bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP8.2.5 Taking the virtual plunge: delivering an intensive curriculum at the 'St Thomas' MRCS course' in the COVID era
Authors: Davis Heather , Patel Ashish , Wythe Odile , Chan Shirley 
Published: October 2021

Abstract

Aims
The Covid-19 global pandemic changed the world. Disruption to teaching and training has been felt across medicine, but more acutely in craft specialities such as surgery. The Royal College of Surgeons has raised concerns and started a campaign: ‘no training today, no surgeons tomorrow’. Innovation and adaptation are required in this new normal.
We assess the effectiveness of adapting an intensive face-to-face revision course covering essential skills and knowledge required for the Membership of the Royal College of Surgeons (MRCS) examination to the virtual world.

Methods
Over five days interactive lectures, small-group teaching (clinical examination, communication, procedural skills), and a complete mock examination were delivered by a faculty of expert lecturers, consultants and actors live over Zoom. Feedback was collected on all aspects of the course by online survey. Sessions were marked for presentation, clarity, relevance and overall quality.

Results
19 participants attended 35 sessions and six mock stations, with a total of 597 candidate sessions and 108 candidate mock stations. 94% of ratings were at least very good; 63% were excellent. Participants reported significantly improved levels of skill and knowledge (p &lt; 0.001). Most felt skills improved from fair to very good. All candidates felt the course was well organised and allowed full participation.

Conclusion
Increasingly, medical education is occurring in the virtual world. Whilst this poses difficulty in craft specialities, particularly for skill acquisition, our data demonstrate high participant satisfaction. Moreover, significant improvements were seen in self-assessment of skills and knowledge as a consequence of this unique course.
TP8.2.6 The effect of checklists on the surgical performance during laparoscopic cholecystectomy: A systematic review
Authors: Boghdady Michael El , Tang Benjie 
Published: October 2021

Abstract

Aims
Laparoscopic cholecystectomy (LC) is known to be one of the most widely performed general surgical operations. However, it is still associated with an increased incidence and severity of complications especially during the period of a surgeon’s proficiency-gain curve. Certain complications could be prevented by decreasing the incidence and consequences of surgeon errors. We aimed to systematically review the use of checklists during LC and their effect on the surgical task performance.

Methods
A systematic review was performed in compliance with the PRISMA guidelines. A search was carried out on PubMed, ScienceDirect and the Cochrane-Library databases. English language articles published to November 2020 were included in this study. The terms included: ‘Checklist and laparoscopic cholecystectomy’, ‘checklist and laparoscopic surgery’, ‘checklist and cholecystectomy’ and checklist and minimally invasive surgery’’. MERSQI score was applied for quality assessment. The research protocol was registered with PROSPERO register (CRD42021209118).

Results
The results of the systematic search resulted in 8862 citations, of which 23 relevant citations were assessed for eligibility. A final 9 articles were included in this study. The endpoints were equipment-related-risk events, numbers and types of adverse events, rate of conversion to open cholecystectomy, team communication and coordination, the number of consequential and inconsequential errors. The positive effect of checklists on the performance during LC was supported with 5 high-quality studies.

Conclusion
The effect of checklists application during LC showed a significant improvement of the surgical task performance by decreasing the number of surgeons’ errors. We envisage the routine use of checklists during LC.
TP8.2.10 Impact of COVID-19 on General Surgery Training in a University Hospital with Ring Fenced Elective Centre
Authors: Gala Tanzeela , Ain Quratul , Obasi Chekwas , Rashid Hajar , Radha Sarkhell , Vig Stella 
Published: October 2021

Abstract

Aim
Higher Surgical training was decimated by the COVID-19 pandemic with cessation of elective care. Trainees raised concerns that the elective restart and need for higher theatre activity to clear backlogs would impact on training opportunities. This study evaluated the resumption of training associated with a ring-fenced elective centre (EC).

Methods
The EC was established in July 2020 and three time periods were determined: pre-COVID (10/19-2/20), 1st wave of COVID (3/20-7/20) and post EC go-live (8/20-12/20). Data was collated from the E-Logbooks of General Surgery Registrars.

Results
The normal all-speciality pre COVID theatre-activity averaged 1052 cases/month. During the first wave elective activity decreased to 254 cases/month (24% of normal activity). Within 5 weeks of establishment of the EC, theatre activity was near normal despite a reduced number of theatres (with higher theatre utilisation).
Pre COVID, trainees accessed 22.9 cases per month which then dropped to 7.7 cases during the first wave of COVID. Post the go live of the EC, trainees were able to operate on 20 cases per month almost back to normal training levels.
Prior to the impact of the second wave, each trainee had developed a deficit of 90 cases during the 5 months pause.

Conclusion
The ring-fenced elective centre has protected training opportunities for higher surgical trainees. However, the pause in training requires a targeted training recovery plan to overcome the deficit secondary to the first and subsequent waves of COVID to ensure that the JCST target of 1200 cases can be met for CCT.
TP8.2.19 Virtual versus In-Person Education Research (VIPER) in Surgical Skills Teaching: A crossover randomised controlled trial
Authors: Yau Jih Dar , Measuria Radheswari , Loubani Professor Mahmoud 
Published: October 2021

Abstract

Aims
To compare effectiveness of virtual versus in-person teaching of one-handed reef knot to medical students.

Methodology
20 students were randomised into 2 groups of 10, to learn to tie one-handed reef knot.
Group A attended a 15-minute virtual session followed by a 15-minute in-person session; vice versa for Group B simultaneously.
For the virtual session, trainer and students used online platform, Zoom, on an overhead webcam-laptop workstation in separate rooms. For the in-person session, trainer and students were in one room.
Anonymous written feedback was collected from all students.

Results
50% of the students had previous experience in knot-tying. On average, the instruction clarity and support received during the virtual session were reported to be less by Group A than Group B.
30% reported non-inferiority in the virtual method to in-person in fulfilling their training needs to learn this skill. 80% said they could have benefited from more time during the virtual session when compared to learning the same skill in-person. During the virtual sessions, 60% encountered technical difficulties relating to internet (20%), Zoom (25%), trainer availability (10%), and hardware (5%).
35% felt that a fully virtual session is suitable for learning one-handed reef knot. 30% stated they would attend a fully virtual basic surgical skills course whilst 40% would attend a partially virtual one.

Conclusion
Initial experience with virtual surgical skills teaching revealed promising potential based on student feedback. Further focused studies with targeted optimisation are warranted for it to be a viable alternative to traditional in-person teaching.
TP8.2.20 Gongs galore: phaleristic study of the relative risk of a healing art related new-year honour
Authors: Mellor Katie , Powell Arfon GMT , James Osian P , Robinson David B , Egan Richard J , Lewis Wyn G 
Published: October 2021

Abstract

Aims
To compare proportional representation of healthcare specialty workers, in receipt of New Year honours (NYHs) and examine system bias.

Methods
Observational study of recipients of NYHs from 2010 to 2019 within the UK honours system including comparative analysis of proportional representation of the UK medical workforce Absolute risk of receiving a NYH, related to medical specialty, gender, and geographical region. Relative Risk (RR) of receiving an NYH for services to healthcare related to specialty.

Results
11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving a NYH was 0.76 (95% CI 0.68 to 0.84, p &lt; 0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n = 181), with Public Health, Clinical Oncology, and General Medicine specialties most likely to be rewarded (RR 20.35 (CI 9.61 to 43.08, p &lt; 0.001), 8.43 (CI 2.70 to 26.30, p &lt; 0.001) and 8.22 (CI 6.22 to 10.86, p &lt; 0.001)) respectively; Anaesthetists received fewest NYHs (RR 0.52 (0.13 to 2.10), p = 0.305). Men were more likely to receive NYHs than women (OR 0.44, 95%CI 0.36 to 0.54; p &lt; 0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p = 0.003), 39 (10.6%) Wales (p &lt; 0.001), and 26 (7.1%) Northern-Ireland (p &lt; 0.001).

Conclusions
Relative risk of receiving a NYH varied over 150-fold by specialty, two-fold by gender, and three-fold by geographical location. Public Health Physicians are perceived to be the pick of the parade.
TP8.2.26 A new simulation-based course to improve trauma management by junior doctors
Authors: Schneiders Hannah 
Published: October 2021

Abstract

Aims
Trauma calls at small hospitals are often attended by small and/or junior teams, especially overnight. The quality of primary surveys was subjectively observed to be extremely variable, sufficient to cause concern about patient safety. In addition, the introduction of the ‘ward trauma call’ for falls was generating anxiety amongst juniors. I recognised an unmet need and gained permission from the Director of Medical Education to create a half-day ‘Introduction to Trauma’ simulation-based course.

Method
A sample group of Foundation doctors attended a pilot course. Confidence in aspects of trauma management was assessed using Likert scales.

Results
Pre-course results indicated doctors were reasonably confident with their A-E assessments (63% moderately or very confident) but lacked confidence in trauma skills such as using a scoop. After the course 100% reported increased confidence about what will happen in a trauma call, and 63% reported increased confidence in their A-E assessments. Increased confidence was also widely reported in trauma skills (e.g. log roll 88%), how to manage a ward trauma call (100%), and where to find further guidance (100%).

Conclusions
This pilot demonstrated that a small group simulation-based teaching intervention can significantly increase the confidence of foundation doctors in all aspects of their role in trauma management. The most notable increases were in trauma equipment use and in managing ward trauma, suggesting these are areas where foundation doctors lack guidance or experience. The course is now part of trust induction for new foundation doctors.
TP8.2.27 Unlocking growth options in surgical education and training during the pandemic
Authors: Shah Adarsh , Walker Kim , Hawick Lorraine , Walker Kenneth G , Cleland Jennifer 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic brought widespread disruption to structured surgical education and training. The knee-jerk reaction is often pessimism about surgical training’s future, particularly in the Improved Surgical Training (IST) pilot’s context. However, Einstein famously once said, “In the midst of every crises lies great opportunity”. Unlocking growth during periods of high uncertainty is a premise of real options theory; one utilised by supply chain managers and decision scientists, but novel to medical education. This study explores the growth options that have resulted from new operational models during the pandemic.

Methods
Using qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken.

Results
Forty-six trainees participated. Analysis from trainees’ perspective revealed: unexpected fulfilment from redeployment to non-surgical specialties, benefits to personal development from the unintended broad-based training across surgical specialties, improved collaborative teamworking between specialties and allied healthcare professionals, and enhanced supervised learning opportunities. Institutional growth options reported by trainees included: rapid uptake of telemedicine and digital technology, implementation of single hospital episode encounters for minor conditions, streamlined processes in theatre and acute admissions, and changes in working culture towards rationalising and teamworking.

Conclusion
Growth options have been deliberately and unintentionally unlocked due to individual and institutional adaptions and innovations in response to exogenous disruption. While some changes may be temporary, hopefully structured reflection on these changes and responders to them will drive surgical education and training into a new sustainable and resilient post-pandemic era.
TP9.2.16Peri-operative Delirium in the Emergency Laparotomy Population
Authors: McCusker Michael , Edwards Jennifer , Clark Margaret 
Published: October 2021

Abstract

Aims
To determine the incidence of peri-operative delirium in our emergency laparotomy population.

Methods
Utilising our local prospectively maintained Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database all cases over a two-month calendar period were identified. Case notes were reviewed retrospectively for all patients. The 4 A's Test (4AT) assessment tool was used to screen for the presence of delirium (a score ≥4 = delirium), performed throughout the peri-operative period. For all patients baseline characteristics were recorded including NELA risk score, 30 day survival, length of stay (LOS), ASA score, age, sex and presence of pre-morbid cognitive dysfunction.

Results
Thirty-two patients were identified through the ELLSA database. Incidence of peri-operative delirium as determined by 4AT was 10/32 patients (31.25%). The thirty day mortality was 4/32 (12.5%). Peri-operative delirium was identified in all non-survivors. NELA risk score for those with delirium 14% / 21% (median / mean) versus 2.5% / 2.3% (median / mean) without (p 0.0015). The LOS for those with delirium 26 / 24.6 days (median / mean) versus 11 / 13.6 (median / mean) without (p 0.0194).

Conclusions
Delirium is a common peri-operative event. In our population it is associated with a higher NELA score. The presence of delirium is associated with poorer outcomes, with an increased mortality and LOS. This single site survey indicates that there is a need to develop care pathways that identify those at risk of delirium and implement treatment guidelines. Our survey suggests that the NELA score could be used as a triage tool for the risk of delirium.
TP9.2.25No beds! Developing ambulatory surgical care in a District General Hospital
Authors: Salem Rola , Hayes Richard , Bowling Kirk , Whitmore Helen , Bleakley Cait , Lunt Adam 
Published: October 2021

Abstract

Aims
Referrals to acute surgery are increasing by 10% a year with no increase in inpatient bed numbers. Our aims are to improve the patient experience with early review and provide early decision making preventing admission to hospital. In August 2019 we launched our ambulatory surgical service, in order to measure the impact we have reviewed every patient that has come through the service from its inception.

Methods
The service is manned by two dedicated surgical fellows based in an ambulatory unit with dedicated early morning USS slots available. To compare old with new we collated presentations into categories, for example ‘Right upper quadrant pain’ and compared the number of patients ‘ambulated’ to the average length of stay for patients with these presentations before ambulatory care.

Results
From August to October a total of 180 patients were ambulated via the new service. Using the comparison described this equated to approximately 423.05 ‘bed days’ saved the three-month initial period. Discharge times were spread throughout the day rather than ‘peaking’ with emergency team handover indicating an improved experience this has been backed up by qualitative reports from patients and families.

Conclusion
The introduction of the ambulatory service has improved the general surgical on-call experience at our hospital both for patients and clinicians alike, whilst decreasing surgical bed occupation. Utilising existing resources we have improved the patient experience, enabled quicker decision making and taken pressure away from the on-call.
TP9.2.30Sigmoid Volvulus: Is a More Aggressive Approach Justified? Results of a Retrospective Cohort Study
Authors: Slack Zoe , Shams Mohamed , Sallam Mahmoud , Bond-Smith Giles , Tebala Giovanni 
Published: October 2021

Abstract

Aims
Sigmoid volvulus is a common cause of emergency surgical admission. It often affects older males who are institutionalised and are less suitable surgical candidates. Definitive treatment is surgical but first line treatment is via endoscopic devolution with or without placement of a rectal tube. After non-operative management recurrence is likely and carries a high mortality, therefore an early surgical approach may be considered in patients who are fit for surgery. We have retrospectively analysed a cohort of patients with sigmoid volvulus in order to clarify if and when a more aggressive management is indicated.

Methods
We have reviewed data on admitted patients diagnosed with sigmoid volvulus over a 2-year period. Demographic, clinical data, morbidity and mortality were recorded in a database. Analysis was carried out with statistical programs. The primary endpoint was patient survival. Secondary endpoint was the estimation of the factors that condition surgical choice.

Results
We analysed 78 cases. 74.4% had multiple admissions and recurrences. 39.7% of patients underwent surgical resection. The average survival was 54.9±8.8 months from the first hospitalisation, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low “social score”, a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival.

Conclusions
In conclusion, we believe that early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient's social and functional condition.
TP10.1.2Evaluating the impact of the COVID-19 pandemic on the presentation and management of UGI cancer at a district general hospital
Authors: Aly Mohamed , Mukerjee Tanmoy , Singh Reya , Whitelaw Douglas , Adil Tanveer , Munasinghe Aruna 
Published: October 2021

Abstract

Introduction
It has been predicted that the COVID-19 pandemic would disrupt the delivery of UK cancer treatment pathways. This study aims to assess the mode of presentation and type of management offered to oesophagogastric (OG) and hepatopancreaticobiliary (HPB) cancer patients at a busy district general hospital during the pandemic.

Methods
Confirmed OG and HPB cancer patients were identified in the local MDT database. Patients were identified between 01/03/2020 - 30/09/2020 (pandemic), and 01/03/2019 - 30/09/2019 (pre-pandemic). Mode of presentation and management was identified and compared.

Results
In 2019, 42 and 15 patients were diagnosed with OG and HPB cancers, compared to 25 and 19 patients in 2020, respectively. 26 (46%) patients were referred via 2ww pathway in 2019, compared to 29 (66%) in 2020. The number of cancers referred routinely or emergently were 28 (49%) and 2 (4%) in 2019, compared to 2 (5%) and 9 (20%) in 2020, respectively (p &lt; 0.0001). Patients suitable for curative treatment were 16 (28%) and 7 (16%), in 2019 and 2020, respectively. Palliative or supportive treatment was offered to 26 (46%) and 14 (25%) patients in 2019, compared to 21 (48%) and 10 (23%) patients in 2020, respectively.

Conclusion
2ww referrals were similar to 2019, while routine referrals reduced significantly. A marked, but not significant, reduction in patients suitable for curative intent is noted, perhaps due to delay in presentation despite the continuation of cancer surgical services. Further work on creating “COVID-free” pathways and increasing awareness of service availability would improve detectability of curable disease.
TP10.1.3SARS-Cov-2 and Colitis: A Case Series
Authors: Banks Jessica , Nair Dheepa , Guy Richard 
Published: October 2021

Abstract

Background
Up to a third of patients with COVID-19 infection present with gastrointestinal (GI) symptoms. The Sars-Cov-2 virus enters enterocytes through a novel mechanism via ACE- 2 receptors, which are expressed throughout the GI tract, especially in the mid-gut. Small bowel and colonic inflammation and alteration of the gut microbiome (“altered inflammasome”) have been observed.

Aims
We report a cluster of cases during the first and second wave UK pandemics involving young patients with unexplained segmental CT-proven colitis.

Methods
All patients diagnosed with CT proven colitis with no history of IBD, ischaemic colitis or significant medical comorbidities were included.

Results
Fifteen patients (median age 33 years; 8 females) were admitted under Emergency General Surgery between Mar 2020 & Jan 2021. All patients were previously well with no history of IBD, ischaemic colitis or significant medical comorbidities. Thirteen patients underwent CT imaging, showing evidence of colitis in 12, with changes affecting the right colon predominating. Campylobacter jejuni was identified in 4 of 7 stool cultures but only 1 patient had a positive PCR nasal swab and another had COVID antibodies detected in serum. Endoscopic and histological appearances of those undergoing colonoscopy were non-specific.

Conclusion
These cases may represent Covid-19 involvement of the gut. Nasal swabs are not validated for use in the GI tract and detection of SARS-Cov-2 virus requires faecal or mucosal sampling. Disruption of the microbiome permits emergence of pathogenic species such as Campylobacter. More work is required in this important area to further define and elucidate COVID-19 GI involvement.