bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP7.1.16 Endoscopy and biopsy for chronic diarrhoea: an audit and cost analysis
Authors: Abdelrahman Shadi , Kim Woo Jae , Daneshyar Adam , Odogwu Stephen 
Published: October 2021

Abstract

Aims
The aim of the study is to analyse the costs of performing diagnostic endoscopy with histopathological sampling for patients suffering with chronic or persistent diarrhoea.

Methods
300 patients were identified who required an endoscopy in 2019 according to the British Society of Gastroenterology guidelines. Patient’s presenting complaint, endoscopic and histological diagnosis and follow up plans were noted. 147 patients were included into our study whose presenting complaint was solely chronic or persistent diarrhoea. Those who presented with acute diarrhoea, PR bleeding or other concomitant indication for lower gastrointestinal endoscopy were excluded. Data from the national schedule of NHS costs was used to calculate expenditure.

Results
The total expenditure calculated for the 147 patients was £55,973. There was a total of 126 colonoscopies and 21 flexible sigmoidoscopies performed by the department. The number of patients who received medical treatment following endoscopy was 13/147 (9%) 8 of whom had nonspecific colitis on histology. There were 29 patients (20%) who required symptomatic treatment and there were 98 patients (66%) who received no intervention or were discharged immediately and 7 patients (5%) that required surgical intervention. The total cost of procedures not leading to surgical or medical management with steroids or immunomodulators was £47733 which is 85.3% of the total expenditure.

Conclusion
A significantly large proportion of investigations lead to no intervention or symptomatic treatment of the patient. Given this lack of diagnostic yield and financial burden, there could be room for advancement in the current guidelines for managing persistent diarrhoea.
SP8.1.5 Breast cancer follow up; Is routine mammography indicated?
Authors: Polak Petr , Beattie Declan , McIlmunn Colin , Kirk Stephen 
Published: October 2021

Abstract

Aim
This paper aims to review the outcome from yearly mammography in detecting breast cancer recurrence and new primary tumours in patients with a history of breast cancer.

Methods
From 2014, following treatment for breast cancer, patients were enrolled in a program of self-directed aftercare (SDA). They were given open access to the Breast service. Regular planned appointments were not offered. All patients underwent annual mammography for 5 years.
Retrospective analysis of the SDA database from 2014 to 2016 was undertaken, time to and mechanism of detection of breast cancer recurrence in this population was determined.

Results
352 patient records were analysed (1760 mammograms), 29 recurrences were identified. 12 locoregional, 12 systemic, 5 locoregional and systemic. Median time to diagnosis of recurrence was 30 months.
Locoregional recurrence was detected by surveillance mammography (4 patients), clinical examination following patient request (7 patients), non-breast radiological investigation (5), by non-breast cancer care Doctors (1). No contralateral cancers were detected in patients who had mastectomy or WLE.

Conclusion
Despite limited evidence for regular clinical assessment post breast cancer treatment, the practice remains recommended.
In this study regular clinical review was replaced by open access. Annual mammography was retained.
Mammographic value out-with detection of malignancy (new/recurrent) was not assessed. The number of tumours detected (4 out of 1760 mammograms) would suggest that non-stratified routine mammography is of limited value for most patients.
Further study is required to determine the risk or value and the cost/benefit analysis of mammographic follow up of breast cancer.
SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study
Authors: Elkadi Hannah , Dodd Eleanor , Poulton Theodore , Bolton William , Burke Joshua , Jayne David 
Published: October 2021

Abstract

Aims
Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses.

Methods
Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D.

Result
133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p &lt; 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921).

Conclusion
Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.
SP9.1.3 Abdominal X-Rays in the Emergency Setting- A Review of Current Practice
Authors: Armstrong Lará , Monaghan Helen , Jeffers Sarah 
Published: October 2021

Abstract

Aim
Abdominal radiographs (AXRs) are commonly used in the setting of acute abdominal pain. However, with low diagnostic yield, they can increase workload within the radiology department, increase patient radiation exposure and ultimately delay further diagnostic imaging. The average cost of an abdominal film, excluding staffing costs, is £45. This study aimed to investigate the appropriate use of AXRs in the emergency setting, as per the Royal College of Radiologists Guidelines (RCR).

Methods
A single centre retrospective review was conducted of all patients referred to the emergency surgical team over a 21 day period. Data was retrieved from electronic handover records. Demographics, radiology request forms and imaging results were obtained from up to date electronic care records.

Results
A total of 160 patients presented within the audit window, with a median age 49 (16-94) and 61.3% male. Overall, 36.9% of patients underwent an abdominal x-ray, 66.1% of which were not indicated in accordance with RCR guidelines. 71.2% of patients who underwent an abdominal x-ray required further diagnostic imaging by means of CT or USS. Only 10.2% of AXRs provided diagnostic information. Total cost expenditure for inappropriate AXRs = £1,755, excluding staffing costs.

Conclusions
Approximately two thirds of AXRs performed did not comply with the published RCR guidelines. Adherence to RCR guidelines can reduce needless radiation exposure, hospital costs and delay to diagnosis. We plan to conduct a teaching session on the RCR guidelines alongside the development of information posters, and re-audit our results.
SP9.1.5 Compliance with the NELA pathway at a District General Hospital. Reducing time to theatre by limiting CT-associated delay - A prospective closed loop audit
Authors: Ahmad Shahrukh , Hasbullah Nazhatul , Handa Siddhartha , Patel Panna 
Published: October 2021

Abstract

Aim
NELA recommends rapid request, conduct and reporting of CT to reduce the delay in time to theatre and thus ultimately improving patient outcomes. Our aim was to identify and reduce delays with regards to CT scanning and reporting.

Methods
Our Local Laparotomy Pathway standard recommends that CT scans be performed within one hour of being requested and reported within one hour of being performed. NELA data and electronic records were reviewed over a 3 month period (January 2020 to March 2020) - revealing that only 59% of pre-laparotomy CTs done (n = 17) complied with this standard.
A dedicated “CT Emergency Laparotomy” protocol was introduced, which assigned the scan as top priority for both radiographers and radiologists. After making this change, data was prospectively collected to see if there was reduced time from CT request to report.

Results
Compliance with the pathway standard for the three month period from October 2020 to January 2021 increased to 81% (n = 21). Reasons for non-compliance included patient instability, awaiting renal profile; and COVID-related deep cleaning between patients. Out of hours, CT reporting was outsourced, which led to even quicker reporting – with multiple scans being both performed and reported within one hour of the request. Of the 16 patients that fit the criteria for urgent laparotomy, 87.5% (14 patients) were operated on within 6 hours of initial intention to operate.

Conclusion
Our re-audit showed that after the introduction of a dedicated laparotomy CT protocol, there was reduced time to CT report and ultimately reduced delay to Laparotomy.
SP9.1.7 Emergency Laparotomy for Trauma in the United Kingdom and Ireland: a Prospective Multicentre Study
Authors: Vulliamy Paul , Marsden Max , Carden Richard , Brohi Karim , Davenport Ross ,   National Trauma Research and Innovation Collaborative NaTRIC
Published: October 2021

Abstract

Aims
Trauma patients requiring abdominal surgery have significant morbidity and mortality, but are not included in existing national audits of emergency laparotomy. The aim of this study was to examine processes of care and outcomes among trauma patients undergoing emergency abdominal surgery in the UK and Ireland.

Methods
A prospective trainee-led multicentre audit was conducted over six months from January 2019 across the national trauma system. Patients undergoing laparotomy or laparoscopy within 24 hours of injury were included. Subgroup analysis was conducted in those requiring major haemorrhage protocol (MHP) activation.

Results
The study included 363 patients from 34 hospitals (22 major trauma centres). The majority were young males with no co-morbidities who required surgery for control of bleeding (51%) or exploration of penetrating injuries (46%). Over 85% received consultant-led care in the emergency department (318/363) and operating theatre (321/363). The MHP subgroup made up 45% of the cohort but accounted for 97% of deaths and 79% of ICU days, with a mortality rate of 19% and a massive transfusion rate of 32%. Compared to non-MHP patients they had shorter times to theatre (122 vs 218 minutes, p &lt; 0.001), higher rates of advanced prehospital care (60% vs 33%, p &lt; 0.001) and higher rates of consultant-led care (95% vs 85%, p &lt; 0.001).

Conclusion
The majority of trauma patients requiring emergency abdominal surgery receive consultant-delivered perioperative care which is appropriately tailored to patient risk profile. Despite this, mortality and resource utilization among high-risk patients remains substantial, justifying ongoing performance improvement initiatives and research into novel therapeutics.
SP9.1.9 Are Tertiary Trauma Surveys a worthwhile use of time and resource?
Authors: Knight Chris , Smith Stella 
Published: October 2021

Abstract

Introduction
Patients sustaining major trauma undergo primary and secondary surveys in the emergency department to rapidly identify and treat injuries. Tertiary trauma surveys (TTS) are performed once the patient has been stabilised, within 24 hours of admission, to assess for further injuries. In December 2019, the major trauma service at our trauma centre was reconfigured to include a larger clinical team. Following this, we have assessed compliance with TTS completion and rate of new injuries identified.

Methods
Data was prospectively collected via hospital and TARN databases from 100 consecutive major trauma patients admitted over a two-month period from 1/8/20. Demographic data and key measures including, date and time of arrival to the hospital, date and time of TTS, performing clinician, injuries identified, mechanism of injury and ISS were collected.

Results
TTS was completed on 79/100 patients during their admission with 16.5% (13/79) of TTS performed identifying at least one additional injury. 18 separate injuries were identified which were categorized by AIS score: 22.2% AIS 1, 61.1% AIS 2 and 16.7% AIS 3. Of these injuries, 17/18 required further imaging and 3 required operative management. In 38.5% (5/13) of cases, the additional injuries increased the patients overall ISS.

Conclusion
This data demonstrates the importance of tertiary survey completion to ensure that all injuries sustained during major trauma are identified and treated promptly. Further development of this project will include expansion to a larger data set over a prolonged period to further evaluate the rate and significance of injuries discovered via TTS.
SP9.1.10 Penthrox for management of fractures, dislocations and more: Orthopaedics in the Emergency Department during the COVID-19 pandemic
Authors: Stephens Christian , Dias Ana , Brennan Ciaran , Lazizi Mohamed , Skinner Edward , Angel Charlotte 
Published: October 2021

Abstract

Aim
Methoxyflurane has undergone a renaissance using a smaller dose in a handheld ‘Penthrox’ device. There is minimal literature regarding its use in common orthopaedic management. Our Minor Injury Unit (MIU) was created due to COVID19 pandemic. The aim of this study was to investigate whether a Penthrox device could improve fracture/joint dislocation management and decreased the need for theatre resources at our MIU.

Methods
We reviewed all cases where Penthrox was used to facilitate minor procedures within a two month period. We recorded patient demographics, injury, time of admission, discharge and management. Success was defined as fracture manipulation into an adequate position, joint congruence achieved or completion of a planned procedure.

Results
101 Penthrox doses were given to 89 patients over 97 episodes between 24/3/2020 and 26/5/2020. No complications were recorded. There was 100% success rate on fracture manipulation. For joint dislocation: 65% on native shoulder reduction; 30% on prosthetic total hip arthroplasty reduction; 100% on native elbow reduction. Penthrox was also used for other procedures such as wound reviews, removing external fixators, and applying braces with 100% success rate.

Conclusion
We have shown that Penthrox is safe and can be used for common emergency Orthopaedic procedures, particularly fracture manipulation. This helped keep operating theatres and other anaesthetic resources free which were especially vital and scarce during the COVID19 pandemic.
SP10.1.1 Incidence, Risk Factors, and Outcomes of ARDS in Patients Admitted to Intensive Care with Asymptomatic SARS-CoV-2 Infection
Authors: Devarakonda Sreekar , Narayanan Sankara , Lingamdenne Paul Emerson , Kandasamy Subramani , Korula Pritish John 
Published: October 2021

Abstract

Aims
Many patients were found to have SARS-CoV-2 infection on admission to our ICU for non-COVID-19 related illness. This may alter the expected course of their presenting condition, especially when they develop ARDS. Hence, we wanted to study the incidence, risk factors, and ARDS outcomes of these patients admitted to our ICU.

Methods
We reviewed all admissions (medical, surgical, and obstetric) to our ICU from May to October of 2020 and studied their age, gender, comorbidities, admission diagnosis, APACHE II score, and in-hospital course. ARDS was defined as PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O) in the absence of cardiac failure or fluid overload. Arterial Blood Gas, chest radiographs, and bedside echocardiography were used to diagnose ARDS.

Results
Of the 832 patients, 119 (14.3%) had SARS-CoV-2 infection. 41 of 119 (34.5%) patients developed ARDS. Among the comorbidities studied, only systemic hypertension (OR 2.6; 95% CI 1.0-6.2) seemed to increase the ARDS odds. Patients with sepsis (OR 5.8; 95% CI 2.4-13.7) and APACHE II score ≥10 (OR 5; 95% CI 2.0-12.3) had higher odds of developing ARDS. These patients required invasive ventilation, vasopressors, steroids and had prolonged hospital stays. Age, gender, trauma, and recent surgery did not seem to increase the risk of ARDS.

Conclusions
Asymptomatic COVID-19 patients with systemic hypertension, sepsis, and APACHE II score ≥10 are at a higher risk of developing ARDS. However, further research is needed to predict the extent to which SARS-CoV-2 infection will influence the course and outcomes of their presenting illness.
SP10.1.5 Are we utilising the predictive potential of FIT during a time of resource scarcity?
Authors: Carswell Victoria , MacLeod Campbell , Watson Angus , MacKintosh John , Docherty James 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic has resulted in an unprecedented challenge. With the abolition of all non-urgent endoscopies nationwide, there has been concerning implications on colorectal cancer (CRC) diagnosis. Rationing of these scarce colonoscopy slots has become a priority. Faecal immunohistochemistry test (FIT) results are predictive of bowel pathology. Here we audit the clinical outcomes of patients that have undergone FIT in our health board in the pre and COVID-19 era.

Methods
Using business intelligence methods, an automated system for NHS eHealth data collection has been established. All patients who have undergone FIT testing are audited for clinical outcomes including investigation and pathology. Results from December 2018-2019 (pre-COVID) were compared to December 2019-January 2021 (COVID).

Results
There was a 70.12% increase in FIT uptake. 58.88% were female. Median age 73 (range 1-100). FIT results are compared below.

Conclusion
Our business intelligence approach has improved uptake of FIT in our community. There have been proportionally higher rates of colorectal cancer diagnosis with less resources. FIT specificity is 98.64% and therefore should be further widely accepted to ration resources.
SP10.2.4 COVID-19 impact on Surgical Training and Recovery Planning (COVID-STAR) - A Cross-Sectional Observational Study
Authors:   COVID-STAR Collaborative
Published: October 2021

Abstract

Aims
The COVID-19 pandemic has led to changes in the delivery of surgical services which impact on surgical training. This study aimed to investigate the qualitative impact of COVID-19 on surgical training in the United Kingdom (UK) & Republic of Ireland (ROI)

Methods
A national, collaborative, cross-sectional study involving 13 surgical trainee associations distributed a pan-surgical specialty questionnaire on the impact of COVID-19 on surgical training (11th May - 8th June 2020). Various aspects of training were assessed. This study was reported according to STROBE guidelines.

Results
810 completed responses were analysed (M:401/F:390) from all deaneries and training grades. A significant negative impact of the pandemic on surgical training experience was observed. (Weighted average = 8.66). 41% of respondents (n = 301) were redeployed. Complete loss of training was reported in elective operating (69.5%), outpatient activity (67.3%) and endoscopy (69.5%). A reduction of &gt; 50% was reported in emergency operating (48%) and completion of work-based assessments (WBAs) (46%). 3.3% (n = 17) of respondents reported plans to leave medicine altogether. Cancellations in study leave and regional teaching programmes without rescheduling were reported in 72% and 60% of the cohort respectively. Elective operative exposure and WBAs completion were the primary reported factors affecting potential trainee progression. Overall, &gt; 50% of trainees (n = 377) felt they would not meet the competencies required for that training period.

Conclusions
COVID-19 has had a negative impact on surgical training across all grades and specialties, with implications for trainee progression, recruitment and retention of the surgical workforce.
TP1.2.7The stuck colonoscope
Authors: Sebastian B , Mirshekar-Syahkal B , Athisayaraj T , Ward N 
Published: October 2021

Abstract

Background
With the increased awareness and push for earlier diagnosis of colorectal cancer, the number of patients undergoing colonoscopy is increasing. Being a common condition, a number of these patients will have herniae. We describe a rare complication during a Sigmoidoscopy in a patient with an Inguinal hernia.

The case
A 75-year-old man was booked for a flexible sigmoidoscopy for rectal bleeding. The scope was successfully inserted to the Splenic flexure. During withdrawal, the scope stopped moving. It was still possible to advance the scope, but not to withdraw. The patient confirmed the presence of a left inguinal hernia. Physical examination and the position on magnetic scope imager confirmed the loop in the hernia.
Various manoeuvres to withdraw the scope were unsuccessful. A colleague was called for a second opinion. We came up with a plan to maintain a ‘long loop‘ position in the hernia, by holding the scope through the scrotum and allowing it to slide on withdrawal. This was successful and the patient was discharged.

Discussion
Incarceration of the scope in the hernia occurs when the hernial defect permits entry and exit of the scope, leaving a loop in the hernia, in a long loop position. During withdrawal, the configuration changes to a short loop, crowding the hernial defect, preventing the scope from sliding. On searching literature, we found that this technique has been described by Koltun et al and is known as the “Pulley” technique. We suggest that colonoscopists are familiar with this technique.
TP5.2.10 Ligation Versus Repair of Isolated Traumatic Peripheral Deep Venous Injury: A Systematic Review And Meta-analysis
Authors: Shahzad Noman , Moosa Asad , Shaikh Fareed , Siddiqui Nadeem , Macierewicz Jan 
Published: October 2021

Abstract

Optimal management of isolated peripheral deep venous injuries remain controversial with no clear evidence based guidelines on repair vs ligation. We aimed to compare the morbidity and mortality after venous reconstruction versus ligation of isolated peripheral venous injuries in patients with trauma.

Methods
We conducted systematic review and meta-analysis of all literature reported on management of isolated vascular injuries in adult trauma patients excluding case reports from 1950 to 2020. Primary outcomes of interest were mortality and amputation while secondary outcomes of interest were compartment syndrome, chronic venous hypertension, deep venous thrombosis and pulmonary embolism. Pubmed, Google Scholar, Cochrane database and Web of Science were searched for relevant literature. Study selection and sysnthesis was done following PRSMA Guidelines. Protocol was registered with PRSPERO (Registration Number: CRD42019143136).

Results
A total of 25 studies met our selection criteria and reported at least one of outcomes of interest. All the data is from observational studies with mostly retrospective data collection. Results of our meta-analysis show that ligation is significantly associated with higher rate of amputations [OR: 1.73 (1.20 – 2.48), p = 0.003] and mortality [OR: 1.5 (1.09 – 2.06), p = 0.01] whereas there is no significant difference in rate of chronic venous insufficiency, deep venous thrombosis and pulmonary embolism. There is not sufficient data to analyze various types of repair. Also data is lacking to account for clinical severity at time of presentation.

Conclusion
Our results favor repair over ligation of isolated peripheral deep venous injury.