bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP1.1.5Association between prior screening involvement and presentation and outcomes in patients with colorectal cancer
Authors: Mshihadani Afnan , Golder Allan M , Mansouri David , McMillan Donald C , Horgan Paul G , Roxburgh Campbell SD 
Published: October 2021

Abstract

Aims
Population bowel cancer screening (BCS) is well established, however many patients still present acutely or with advanced disease. Within a cohort of patients with colorectal cancer (CRC), this study aimed to analyse the relationship between prior engagement with the screening programme and mode of presentation, disease stage and survival.

Methods
All patients diagnosed with CRC from 2011-2014 in West of Scotland were identified from a regional database and linked into the Bowel Screening dataset for screening participation within two years preceding diagnosis.

Results
6551 patients were diagnosed with CRC, 19% (n = 1217) through screening. 39% of patients were not invited for screening and 29% of patients did not respond to invite. Non-response to invite was associated with male sex, increasing age, socioeconomic deprivation, co-morbidity and smoking (all p &lt; 0.001). 13% had previously returned negative screening tests. Negative screening was associated with female sex, anaemia, right sided, poorly differentiated and EMVI positive tumours, and screening with gFOBT versus FIT (all p ≤ 0.001). 2% did not undergo further investigation of a positive test, and &lt;1% had a negative colonoscopy. Participation in screening was associated with reduced emergency presentations (8%vs22%), lower TNM Stage, and improved 3-year CSS (88%vs74%) and OS (85%vs69%) (all p &lt; 0.001).

Conclusion
Most new cases of CRC are diagnosed outwith the screening programme, predominantly due to non-invite/failure to respond to invite. This has a significant association with adverse outcomes including emergency presentation, advanced TNM stage and poorer survival. Further work is required to increase screening uptake and widen access to BCS.
SP1.1.16Endoscopic evaluation after acute colonic diverticulitis: Review of literature
Authors: Eltyeb Hazim A. , Subramonia Sriram 
Published: October 2021

Abstract

Aim
To compare the current evidence for routine endoscopic evaluation of the colon after an episode of acute diverticulitis against existing guidelines in the United Kingdom.

Methodology
A systematic literature search of Medline, Embase and Cochrane databases was performed using keywords “Diverticular disease”, “Diverticulitis”, “acute”, “Colorectal Cancer” and “endoscopy”. Recommendations from guidelines of specialist medical societies were reviewed. Available literature was explored to assess the risk of colorectal cancer in patients presenting with acute diverticulitis.

Results
The most recent UK guideline (Royal College of Surgeons Commissioning guide 2014 supported by ACPGBI) recommends the routine evaluation of colonic lumen after resolution of an acute attack of diverticulitis. More recent guidelines from specialist medical societies (European Society of Coloproctology 2020, World Society of Emergency Surgery 2020, European Association for Endoscopic Surgery and Society of American Gastrointestinal and Endoscopic Surgeons 2018) do not recommend routine endoscopic evaluation after recovery from uncomplicated colonic diverticulitis. Two meta-analyses as well as three large cohort studies showed no significant risk of colorectal cancer ((1.22% (95% confidence interval 0.63-1.97) and (0.7%; confidence interval 0.3%−1.4%)) following uncomplicated acute diverticulitis.

Conclusion
Existing UK guidance on routine colonic luminal evaluation after resolution of acute diverticulitis should be revised based on current evidence.
SP1.2.3General Surgical Registrar in the Emergency Department: Developing and Evaluating a New Surgical Role
Authors: Aseem Rabiya , Naseem Tariq , Simillis Costas , Pawa Nikhil , Jason Smith 
Published: October 2021

Abstract

Intro
NHS Departments are experiencing unprecedented pressures with exponentially growing patient numbers and severe delays in waiting time. This directly influences bed pressures leading to cancellation of elective surgical lists to aid acute admissions. We introduce the role of a surgical registrar in emergency departments (ED) to review general surgical patients to (i) help reduce ED waiting times (ii) prevent unnecessary admissions and (iii) accelerate management plans.

Methods
This unique role was introduced in our local ED department for 3 months (Nov 2019 - Jan 2020). The shift was trialled Mon-Fri from midday to 8pm. Patient length of stay (LOS), referral times, admissions, discharges and breaches (&gt; 4hrs) were recorded.

Results
The admission rate was 24% (n 681), with a 10% reduction compared with preceding months. 75% patients were discharged following review from which 20% had outpatient investigations arranged. Average LOS at time of referral was 1hr37mins. Peak referral activity was observed on Mondays, Fridays and between 2-5pm. 98% underwent investigations and 79% received active treatments. Feedback from stakeholders, including surgical colleagues was favourable as it allowed more time spent on operative activities.

Conclusion
The NHS has some of the most challenging performance standards in the world. We introduce an innovative solution to help reduce rising clinical and financial pressures. The role of the surgical ED registrar helps reduce waiting times, escalate management and prevent unnecessary surgical admissions. Further studies are being conducted to further evaluate the sustainability of this service and extending it to neighbouring trust hospitals.
SP2.1.10Prescription of regular medications to surgical patients within 24 hours of admission:Is it being done?
Authors: Rai Anil , Singh Rhea , Brown Katherine 
Published: October 2021

Abstract

Aim
Prescription of necessary regular medications to patients within 24 hours of admission to the hospital is vital for better healthcare. Our aim was to analyse whether regular medications were prescribed to all general surgical patients within that time limit, to find the rationale behind the shortcomings and to suggest a more efficient way to overcome them.

Materials and Methods
A retrospective analysis of 186 surgical patients in the month of February 2020 who stayed in the hospital for more than 24 hours in General Surgery (167) and Urology (19) were analysed. Out of these, 100 were females and 86 males with the maximum in age group of 31-60 years (80) and 75 patients were more than 6o years. 11 groups of medications were analysed.

Findings

Conclusion
More attention needs to be paid towards prescribing medications at the earliest. This could be improved by careful history taking and prescribing medications at the time of admission itself; GP to include all the medication history while referring a patient, liaising with pharmacist and family members for confirming the patients’ medications and providing portable bedside computers for doctors while they are seeing patients.
SP2.1.16Prognostic significance of Drivers at Work and Learning Styles in surgical training
Authors: Mellor Katie , Hopkins Luke , James Osian P , Luton Oliver , Egan Richard J , Lewis Wyn G 
Published: October 2021

Abstract

Aims
Drivers at Work (DW) and Learning Styles (LS) refer to a range of contentious theories that aim to account for differences in career progression, yet seldom feature in training assessment. This study aimed to quantify the influence of Core Surgical Trainees’ (CST) DW and LS on career progression.

Methods
Kolb LS inventories were distributed to 168 CSTs during five consecutive induction boot camps in a single Statutory Education Body. Primary outcome measures were MRCS and National Training Number (NTN) success.

Results
Of 108 responses received (response rate 64.3%), 64.8% were male and 35.2% female (p = 0.003). The spectrum of DW was: Please People (25%), Be Perfect (21.3%), Hurry Up (18.5%), Be Strong (13.9%), and Try Hard (0%, p &lt; 0.001). DW was either unequivocal or not provided by 23 CSTs (21.3%). The spectrum of LS was: Converging (34.3%), Accommodating (28.7%), Diverging (23.1%), and Assimilating (13.9%, p = 0.021). MRCS success was not associated with DW (p = 0.703) or LS (p = 0.598). Men were more likely to have Converging LS (29/70, 41.4%), and women Diverging LS (15/38, 39.5%, p = 0.018) and to have team-based LS (Accommodating / Diverging, 26/38 vs. 30/70, p = 0.010). NTN success was associated with LS (p = 0.038) with Convergers achieving most NTNs (65.4%).

Conclusions
LS are associated with important differences in career progression with Converging LS three-fold more likely to achieve NTNs than Diverging LS.
SP2.2.1Improving surgical training: core programme performance related to rotation theme, design, and trainee protocol engagement
Authors: Mellor Katie , Robinson David B , James Osian P , Powell Arfon GMT , Egan Richard J , Lewis Wyn G 
Published: October 2021

Abstract

Aims
Core Surgical Training (CST) and Improving ST (IST) programmes are in flux and their design controversial. This study aimed to evaluate the relative performance of a single Statutory Education Board’s (SEB) CST and IST programmes related to rotation design, theme, and protocol engagement.

Methods
Individual rotations numbering 181 were analysed prospectively over six-years (2014 to 2020). Primary outcome measures were MRCS pass and specialty National Training Number (NTN) appointment.

Results
Overall MRCS pass was 68.5% and NTN appointment 39.2%. NTN appointment related to rotation design varied from zero to 100% (median 40.0%). Conversion to NTN varied by specialty theme and ranged from: General surgery CST 35.6% to General surgery (IST pilot) 87.5% (p = 0.004). Multivariable analysis revealed NTN appointment was associated with: operative logbook caseload &gt;464 (OR 3.02, p = 0.068), scientific article publication (OR 4.82, p = 0.006), and universal ARCP Outcome 1 (OR 37.83, p &lt; 0.001), and IST (OR 55.54, p = 0.006).

Conclusions
Focused rotational design allied to enhanced performance management, and protocol engagement, were associated with improved conversion to higher surgical specialty training.
SP2.2.6An audit on core surgical trainees’ operating theatre experience to improve compliance against JCST training quality indicators
Authors: Khawar Haseeb , Rehman Saad , Nair Nandu , Luke David 
Published: October 2021

Abstract

Aims
The primary aim of this study was to audit the experience of core surgical trainees in operating theatres with a view to devise some interventions to improve the quality of theatre experience.

Methods
This study was a prospective audit that involved filling out a set proforma by all core surgical trainees working in a busy surgical department of a tertiary care university hospital. The proforma included a breakdown of questions to signpost indicators of quality experience and check compliance with the Joint Committee on Surgical Training (JCST) guidelines. It was completed with particular consideration given to the experience while trainees were on their CEPOD week to facilitate accuracy and relevance of feedback.

Results
8 core surgical trainees filled out the proforma. 75% of trainees had the opportunity to reflect the case with the senior surgeon. Lowest compliance was shown for pre-operative discussion of crucial learning points with the senior surgeon. Only 50% of trainees had a chance to do a briefing pre-operatively which is one of the JCST quality indicator for core surgical trainees.

Conclusion
This audit demonstrates the potential for improvement in the operating theatre experience of junior surgical trainees considering JCST Quality Improvement indicators. A checklist may be introduced to achieve maximum utilisation of the finite training opportunities available to current junior surgical trainees. A loop closing audit after the checklist will be able to assess the change in practice and theatre experience.
SP2.2.8Teams, performance, and trust: a perspective from the vanguard
Authors: James Osian , Bowman Chris , Parker Jody , Luton Oliver , Egan Richard , Lewis Wyn 
Published: October 2021

Abstract

Aims
The aim of this study was to determine surgical trainees’ perspective regarding team environment, function, performance, and trust.

Methods
A 44-point, anonymous survey was distributed to all doctors working in surgery in a single UK Statutory Education Body with responses received from 116 (n = 17 Foundation Year 1 (FY1), n = 50 Senior House Officer (SHO), n = 49 Specialist Registrar (SpR)).

Results
Psychological safety was associated with trainee grade; SHO perception of support (60.4%, n = 29), FY1 (88.2%, n = 15), SpR (82.4%, n = 42), p = 0.016; and ability to ask for help: SHO (70.8%, n = 34), FY1 (100.0%, n = 17), SpR (92.2%, n = 47 p = 0.043). Dependability among colleagues was perceived to be poorer by women (69.8%, n = 30) than men (87.5%, n = 63, p = 0.009). Clarity of team structure was associated with grade and perceived to be poor by SHOs (60.4%, n = 29) vs. FY1 (94.1%, n = 16) vs. SpR (78.4%, n = 40), p = 0.014. Meaningfulness and impact of team achievement was associated with grade: SHO (68.8%, n = 33) vs. FY1 (76.5%, n = 13) vs. SpR (94.1%, n = 48), p = 0.005. Inverse correlations were observed between the prevalence of harassment/bullying and markers of psychological safety (rho -0.382, p &lt; 0.001), dependability (rho -0.270, p = 0.003), and clarity of team structure (rho -0.355, p &lt; 0.001).

Conclusion
Important deficiencies in psychological safety impacted two in five of SHOs adversely. Countermeasures (Enhanced Surgical Resilience Training) are needed to protect morale, patient safety, and clinical outcomes.
SP2.2.15MRCS performance predicts surgical career outcomes
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter 
Published: October 2021

Abstract

Aims
Successful completion of the MRCS examination is mandatory for progression into higher surgical (registrar) training in the UK. National selection for training programmes is a highly competitive process. Despite this, the ranking of applicants does not currently include MRCS performance scores. This offers a unique opportunity to compare two independent assessments of surgical trainees to establish whether MRCS performance can predict future surgical career outcomes and competitiveness in training.

Methods
All UK candidates who attempted MRCS between 2007-2020 were matched to career outcome data using the GMC list of registered medical practitioners and anonymised (n = 2910). Chi-squared tests determined associations with first attempt MRCS pass/fail outcomes. Multinomial regression models were developed to establish the predictive power of success at MRCS in determining surgical specialty and training deanery choices.

Results
There was statistically significant variability in MRCS Part A pass rates, ranging from 55.1%-76.7% between surgical specialties (P = 0.001) but no significant variability in Part B pass rates (P = 0.655). There was significant variability in Part A and Part B pass rates between training deaneries (P = 0.010 and P = 0.036 respectively). Pass rates ranged from 59.9%-77.7% for Part A and 70.1%-85.0% for Part B between training deaneries. Those in more competitive specialties and training deaneries performed better in MRCS in terms of first attempt pass rate, scores and number of attempts taken to pass.

Conclusion
MRCS performance is an early predictor of surgical career choice and competitiveness. Trainees who perform well at MRCS are more likely to enter competitive surgical specialties and training deaneries.
SP2.2.16Hospital compound level endoscopy training quality performance: scoping the spectrum
Authors: Eley Catherine , Brown Christopher , Hawkes Neil , Egan Richard , Lewis Wyn 
Published: October 2021

Abstract

Aims
This study aimed to assess the quality of endoscopy training in a single UK Statutory Educational Body (SEB), related to individual hospitals,compared with the Joint Advisory Group on Gastrointestinal Endoscopy Training (JETS) certification standards.

Methods
Training procedures numbering 28,928 recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in18 hospitals during 2019were analysed. Data included trainer and trainee numbers, training list frequency, procedures, Direct Observation of Procedural Skills (DOPS) completion and Key Performance Indicators (KPI).

Results
Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median (IQR) trainers and trainees per unit were 11 (6-18) and 12 (7-16) respectively (ratio 0.8 (0.7-1.3)). Annual training list frequency per trainee was 13 (10-17), 35.0% short of JAG standard (n = 20, p = 0.001, effect size -0.56), and median points per adjusted training list were 11 (5-18). Median DOPS completion per trainee and trainer were 3 (1-6) and 4 (1-7) respectively; completing 0.2 DOPS (0.1-0.4) per list and amounting to 6 (2-12) per 200 procedures: less than half of the JAG standard (p &lt; 0.001, -0.61). Median KPI for OGD: J Manoeuvre 94% (90-96), D2 intubation was 93% (91-96); and for Colonoscopy: Caecal intubation 82% (72-90), and Polyp Detection Rate 25% (18-34). Compound hospital training quality score varied 3-fold, the highest performing hospital scoring 26; compared to the poorest performing scoring 9: median 17 (14-20).

Conclusion
Important variation in endoscopy unit performance were apparent with compound hospital training quality varying almost 3-fold. Trainees, Training Programme Directors alike, should be aware of such data when planning educational programmes to focus, optimise the quality of endoscopic training.
SP3.1.3 Use of a Care Bundle to reduce Surgical Site Infection after Emergency Laparotomy
Authors: Swain C , Rogers J , Gane D , Quinn M , Hopkins J , Pullyblank AM 
Published: October 2021

Abstract

Aim
Surgical Site Infection (SSI) is common after abdominal surgery. A care bundle was introduced to sustainably reduce SSI after elective colorectal surgery. This study aimed to implement an expanded care bundle after emergency laparotomy.

Methods
Quality improvement methodology was used. SSI was measured by direct assessment of the wound in patients in hospital at 30 days. For discharged patients, the PHE SSI surveillance questionnaire was used to measure patient-reported SSI 30 days post-operatively. The care bundle included: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; second dose of antibiotics &gt;4 hours, betadine to the wound and glove change before closure. Bundle compliance was measured and fed back to surgical teams.

Results
Baseline SSI was 13.5% (178 patients) which reduced to 8.5% (118 patients) following bundle introduction. Response rate was 60%. Compliance with antibacterial sutures was measured for patients whose wounds were closed; 10% received negative pressure dressings. Mortality within 30 days was 9%. Length of stay reduced from mean 22.6 to 12.45, median 13.5 to 9 days.

Conclusion
The care bundle reduced SSI after emergency laparotomy. Measuring SSI is more difficult after emergency surgery due to higher death rate, longer length of stay and use of laparostomy. Other challenges include difficulty using wound protectors for some procedures e.g. adhesiolysis and changing practice from use of skin clips.
SP3.1.5 Variation and predictors of emergency surgery in emergency hospital admissions from the Emergency Surgery Or Not (ESORT) study
Authors: Hutchings Andrew , O'Neill Stephen , Zapata Silvia Moler , Smart Neil , Hinchliffe Robert , Grieve Richard 
Published: October 2021

Abstract

Aims
To assess variation in use of emergency surgery (ES) for emergency hospital admissions with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction.

Methods
Cohorts were extracted from Hospital Episode Statistics for 136 acute NHS trusts in England. Clinical panel consensus defined ES for emergency admissions between 1/4/2010 and 31/12/2019. The association of socio-demographic characteristics with ES use was estimated by multivariable logistic regression, with adjustment for comorbidity, frailty, diagnosis and trust.

Results
The cohort sizes ranged from 49,385 (hernia) to 184,777 (appendicitis) patients. ES was less likely for: patients aged over 80, with odds ratios (ORs) across conditions from 0.15 to 0.84 versus those aged under 40; the most deprived, ORs 0.83 to 0.92, versus least deprived; and Asian patients, ORs 0.72 to 0.88, versus White patients. Black patients were less likely to have emergency surgery for appendicitis (OR 0.78) and cholelithiasis (OR 0.78). Females were less likely to have ES for appendicitis (OR 0.94 versus males), but more likely to have surgery for intestinal obstruction (OR 1.29), hernia (OR 1.13) and cholelithiasis (OR 1.22). Unexplained variation in ES across trusts, remained after case-mix adjustment, and was greatest for cholelithiasis (median of 16%, 10 to 90 centile 5%-34%), and hernia (61%, 52%-71%), followed by intestinal obstruction (29%, 24%-36%). appendicitis (93%, 89%-95%), and diverticular disease (15%, 11%-20%).

Conclusions
The socio-demographic characteristics of emergency admissions are associated with the likelihood of receiving ES. Variation in ES use between NHS trusts remained after adjustment for demographic and clinical characteristics.
SP3.1.17 Assessment of the utility of CT to predict the requirement for resection at laparotomy in patients presenting with acute mesenteric arterial insufficiency
Authors: Ng James , Hennessy Martin , Hussey Keith 
Published: October 2021

Abstract

Introduction
Mesenteric ischaemia as a consequence of arterial atherosclerosis is associated with significant morbidity and mortality. Practice has been influenced by the rise in cross-sectional imaging. In Glasgow a policy of laparotomy for patients presenting with acute mesenteric ischaemia at the time of mesenteric revascularisation has been adopted. We have sought to define whether CT can predict visceral necrosis and a requirement for tissue resection at the primary revascularisation.

Methods
This was a retrospective review of interventions performed for mesenteric ischaemia. Radiological variables described in the context of mesenteric ischaemia were defined. The primary CT report was reviewed to define whether these features were recorded and whether a diagnosis of mesenteric ischaemia was suggested. Imaging was then retrospectively reviewed with reference to the dataset by a radiologist. The radiologist was asked to offer a subjective opinion as to whether there was mesenteric infarction. These data were compared with laparotomy findings.

Results
There were 129 interventions performed for mesenteric ischaemia over the study period and 147 laparotomies. There was no specific radiological variable that was consistently reported in the primary or secondary CT review. However when bowel wall thinning, hypoattenuation or portal venous gas reported (independently) they seemed to be specific as in each case there was mesenteric infarction at laparotomy.

Conclusion
Even with retrospective radiological assessment there is no reliable feature that will predict mesenteric infarction and a requirement for tissue resection. As such a policy of laparotomy in patients who considered physiologically well enough would appear to be justified.