and disadvantages, including mental health impact.

Method

A webinar series was created, entitled back2basics (B2B) surgery, which was run for around 2 months with weekly, 1-hour long webinars on a surgical topic. Feedback was collected following each session specific to that week’s webinar as a general opinion of our participants on webinars.

Results

Both qualitative and quantitative data was collected. The majority (83%) of participants agreed by the 8th week that webinars were an effective mode of medical teaching compared to 48% in the 1st week. Participants pointed out that webinars are ‘low pressure’ and ‘less competitive’ than in person lectures, so good for mental health.

Conclusions

Participants agree that the webinars are effective for medical teaching and that there are mental health benefits.
346 Accuracy of Tympanic Versus Digital Infra-Red Thermometers for Measuring Core Body Temperature in Critical Care Department - a Quality Improvement Project During Covid-19 Redeployment at a District General Hospital in Surrey, England
Authors: Kesharwani D , Thacker J , Dsouza W , Somasundaram K
Published: February 2022

Aim

Accurate determination of core body temperature in critically ill patients is required for initiating diagnosis and management. (1) Ideally, temperature measurement should be non-invasive, hygienic, convenient, and affordable. Infrared thermometers are convenient and non-invasive but sensitive to environmental factors. Alternatively, tympanic thermometers are cost effective but invasive. Various observational studies have concluded that tympanic thermometers have high specificity/sensitivity compared to infrared thermometers (2,3). We aimed to demonstrate accuracy of tympanic over infrared thermometers.

Method

In this observational prospective study, eighty patients (forty each) admitted in intensive care from February 2021 – July 2021 were included. Temperature measurements with were conducted - measuring differences between digital and tympanic thermometers. A Plan Do Study Act cycle was used to facilitate change. Excel and SPSS software were used for data analysis.

Results

Our study concluded a statistically significant (p<0.01) difference in readings with mean difference of 1.18°C (highest -6°C, lowest- 0.5°C). Pyrexia was undetected in 4 of 40 patients with digital thermometers. Additionally, two patients undergoing hypothermia correction were not adequately measured. Therefore, infrared thermometers were significantly less sensitive and were replaced with tympanic thermometers. A second cycle conducted again demonstrated significant (p<0.01) difference with mean difference of 1.92°C. (highest -6.5°C, lowest -1°C).

Conclusions

Tympanic thermometers have higher accuracy and precision over digital thermometers. We managed to establish change during our audit with concluding evidence showing infrared thermometers procure false observations affecting patient care, hence, unsafe. In conclusion, tympanic thermometers should be encouraged in critical care settings for vigilant care.
349 Improving Surgical Teaching for Junior Trainees Internationally in Light of Covid-19
Authors: Turner B. , Jasionowska S. , Bakko F. , Huttman M. , Hall R. , Doshi A. , Agarwal T.
Published: February 2022

Aim

During the Covid-19 pandemic there has been a gross effect on surgical training at all grades. A cohort that has been affected but reported less frequently are medical students and foundation doctors (junior trainees), whose interest in the field and clinical skills may have been affected by reduced service provision.

Method

A survey of junior trainees was conducted to analyse their perceived adequacy of surgical teaching in light of the effect of Covid-19. An online teaching course was then designed to target areas of weakness identified in the survey. The content was designed with the Imperial College London surgery curriculum and was vetted by a consultant surgeon.

Results

Of the 713 people surveyed, 393 (55%) had received little or no surgical teaching and 496 (70%) respondents said they were “not” or “slightly” confident in managing common and emergency surgical presentations. A free text box highlighted that deteriorating patients, clinical decision-making, and initiating management were the greatest concerns. This was used to design an international online teaching course for junior trainees, that focused explicitly on clinical care. The sessions were run live on MindTheBleep via Facebook live, to answer questions in real time and examine cases with live audience participation, receiving feedback after every session. This model has reached trainees in >30 countries with >200 feedback responses and an average rating of 4.5/5.

Conclusions

Junior trainees are a key cohort whose interest and education in surgery has suffered due to the pandemic. An innovative, online, clinically orientated course is assisting to re-engage trainees internationally.
353 The Rise of the Exoscope
Authors: Parwez R. , Baig A. , Rahman S.
Published: February 2022

Introduction

An exoscope is a next generation HD telescope video monitoring system used to perform microsurgeries that is now a formidable rival to the existing operating microscope in neurosurgery. While the microscope revolutionised neurosurgery with its advent in 1957, the exoscope allows surgeons to operate utilising high-definition images enhancing the field of vision and focus. The exoscope opens new avenues with regards to ergonomics, teaching in theatre and enhances the surgeon’s experience.

Method

We will do a literature review on available literature on the use of exoscope in neurosurgery with regards to the operating microscope. Both qualitative and quantitative data will be reviewed. Personal experience of Neurosurgeons in our unit will also be reviewed using questionnaires.

Results

The exoscope has many benefits when compared to the operating microscope where it surpasses its predecessor in many ways. 15 studies were reviewed where the exoscope was compared to the operating microscope which concluded the exoscope equal or superior in many aspects such as teaching, ergonomics, image definition and being user friendly. There were some pitfalls of the exoscope reported such as the image being in 2D which limited the surgeon’s stereoscopic vision and the costs involved.

Conclusions

The exoscope is a revolutionary advent in neurosurgery and may soon make the operating microscope obsolete but there is still room for improvement.
354 Virtual Consultation in Vascular Practice: The New Normal
Authors: Lo N. , Khan M. , Sadia U. , Jaipersad A.
Published: February 2022

Aim

Face to face vascular clinics were suspended at a major trauma centre at the beginning of the COVID-19 pandemic, however Royal Stoke Hospital Vascular team were still undertaking emergency vascular operations. Consequently, virtual telephone consultations were set up and delivered to facilitate post-operative follow ups. The objective of this improvement study is to compare the virtual clinic documentation against The Royal College of Surgeons of England (RCS Eng) Best Practice Guidance on Conducting Virtual Consultations, which was published in June 2020. This is important as good documentation is vital to patient care as well as being a medico-legal document.

Method

We retrospectively identified 30 vascular patients operated between May 2021 and June 2021; 10 of which had had a virtual telephone clinic and the majority underwent an amputation. We audited the clinic note documentation against the RCS Eng guidelines.

Results

Total of 9 RCS Eng guidelines were identified and audited. The first cycle revealed poor areas in documentation of the surgeon introducing themselves, confirmation of patient details, obtaining consent to proceed, summary of consult and plan discussed.

Findings were presented at the trust governance meeting. Areas which required improvement in documentation were highlighted. In addition to education of surgeons, it was decided to introduce a checklist as a requirement.

Conclusions

Clinic note documentation is of paramount importance as it has legal and medical ramifications. The education of surgeons and introduction of a checklist to ensure compliance with RCS Eng guidelines and we will re-audit to ensure improvement.
357 A Novel Protocol for Post-Operative Bloods Following Elective Colorectal Cancer Resections - a Re-Audit of a Closed Loop
Authors: Matwala K. , Iqbal M.R. , Walton S.J.
Published: February 2022

Aim

Indications for blood tests are often poorly considered. Appropriate blood requests reduce trauma for patients, improve laboratory workflow and reduce costs. We therefore created a novel protocol for bloods requested in the post-operative period for patients undergoing elective colorectal cancer resections.

We performed two audit cycle loops to assess protocol adherence and evaluate financial savings.

Method

The protocol was agreed locally by consultant consensus, presented locally in February 2021, and displayed on surgical wards in May 2021.

Bloods requested were reviewed retrospectively for patients undergoing elective colonic resection with an uncomplicated post-operative course. Data was collected prior to the local meeting between September-November 2020 (audit 1, cycle 1), after the meeting between March-April 2021 (audit 2, cycle 1), then after distribution of the protocol to wards between July-August 2021 (cycle 2).

Results

The locally agreed protocol was post-op day 1,5,7 FBC, U&E, CRP; day 3 FBC, U&E, CRP, LFT; day 2,4,6 no bloods.

In audit 1 (cycle 1) 100% protocol adherence would have saved £15.96 per patient (n = 20). In audit 2 (cycle 1) the protocol was followed on 21.4% of days with further savings of £14.21 per patient (n = 23) had there been 100% adherence. In cycle 2, there was 40.74% protocol adherence with £6.62 further potential savings per patient (n = 15).

Conclusions

Following the post-elective colorectal resection bloods protocol may save our hospital £1700 per annum. Protocol adherence improved when displayed on surgical wards. With these exciting results, we are working with Medway EPR to create an order set containing this protocol.
358 An Anatomical Study of the Sylvian Fissure Using a Large Number of MRI Data Sets
Authors: Chia C.W.L. , Shastin D. , Gray W.
Published: February 2022

Introduction

Accurate manoeuvring of the Sylvian fissure borders to provide an optimal operating corridor is vital for minimising retraction. The anatomy of the fissure can pose technical challenges impacting the overall success of the procedure. Yaşargil previously proposed a classification distinguishing four anatomical variants correlating with surgical difficulty. We aim to utilise the open-source Human Connectome Project MRI data set to provide a computational classification of the fissure based on morphology.

Method

MR images of 2226 hemispheres were included in this study. Morphometrical parameters were designed and refined in MATLAB simulations. Combinations of parameters were analysed using K-Means Clustering.

Results

Following segmentation and removal of outliers, 1693 fissures remain for analysis. K-Means Clustering revealed three clusters with sulcal bulk displacement measure (deviation of the fissure towards the frontal or temporal lobe) and sulcal distance (width of the fissure) (silhouette score = 0.383).

Conclusions

Analysis of a large neuroimaging cohort suggested the existence of three weakly separated anatomical variants. We propose that looking at the quantitative scores rather than class allocation would be more informative for preoperative planning.
362 Neurological Outcomes in Patients Presenting with a Low GCS Due to CSDH
Authors: Edwards B. , Zolnourian A. , Sadek A.R.
Published: February 2022

Introduction

Chronic Subdural Haematoma (CSDH) is a common neurosurgical pathology. Neuroprognostication remains a challenge and evidence remain limited, particularly in patients presenting with a low GCS (8 or lower). Further clarification on neuroprognostication is important to inform surgical decision making.

Method

1278 patients who had CSDH surgically evacuated were retrospectively reviewed for GCS at presentation. 77 patients with GCS of 8 or less were detected. Mortality at discharge and 6 months, GCS, Glasgow Outcome Score (GOS) on discharge, discharge destination and other relevant clinical information were recorded from their paper and electronic notes.

Results

35 patients (45.4%) had a good neurological outcome (GOS 4 or 5). Inpatient mortality was 7.8% (n = 6). 6-month all-cause mortality was 20.7% (n = 16). Only 21.1% were discharged directly to their usual place of residence, with the remainder being discharged to local hospitals or rehabilitation units. Overall GCS (p = 0.003) and motor score (p = 0.013) at presentation was significantly associated with neurological outcome. Only overall GCS was associated with inpatient mortality (p = 0.037) but there was no association with mortality at 6 months (p = 0.603).

Conclusions

GCS of 8 or less in patients with CSDH is an important finding, with significant subsequent neurological morbidity and mortality. Although it is not the only prognostic indicator, a large number of patients had a good outcome despite this, indicating that intervention is not futile in all.
363 Developing an International Clinical Teaching Programme for Final Year Medical Students for the COVID Pandemic and Beyond, an Italian Experience
Authors: Vijayagopal K.A. , Wa Katolo H.
Published: February 2022

Introduction

During the COVID-19 pandemic medical students’ time in a clinical setting in the University of Pavia (UNIPV) had been greatly reduced for justifiable safety concerns.

Aim

Providing clinical teaching to medical students with an international network of UNIPV alumni.

Method

We recruited a cohort of UNIPV alumni, now working as junior-doctors throughout the UK and Ireland to teach and share their experience in assessing patients and creating management plans for commonly encountered scenarios on-call. 12 sessions were held over Zoom Online Videoconferencing and covered a broad surgical and medical syllabus via clinical cases. Pre- and post- teaching questionnaires were used to review the outcomes of intervention.

Results

Students reported an average confidence increase from 4.48/10 to 6.63/10 in patient assessment. Encouragingly, confidence in history taking stood at 8.38/10 after participating in the course. 37.5% of participants were interested in becoming tutors when running the course again next year and overall, 75% of participating students would recommend this course to students in successive years.

Conclusions

From our results the significant increase in confidence of students in assessing, examining, and patients as expected of day one junior doctors is notable. One limitation was the inability to substitute the practical skills aspect of clinical teaching due to the online delivery of the course. A future ‘blended’ delivery may overcome this. Given its positive response, we hope that this course can leave a lasting impact with further courses being run in the future for successive years by the future UNIPV alumni.
364 A Novel Preparation of Bone Cement for Vertebroplasty: Can Strontium Folate Improve the Mechanical and Biological Properties of Calcium Phosphate Cement?
Authors: Heer B.
Published: February 2022

Aim

Bone cements currently used for vertebral body augmentation procedures lack biological properties that allow them to osseointegrate. Strontium folate (SrFo) has been shown to increase the viability of human osteoblast (HOb) cells. The potential of a novel preparation of calcium phosphate cement (CPC) with added SrFo is explored to investigate whether SrFo can increase its biocompatibility.

Method

Brushite-forming CPCs with 0% (negative control) and 5% and 10% weight-weight additions of SrR (positive control) and SrFo were formulated. Initial (Ti) and final (Tf) setting times were measured. Mechanical analyses included ultimate compressive strength and plane strain fracture toughness. Topography and distribution analyses occurred during materials characterisation and in vitro analysis using scanning electron microscopy (SEM).

Results

There was no significant difference in the Ti between the CPCs, but significantly greater Tf for all SrFo-CPCs. There was no significant difference in the compressive strength between the CPCs, but a significantly decreased fracture toughness in all SrFo-CPCs. SEM revealed non-homogeneous structures in all SrFo-CPCs. Whilst the pH of the HOb cell culture medium remained the same for all CPCs, the proportion of dead cells was significantly higher than that of alive cells.

Conclusions

The addition of SrFo did not produce any significant differences in the material characteristics of the cements, nor the in vitro properties, except for a prolonged setting time. Future studies should seek to determine the osteogenic nature of SrFo by altering the formulation of the CPCs to a non-toxic preparation, such as apatite-forming cements which are known to have superior mechanical properties.
365 Local Anaesthetic Transperineal Template Biopsy in the Outpatient Setting: A More Sustainable Option in the NHS?
Authors: Olaitan O. , Abdelqader B. , Butt U. , Shrestha S. , Nemade H. , Pai A.
Published: February 2022

Introduction

Transperineal prostate (TP) biopsies have traditionally been performed under general anaesthesia using a grid plate, ultrasound probe and access cannula. This requires theatre heavy resources. Novel techniques and equipment allow TP biopsies to be performed under local anaesthetic (LA) and are well tolerated. However, this equipment tends to be single use and disposable.

Our urology department uses the re-usable BK Medical® needle guide and biplanar probe in the outpatient department (OPD). We present outcomes from patients who have undergone LA prostate biopsies using a re-usable system.

Method

Data was collected from 92 patients who had TP biopsies in the OPD from November 2020 – August 2021. Clinical parameters including MRI Prostate Imaging-Reporting and Data System (PI-RADS) score, prostate specific antigen (PSA) level, histopathological outcomes, re-biopsy and post-procedure complications were collated. Patient Reported Outcome Measures were collected prospectively.

Results

Median (range) PSA level was 7 (2.28–59.3)ng/mL. Mean prostate core samples taken were 24(17–40). All procedures were successfully completed under LA. 93% of patients reported a pain score of 3 or less on the visual analogue scale. 93% of patients would recommend this method of biopsy. 44/92(47.8%) had clinically significant prostate cancer (Gleason ≥3+4). Two patients required repeat biopsies, one was benign, the other clinically significant prostate cancer.

Conclusions

TP biopsies with the re-usable BK Medical® needle probe are effective, safe and well tolerated with an overall one-off cost of £1400 per grid versus £200 per single use kit, and an environmental advantage by being re-useable thereby contributing to NHS sustainability goals.
366 An Audit of Electronic Discharge Summaries and the Impact of Dedicated Teaching and Training in an Emergency Surgical Unit
Authors: Clements J. , Kakos C. , Clements B.
Published: February 2022

Introduction

Electronic discharge summary forms a vital part of a patient’s journey. As established in GAIN Guidelines 2011 ‘Clear and complete documentation in a patient’s health record is directly linked to the quality of the care they receive’. By improving the quality of E-Discharge summaries this will help to improve patient outcomes.

Method

In the Emergency surgical unit [EMSU] there are over 3500 completed consultant episodes per annum. We audited the quality of E-Discharges using 33 separate parameters included in the Trust’s dedicated discharge proforma. An E-Discharge summary was considered acceptable if >90% of the information was recorded accurately. Discharge failure rate was audited in a randomised sample of 20 discharges in November 2019 and one year later in November 2020 following implementation of specific training and teaching at induction on E-Discharge compilation.

Results

In November 2019 the discharge failure rate was 60%. Common failings were in general omission of data, lack of follow-up planning and inaccurate pharmaceutical arrangements. In November 2020, following dedicated teaching at induction, failure rate was 15%. Where accurate recording of demographic information and pertinent inpatient detail improved, shortcomings remained in inadequate recording of follow-up care and ongoing involvement of the primary healthcare team.

Conclusions

E-Discharge recording is sub-standard. It is often the remit of the least experienced member of the medical team, as is the case in our unit. We have shown that dedicated teaching and training in this area can improve the quality of discharge summaries.
367 Comparing Mortality Rates in Patients with Gastric Cancer in a Single Tertiary Centre: What Can We Learn from the Numbers?
Authors: Thu K.T.
Published: February 2022

Aim

Over 6500 of primary gastric cancer diagnoses are made each year in the United Kingdom. Depending on the suitability of a surgical intervention and the patient’s choice, the treatment plans for such patients can be generally divided into curative, palliative, and no treatment. Recently, a tertiary Upper Gastrointestinal (UGI) Department has noticed an increase in mortality rates after a curative intervention and therefore, the aim of this study is to compare mortality rates in the three aforementioned subgroups with respect to the TNM staging in this tertiary centre.

Method

Patients who were discussed at an UGI disciplinary team meeting between 1st January 2013 and 31st December 2020 were identified. Among them, patients with a primary gastric cancer were selected and patients with metastatic gastric cancer at the time of diagnosis were excluded. In addition, patients without histological staging were excluded as well.

Results

279 patients with primary gastric cancer were included in this study. Patients who received palliative treatment have higher mortality rates in all T stages apart from T1 where the 90 days mortality rate was 16.67% and 0% for curative and palliative treatment respectively.

Conclusions

As it has been shown that the majority of patients who received palliative treatment has higher mortality rates, clinicians should continue to consider curative surgical resection in patients who are suitable. In addition, other precautions including consideration of dual consultant operation in patients with borderline respectability or patients with borderline fitness for surgery need to be taken to reduce the mortality rates further.
370 Scrotal Ultrasound in Young Men with Acute Scrotal Pain: A Retrospective Consecutive Case Series Audit
Authors: Sultana A. , Sandhar P. , Obeida M. , Dunk S. , Kitchen M. , Kalejaiye O.
Published: February 2022

Introduction

Although not recommended by EAU guidelines, many men with acute scrotal pain undergo ultrasound (US) to screen for occult tumours. This has low diagnostic yield and must be weighed against the increased risks of coronavirus due to additional hospital attendances, inconvenience for the patient, and demand on NHS resources. We evaluated our case series to determine current practice and diagnostic yield.

Method

141 consecutive cases of scrotal pain and/or swelling were identified from our Trust’s Surgical Assessment Unit (September-December 2020). Clinical diagnosis, and where performed, timing, indication and outcome of scrotal US was recorded.

Results

109/141 patients underwent scrotal US; the only urgent clinical indications were suspected collection/abscess (5 cases) or testicular mass (4). Relative indications included uncertain diagnosis (27 cases), suspected missed testicular torsion (6) and suspected hernia (1). 66/109 US performed were for ‘soft’ indications, however one occult testicular tumour, one acute testicular torsion and two inguinal herniae were unexpectedly found.

Conclusions

Scrotal US changed immediate patient management in 1/109 cases (acute testicular torsion). Early outpatient US would be sufficient to diagnose occult testicular tumour, missed testicular torsions and groin herniae. There is too much reliance on US; more focus on history and examination is needed.
373 Treatment Escalation Plan Completion in DNACPR Patients in Trauma & Orthopaedics
Authors: Elbayyar O. , Al Kharouf K.
Published: February 2022

Introduction

A Treatment Escalation Plan (TEP) is a communication tool which is helpful when a person with serious illness has a potential for acute deterioration. This policy fully supports the national guidance and recommendations published in a joint statement by the Resuscitation Council (UK) and the Royal College of Nursing (2016) and the latest Gerneral Medical Council guidance (2010) relating to the treatment and care towards the end-of-life decision making. Crucially, a TEP provides on-call hospital staff with immediately accessible guidance about how to respond to an individual in times of crisis, especially out of hours and at weekends.

Aim

To assess and improve the TEP completion in DNACPR patients.

Method

Parameters examined included: patient identifiers, age, sex, comorbidities, DNACPR completion of the form.

1st cycle: 30 patients included were analysed in May 2021.

Implementation: Education session at the department for staff about importance of form completion.

2nd cycle: 30 patients were included and analysed in July 2021.

Results

1st cycle showed only 30% adherence to the form completion. It was discussed in the session and various ways for improvement were implemented.

2nd cycle showed great improvement of 70% form completion for DNACPR patients.

Conclusions

A TEP becomes particularly important when there is agreement that interventions or referrals for more intensive care that are contrary to a person's wishes or are futile shouldn't be undertaken. Equally in many patients who may have an agreed DNACPR, a TEP clarifies all the treatments and care that should continue. This has improved with local education.
375 Discitis – A large cohort analysis of its management in a tertiary orthopaedics centre
Authors: Sriramanarayanan A. , Prabha S. , Prasad K. , Dholoo F. , Unnithan A.
Published: February 2022

Aim

Discitis is characterized as an infection of the intervertebral disc. It classically presents with fever and back pain. However, varied presentation and lack of adherence to guidelines leads to significant variation in its identification and management. We assessed adherence to guidelines, in the management of Discitis, in a tertiary orthopaedic centre.

Method

A retrospective study was conducted in a tertiary orthopaedic centre, between January 2017-September 2019. The study analysed patients with Magnetic Resonance Imaging (MRI) proven discitis.

Results

Out of the 305 spine MRIs reported as discitis, 152 (35%) had discitis based on imaging and only 38 patients (55%) clinically correlating, presenting symptoms. Back pain (47.3%) was the most common presenting complaint followed by fever. The commonest site of involvement was the lumbar vertebrae (70.4%). All patients had a baseline C-reactive protein and 34 (92.11%) had blood cultures taken. 70.5% patients with negative blood culture had Computerised Tomography (CT) -guided biopsy. Staphylococcus aureus was the most commonly isolated organism. Treatment was commonly with intravenous Flucloxacillin with 63% of the patients being treated for 6 weeks or more.

Conclusions

A structured follow up protocol will now be implemented within our centre. This will aim on correcting common errors within the management of discitis, including blood cultures prior to starting antibiotics and CT guided biopsies if blood cultures remain negative. We hope that the above will help achieve higher success rate in outcome of discitis.
378 Endovascular Stenting vs. Open Surgery in Cerebral AVF Patients
Authors: Parwez R. , Baig A. , Rahman S.
Published: February 2022

Introduction

Intracranial dural arteriovenous fistulae (dAVF), typically found in the dural leaflets, are vascular malformations defined by a pathological communication between meningeal arteries and dural sinus or cortical veins. Despite many of them spontaneously resolving, they are still at high risk of hemorrhage and mortality if not effectively treated and monitored. Treatment options include endovascular embolization, surgical disconnection, and radiosurgery. With the rise of endovascular treatments now widely available, there is a massive shift towards minimally invasive surgical options while it can still be argued they are not the end of open surgical repairs.

Method

We reviewed 12 cases each of endovascular embolization and microsurgical resection in our Neurosurgical Unit retrospectively and compare between length of hospital stay, hemorrhage, need for open surgery following endovascular technique and wound infection. Cases will be selected at random over a period of 6 months.

Results

We compared surgical outcomes of 12 cases each of dural AvFs that were either managed as surgical repair or endovascular embolization. In cases with associated complication, surgical repair was the preferred method although endovascular repairs had shorter length of hospital stay, lower rates of infections and rarely needed to be followed by surgical repair.

Conclusions

Based on the result we conclude that endovascular repairs have a shorter length of hospital stay, infections and hemorrhage, yet there are instances where surgical disconnection may be the preferred treatment method on a case-by-case basis. Endovascular treatment may not have replaced open surgical procedures just yet, but the future may hold more advances in this field.
379 Consenting on the Day of Surgery – Futility or Formality?
Authors: Martyn C.J. , McGowan K.E. , Clements J.M. , Kirk S.
Published: February 2022

Aim

Obtaining written informed consent is essential prior to proceeding with any surgical intervention. There is no consensus on the timing of when consent is complete. We aimed to assess the consent practices in our institution.

Method

A prospective snapshot audit was conducted on consecutive elective general surgical patients over a 4-week Period (August 2021). Data was collected on the content of pre-operative consent discussions as well as when the consent form was completed. Local audit approval was obtained

Results

56 patients underwent an elective general surgical procedure. Median age was 55. 73% (n = 41) were female. 63% cases were for malignant disease (n = 35). All patients completed a consent form 1. 54 patients had documented pre-operative consultations with a consultant. In all malignant cases, patients underwent discussion with a cancer specialist nurse present. All patients received a diagnosis and discussion regarding treatment. 69% of patients underwent discussion about alternative treatment options and a discussion about surgical risk took place in 30% of cases. 95% of patients signed their consent form on the day of surgery with 80% registrars and 20% consultants countersigning the forms respectively.

Conclusions

Despite the majority of patient completing their consent form on the day of surgery, the preceding consent discussions would suggest that consent is a process, and that completion of the form is a formality.
381 Is Risk of Postoperative Seizures Higher in Patients with Blood Type a in Chronic Subdural Haematoma?
Authors: Edwards B. , Zolnourian A. , Sadek A.R.
Published: February 2022

Introduction

Seizure is a recognised complication of Chronic Subdural Haematoma (CSDH). Blood Type A has been indicated as a risk factor for developing postoperative seizures in Acute Subdural Haematoma (ASDH). However, to our knowledge there has not been a similar study to see if there is an association between blood type and seizure risk in CSDH.

Method

699 patients who had a CSDH surgically evacuated with burr holes between 2013 and 2019 were identified and their electronic and paper notes were retrospectively reviewed. Clinical information including their blood type and occurrence of postoperative seizure were recorded.

Results

26/699 patients overall had a postoperative seizure (3.7%). Blood type A had a higher overall number of seizures (4.3%, 13/301) than other blood types (3.4%,13/379) however this difference was not statistically significant (p = 0.22).

Conclusions

There is no convincing evidence that patients with blood type A have a higher risk of seizures after CSDH than patients with other blood types. Therefore, there is no reason to manage patients with blood type A differently regarding seizure prophylaxis.
385 Improving Neurosurgical Handover: A Quality Improvement Project
Authors: Mohamed M. , Edwards B. , Parmar V.
Published: February 2022

Aim

Efficient, succinct, and salient handover of current issues of surgical inpatients between doctors is an essential process which, if done ineffectively can contribute to patient harm. It was recognised that existing junior neurosurgical handover could be improved and using the Royal College of Surgeons’ and NICE guidelines for clinical handover we aimed to improve the existing handover system, improving doctor’s satisfaction with handover and patient safety.

Method

19 junior doctors on the SHO rota were surveyed to establish their perspective on the existing handover process. Based on this feedback, we redesigned handover combining national bodies’ guidance and local ideas. We resurveyed following these changes to measure improvement.

Results

Initial results showed only 36 % of junior doctors were satisfied with the existing handover procedure and only 50.5% felt the existing handover was safe. After these changes there was a 44% improvement in satisfaction with handover and a 24% improvement in the perceived safety of the handover process.

Conclusions

Handovers should be optimised to improve patient care and doctors working environment. We have improved our existing handover procedure increasing the perceived safety and doctor’s satisfaction of the handover process.
388 The SIMple Things: Using Surgical Simulation to Improve Junior and Undergraduate Surgical Teaching in a Rural DGH
Authors: Bruce N.
Published: February 2022

Aim

Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our rural DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions.

Method

We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching.

Results

Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as “great” or “good” (options great, good, average, fair, poor). Attendance varied from 2–15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience “great” or “good”. All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery.

Conclusions

Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.
389 The Benefit of Pre-Emptive Peri-Incisional Local Anesthesia in Day-Case Open Hernia Repair
Authors: Ramasamy S. , Bylapudi S. K. , Toe K.
Published: February 2022

Introduction

Hernia repair is one of the common operations performed in the United Kingdom. The novel technique of intra-operative local anaesthesia has improved the outcomes in recovery and has reduced overnight hospital stay. The aim of the study was to compare the postoperative pain, LOS and overall satisfaction in the group where local anaesthesia (LA) was injected peri incisional versus LA at the end of the procedure.

Method

In this prospective observational study, 70 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 35 underwent repair under GA + peri-incisional LA solution (an equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline) (Group A) and 35 with GA with LA injected at the end of the procedure (Group B). Pain score assessed postoperatively at 2 hours and the next day after the procedure telephonically. A validated patient questionnaire was used to get the satisfaction level of the patients.

Results

The median age of group A was 57.1 years, and, in group B, it was 59.7 years. All of them underwent Lichenstein hernia repair. None of them in group A had a pain score of more than three. 4 patients in group B had a pain score of more than 3 post-operatively (11%). On postoperative day 1, only one patient had pain score of 4, whereas, in Group B 14 patients (40%) had pain score > 4 (P-value 0.042). Six patients (14.2%) in group B failed day-case discharge criteria. None of the patients in both groups were dissatisfied.

Conclusions

Patients undergoing day-case GA inguinal hernioplasty with peri-incisional pre-emptive LA solution infiltration have adequate postoperative pain control and a good satisfaction level. These patients are unlikely to fail discharge for planned day-case surgery.
394 Gentamicin Guidelines – Available but Are They Followed? a Retrospective Audit
Authors: Ash J. , Wolff N.
Published: February 2022

Introduction

Many hospitals include gentamicin as part of prescribing protocols for clinical situations such as bacterial septicemia and urinary tract infections. High doses of gentamicin can lead to nephrotoxicity and/or auditory dysfunction. To prevent this, most hospital guidelines advise to adjust dosing according to age, renal function and if the patient is overweight. With therefore quite a complex prescribing protocol, an audit of the prescribing practices at the trust was deemed necessary to determine if clinical protocol was being followed for inpatient gentamicin dosing.

Method

A retrospective audit of all patients prescribed gentamicin as an inpatient between 1st of August and 31st of October 2020 was performed. Data was collected from two separate electronic record systems and combined.

Results

2224 doses of Gentamicin (to 1224 patients) were given in the study period. Gentamicin dosing was not adjusted for obesity in either the <70 or >70 age group (p<0.05 for both). Dosing was not adjusted for Creatine clearance (p<0.05). 86% of patients that needed a gentamicin level had one taken but 15% had it taken too early. Of those who had a Gentamicin level >1, 100% had their next dose held.

Conclusions

Although gentamicin levels are taken and acted on effectively in most cases, a large proportion of patients are not being dosed as per protocol and therefore at risk of the side effects of overdosing or being clinically under treated. With such a complex prescribing protocol, electronic tools need to be implemented to improve compliance across the trust.