bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP7.2.16 Systematic review and meta analysis of pre operative antibiotics and bowel preparation on ileus following colorectal resection
Authors: Kelly Michael , McKnight Gerard , Scott Alisdair J. 
Published: October 2021

Abstract

Aims
Pre-operative oral antibiotics (OAB) and mechanical bowel preparation (MBP) may reduce rates of post-operative infectious complications following colorectal surgery but their effects on post-operative ileus (POI) are not well-established. We conducted a systematic review and meta-analysis to address this question.

Methods
Medline and Embase databases were searched to identify randomised controlled trials and cohort studies comparing pre-operative MBP or OAB to control in patients undergoing elective colorectal resection and reporting the rate of POI as an outcome. Risk ratios were pooled using a random-effects model to generate a summary risk ratio and 95% confidence interval.

Results
Five randomised trials and three cohort studies were included which reported the effect of pre-operative MBP on POI. Some 29056 patients received MBP compared to 13077 who did not. The rates of POI were 10.0% vs 12.0% respectively. Meta-analysis gave a risk ratio of 0.85 (0.80-0.91, p &lt; 0.0001) for the development of POI with MBP versus control. Four randomised trials and four cohort studies were included which reported the effect of pre-operative OAB on POI. Some 9.5% of 19,903 patients receiving OAB developed POI compared to 11.8% of 23,884 control patients. The pooled risk ratio for the development of POI with OAB compared to control was 0.86 (0.81-0.91, p &lt; 0.0001). However, when limiting analyses to randomised trials alone, neither MBP (RR 1.13, 0.67-1.90) nor OAB 1.01, 0.75-1.35) had a significant effect on the rate of POI.

Conclusions
Pre-operative MBP or OAB may reduce POI following colorectal resection but this has not been confirmed in randomised trials.
TP7.2.19 Review of bascom cleft lift and flap-procedures versus excision for pilonidal disease in a single centre (2017-2019)
Authors: Stonelake Stephen , Bhattacharya Pratik , Thompson Christopher 
Published: October 2021

Abstract

Introduction
Pilonidal disease continues to be managed with varying surgical techniques. We review results with Bascom cleft lift comparing to other practices at our institution.

Methods
All elective procedures for pilonidal disease reviewed from December 2017 to December 2019. Patient demographics, previous emergency and elective procedures for pilonidal disease, follow-up, dehiscence and recurrence rates, and all-cause morbidity were examined retrospectively.

Results
In the study period there were 106 procedures. Average age was 27 years (range 15-64). Male to female ratio was 83:23. Procedures were excision and primary closure (48), excision and packing (19), rhomboid flap (2), Bascom cleft lift flap (31), other rotational/perforator or V to Y flaps (6). Rates of previous elective procedures in the flap procedures versus excision group were 31% and 10% respectively (P = 0.01). Rates of previous emergency procedures in the flap-procedures versus excision group were 41% and 31% respectively (P = 0.40). In 50 procedures there was a documented follow up encounter at a mean time of 55 days (median 34 days, range 2-239). Dehiscence (partial and full) in flap procedures versus excision and closure was 33% and 27% respectively (P = 0.64). Recurrence rates in flap procedures versus excision +/- closure or packing were 0% and 8% respectively (P = 0.16).

Conclusion
Flap procedures have a lower rate of recurrence and comparable dehiscence rates despite being performed in patients with higher rates of prior procedures for pilonidal disease. Bascom cleft lift was the simplest flap procedure most commonly performed and matches the results of more complex flaps.
TP7.2.20 Systematic Review and meta-analysis of Interventions for Benign Large Non-Pedunculated Colonic Polyps (BLNPCP)
Authors: Wheldon L , Spence O , Lee MJ , Riley S , Brown SR , Wyld L 
Published: October 2021

Abstract

Aim
To examine the efficacy of treatment options for benign large non-pedunculated colonic polyps (BLNPCP).

Background
BLNPCP may harbour covert malignancy and opinions differ about the optimal treatment modality, be it endoscopic mucosal resection (EMR), endoscopic submucosal resection (ESD), combined endoscopic laparoscopic surgery (CELS) or surgical resection (SR). Despite the widespread availability of endoscopic resection (ER) techniques, rates of surgery in the UK remain high.

Methods
This review is reported in line with PRISMA guidelines (PROSPERO registration: CRD42021148944). EMBASE, CENTRAL, and MEDLINE databases were searched from January 2000 to January 2020 to evaluate interventions for treating BLNPCP in adults. The primary outcome was recurrence, adverse events were secondary outcomes. Meta-analysis was performed using a random effects model expressed as a percentage with 95% confidence interval. Quality assessment was performed using ROBINS-I.

Results
Ten studies (2499 polyps in 2327patients) were included (five assessed EMR, four SR, two CELS, two ESD). All studies were at moderate risk of bias. SR, ESD and CELS had the lowest recurrence rates 0% CI:0-1, 1% CI:0-2 and 2% CI:0-12 respectively. EMR had the highest (15% CI:9-22). SR complication rate was 12% CI:7-19, ESD 12% CI:9-15, CELS and EMR 11% CI:0-45 and 7% CI:5-9 respectively. Rescue surgery for complication or finding of invasive cancer was 17% CI:5-35 for ESD, CELS 14% CI:3-30, EMR 11% CI:7-15, SR 4% CI:2-6.

Conclusion
These data provide information that should be taken into account when considering the choice of intervention. It will allow a more robust shared decision-making process to occur.
TP8.1.4 Can volume replacement with local perforator flaps reduce the trauma to patients caused by mastectomies and cost of reconstructions in breast cancer treatment?
Authors: Karagiannidis Georgios , Mortimer Caroline , Tuffaha Hussein , Peerlinck Inga , Mallidis Evangelos 
Published: October 2021

Abstract

Aims
Improved screening and raised breast awareness raises the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. Can the “relative new” technique of local perforator flaps, reduce the volume of mastectomies (and subsequently reconstructions) in a District General Hospital?

Methods
Retrospective review of yearly breast cancer treatment operations from 2017 to 2020 in Ipswich Hospital.

Results
1094 surgical operations performed for breast cancer. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed.

Conclusions
Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.
TP8.1.9 Effect of Covid 19 on breast referrals from GP
Authors: Sandhya Anu , Narayan Prabhat , Pogson Caroline , Waheed Shamaela , Singh Jagdeep , Suleiman Usama , Silva Tania De 
Published: October 2021

Abstract

Aim
Coronavirus disease 2019 (COVID-19) has put a strain on regular healthcare worldwide. This study shares a DGH experience of effect of covid 19 on breast referrals from GP.

Methods
It is a single centre retrospective comparative study to analyze the effect of Covid 19 on breast referrals during the pandemic.
Patients referred under TWR from 15th march to 15th July 2020 were included and a comparison was made with March to July 2019. The primary outcome was number of referrals and number of cancer diagnosis.
Secondary outcomes were breach in 62 day pathway.

Results
In Covid pandemic, 1231 symptomatic patient were referred under TWR, of which 91 (7.4%) were diagnosed with breast cancer. There were 22 (24%) 62 days breaches.
Comparing this with similar 4 months in 2019 there were 1826 symptomatic patients referred under TWR of which 131 (7.1%) diagnosed with cancer. There were 34 screen detected cancers as well. There were 28 (21%)62 day breaches.
The reduction in GP referral was 32%.

Conclusion
There was an overall decrease in number of patients referred from GP but cancer diagnosis remained almost same for symptomatic patients since TWR pathway carried on with telephonic clinics & assessments at nearby closed screening centres.
TP8.2.3 Horses for Courses – the Impact of Covid-19 on Surgical Training Courses
Authors: Ali Roshneen , Baker Alexander , Lewis Christopher 
Published: October 2021

Abstract

Aims
Surgical training has been disrupted by the Covid-19 pandemic. Educational courses may be mandatory for training progression, complementing critical skills for surgical trainees. Previous work collated a first comprehensive database of available courses. The aim of this project was to determine the extent of disruption caused to courses by the current pandemic.

Methods
A snowballing approach was used to systematically search all online resources for courses available in 2021. This included websites of the Royal Colleges, sub-speciality societies, trainee organisations, regional centres, deaneries and surgical technology companies. Course target grade, price, provider and dates were collated and compared to matching data from 2020.

Results
35 sources yielded 127 courses. Since 2020, 78 courses had been cancelled and 37 new courses had been introduced. Courses price ranged between £90-1260 (median £495), with 12 courses increasing in cost overall and 4 reducing in cost due to online delivery. Only 13/127 courses were delivered online, 9 of which were newly available in 2021. Technical, clinical and revision courses constituted the majority (115/127), with only 3 courses dedicated to leadership or research.

Conclusions
Educational courses supplement aspects of deanery-led teaching which are perceived to be lacking. However, course providers must respond to the need of trainees and adapt to the training restrictions necessitated by the Covid-19 pandemic by improving the availability of online courses. Whilst technical skills are often the primary focus of surgical training, the importance of non-technical, leadership and research skills is arguably greater than ever and should be recognised.
TP8.2.7 The Post Graduate Virtual Learning Environment: an effective platform for the delivery of a surgical teaching programme in the West Midlands
Authors: El-Sayed Charlotte , Ahmed Usman , Farquharson Adam 
Published: October 2021

Abstract

Aim
The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees to review content at their convenience. We performed a contemporaneous study to review the effectiveness and quality of the platform in delivering teaching and suggest its future role in the surgical curriculum.

Method
Anonymised feedback was gathered of trainee’s perspective of the platform experience, the quality of teaching and the archived content. All trainees were General Surgery higher trainees (HST) (ST3-ST8). The data from sequential teaching days was analysed.

Results
Of 90 HST, on average 40 attended each monthly training day (consistent with pre-COVID attendance). 122 trainee responses were completed. 68% of respondents were between ST3-ST5. 91% rated the administration and delivery of the teaching sessions as excellent or very good. 16% of trainees watched the archived sessions after the teaching day of which 46% felt it met their educational expectations.

Conclusions
The PGVLE is an effective platform for the delivery of a virtual surgical teaching programme. It met with high levels of trainee satisfaction in the context of the pandemic. The archived content provides advantages to consolidation of learning. It is thought that the PGVLE platform will become a key feature of the surgical training programme in a hybrid learning model, related to relevant curricula, in the future.
TP8.2.8 Medical School Selection scores correlate with MRCS Part A performance
Authors: Ellis Ricky , Brennan Peter , Cleland Jennifer , Lee Amanda , Scrimgeour Duncan 
Published: October 2021

Abstract

Aims
Selection into UK medical school involves a combination of three measures: prior academic attainment, selection tests (e.g. the University Clinical Aptitude Test (UCAT), Biomedical Admissions Test (BMAT), or Graduate Medical School Admissions Test (GAMSAT)) followed by interview. We investigated the predictive power of current UK medical selection tests and measures of prior attainment on success in the Membership of the Royal College of Surgeons (MRCS) examination.

Methods
The UKMED database was used to analyse A-Levels and medical school selection data for all UK graduates who attempted the MRCS Part A written examination (n = 9729) and Part B clinical examination (n = 4644) between 2007 and 2017. Univariate analysis and Pearson correlation coefficients examined the relationship between selection scores and first attempt MRCS success.

Results
Successful MRCS Part A candidates scored higher in A-Levels, UCAT, BMAT and GAMSAT examinations (p &lt; 0.05) than their unsuccessful peers, but no differences were observed for MRCS Part B. Statistically significant positive correlation was found between MRCS Part A, BMAT (r = 0.32, p &lt; 0.001) and GAMSAT scores (r = 0.35, p = &lt;0.001). While a weaker statistically significant correlation was found between Part A, A-Level (r = 0.14, p &lt; 0.001) and UCAT scores (r = 0.25, p &lt; 0.001).

Conclusions
This, the first study to investigate the relationship between all UK medical school selection tests and success in a postgraduate examination found statistically significant correlations between selection test scores and performance on Part A of the MRCS. The strength of correlations found in this study are similar to those of other validated selection tests used in the United States.
TP8.2.15 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic
Authors: Khan Khurram , Torpiano Giuliana , Galbraith Norman , McLellan Morag , Lannigan Alison 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.

Methods
All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared.

Results
Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).

Conclusions
The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.
TP8.2.18 Every little helps. A trainee led cost saving initiative
Authors: Lunt Adam , Bleakley Cait , Marshall Douglas , Rees-Lee Jacqui 
Published: October 2021

Abstract

Aim
The NHS is under pressure to deliver the best quality care within a confined budget. The cost of spending on medications is growing by 12% per annum. The five year forward plan for the NHS called for £22 Billion in efficiency savings. All NHS staff are being asked to help deliver better outcomes at lower costs. We aimed to review costs in the surgical department, identify savings, implement changes and evaluate the outcome.

Method
Pharmacy orders from 2016-17 were reviewed. Prices of branded and generic medications were compared. Levobupivicaine was identified as a product with cost savings between branded and generic forms. Procurement officers were advised to switch to generic alternatives and the pharmacy system was adjusted to highlight that generic forms should be ordered. Orders for 2018-19 were reviewed and savings calculated.

Results
29,280 units of levobupivicaine were ordered in 2016-17. 100% of these orders were of the branded product. Projected savings of switching to a generic product was £12,846 per annum. 31,355 units of levobupivicaine were purchased during the 2018-19 period. 83% of orders were for the generic product. £11,805 was saved over this period. £1,703 of further savings have been highlighted.

Conclusion
We have shown that simple changes can result in modest savings. All NHS staff, including trainees, can lead cost reducing initiatives. Multiple small savings will summate to larger savings, resulting in resources being better utilised to improve patient outcomes.
TP8.2.24 Returning to Surgical Training - a survey of surgical trainees' experiences in Yorkshire and the Humber Deanery
Authors: Richards Eleanor , Renwick Paul 
Published: October 2021

Abstract

Aims
To assess the support given to this deanery's surgical trainees returning after time out of programme.

Methods
An online survey was circulated to surgical trainees within the deanery. The survey included questions about their return, on calls, their experience of support and to evaluate interest in a return to work course.

Results
Of 35 respondents, 33 had had time out of training. Reasons were health (2), leadership fellow (3), research (11), research and parental leave (6) and parental leave alone (11). Twenty-three trainees reported feeling well supported, 4 were neutral and 6 reported negative experiences. Many returned to a new trust. Twenty were on-call within the first few days and 5 felt unprepared for this. Confidence and operative skills were commonly affected. Whilst trainees out for research or leadership deemed a return to work course unnecessary, those returning from parental leave expressed interest. This could enable trainees to network and gain information and support from peers and senior colleagues. Respondents came from a wide mix of surgical specialties indicating bespoke cadaveric courses might be appropriate. Childcare friendly hours were a priority.

Conclusions
There is scope for significantly improving the return to work experience through the SuppoRRT (Supported Return to Training) programme. Returning to an on-call shift or being prevented from attending induction is unacceptable. This deanery is developing a surgical return to work course combining cadaveric and animal model technical skills training with clinical scenarios for non technical skills. This is hoped to help improve returning trainees' confidence and operative skills, both commonly affected by time out of training.
TP8.2.28 Can surgical advanced care practitioners provide a cost effective local anaesthetic minor procedures service? Results from a 5-year retrospective study
Authors: Taib Adnan , Hammill Christa , Abraham Aleyamma , Garstang Paula , Fakim Bilal , Subar Daren 
Published: October 2021

Abstract

Aims
Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists.

Methods
This was a retrospective cohort study including all patients who had a minor ‘lumps and bumps’ procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected.
The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding.

Results
A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n = 907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (£21.72) more on average than those on SACP lists (£56.55 vs £34.83 median respectively, p &lt; 0.001) due to excess staff for these cases.

Conclusion
A dedicated and independent SACP ‘lumps and bumps’ list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.
TP8.2.30 Bleep paralysis: preventing inefficiency on the general surgical on-call
Authors: Whitmore Helen , Salem Rola , Bowling Kirk , Clamp Holly , Chandra Rosaline , Jaralla Nasir 
Published: October 2021

Abstract

Aims
The demand on surgical services is increasing. In our Trust, all surgical referrals and queries are directed through the Senior House Officer (SHO) on-call. This leads to inefficiency, with many hours spent on the telephone and away from clinical duties. Such constant intensity can cause increased stress and anxiety amongst those involved. Junior doctor burnout and stress-related sickness are increasing concerns amongst the current surgical workforce. In an attempt to alleviate these factors, we instigated an intervention to evenly distribute workload during surgical on-calls.

Method
The number of bleeps through the surgical SHO on-call were audited for four consecutive thirteen hour shifts. Each call was estimated to take an average of five minutes to resolve. A separate GP referral phone was introduced to reduce the volume of traffic through the SHO bleep. The number of calls through the SHO and referral phone were re-audited following this intervention.

Results
Before introduction of a referral phone, the mean length of time spent by the SHO per shift answering calls was 232.5 minutes, with a maximum of 330 minutes. Post intervention, the SHO spent an average of 92.5 minutes per shift answering calls and referrals through the GP phone averaged 43.75 minutes.

Conclusion
The introduction of a single point GP referral system has significantly reduced the volume of calls through the SHO, thus has also minimised time spent away from on-call duties. Not only does this improve efficiency within the on-call team, but also reduces risk of burnout amongst trainees.