bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.582Impact of enteral prophylactic antibiotic course on the trends of inflammatory markers following laparoscopic colorectal cancer surgery
Authors: Najdawi Amal , Rao Ahsan , Razzaq Humayun , Dworkin Michael 
Published: October 2021

Abstract

Introduction
The study aimed to assess the effect of oral prophylactic antibiotic (OAB) with mechanical bowel preparation (MBP) on the serial measurement of postoperative inflammatory markers and clinical outcomes of the patients undergoing laparoscopic colorectal cancer resection surgery.

Methods
A retrospective data collection was carried out from January 2019 to March 2020 for the patients undergoing laparoscopic colorectal cancer resection. Daily measurements of inflammatory markers were obtained upto 7 days following surgery. The measurements of inflammatory markers were compared between patients who received a 1 week course of OAB along with MBP to those who only received MBP.

Results
There were a total of 110 patients that were divided into 2 groups: patients who received OAB and MBP (n = 44, 40%) and those who had MBP only (n = 66, 60%). There was no significant difference between the patient characteristics and preoperative staging of the cancer between the 2 groups. The overall length of stay was significantly lower in the patients who received OAB (9.09 days [SD 7.94] vs. 6.63 days [SD 4.96], P 0.02). The patients with OAB and MAP had persistently and significantly low levels of white blood cell count, CRP, and neutrophil count throughout the postoperative period as compared to those who only had MBP.

Conclusion
The study demonstrated reduction in serial measurement of inflammatory markers throughout postoperative stay for the patients receiving preoperative OAB. The use of OAB helps in physiological recovery of the patient by reducing the inflammatory process postoperatively.
EP.TU.590Making the cut – Tailoring an undergraduate surgical teaching programme a QI project
Authors: Koo Hui Fen , Huttman Marc , Boardman Charlotte , Saunders Michael 
Published: October 2021

Abstract

Aims
This project set out to improve the quality of surgical teaching for final year students on a DGH placement. A four-week programme was introduced and regular modification was undertaken through systematic gathering of feedback. The sessions developed were interactive question-based tutorials, suturing, and on-call simulation with common F1 scenarios.

Methods
Material was developed and piloted based on topics the facilitators felt were poorly taught as students. Feedback was gathered by questionnaire after each session comparing the student’s confidence before and after, along with suggestions for improvement. This process was repeated through all six rotations.

Results
A total of 95 questionnaires were completed. Average confidence increased from 52% to 77%. The programme was expanded based on suggestions to include orthopaedic examinations and plastic surgery. The tutor pool was increased to include more foundation doctors to ensure sustainable weekly delivery.
Examples of how suggestions were implemented include:

Conclusions
The success of the teaching programme was evident through positive feedback and good student attendance. By playing to the strength of foundation trainees as recent graduates, the programme complemented content-based teaching from more senior colleagues with sessions targeting practical F1 skills and exam specific needs of students. Early piloting also meant ability to constantly adapt the programme to enhance its benefit to the students.
EP.TU.637To Resect or Not to Resect? Incidental Meckel’s Diverticulum at Colon Cancer Resection
Authors: Mishra Shashwat , Martin Graham , Chowdhury Ashim , Aravind Biju 
Published: October 2021

Abstract

Case
An 85-year-old man underwent elective resection for a large proximal transverse colon tumour. At the time of this open extended right hemicolectomy, a Meckel’s diverticulum was identified in the ileum, but not resected considering the age and character of the diverticulum. However, on the sixth post-operative day, he developed small bowel obstructive symptoms which required a reoperation. It was found that the cause of obstruction was identified as a long pedunculated Meckel’s diverticulum wrapped 15 centimetres proximal to the anastomosis. Considering the general condition of the patient and co-morbidities, resection of the Meckel’s diverticulum and loop ileostomy was performed. The patient has now recovered and is being followed up in the community awaiting stoma reversal.

Background
Occurring in 2% of the population, Meckel’s diverticulum is the most common congenital gastrointestinal malformation. Complications of a Meckel’s diverticulum include obstruction, haemorrhage, perforation, diverticulitis and intussusception. Most complications manifest in childhood and are less likely to occur in adults. The indication for resection of incidental Meckel’s diverticula in an adults is still debated amongst surgeons.

Discussion and Conclusion
This case demonstrates an unfortunate scenario of a post-operative complication from an abnormality detected at the time of the index surgery. A recent systematic review has shown that evidence in literature remains controversial for resection in asymptomatic Meckel’s Diverticulum. There are even scoring systems to facilitate decisions in such situations. This case offers an interesting perspective where morbidity may have been reduced if resection was undertaken.
EP.TU.639Daily Next of Kin Updates in the Intensive Care Unit: A Crucial Message in Effective Communication
Authors: Afify Sarah , Mohamud Halima , Popoola Adebusola 
Published: October 2021

Abstract

Aim
The Society of Critical Care Medicine has stated that next of kin (NOK) should be updated daily to inform and support family members of patients in the ICU.
We aimed to determine whether daily NOK updates of surgical patients were performed routinely by ICU doctors and to explore any associated difficulties.

Method
A retrospective audit of 132 patient records from surgical ICU admissions between September and October 2020 was reviewed to assess frequency of NOK updates. A concurrent survey was circulated amongst ICU doctors to assess the self-reported frequency of NOK updates and perceived challenges.

Results
Daily NOK updates were carried out in 61.2% of cases. On admission, NOK were contacted in only 19.4% of cases and only 4.7% of NOK were contacted on step-down days. Conversations were documented in 65% of contacts.
The survey was completed by 20 ICU doctors, 60% stating they always carried out updates. High workload was a contributory factor for not performing updates. 60% found it challenging to speak to NOK.

Conclusion
Although NOK updates are occurring there is scope for improvement. We assume from our study that the parent surgical teams will inform NOK of patients being admitted to ICU; however, this should be better communicated to ICU staff to ensure that updates for these patients are not being overlooked.
A nominated doctor or nurse is recommended to ensure NOK updates are performed. Juniors should be provided with a forum to discuss and learn from challenging conversations.
EP.TU.642An ANTTiclimax for Antiseptic Non-Touch Technique? A Survey of Junior Doctor Awareness
Authors: Afify Sarah , Shabbir Sehrish 
Published: October 2021

Abstract

Aim
Hospital acquired infections are a significant problem, costing the NHS an estimated £1 billion per year and impact on the health and safety of patients. Antiseptic non-touch technique (ANTT) has repeatedly been demonstrated as a method to reduce this burden but there is often a lack of understanding of this topic. We investigated the extent of junior doctors’ knowledge of ANTT during invasive procedures and the precautions that are taken in practice.

Method
This study utilised information from the World Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare, NICE guidelines on Infection Prevention and Control and local protocols to create a questionnaire assessing the following domains; general knowledge, hand washing, procedural and post-procedure actions. This was distributed to junior doctors in the ICU.

Results
A total of 20 participants were assessed from foundation trainees to registrar level. 55% understood the acronym ANTT, whilst 45% did not.
A staggering 85% of participants were not aware of Trust ANTT key principles. 70% of respondents were not aware of WHO and local guidelines relating to ANTT for invasive procedures. 95% of participants did wash their hands prior to invasive procedures and 90% post-procedure.
95% of participants stated they would benefit from a formal teaching session on ANTT.

Conclusion
These results indicate little comprehension of ANTT with reference to both national and local guidelines. Mandatory online and formal education should be integrated into compulsory induction sessions of new staff Trust-wide.
EP.TU.659Comparison of Gallbladder Tissue Tensile Strength between Thiel Embalmed Cadavers and Living Patients
Authors: Chan Deona Mei Lam , Rossolatos Kostantinos , Brown Stuart , Alijani Afshin , Kulli Christoph 
Published: October 2021

Abstract

Aim
Formalin-embalmed cadavers have traditionally been used as an integral part of anatomy teaching and surgical training. Cadaveric tissue can, however, be compromised by distorted appearance, shrinkage, rigidity and unnatural colouration. The Thiel embalming process produces more ‘life-like’ specimens and it could be postulated that these may be more suitable for surgical training. This study aimed to provide quantifiable and repeatable measurements for the mechanical tissue properties of Thiel embalmed cadavers.

Methods
Four gallbladders were removed from Thiel Embalmed cadavers and eleven from living patients during laparoscopic cholecystectomies. The specimens were prepared into a uniform ‘hour-glass’ shape. The cadaveric specimens were loaded onto the Instron tensometer and the patient specimens were loaded onto a portable hand-held tensometer. The samples were extended until complete tensile failure occurred allowing measurement of the tissues’ tensile strength and strain.

Results
Nine samples were obtained from the four Thiel embalmed gallbladders and 27 samples yielded from the 11 living patients’ gallbladders. The mean ultimate tensile strength of the Thiel samples was 2.16 ± 0.91 MPa compared with 2.24 ± 1.40 MPa in the living patient group (p = 0.85). The Thiel embalmed cadaveric samples had a lower measured mean strain than the living patient gallbladders of (123 ± 33% vs. 233 ± 91%, p &lt; 0.01).

Conclusion
This study demonstrates that, while tissue strength is well preserved, there may be some differences in how the tissues feel, related to differences in elongation during handling in Thiel embalmed gallbladder tissue.
EP.TU.660The rate of interval colorectal cancer within 5 years of a negative colonoscopy at a district general hospital
Authors: Alqallaf Abdullah , Grant Aimee , Lavelle Corina , Chandran Palanichamy 
Published: October 2021

Abstract

Aims
Interval colorectal cancer is defined as cancer that has developed within a short interval of a diagnostic test that did not detect a cancer. Many authors define this interval as five years, though more complex definitions of interval cancer have been proposed. Our aim was to determine what percentage of colorectal cancers diagnosed at our hospital had a negative colonoscopy within the 5 years prior to their diagnosis.

Methods
We obtained details of all colorectal cancers diagnosed between 2017-2019 at our department. We then surveyed the endoscopy system to detect the patients who had a negative colonoscopy within the 5 years prior to their diagnosis, to calculate what percentage of cancers diagnosed within that period were interval cancers.

Results
Between 2017-2019, 539 patients were diagnosed with colorectal cancer. Age at diagnosis varied widely from 21 to 107, and 310 (57.5%) of patients were male. Seventeen patients had a negative colonoscopy within 5 years (though two of these were planned repeat procedures within a few months of the index ‘negative’ colonoscopy). We can therefore calculate the rate of interval cancer at 3.1% between 2017-2019.

Conclusions
The aetiology of interval colorectal cancer has been attributed to patient/tumour factors (right colon and female sex) and technical factors (adenoma detection and caecal intubation rate). Though the rate of interval cancer at our department seems pleasingly low compared to the literature, we plan to investigate the risk factors that might be at play: are biological factors to blame or can our endoscopy service be improved?
EP.TU.672Privacy and security in surgical communication: Is Signal app the future?
Authors: Cheah Hock Ping , Quah Samantha , Wong Kenneth 
Published: October 2021

Abstract

Aims
Electronic communication amongst surgical team members improves the team's ability to care for patients. Security and privacy of patient data are significant concerns. Recent controversy involving private data collection with WhatsApp has led to many users changing to other forms of messaging apps to protect user privacy. The aim of this study is the analyse the efficiency and effectiveness of the Signal messaging app in a research setting in Australia.

Methods
Members of our research group comprising three junior doctors and a supervising consultant surgeon used the Signal app as our main method of communication to discuss matters relating to our various research projects. No patient details were discussed in the messaging app.

Results
A total of 234 personal and 148 group messages were sent during the study period in a group and personal message setting. Most messages including picture files sent were received within one minute by the recipient. We did encounter a 24 hour period where Signal encountered some technical difficulties and some messages did not go through.

Conclusion
Signal messaging app is a good alternative to WhatsApp messaging app with better user privacy protection. With more user uptake on Signal app, it has the potential to be used for clinical care as Signal also provides end-to-end encryption to protect patient privacy.
EP.TU.693A rare case of anal melanoma: An entity to be aware of
Authors: Dhaif Ahmed , Boyle Cameron , Lowe Katherine , Paterson Rosemary , Gumber Ashutosh 
Published: October 2021

Abstract

Aims
Anal melanoma is a rare but aggressive malignancy representing a small percentage anorectal cancers. We report a rare case incidentally detected during bowel screening.

Methods
A 74-year-old female presented for endoscopy after a positive qFIT. She was asymptomatic. During endoscopy, perianal examination revealed a jet black naevus of approximately 3x3cm from 9 to 12’O clock position, overlying the perianal body, involving anal margin to the posterior vagina. General physical, abdominal and rectal examinations were unremarkable.
During colonoscopy, a benign polyp was removed from the sigmoid colon. She underwent examination of rectum and vagina under general anaesthetic, and incisional biopsies were obtained. Histopathology confirmed an invasive, superficial spreading malignant melanoma, with a Breslow thickness of 1.5mm and Clark Level IV invasion. Staging CT scans did not reveal metastasis.
Following loco-regional MDT discussion, a combined colorectal and plastic surgery was offered. She underwent wide local excision from the posterior vaginal fourchette to the anal canal, bilateral perforator flap reconstruction, and defunctioning sigmoid loop colostomy.

Results
There were no intraoperative complications. She recovered well post-operatively. After histopathology, her tumour was staged as pT2b, N0, M0. She did not require further treatment post-operatively as per MDTdiscussion. No disease recurrence has been detected yet with 30 months follow up, and she is awaiting reversal of colostomy.

Conclusions
Prognosis is generally poor in anal melanoma. This case report adds to the limited literature and emphasizs that despite no consensus on management, early detection and surgical resection offers the best chance for favorable outcomes.
EP.TU.702Role of cadaveric dissections in current medical education
Authors: Narayanasamy Sangara , Thomas Pradeep 
Published: October 2021

Abstract

Introduction
Today’s digital world has surplus educational resources for the students. Medical curriculum has changed the traditional way of teaching to audio-visual methods. Learning anatomy has changed from cadaveric dissection to specimen models, life models and three-dimensional models, which has raised questions as to whether cadaver dissection should be continued.

Multimodel Approach
Computer software with 3-D models is a useful tool for the beginners (Silen et al., 2008). Didactic lectures provide easy steps to be followed during dissection. Body paintings explain the surface anatomy in an appropriate way. Online videos are user friendly and personalized, so that one could review them repeatedly. Finally, live demonstration in theatre explains the structures and relations, with the flaws of only limited students benefited

Pros
Cadaver dissection creates interest to explore and learn detailed anatomy, to gain everlasting knowledge blending the theoretical knowledge with the practical and to involve in research. In addition, students develop the art of team work building their interpersonal skills.

Cons
Unpleasant smell of the formalin preserved cadaver, limited opportunities for everyone to learn, inadequate fund, inexperienced staff and psychological distress (Evans and Fitzgibbon, 1992).

Conclusion
Cadaveric dissection is a better method of learning (Winkelmann, 2007). Students understanding subjects precisely, make them better clinicians. Other teaching methods could be used as supplements.

Recommendations
Organize different teaching techniques helping diversity of students to learn anatomy based on their learning styles. Use of advanced technology like real time pictures, videos and imaging modalities to learn anatomy (Swamy and Searle, 2012).
EP.TU.825Virtual general surgery teaching for higher surgical trainees in KSS during COVID-19
Authors: O'Brien James , Obeid Noor , Tucker Sally , Hawkins Will 
Published: October 2021

Abstract

Aims
From the start of the coronavirus pandemic, it became clear that the traditional deanery teaching model for higher surgical trainees had to change. Face-to-face lectures and tutorials are not appropriate in light of UK government measures, social distancing and reduced non-essential travel. To replace deanery teaching days we established a once weekly programme of evening tutorials, delivered via Zoom by Consultant surgeons, covering a breadth of general surgical specialities. Each session was archived and a secure digital link provided for trainees to watch later if necessary. We conducted a survey of higher surgical trainees to assess response.

Methods
A 10-question web survey distributed to all general surgery trainees in West KSS. 24/38 trainees responded (response rate 63.2%).

Results
75% rated the teaching as very or extremely useful. Commute, personal responsibilities and late theatre/ clinic sessions were barriers to joining teaching live. 71% found it very or extremely enjoyable. 78% found it at least as good as traditional teaching days. 87% found it very or extremely relevant to their development as a surgeon. 42% would prefer the Zoom format was utilised for longer sessions, to further recreate the traditional teaching "day".

Conclusions
Feedback was broadly positive and the tutorials were well received, but probably need to run less frequently than once a week. Half day sessions could be considered. The teaching quality was rated overall better or at least as good as in-person teaching. There appears to be clear benefit in detailed, reflective surgical teaching delivered efficiently via Zoom.
EP.TU.826Using Indocyanine Green (ICG) during laparoscopic bowel resections for elective cancer patients reduces anastomotic leaks and length of stay
Authors: Bleakley Anna , Komolafe Olusegun 
Published: October 2021

Abstract

Introduction
Anastomotic leakage (AL) after colorectal surgery is associated with significant morbidity and mortality. Poor perfusion of bowel anastomosis is a significant contributing factor. ICG is a dye administered during laparoscopic surgery to assess bowel perfusion by fluorescent imaging – the aim of this study was to determine whether its use in our centre during elective laparoscopic colorectal cancer resections led to improved patient outcomes.

Method
Single-centre comparative study of all patients who underwent elective colorectal laparoscopic resections for cancer January 2019- January 2021. Primary outcome investigated was AL. Secondary outcomes: in-patient length of stay, clinical suspicion of AL and post-operative ileus. Cohorts compared with χ2 test.

Results
25 patients had resections with ICG, 60 without. None in ICG group, and three in non-ICG group (5%) had AL; p-value 0.29. The ICG group were less likely to have CT for suspected anastomotic leak 12% vs 23.3%, p-value 0.29; and, post-operative ileus 5.3% vs 19.6%, p-value 0.09. Statistically significant reduction in mean inpatient length of stay when ICG used (4.0 days, 95% CI 3.3-4.7) compared to when not used (6.7 days, 95% CI 5.0-8.3).

Conclusion
Only a small number of previous studies have compared AL rates with and without ICG, finding that its use leads to a significant reduction in AL. While sample size small, our findings supports this. Using ICG also led to a significant reduction in inpatient length of stay. ICG fluorescence angiography is now established as our normal practice for all colorectal resections as a safe, innovative, simple technology.
EP.TU.911Analysis of the outcomes following reversal of loop ileostomy
Authors: Lutfi Sawsan , Camilleri-Brennan John 
Published: October 2021

Abstract

Aims
A defunctioning loop ileostomy is constructed to reduce the incidence and the consequences of anastomotic leaks following sphincter-sparing colorectal resection. Its construction and reversal may be associated with complications. The aim of this study is to present a snapshot of the outcome of reversal of loop ileostomy in a teaching general hospital.

Methods
All patients whose loop ileostomy was reversed in 2018 were studied. Sociodemographic and clinical data were collected. The outcomes measured were length of hospital stay, return of bowel function, morbidity and mortality.

Results
Nine patients had reversal of ileostomy by experienced colorectal surgeons during this period. The patients, 5 males and 4 females, had a median age of 58 years (range 20 to 77 years). The main indications for construction of a loop ileostomy were low anterior resection for rectal neoplasia (7 patients) and iatrogenic rectal perforation during hysterectomy (1 patient), and total colectomy with ileoanal pouch reservoir for ulcerative colitis (1 patient). The ileostomies were reversed between 5 to 10 months following the main operations. The postoperative stay was between 2 to 12 days. The complications included one anastomotic leak, requiring immediate re-operation, 3 wound infections and 2 incisional hernias. There were no postoperative deaths.

Conclusion
In this study our overall complication rate was well within the range reported in the literature, with only one patient requiring immediate re-operation. The presence of a senior colorectal surgeon at operation as well as careful attention to detail is key to keeping complications to a minimum.