bluuebunny/crossref_metadata_2025_split huggingface dataset:
855 Patient Specific Digital Modelling And 3D Printing of Abdominal Anatomy- The Next Frontier in Surgical Simulation?
Authors: Fletcher J , Myles C , Miskovic D , Jones J , Cahill R 
Published: May 2021

Abstract

Introduction
Innovations in digital technologies afford new opportunities in surgical education.
We describe a novel method of combining medical imaging data with virtual 3D modelling and printing techniques that could facilitate patient specific pre-operative planning and rehearsal.

Method
A series of silicone castings was produced to simulate upper abdominal viscera using a novel polyvinyl alcohol (PVA) injection moulding method. Digital models were generated by segmenting CT dual phase imaging in ITK-SNAP. A 3D polygon mesh was exported and optimised in the computer graphics software: Blender. Two 3D printers were used to manufacture a dissolvable mould of the digital models. Moulds were injected with coloured silicones and dissolved in water to reveal the multicolour/multi-material models.

Results
The silicone models retained the anatomical detail of the digitally segmented CT data sets. The multi-colour models were achieved with a single print and at very low cost (approx. £248/ model) and possessed varying shore hardness between viscera recreating lifelike fidelity.

Conclusions
The hybrid 3D printing/injection moulding method offers an avenue to realistic surgical and anatomical simulation. A combination of both virtual models and 3D physical models may provide an enhanced surgical experience for preoperative and intraoperative planning allowing patient specific rehearsal.
94 An Observational Cohort Study to Evaluate Volume and Severity of Emergency General Surgery Admissions During The COVID-19 Pandemic: Is There A “Lockdown” Effect?
Authors: McLean R , Young J , Musbahi A , Lee J X , Hidayat H , Abdalla N , Chowdhury S , Baker E , Etherson K 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has led to changes in NHS surgical service provision. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. This study aimed to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and outcomes.

Method
Two cohorts of adult emergency general surgery admissions 30 days immediately before (16/2/2020 to 15/3/2020), and after UK government advice (16/3/2020 to 15/4/2020). Data were collected relating to patient characteristics, disease severity, clinical outcomes, and compared between these groups.

Results
Following lockdown, a significant reduction in median daily admissions from 7 to 3 (p &lt; 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of AKI, and more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all-cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality.

Conclusions
There appears to be a “lockdown” effect on general surgical admissions with fewer admissions, more acutely unwell patients, and an increase in all-cause 30-day mortality. Patients should be advised to present promptly, and this should be reinforced for future lockdowns during the pandemic.
110 The Results of Treatment of Acute Appendicitis During COVID-19 Pandemic in A District General Hospital
Authors: Urbonas T , Centea D , Wild T , Thomas P 
Published: May 2021

Abstract

Aim:
At the beginning of the Covid-19 pandemic conservative management of acute appendicitis (AA) was advised to reduce the risk the spread of infection during aerosol generating procedures. The aim of this study was to audit the outcomes of the management of AA in a district general hospital during the pandemic.

Method
The prospective data was collected for all patients treated for AA from 12/03/2020 to 18/05/2020. The primary objective was the failure rate of conservative management requiring surgical intervention. Statistical analysis was performed using JASP software.

Results
There were 22 patients included. 19 (86%) were managed conservatively of which 4 (21%) patients failed and progressed to surgery and 3 (14%) patients had appendicectomy on admission. 3 patients (20%) treated non-operatively were readmitted within median 4 days (4-6); 2 (13%) of them developed appendix mass. None of the patients had positive SARS-CoV-2 test. Median length of stay (LOS) was 3.5 (1-8) days; 4 (3-8) days in the immediate appendicectomy group, 3 (1-7) in the group managed conservatively.

Conclusions
The sample size was small hence it is difficult to draw any solid conclusions. We feel that appendicectomy should remain standard treatment for AA. However, antibiotics should be considered as the first line during the pandemic.
174 SARS-Cov-2 Increases The 30-Day Mortality in Hip Fracture Patients. A UK District Hospital’s Experience
Authors: Oduoza U , Mamarelis G , Chekuri R , Estfan R , Greer A 
Published: May 2021

Abstract

Introduction
Coronavirus disease 2019 (COVID-19) is a worldwide pandemic with a case mortality ratio of approximately 6.4%. Hip fracture patients are vulnerable if contracting COVID-19. Evidence is lacking regarding the mortality rate of hip fracture patients admitted during the COVID-19 pandemic.

Method
Retrospective review of all patients admitted to Southend University Hospital from March – April 2020. Demographic data (age, BMI, gender, co-morbidities) along with diagnosis of COVID-19 (clinical + (radiology +/- microbiology positive) and operative characteristics (time to operation, length of stay, ASA grading, Nottingham Hip Fracture Score), blood tests. Primary outcome was 30-day mortality rate in COVID-19 positive/negative patients who had hip fracture.

Results
41 patients were included in the study of which 37 had a COVID-19 swab. Overall mortality in the group was 22%. Eleven patients tested positive for COVID-19. There was a statistically significant difference in mortality between those testing positive compared to those testing negative (54.5% versus 7,69% respectively, Fisher’s exact test, p = 0.004) and when comparing those who had an operation and tested positive for COVID-19 against those who had an operation and tested negative (37.5% versus 4,34% respectively, Fisher’s exact test, p = 0.043).

Conclusions
COVID-19 increases the 30-day mortality in neck of femur fracture patients.
417 COVID-19 and the Return to Head and Neck Outpatient Activity in The United Kingdom: What Is the New Normal?
Authors: Jaikaransingh D , Bola S , Winter S 
Published: May 2021

Abstract

Background
We aim to investigate current head and neck outpatient practices across the United Kingdom during the COVID-19 pandemic.

Method
A cross-sectional study comprising of an online 20-item survey was emailed to members of the British Association of Head and Neck Oncologists (BAHNO). Topics covered included safety measures, protective equipment used and protocols around the use of flexible nasendoscopy (FNE) in clinic.

Results
117 participants completed the survey covering 66 Trusts across the UK. There was a significant reduction in face-to-face clinic patients compared to pre-pandemic numbers. Room down-time after FNE ranged from 0-6 hours and there was a significant increase in allocated down-time after the patient had coughed or sneezed. Natural ventilation existed in 36% of clinics and the majority of responders didn’t know the calculated Air Change Per Hour (ACPH) of the room (77%). Where ACPH was known, it often did not match the allocated room down-time.

Conclusions
Adaptations are being made across the UK to maintain staff and patient safety, but more can still be done by liaising with hospital infectious diseases and the hospital estates team to clarify outpatient protocols.Outpatient activity will likely remain limited and alternative strategies will need to develop to manage the backlog in face-to-face clinics.
579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London
Authors: Chatzikonstantinou M , David M , Pouncey A , Aljarad F , Sorelli P 
Published: May 2021

Abstract

Background
The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery.

Aim
To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19.

Method
Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team.

Results
A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19).

Conclusions
CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.
617 Does Wearing Enhanced Personal Protective Equipment (PPE) In Theatre Increase Surgeon Workload and Patient Morbidity?
Authors: Gysling S , Maresca G , Brooks A , Patel A , Caruana E 
Published: May 2021

Abstract

Introduction
Delivery of surgical services during the Covid-19 pandemic has required the use of enhanced PPE in the operating theatre. We sought to evaluate the impact of this change on surgeon workload and intraoperative patient outcomes.

Method
Surgeons performing as primary operator completed an online procedure-specific questionnaire on workload ratings for each operative case, using an extension of the validated Surgeon Task Load Index (SURG-TLX) tool (reported on a 20-point scale), together with operative details. Local approval was obtained at individual sites. Data was analysed in Stata SE v16.

Results
118 responses (17 surgeons, 7 specialties) were collected from June to September 2020. 77.1% used enhanced PPE. There was no association between enhanced PPE use and overall workload (p = 0.151) as measured with SURG-TLX, although surgeons wearing enhanced PPE commonly reported finding individual procedures harder than expected (37% vs 0%, p &lt; 0.001). Communication was rated worse when using enhanced PPE use (MD -4.38, 95%CI -6.74 to 02.03; p &lt; 0.001). There was no association between enhanced PPE use and intraoperative complications (p = 0.745).

Conclusions
The use of enhanced PPE is not associated with complications or increased surgeon workload assessed by SURG-TLX. It is, however, associated with difficulty in communicating, and subjectively experiencing more procedural challenge than anticipated.
649 COVID BOAST In Practice: Our Experience Implementing BOA Recommendations During the UK Coronavirus Pandemic Peak
Authors: Hoyle A , Iqbal K , Henry J , Hughes L , Johnson D 
Published: May 2021

Abstract

Background
In anticipation of the UK coronavirus pandemic peak, BOA published new pandemic-specific guidance (“COVID BOAST”) in April 2020. We describe our experience implementing this restructured T&O service in a busy DGH setting during the pandemic peak.

Method
A rapid retrospective audit was conducted of all patients presenting to our T&O service in April 2020, with particular emphasis compliance with COVID BOAST.

Results
Our service conducted 511 outpatient reviews, and 95 operative procedures. 94% of outpatients were treated non-operatively. We provided telephone appointments to 12.8% of follow-up patients, and 39% of new patients. 82% of patients were treated with removable casts/splints/boots. 23% of patients were discharged direct from VFC or after one face-to-face fracture clinic review. Residual deformity was consciously accepted in 13% of patients. Theatre throughput fell significantly due to pandemic precautions however, femoral neck fracture volumes remained constant.

Conclusions
We demonstrate broad compliance with COVID BOAST guidance. The majority of patients were treated non-operatively, including conscious acceptance of residual deformity. Our pre-existing VFC allowed us to provide a significant number of telephone consultations, although despite the practice shift towards removable splintage, face-to-face consultations were required for clinical and/or radiological assessment. The impact of increased conservative management on patients’ long-term outcomes needs further evaluation.
727 Ambulatory Management of Acute Uncomplicated Diverticulitis During COVID-19 Pandemic
Authors: Harty M , Armstrong L , McElvanna K , McElvanna K 
Published: May 2021

Abstract

Introduction
Acute diverticulitis remains a common acute presentation to the emergency department(ED). During the COVID-19 pandemic, surgical services have been adapted to reduce hospital admissions. Our aim is to assess the safety and efficacy of the surgical ambulatory service in the management of acute diverticulitis.

Method
Data was retrospectively collected on consecutive patients referred to the surgical team with a suspected diagnosis of diverticulitis between 30.04.20-16.08.20. Unsuccessful ambulation was determined by representation at 30 days.

Results
83 patients presented with suspected diverticulitis. 36 patients were deemed clinically stable and suitable for ambulation. 21 of these patients underwent a CT abdomen in the ED, confirming uncomplicated diverticulitis and were discharged with oral antibiotics as per trust guidance. 4 patients were discharged from ED for an ambulatory CT abdomen, with a median waiting time of 3 days. 11 patients received no imaging prior to discharge, all of whom had known diverticular disease. 86% of ambulated patients underwent a telephone review within 72 hours of acute presentation. 8.3% of ambulated patients represented within a 30 day window, 0 of which required surgical management.

Conclusions
Patients presenting with uncomplicated acute diverticulitis can be safely managed in an ambulatory setting. Access to imaging early can facilitate successful discharge.
783 Brachial Plexopathy Secondary to Prone Position Used in The Treatment of a Ventilated Patient With COVID-19: A Case Report and Service Improvement Recommendations
Authors: Baldwin A , Truelove A , Ali T 
Published: May 2021

Abstract

Introduction
Prone position has been recommended by many authorities as part of the management of ventilated patients with COVID-19. However, proning with concurrent use of sedation and muscle relaxants carries the hypothetical risk of brachial plexus injuries, thought to be due to stretch and compression of the abducted shoulder.

Case

We report the case of a long-stay critical care patient who required frequent proning due to SARS-CoV-2 infection, and who presented with new right upper limb weakness. This case was referred to our local plastic surgery service and an injury to the upper trunk of the right brachial plexus was confirmed on nerve conduction studies.

Recommendations

Following this case, we made adaptations to our local practice and modified our prone-specific SSKIN bundle (originally created to prevent pressure sores) to include a section on ‘Nerves’, with an accompanying diagram. We dubbed this the SSKINN bundle. This ensured safe prone positioning. We encourage other hospitals to put in place similar interventions.

Conclusions
We present this as a pathology to consider in patients proned during the COVID-19 pandemic; and recommend checking for signs of focal neurological deficits of the upper limb upon removal of paralysis and sedation, with early referral of suspected cases.
814 The Ambulatory Management of Acute Biliary Disease During the COVID-19 Pandemic
Authors: Lockhart J , Deeny D , Armstrong L 
Published: May 2021

Abstract

Introduction
Biliary pathology creates a significant burden on the NHS in terms of acute admissions, investigative imaging and elective operating. During the COVID-19 pandemic, surgical services were adapted to minimise hospital admissions. Our aim is to review the safety and efficacy of the surgical ambulatory service in the management of varying biliary pathology.

Method
Data was retrospectively collected on consecutive patients referred to the surgical team with presumed biliary pathology between 30th April and 16th August 2020. Patients with presumed cholecystitis were discharged with oral antibiotics following local guidance with follow-up telephone consultations. Unsuccessful ambulation was determined by representation at 30 days.

Results
One-hundred-and-seventy patients were referred to the acute surgical team with presumed biliary pathology; 81 were suitable for ambulatory management and their first line imaging (abdominal ultrasound, MRCP or CT) was performed within a median of 4 days; 17% of these patients underwent second line imaging in the form of MRCP. Fourteen percent of these patients failed ambulatory management and were admitted to hospital; 3 underwent a cholecystectomy and 2 had an ERCP.

Conclusions
Patients presenting with biliary disease can be safely managed in an ambulatory setting. Access to imaging early can facilitate successful discharge and ongoing ambulatory investigation and definitive management.
918 COVID-19: A Detailed Analysis on Fit-Testing for Respiratory Protective Equipment in the UK
Authors: Gani A , Green S , Bailey M , Brown O , Hing C 
Published: May 2021

Abstract

Introduction
There is limited data in the literature regarding the adequacy of generic FFP3 masks and their facial fit to ensure adequate protection. Mask fit-testing is therefore essential to protect healthcare workers.

Method
Using the Freedom of Information Act, 137 acute NHS trusts in the UK were approached on the 26/3/2020 by an independent researcher to provide data on the outcome of fit testing at each site.

Results
85 Trusts responded to the FOI with 51 trusts providing pertinent data relevant to the FOI request. There was a total of 72 mask types used across 51 trusts. The commonest of which was the FFP3M1863 (used by 47/51 trusts, 92.16%). A positive correlation was found between staff members and number of mask types used (r = 0.75, P = &lt;0.05).
Overall fit-testing pass rates were provided by 32 trusts. The mean percentage pass rate was 80.74%.
Gender specific failure rates were provided by seven trusts. 4386 males underwent fit-testing in comparison to 16305 females. Across all seven trusts 20.08% of men tested failed the fit-test while only 19.89% of women failed the fit-test.

Conclusions
Our results may be utilised in choosing respirators for fit testing programme in healthcare-workers during the COVID-19 pandemic.
931 COVID-19 and the Irish National Spinal Injuries Unit: Impact on Service Provision and Strategies to Protect Urgent Care
Authors: Power F , Juhdi A , Macken M , Synnott K A , Butler J S 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has had a dramatic impact on the provision of healthcare worldwide. The delivery of a national spinal service for emergent surgery, elective surgery and outpatient assessment has been incredibly challenging.

Method
Prospectively collected data regarding referrals to, and operative workload of, the Irish National Spinal Injuries Unit (NSIU) during the period of national lockdown in response to the COVID-19 pandemic was compared to the same period in 2019.

Results
During the period of national lockdown there was a 47% decrease in the number of urgent referrals to the NSIU and a 61% reduction in the number of surgical cases performed. A particularly concerning finding was that for surgical cases there was a 400% increase in attempted suicide as the cause of injury with this cohort representing 11% of all surgical cases performed during the pandemic lockdown. The introduction of a national instant messaging application (Siilo) referral group resulted in a median time to first response by a National Spinal Injuries Unit (NSIU) surgeon of 15.5 minutes.

Conclusions
The COVID-19 pandemic has had a significant impact on the provision of a national spinal service, however innovative strategies have been adopted to protect the capacity to provide urgent care.
952 In-Patient Trauma Surgery in COVID-19 Positive Patients Carries A Significantly Higher Mortality Risk When Compared to In-Patient Covid-19 Negative Patients and Day Case Trauma Patients
Authors: Qureshi M , Lokanathan S , Adapa A , Stansfield J , Jain N , Bhutta A 
Published: May 2021

Abstract

Introduction
Covid-19 caused many service changes, yet Trauma surgery continued throughout. We compare mortality rates from In-Patient (IP) and Day Case (DC) trauma patients and compare the mortality rates of patients who tested positive or negative for Covid-19.

Method
We reviewed all trauma admissions that underwent surgical intervention in both our IP and DC services during 31 days from March 23rd 2020. We recorded their sex, age, operation, Covid-19 symptoms, Covid-19 test results and mortality. The findings were compared between the groups.

Results
In total 127 patients underwent surgery (66 IP; 61 DC). There were 6 deaths (9.1%) within the IP group and 0 deaths in the DC group (p = 0.006). In the IP group 8 patients (12.1%) tested positive for Covid-19 of which 4 died (50%) compared to the remaining 58 patients (87.9%) of which 2 (3.4%) died (p &lt; 0.001). A higher mortality rate was observed in patients with symptoms but a negative Covid-19 test (6.7%) than patients in whom a test was never indicated (2.3%).

Conclusion
Covid-19 positive patients requiring in-patient admission for trauma surgery have a significantly higher mortality rate than both in-patient admissions that were Covid-19 negative or asymptomatic and patients that were treated with Day Case Trauma surgery.
40 Across the Pond: Why Are Junior Doctors Seeking Surgical Training Abroad?
Authors: Irfan A , Ahmed I 
Published: May 2021

Abstract

Introduction
The loss of junior doctors from the NHS has been an ongoing issue. A subset are now seeking surgical training in other systems, such as the US. This is a costly and difficult process and many enter into undesignated positions with no guarantee of a job. With so much career uncertainty, why are trainees willing to take the risk?

Method
We performed a survey of trainees who graduated from British medical schools; all are currently enrolled in a US surgical training programme. They were asked about their experiences and perceptions of

Results
Nine trainees completed the survey. The most common time for trainees to move was during or after foundation training and the majority initially matched into preliminary positions. The most common reason cited to move was to receive better quality training. Many perceived the US training to be better and felt that they had a reasonable work-life balance.

Conclusions
The potential loss of the future NHS surgical workforce is worrying. Our survey highlights that surgical trainees place a high value on the quality of their training and were willing to enter an intense and uncertain process to achieve it. This needs to be addressed to retain potential trainees.