bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.201Evaluating and Improving the Management of Tonsilitis in an A+E Department: An Educational Intervention
Authors: Koslover Nicolas , Levene Tamara 
Published: October 2021

Abstract

Aims
Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management.

Methods
All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later.

Results
Over the study period, 49 patients were included; only 35% (n = 17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n = 19) were treated with antibiotics. Of these, 63% (n = 12) should not have been prescribed an antibiotic and 37% (n = 7) were prescribed an inappropriate antibiotic.
At re-audit, (n = 50 cases), 58% (n = 29) had a clinical score documented and 28% (n = 14) were treated with antibiotics. Of these, 29% (n = 4) should not have been prescribed antibiotics and 21% (n = 3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs 29%, p = 0.026).

Conclusions
A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.
EP.TU.203COVID-19 related myocarditis following laparoscopic appendicectomy
Authors: O'Connor Adam , Loganathan Santosh , Aziz Rizwan 
Published: October 2021

Abstract
We report a 23 year-old male patient who presented to the emergency department with 2 days of central abdominal pain, with associated pyrexia, lethargy and nausea. Of note he had had COVID-19 in November 2020 which self-resolved. Examination revealed right sided abdominal and epigastric tenderness. His C-reactive protein was 302U/L but the remaining bloods unremarkable. The working diagnosis was unclear and a computed tomograph of the abdomen and pelvis arranged which revealed uncomplicated appendicitis with mesenteric lymphadenopathy. He underwent laparoscopic appendicectomy, revealing a macroscopically inflamed appendix without perforation or peritoneal contamination. Day 1 post-operatively, he deteriorated with acute hypoxia, tachypnoea and rigors. Additionally his inflammatory markers had increased. Respiratory physician advice was sought and an urgent computed tomograph pulmonary artertiogram performed, showing no pulmonary embolus but did show bilateral lower lobe consolidation and groundglass opacities in both lungs suspicious of COVID-19. Furthermore given his persistently low blood pressure, he underwent echocardiogram which revealed the presence of COVID-19 myocarditis and impaired left ventricular systolic dysfunction with an ejection fraction of 35%. He was admitted to the intensive care unit for blood pressure support and monitoring from a respiratory perspective. With such measures both his chest and cardiovascular function improved markedly and he was discharged on long-term cardioprotective medication. This highly rare long COVID-19 related complication following laparoscopic appendicectomy is highlighted for surgeons to be aware of and consider in cases of post-operative deterioration in patients with prior COVID-19 infection.
EP.TU.266Anatomy teaching to prepare medical students for placements during COVID-19 pandemic: a cross-sectional study on the use of online near-peer teaching
Authors: Thirupathirajan Vikram Ajit Rajan , Georgi Maria 
Published: October 2021

Abstract

Aims
Medical students have reduced small-group teaching due to the COVID-19 Pandemic. Anatomy is taught thoroughly in pre-clinical years but not specifically during clinical years. We introduced online small-group near-peer anatomy teaching for students in their first clinical year to help them before starting clinical placements. We investigated the usefulness of revisiting anatomy and the effectiveness of small-group teaching in an online setting.

Methods
Tutors were 5th or 6th Year medical students, each teaching a group of 5 to 8 tutees anatomy relevant to their clinical placements via Microsoft Teams. Tutees completed a post-tutorial feedback form. The primary outcome was confidence on subject content before and after the tutorial. Each outcome was measured by a Likert Scale, 1 (worst outcome) to 4 (best outcome).

Results
127 feedback responses were analysed, a response rate of 62.0%. Mean tutee confidence improved markedly, from 1.520(SD 0.6281) to 3.079(SD 0.5856, p &lt; 0.0001). The mean score for effectiveness of delivery and the effect of technical issues was 3.811 (SD 0.4127) and 3.667 (SD 0.7114) respectively. Analysis of free-text comments showed that the tutorials had a “really great group size” and were “interactive and well-informed”.

Conclusions
Clinically relevant anatomy teaching in a small-group-setting is useful in improving students’ confidence about the content covered in the placements. The use of online platforms to deliver this in small groups was successful, underwent smoothly and is something that can potentially be implemented in the curriculum.
EP.TU.296A Significant Difference in Cancer Proportions Between Two Modelled Cohorts Investigated by 2-WeekWait (2WW) Colorectal referral pathway
Authors: Gendia A , Tam A , Faux W 
Published: October 2021

Abstract

Aim
To compare the proportions of malignancy between two modelled cohorts of referred and investigated by our colorectal 2 WW referrals pathway.

Methods
Two modelled cohorts were analysed from our prospectively maintained colorectal 2WW referrals database from August 2018 to July 2019. One cohort (group A) included patients without anemia, rectal mass or overt rectal bleeding. The other (group B) included the rest of referrals. Data collected and analysed in each group included total numbers of referrals, investigated referrals and malignancy proportion in each group. One tailed Z test was used to analysis statistical difference.

Results
4240 referrals were made to our colorectal 2 WW pathway during the given period. 1333 (31%) were group A and 2907 (69%) were group B. Total number of patients investigated in group A was 1227, of those only 34 (2.8%) were colorectal cancer and 18 (1.5%) were extracolonic cancer. One the other hand, 2705 patients were investigated in group B, colorectal malignancy were found in 142 (5.3%) patients and 33 (1.2%) were extracolonic. There was a significant difference (p &lt; 0.05) in total number of malignancies between Group A (53/4.3%) and Group B (175/6.5%).

Conclusion
While the 2 Week-Wait referral pathway plays an important role in rapid testing and identifying colorectal cancer, there was a difference between malignancy distribution within the referrals. this difference doesn’t reflect a clinical significance but it can be a good stratification tool.
EP.TU.313Colorectal cancer follow up: Can CT Colonography replace Colonoscopy?
Authors: Jolliffe Samantha , McGivney Feidhilm , Chin Mei , Shalli Kawan 
Published: October 2021

Abstract

Aims
Current guidelines recommend surveillance colonoscopy at one year following Colorectal Cancer Resection (CCR), yearly CT chest, abdomen and pelvis, CEA, and colonoscopy in 3 years. Previous studies showed no significant difference between CTC and colonoscopy detection rates of colorectal cancer or polyps &gt;6mm. A review of abnormalities detected on surveillance colonoscopies one year following CCR. If the incidence is low CT Colonography (CTC) would be an alternative to colonoscopy and, when performed simultaneously with surveillance CT chest would be cost-effective, and help in the selective use of colonoscopy.

Methods
A retrospective analysis of one-year surveillance colonoscopies following CCR in 2016 at a health board with three different sites. Normal colonoscopy criteria included: no polyps, no tumour, and no abnormality at the anastomosis. Subtotal colectomy, panproctocolectomies and incomplete colonoscopies were excluded.

Results
111 surveillance colonoscopies were performed one-year post CCR. Age range 30-87 years (39 patients were above 75). Ninety scopes were normal (81.1%). Eight identified only hyperplastic polyps (7.2%); indirectly making over 88% of surveillance colonoscopies unremarkable. Detected abnormalities: nine low-grade adenomas (8.1%), one anastomotic recurrence (0.9%), and only three new cancers (2.7%). There were no complications related to the procedure. Each colonoscopy costs £996 at this health board, CTC is significantly cheaper.

Conclusion
New cancer or recurrence post-CCR detected at one-year colonoscopy is very low; therefore, CTC would be ideal alternative surveillance. Adding it to CT Chest would significantly reduce the number of hospital attendances per patient, which is more cost-effective and reduces risk.
EP.TU.333FIT stratification in the COVID era - Is it safe for rectal bleeding?
Authors: Seehra Jaspreet , Bailey James , Chapman Caroline , Morling Joanne , Humes David , Banerjea Ayan 
Published: October 2021

Abstract

Aims
Faecal Immunochemical Tests (FIT) are increasingly used for stratification of colorectal cancer risk in symptomatic patients. FIT is not currently recommended for use in patients with rectal bleeding, but recent studies have reported its safe use. We report our experiences of FIT in patients presenting with rectal bleeding during the COVID-19 pandemic.

Methods
Patients referred to NUH NHS Trust with rectal bleeding from 15/04/20-15/08/20 were invited to complete a postal-based FIT (OC-Sensor). Demographics, symptoms, investigations and results were recorded. Outcomes were retrospectively reviewed using an electronic hospital system.

Result
344 patients were invited to participate, with 301 (87.5%) returning FITs in accordance with testing protocol. 36 patients declined to be seen, 4 were considered not fit for investigation, and 4 had incomplete records. 257 patients were included in the final analysis with 10 CRC detected (3.9%).
Rectal bleeding (257, 100%) was the most common presenting symptom followed by change in bowel habit (133, 51.8%). 10 CRC were diagnosed (3.9%). 2 CRC were detected with FIT &lt;4 µg Hb / g faeces (2/137, 1.5%) and 8 were detected &gt;100 µg Hb / g faeces (8/45, 17.8%). FIT result was significantly associated with CRC diagnosis (p &lt; 0.0001). 4 with CRC had anaemia (4/53, 7.5%), 1 had thrombocytosis (1/12, 8.3%).

Conclusions
FIT missed 20% of CRC in this patient group with the application of a very low threshold (&lt;4 µg Hb / g faeces). Both cancers missed by FIT were detectable on digital rectal examination, emphasising the importance of this examination in primary care.
EP.TU.370A 5-year re-audit of quality indicators for potentially curative rectal cancer resections by a single surgeon
Authors: Lockhart Jessica , McKay Damian 
Published: October 2021

Abstract

Aim
High quality operations with low rates of tumour perforation and circumferential resection margin (CRM) positivity are associated with improved long-term outcomes following surgery for rectal cancer. Previous audit has demonstrated lower rates of tumour perforation and CRM positivity by a single surgeon compared to the published standards. Our aim is to re-audit this surgeons’ outcomes for curative rectal resections.

Methods
Data was collected retrospectively for all potentially curative rectal resections over a 5-year period performed by a single surgeon using a local database and electronic care records. The CRM status and tumour perforation status were considered. Other end points included the rate of local recurrence, survival and length of stay.

Results
Fifty-one patients underwent rectal resections with curative intent, with a median age of 67. Complete resection (R0) was achieved in 94.1% of cases; 3.92% were found to have nodes less than 1mm from the margin and 1.96% were found to have tumour deposit less than 1mm from the margin – these cases were considered to be an R1 resection. Tumour perforation was present in 3.92% of cases, all of which had occurred pre-operatively. Local recurrence was found in 5.88% of cases and 90-day mortality was 1.96%. Median length of hospital stay was 7 days.

Conclusion
Our data demonstrates sustained high quality surgical outcomes with low tumour perforation rates and CRM positivity rates which compare favourably with the published standards to date. Local recurrence rates are comparable to published standards and 90-day mortality continues to be low.
EP.TU.482A closed loop audit on patient nutrition in a general surgical ward
Authors: Ramadan Wafaa , Iqbal Muhammad Rafaih , Walton Sarah-Jane 
Published: October 2021

Abstract

Aim
Nutrition is an important aspect in the patient’s road to recovery after any surgical procedure. Often there is a communication gap which is not beneficial for the patient. The aim of this audit was to evaluate the communication regarding patient nutrition requirements.

Method
All consecutive patients on a General surgical morning ward round were included. Four communication points were reviewed:
Data was collected prospectively on a predesigned proforma.

Results
First Cycle:
Second Cycle:

Conclusion
Nutrition in surgical patients is very important. It is proven that patients on ERAS programme have fewer complications, more rapid return to function and shorter hospital stay. Emphasis and education about the importance of nutrition is the way forward.
EP.TU.653Improving surgical admission clerking by introducing a standardized clerking proforma: a quality improvement project
Authors: Geropoulos Georgios , Kennedy Clio , Tang Stanley , Elhamshary Ahmed , Rakhshani-Moghadam Sara , Grant Calum 
Published: October 2021

Abstract

Aims
When clerking new admissions several critical actions must be performed in a timely and accurate way. These include reviewing referral letters, obtaining a detailed medical history and documenting the patient’s plan. This is of paramount importance, especially in high volume surgical hospitals. The aim of this quality improvement project is to evaluate a standardized electronic proforma for surgical patient clerking in an attempt to minimize missing information that can compromise peri-operative care.

Methods
A short questionnaire assessing the clerking process was handed out to doctors and allied health professionals. It was completed before and after the introduction of the clerking proforma. Proportion confidence intervals (95% CI) compared for each answer before and after the proforma releasing.

Results
Domains with a statistically significant improvement were the admission reason, management, treatment escalation and venous thromboprophylaxis plan in patients on long term anticoagulation. After introduction of the proforma, feedback still implied that the social history needed to be more extensive. Further edits to the proforma in a second cycle include prompts regarding baseline function and ADLs, as well as existing packages of care.

Conclusions
Overall, the introduction of the surgical patient clerking proforma lead to an improvement of the quality of the clerking as assessed by standardized questionnaires. It is noteworthy that a complete clerking is correlated with more effective handover between health care providers, less medical errors, less treatment delays and improved patient outcomes.
EP.TU.734Rectal mesh erosion post pelvic gynaecological surgery: A literature review
Authors: Morris Lucy , Patrick Robyn , Ali Bakar , Tarazi Munir 
Published: October 2021

Abstract

Introduction
Surgical mesh has long been used for the repair of pelvic organ prolapse. In recent years high rates of serious complications have been reported and the US has withdrawn it from use, while the UK advises extreme caution. Here, we present a review of the literature with a focus on causative factors.

Methods
Twenty-three articles were included in the review: 21 cases of rectal mesh erosion and three cases of sigmoid mesh erosion. Causative factors were subdivided into patient-related, mesh-related and procedure-related.

Results
Main patient related risk factors included pre-existing intestinal diseases (reported in 4 cases) and an older age (median 65.5). Risk factors that were mesh related included increased porosity. 11 cases were reported with a macroporous (&gt;75µm) mesh, whereas only 1 case had used a microporous (&lt;10µM) mesh. 9 cases with partial/ no details of the mesh. The main risk factor that was procedure related was concomitant hysterectomy with 7 cases of mesh erosion had concomitant hysterectomy, 11 cases without concomitant hysterectomy, with a further 5 being unclear.

Conclusion
Pre-existing bowel disease, mesh type and mechanical factors associated with surgical technique all influenced the risk of mesh erosion into the bowels. A lack of reported information regarding the original surgical mesh and operation hindered the ability to draw conclusions. A step into rectifying this in the future would be the provision of medical device cards directly to the patient detailing the mesh.
EP.TU.785Quality Improvement Project: Improving Oxygen therapy prescription in surgical inpatients
Authors: Hamid Mohammed , Al-Saket Laith , Rawashdeh Arab , Sudarsanam Raman 
Published: October 2021

Abstract

Aims
The 2015, British Thoracic Society (BTS) Oxygen audit demonstrated that 42% of hospital inpatients were using Oxygen without a prescription. National and local standards state that Oxygen, as a drug, should be routinely prescribed and checked along with regular medications and VTE risk assessment. Our baseline audit conducted over a two month period on the surgical wards of a large city hospital revealed that 78% of patients were not being prescribed oxygen. We set a SMART aim to increase the percentage of surgical inpatients being prescribed oxygen by 20% each month.

Methods
We used the trust e-prescription software to record our data, with three-stage verification and subsequent senior analysis of data. The three primary drivers identified were factors intrinsic to the department: lack of standard awareness, education and safety-net to ensure sustainability. To tackle these in-turns, we designed three PDSA cycles: Departmental poster, seminar with induction material, and system checklist notification.

Results
Following our first PDSA cycle, the mean percentage increased from 22% to 60%. Using projection analysis, we anticipate this to increase to &gt; 75% after the second PDSA cycle, and &gt;95% after PDSA3, with 100% sustainability one year later.

Conclusion
Our results to-date show that practice standards have improved following our first PDSA cycle, indicating that awareness played an important role. We predict that education will play an equal role; and given the research supporting the implications of checklists, we forecast that this later element will be the ultimatum leading to 100% sustainability of patients receiving oxygen prescription.
EP.TU.809Challenges in management of acute diverticulitis within a district general hospital
Authors: Butterworth James William , Lafaurie Guillaume , Fabowalwe-Makinde Blessing , Aikins Lois , Oke Tayo Olatokunbo 
Published: October 2021

Abstract

Aim
Incidence of perforated sigmoid diverticular disease is estimated at 3.4 to 4.5 per 100,000. Perforation may be the first manifestation of complicated diverticulitis with a range of 50% to 70%. We aim to review management of systemically unwell patients with acute diverticulitis in a district general hospital against the 2019 NICE guidelines.

Methods
29 patients presenting septic with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed over a 6-month period.

Results
Mean time to antibiotics was 3.96 hours (range 0-23.11). Of the 7 with perforated diverticulitis severity classification included: Hinchey I – n = 1, 3.4%; Hinchey IIa – 5 (17.2%), and; Hinchey IIb – 1 (3.4%). Time to CT abdomen pelvis was 3.38 hours (range 0-16.4 hours). Two pericolic abscesses met NICE drainage criteria at 3.7 cm and 3.9 cm respectively. The 3.7 cm abscess was drained radiologically at 7 days post-admission and was re-admitted 6 days later requiring further radiological drainage. The patient with a 3.9 cm abscess received a Hartmann’s procedure and had multiple re-admissions requiring a hospital stay of 34 days. There was 0% mortality at 30 days.

Conclusion
Management of acute diverticulitis continues to present a unique challenge. For systemically unwell patients, timely administration of antibiotics within an hour of sepsis recognition is encouraged to optimise outcomes. Timely cross-sectional imaging is pivotal in disease classification and decision-making regarding acute management. Interventional drainage and surgical resection remain important therapeutic strategies for unwell patients with Hinchey grade II diverticulitis.
EP.TU.854Happy Patients and Updated Open Wound Management Protocols
Authors: Peri Harish , Harvitkar Rafique Umer 
Published: October 2021

Abstract

Introduction
Open injuries have a potential for serious bacterial wound infections and may lead to long term disabilities, chronic wound or bone infection, and even death. This QI study was undertaken to ring in changes to the current management protocol and align them as per WHO guidelines.

Method
Implementing changes through a Plan-Do-Study-Act (PDSA) cycle post an initial clinical audit among 38 patients of the organization. Re-audits were done to measure the outcome against the standard and establish a new protocol.

Results
Initial audit showed only a dismal 37% (n = 14) of patients being managed as per WHO protocol. Patient satisfaction percentage (as measured by a questionnaire) was also low with only 54% of patients satisfied with the treatment. Significant variations were noted post implementation of changes after the first PDSA cycle where &gt;90% (n = 35) of patients reported that they noticed better wound healing, transition to optimal performance and were satisfied with treatment outcomes.

Conclusions
Timely wound dressings, appropriate antibiotic prophylaxis and increased patient’s awareness on wound hygiene through means of regular educational sessions and updated management protocols have led to healthier patients, lesser long term disabilities and happy patients.