bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.449Routine G&S in elective laparoscopic cholecystectomy and the impact on NHS resources
Authors: Kronberga Madara , Matias Mariana , Wiggins Tom 
Published: October 2021

Abstract

Aim
Current guidelines for routine pre-operative tests for elective surgery, don’t mention routine Group & Save (G&S). At present the need for G&S sample is dependent on the operative severity and the likelihood of blood loss. However, despite consistently low major bleeding rates in elective laparoscopic cholecystectomy (ELC) (0.1 – 0.46%) many hospitals, including ours, still hold local policies to have routine G&S pre-operatively and/or on the day of surgery. Our aim is to audit our hospitals local policy regarding G&S samples in ELC and establish its necessity and financial impact.

Methods
Retrospective study looking at adult patients undergoing ELC at University Hospitals Birmingham NHS Foundation Trust in 2020.

Results
344 ELC procedures were carried out in 2020. Of those 82 had no G&S, 137 had pre-op sample taken with no following samples, with a total of 182 samples sent on the day of surgery. Antibodies were identified in 5 patients (1,45%) however none were cross-matched before surgery. Only 1 patient needed transfusion in the peri-operative period and was cross-matched from sample sent after surgery.

Conclusion
Based on our results the likelihood of having peri-operative bleeding in ELC requiring blood transfusion is minimal (0.29%), therefore the need for routine G&S in this context is questionable. Arguably, diagnosing antibodies in itself would justify one G&S sample. In agreement with this our results show that in 2020 our Trust spent unnecessarily more that 2’431£, additionally adding workload to already stretched staff and delaying theatres.
EP.TH.632A single centre’s experience with bariatric surgery outcomes compared to UK NBSR third report 2020
Authors: James Georgina , Gopinath Bussa , Rao Milind 
Published: October 2021

Abstract

Bariatric Surgery has become a routine elective operation offered to patients with obesity (BMI &gt;30) and obesity related diseases. The UK national Bariatric Surgery registry (NBSR) publishes data from record bariatric surgeries.

Aim
We compare one Bariatric service’s outcomes with the outcomes of the NBSR- Third Report 2020. Outcomes; 30-day mortality and complications, length of stay (LOS), 1-year weight loss for Gastric Sleeve (GS) and Roux-en-Y gastric bypasses.

Method
We collected data from one bariatric unit over a 98-month period. Data were taken from bariatric specialist nurses and electronic patient records. This was then compared with the NBSR report 2020.

Results
NBSR UK records 48.8% bypasses and 35.4% GS compared with our department (81.2% bypasses and 9.5% GS.)
The average weight-loss 1-year post op for GS 36.9kg (NBSR 40.3kg) and for bypass 60.2kg (NBSR 44.1 kg)
The average LOS for Bypass was 2.37 days (95%CI 2.3-.2.7) compared with the NBSR 2.6 (95% CI: 2.5-2.7). Whereas GS 2.9 (95%CI: 2.3-3.4) compared to NBSR 2.5 (95% CI: 2.4-2.6). 30-day mortality for primary procedures was 0% for Bypasses and GS compared with the NBSR 0.05%. 30 day complications at 1.74% compared with NBSR &lt;2.38%.

Conclusion
Our unit proportionally performs more bypasses compared with the rest of UK and has greater 1-year weight-Loss with bypass procedures. This bariatric unit had less 30 day mortality and complications compared with NBSR. Our department is meeting the national outcomes when compared with the rest of the UK.
EP.TH.665Where’s the gallbladder? A rare case of gallbladder agenesis with cystic duct stone
Authors: Cheung Tiffany , Presa Roberto , Manzelli Antonio 
Published: October 2021

Abstract

Aims
Gallbladder agenesis is a rare congenital anatomical malformation with an incidence of 0.007-0.0027%. Although usually asymptomatic, clinically it may present similarly to biliary colic. There may be increased risk of de novo biliary duct stone formation due to biliary dyskinesia, subsequent duct dilatation and biliary stasis. We present a case of incidental gallbladder agenesis identified during intended laparoscopic cholecystectomy.

Methods
A 68 year-old female with no significant comorbidities presented with a 16 hour history of colicky right upper quadrant pain and vomiting. She had been awaiting cholecystectomy for increasingly symptomatic gallstones, most recently visualised within a contracted gallbladder on ultrasound two months prior. Recurrently obstructive LFT’s warranted urgent magnetic resonance cholangiopancreatography (MRCP), which identified a poorly-visualised contracted gallbladder and a 10mm common bile duct without filling defect. At index laparoscopic cholecystectomy, a very small thick-walled structure resembling the gallbladder was identified and safely excised in retrograde; a stone was seen within.

Results
Macroscopic examination revealed a 27 x 9 x 11mm piece of dark brown tissue containing soft orange material. Microscopic histological examination confirmed this to be cystic duct focally lined by mucinous epithelium with chronic inflammation. Findings were consistent with gallbladder agenesis.

Conclusions
Although rare, it is important for surgeons to maintain an index of suspicion for gallbladder agenesis, particularly if repeated imaging demonstrates a poorly-visualised or ‘contracted’ gallbladder despite adequate fasting. Furthermore, as in this case, the presence of ‘gallbladder’ stones radiologically does not preclude gallbladder agenesis. Anticipation of this malformation may aid interpretation of biliary anatomy, if incidentally found intra-operatively.
EP.TH.754One Year Experience of Laparoscopic Common Bile Duct Exploration in a District General Hospital Using Ambu Disposable Scope
Authors: Diab Alsarah , Kilkenny Jane , Eltayeb Omer 
Published: October 2021

Abstract

Aim
Common bile duct (CBD) stones are the most common cause of obstructive jaundice. Laparoscopic exploration of the CBD with laparoscopic cholecystectomy has been preferred to endoscopic treatment, as a single-stage modality of treatment for CBD stones. This procedure was started in a District General Hospital in May 2019 using the standard port sites and Ambu® aScope™ 2 single-use flexible scope.

Methods
Retrospective analysis of outcome of all laparoscopic CBD explorations done in a District General Hospital between May 2019 and September 2020.

Results
A total of ten laparoscopic CBD explorations were carried out during the identified period, the main indications were young patients (40%), referral by gastroenterologist (40%) and failed endoscopic retrograde cholangiopancreatography (ERCP) (20%). The mean age (±SD) was 54.7 (± 19.2) and 70% of patients were females. Two thirds of the operations were done in emergency setting, with choledochotomy approach being used in 60% of cases and primary closure in all cases. The average length of stay (±SD) after the operation was 3.1 (±1.9). Only one patient developed a haemoserous collection that required a laparoscopic washout, none of the patients required readmission.

Conclusion
Laparoscopic CBD exploration can be performed safely in a district general hospital, the disposable Ambu® aScope™ 2 is safe, feasible and cost-effective substitute to the reusable choledochoscope. Provision of this laparoscopic CBD exploration at district general hospital level is more convenient to patients and can reduce referrals to regional hepatobiliary units, and therefore provide a good training opportunity for surgical registrars in this setting.
EP.TH.855Hartmanns reversal - Laparoscopic Vs Open, UHNM experience over the last 3 years
Authors: Nair Nandu , Haneef Umar , Chen Zehong , Roy Sudipta 
Published: October 2021

Abstract

Aim
Reversal of hartmanns is still an operation associated with significant morbidity. Although various studies have tried to assess the best time for attempting reversal after the primary operation, there is still no consensus. The aim of our study was to look at our experience over the last three years to find any possible factors which determine the duration between primary operation and reversal and compare laparoscopic vs open approach.

Methods
Prospective cohort including consisting of patients who underwent hartmanns reversal in 3 years was analysed (January-2017 to December-2019). Data was collected retrospectively from clinical notes.

Results
Among the patients (n = 50) there was equal distribution of males (52%) and females (48%). Although the initial operation was open in 74% patients, reversal was attempted laparoscopically in 46% with a conversion rate of 43.4%. Median duration between initial operation and reversal was 433 days. There was no significant association between duration before reversal and patient comorbidities or the indication for the index procedure. Also there was no statistical difference in postoperative hospital stay or immediate postoperative morbidity between laparoscopic and open hartmanns reversal.

Conclusion
There was no difference in immediate postoperative outcomes between patients who had laparoscopic or open hartmanns reversal. There was no determining factor which made the surgeon prefer laparoscopic over open approach nor was there a difference in duration between primary operation and reversal based of patient factors or method of approach. Hence timing of hartmanns reversal and the method of approach still depends on surgeon preference and experience.
EP.TH.860Audit to review the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests obtained
Authors: Cormack Jonathan , Wong Nicholas 
Published: October 2021

Abstract

Aims
Open hernia repair is a common elective and emergency surgical procedure. The majority of hernia repairs are performed without complications. Current dogma dictates 2 pre-operative group and save tests must be obtained prior to hernia repair. Post-operative haemorrhage is rare and there is equipoise as to whether all patients must be group and saved pre-operatively.

Methods
Retrospective review of electronic patient records between April 2018 to March 2019 in a large district general hospital. Cross referencing of operative, blood transfusion and blood science records was performed.

Results
410 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed. The hernia repairs were elective and emergency procedures with patients ASA 1 - 5.
A total of 820 pre-operative group and save test were obtained with a total cost of £7,978.60. The post-operative blood transfusion rate was 1.46%.

Conclusions
A large number of open hernia repairs were performed over a 12-month period with a very low post-operative blood transfusion rate. This small single centre study indicates that many pre-operative group and save tests may be unnecessary as the majority of hernia repairs were performed without post-operative blood transfusion. Abolishing unnecessary group and save tests could reduce clinical and financial burden without compromising patient safety. The study also suggests that a selective group and save policy be instituted for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction for incisional hernia. A selective group and save policy will be implemented and re-audit in 6 months.
EP.TH.955Surgical site Infection prevention Bundle- One Centres Experience
Authors: Thomas Rhys , Reeves Nicola , Torkington Jared 
Published: October 2021

Abstract

Aim
Surgical Site Infections (SSIs) affects the patient’s recovery following surgery. Within Wales the colorectal SSI rate for both emergency and elective patients is 13%, as per a prospective all Wales observational study. The study further demonstrated that elective colorectal SSI rate was 21.1%. In light of this, a single centre within Wales developed and implemented an SSI bundle to help prevent SSIs.

Methods
A bundle was designed based on the WHO and CDCs guidelines and was agreed on by all colorectal consultants within the centre. There were 3 elements to the bundle – pre-operative, intra-operative and post-operative. The bundle was implemented for 50 elective colorectal patients to assess its feasibility and effectiveness.

Results
50 patients had the SSI bundle from 1 st November to 20 th December 2019. Compliance with the bundle was assessed and the resultant SSI rate improved by 40% with an SSI rate of 20% in this centre reducing to 12%. Further analysis of the SSIs that developed demonstrated that 2 were secondary to intra-abdominal complications and the other 4 failed to have all elements of the bundle implemented.

Conclusion
An SSI bundle can by effectively implemented and become standard care for colorectal patients to effectively reduce the SSI rate.
BJS.02Graduates from different medical schools vary in their performance on the Intercollegiate Membership of the Royal College of Surgeons (MRCS) Examinations
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter 
Published: October 2021

Abstract

Aims
UK medical schools vary in their mission, curricula and pedagogy, but little is known of the effect of this on postgraduate examination performance. We explored differences in outcomes at the Membership of the Royal College of Surgeons examination (MRCS) between medical schools, course types, national ranking and candidate sociodemographic factors.

Methods
A retrospective longitudinal study of all UK medical graduates who attempted MRCS Part A (n = 9730) and MRCS Part B (n = 4645) between 2007 and 2017, utilising the UK Medical Education Database (https://www.ukmed.ac.uk). We examined the relationship between medical school and success at first attempt of the MRCS using univariate analysis. Logistic regression modelling was used to identify independent predictors of MRCS success.

Results
MRCS pass rates differed significantly between medical schools (P &lt; 0.001). Russell Group graduates were more likely to pass MRCS Part A (Odds Ratio (OR) 1.79 [95% Confidence Interval (CI) 1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])). Trainees from Standard-Entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses, Part A OR 3.72 [2.69-5.15]; Part B (OR 1.67 [1.02-2.76]. Non-graduates entering medical school were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]) than graduate-entrants.

Conclusion
Medical school, course type and socio-demographic factors are associated with success on the MRCS. This information will help to identify surgical trainees at risk of failing the MRCS in order for schools of surgery to redistribute resources to those in need.
BJS.03Markov Decision Analysis of Treatment Pathways for Resectable Malignancy of the Oesophagus or Gastrooesophageal Junction
Authors: Bradley Alison , Brown Leo 
Published: October 2021

Abstract

Aims
To perform decision-analysis of treatment options for resectable malignancy of the oesophagus or gastroesophageal junction including: surgery alone, neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy and surgery followed by adjuvant therapy based on current highest-level evidence.

Methods
A Markov decision analysis model in an advanced decision-tree format was constructedand populated with data from existing randomised controlled trials. Markov model transition probabilities were based on weighted pooled estimates of proportions from included studies, calculated using Freeman-Tukey arcsine square root transformation under random effects model to account for heterogeneity.Each Markov cycle equated with one month and Markov states within the model included: alive without disease, alive with disease and dead. Extensive deterministic and Monte Carlo probabilistic sensitivity analysis was performed to test all parameters contained within the model.

Results
23 randomised controlled trials were included. Intention-to-treat analysis of the treatment pathways showed that neoadjuvant chemoradiotherapy was the superior pathway with an overall survival time of 50.52 months (42.26 QALMs). Monte Carlo sensitivity analysis run over 10000 iterations showed that neoadjuvant chemoradiotherapy was selected as the superior treatment pathway at a frequency of 93.21% followed by surgery followed by adjuvant therapy with a frequency of 6.79%. Subgroup analysis of only squamous cell carcinomas demonstrated that neoadjuvant chemoradiotherapy was the superior pathway with an overall survival time of 62.67 months (55.22 QALMs).

Conclusions
Based on current best available evidence this decision analysis supports neoadjuvant chemoradiotherapy as the treatment strategy of choice for resectable malignancy of the oesophagus or gastroesophageal junction.
EP.TU.23Impact of a multi-disciplinary team teaching programme on understanding of roles and communication among the multi-disciplinary team
Authors: Ishak Lisa 
Published: October 2021

Abstract

Background
Multidisciplinary teamwork is a critical aspect of patient care. It has a well recognised impact on patient healthcare outcomes. Communication among the multidisciplinary team (MDT) is paramount for effective collaboration, joint care planning and co-ordinated assessments of patients.

Aim
To evaluate the impact of an MDT teaching programme on understanding of roles, and communication among the MDT.

Methods
A questionnaire was distributed among ward staff who rated their understanding of roles and experience of communication for 8 teams within the MDT. An MDT teaching programme was designed and ran weekly over 6 weeks, aimed at improving understanding of roles and communication among the MDT. Sessions were attended by various members of staff including junior doctors, occupational therapy, physiotherapy, junior and senior nursing staff, consultants, and ward clark. The questionnaire was repeated and results were compared.

Results
Understanding of MDT roles was rated 15-32% higher after the teaching programme. For MDT teams not involved in the teaching programme, understanding of roles was rated the same or lower than before the programme. Staff experience of communication among the MDT was rated higher by 18% after the teaching programme. Additionally, the teaching programme provided an opportunity for MDT members to organise weekly MDT-based activities aimed at improving patient healthcare outcomes.

Conclusion
In conclusion, MDT teaching programmes are an effective way of improving understanding of roles and communication among the MDT.
EP.TU.292Role of varying cultural backgrounds on patient safety in modern health care (NHS)
Authors: Narayanasamy Sangara Narayanan , Thomas Pradeep 
Published: October 2021

Abstract

Introduction
Patient’s safety and quality health care are prime motive in today’s health system. To avoid incidents on the minority, safe health system has to function linking different cultures and diversity. Cultural competency is applying clinical skills, knowledge and attitude towards the betterment and clinical safety of minority patients.

Cultural competency
Culture is defined as traditions and norms within group of people, linked by similar beliefs, behaviour,food habits and moral values. Ethno-pharmacology is the branch of science analysing the variations and effect of medications on different group of people. Cultural competency expanded as multicultural education, including patient outcomes, provider outcomes and health service and organizational outcomes (Vega, 2005; Srivastava, 2008). Current debate is that could cultural competency reduce the racial discrimination (Drevdahl et al., 2008).

Cultural competency and outcomes
Patient outcomes are measured in terms of physiological parameters (Hawthrone et al., 2008) and organisational outcomes include multilingual health workers, translators and help desks. (Fisher et al., 2007). Workshop, conferences, and training programs, orientation programs, peer education, interpreters, and meetings improve health care delivery.

Conclusion
Provider and organizational outcomes show moderate improvements in health services, whereas weak evidence of improvements in patient outcome. Henderson et al and Fisher et al reported that health workers trained culturally are most effective in delivering care.

Recommendations
Appropriate terminology and methods of interventions has to be formulated. Periodic reviews and new assessment tools has to be done. Systematic and organizational approach with cost effectiveness to be handled to improve the cultural competency.
EP.TU.317Assessing the competency of foundation doctors in urethral catheterisation
Authors: Walker Emily , Rao Praveen , Khan Zia 
Published: October 2021

Abstract

Aim
Our aim was to assess FY1/FY2 doctors’ experiences and confidence in performing urethral catheterisation in a teaching hospital.

Methods
This was a single centre, survey based study. An anonymous online questionnaire was circulated to all foundation doctors at the trust. The survey contained 18 questions. The domains included the number of catheterisations performed, confidence levels and whether they had been signed off as competent. This was followed by a series of knowledge questions.

Results
The survey was sent to 71 email addresses and the response rate was 53%. The results showed that respondents’ lacked experience and confidence in urethral catheterisation. We also found that 32% trainees had not inserted a female catheter during foundation training, and 55% had failed to insert a catheter in the last year. The vast majority (71%) of respondents did not feel confident in female catheterisation.

Conclusions
This study shows that knowledge and competency in urethral catheterisation (which is an essential GMC requirement) amongst junior doctors is still inadequate.
EP.TU.369Straight to Test (STT) vs. Traditional Colorectal Target Investigations Pathway - A Local Audit
Authors: Fong Michelle , Shepherd Sophie , Dixon Luluwa , Meleagros Loukis , Dvorkin Lee , Navaratnam Romesh 
Published: October 2021

Abstract

Aims
The STT pathway was borne out of the National Cancer Strategy 2015 and faster diagnosis standard to rule in, or out, cancer within 28 days of referral. We aimed to review local target standard of practice, including comparison of STT vs Traditional pathways towards reaching the national standards.

Methods
The Somerset Database for all target referrals to the department was accessed. We chose October 2019 as a period unaffected by COVID-19. Time to investigation, results and treatment were reviewed. SPSS v.16 was used to perform an unpaired T-test of Traditional vs. STT time to diagnosis.

Results
212 patients were referred for target investigations. 53 declined, DNA-ed or were unfit. 159 proceeded to investigations of which 7 cancers were diagnosed: 4 colorectal, 1 gastric and 2 lung. Time to diagnosis averaged 45.8 days and only 47/159 (29.6%) had their definitive diagnosis in 28 days. 52 patients were streamed to STT and 107 traditional pathways. STT patients were diagnosed at 36.3 days (95% CI 28.1-44.6) and traditional patients 50.5 days (95% CI 45.4-55.7) (P = 0.005). Cancer treatment was received median day 59 (range 27-189) and 4/7 received this within 62 days.

Conclusion
Target investigations have low pick up rates of cancers with ever increasing referrals. Our centre did not meet aspirational national targets of time to treatment or diagnosis, although STT patients were diagnosed significantly faster. With COVID-19, rationalisation of patient contact with maintained diagnosis rates must be strategised. Stricter FIT testing with risk stratification and STT expansion is one strategy.