bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.45Organising The Huddle: An Audit Loop of the Surgical Handover
Authors: Ali Kiren , Gumber Ashutosh , Dampetla Srilatha , Pareek Raju , Shalli Kawan 
Published: October 2021

Abstract

Aim
Structured patient handover is a critical element for the patient safety. There are several guidelines including the ones from NICE and Royal College of surgeons emphasizing its importance in today’s practice. It entails appropriate coordination and communication among health-care providers to ensure safety of the patients and avoid adverse incidences. This audit was performed to assess and improve the current Surgical Handover Meeting in line with the Handover Guidelines from the Royal College of Surgeons of England (Rcseng.ac.uk, 2007).

Method
A questionnaire was circulated among the surgical doctors involved in the handover meetings. Outcomes were compared with the NICE and RCS guidelines. Recommended changes were implemented after training the staff which was followed by second cycle of audit.

Results
During the first cycle of audit, 80% of the junior surgical doctors contributed towards the study who agreed there was no standard format of handover, information was incomplete and there was lack of privacy. A standardized handover sheet was introduced which included accurate and concise information about patients with their management plans. There was noticeable improvement in staff satisfaction in second cycle but use of quiet room and nurse’s attendance remained poor.

Conclusion
Safe handover reflects quality of patient care. Despite achieving remarkable improvement after first audit we still lag behind the recommended practice. With all the support and coordination; further projects, meetings and presentations are required to achieve the outstanding standards.
EP.TU.53Mark of Cain: lessons from a field hospital Boot Camp under COVID’s Cloak
Authors: Luton Oliver , James Osian , Mellor Katie , Eley Catherine , Egan Richard , Lewis Wyn 
Published: October 2021

Abstract

COVID-19 restrictions have cursed and canceled most academic training events. Because of fears related to social distancing, centres normally housing &gt;100 delegates now accommodate only 12.

Aim
To assess the feasibility of a multidisciplinary Core Surgical Trainee (CST) Boot camp training event at a UK field hospital.

Method
All CST1s within a single UK Statutory Education Body were invited to participate in a three-day Boot camp at the Dragon’s Heart Hospital, Millennium Stadium, Cardiff, consisting of simulated, Operative and Non-Operative Technical Skills for Surgeons (NOTSS). Primary outcome measures were; satisfaction and perceived competence using Likert scale (1-5).

Results
Attendees numbered 44 (median age 29 yr. 21 female, 23 male). Median satisfaction scores by domain were: Overall course satisfaction 4 (range 2-5), simulation skills 5 (3-5), lecture-based learning 4 (2-5), academic skills 4 (2-5), and NOTSS 5 (1-5). Levels of perceived confidence in performing simulated index procedures improved markedly (before median 2 (1-5) vs. after 4 (2-5), (p &lt; 0.001). Free text comments reflected and praised the quality of staff commitment, enthusiasm, and in particular interactive workshops related to NOTSS. In contrast, resource limitations inherent to the marquee character of the venue (ambient temperature, IT limitations) received criticism.

Conclusion
COVID’s curse can be broken by creativity, enthusiasm, and engagement of translational multidisciplinary team leadership.
EP.TU.153Face to face teaching in the covid era: Basic Surgical Skill Development
Authors: Kirchhoff Chris , Davis Heather 
Published: October 2021

Abstract

Aims
According to literature,newly qualified doctors are at risk of being unable to perform practical procedures safely. This has been exacerbated by the disruptions to training and education which the covid-19 pandemic has caused. This intensive course has been developed to improve basic surgical skills and improve confidence in simple wound closure, to mitigate these disruptions.

Methods
Candidates attended a three-part course in small groups, where they learned hand ties, basic laparoscopic skills and wound closure on animal models. Self assessment data were collected pre and post workshop on a Likert scale. All data was assessed using basic descriptive analysis.

Results
Data was collected from 13 participants (M:F, 5:8) at the level of foundation year 1(61.5%,n=8) and foundation year 2(38.5%,n=5). Only 38.5% (n = 5) had previous basic surgical skills training. Our delegates reported an improvement in the following surgical skills: suturing (n = 11, 84.6%), hand tying (n = 10, 76.9%), laparoscopic skills (n = 10, 76.9%). Overall 61.5% (n = 8) of our delegates reported an improvement in all three domains.

Conclusions
Participants reported limited exposure prior to this course despite successfully completing an undergraduate curriculum. Overall, participants' self-scores improved in all three taught surgical skills. We believe ourcourse is a practical and reproducible solution to help bridge training gaps, which can be safely conducted with social distancing measures.
EP.TU.182Surgical Serendipity: The Accident that Exposed an Autoimmune disease
Authors: Sultana Emiko 
Published: October 2021

Abstract

Objectives
IgG4 related disease is an autoimmune condition that often leads to diagnostic challenges which can often delay timely treatment. It rarely presents with pulmonary findings which can radiologically mimic cancer. We describe a unique case of an incidentally diagnosed IgG4- related lung disease (IgG4-RLD).

Case description
A 32-year-old healthy female suffered a car accident and had a CT Trauma. This revealed an indeterminate soft tissue lesion in the middle lobe of the right lung with an endobronchial component of uncertain histology which had central extension into the right inferior hilum. She had a bronchoscopic biopsy revealing that the mass was an Inflammatory Myofibroblastic Tumour (IMT). Due to the close relationship of this tumour with the root of her right lung, she was planned for a right pneumonectomy. However, it was agreed for that she underwent another bronchoscopy with biopsy to obtain more histology before proceeding with a pneumonectomy for the uncertainty about the diagnosis of an IMT and due to the absence of distinct clinical features from this mass. This revealed that the mass was highly suggestive of IgG4-RLD. Her blood tests revealed high serum IgG4 levels which confirmed the diagnosis of IgG4-RLD.

Conclusion
IgG4-RLD is a rare condition which can seldom be diagnosed incidentally. Patients with biopsies suggestive of IMT should undergo a repeat biopsy before proceeding to surgical resection of the tumour. Alternatively, a serum IgG4 level can also be deemed a useful tool for screening such patients.
EP.TU.200Improving variable rate insulin infusion compliance in general surgery
Authors: George Jayan , Jackson Samuel , Orsi Andrew , Ardley Rohan 
Published: October 2021

Abstract

Aims
1. Audit the current variable rate insulin infusion (VRII) practice per local guidelines.
2. Understand barriers to good VRII practice to create an intervention.
3. Re-Audit the VRII practice following intervention.

Methods
Junior doctors were surveyed using Likert scales (1 to 5: not at all confident to very confident) as well as closed and open questions. Chain action reaction (CAR) theory was used. Six domains were identified against a local proforma. Initial audit and questionnaire were collected from November 2019 to January 2020 and analysed using Microsoft Excel. Intervention consisted of a condensed one-page algorithm with group teaching. Re-audit data was collected between June 2020 to August 2020 for comparison.

Results
Questionnaire – 53.6% (15/28) of juniors responded. Challenges included conversion oral hypoglycaemics and complexity of the guidance. Group teaching and a condensed portable format were the most popular modalities for delivery of further education.
Initial Audit – 12 VRII charts were audited. 33.3% (4/12) were completed correctly. Areas of significant need for improvement were as follows: ensuring long-acting insulin is prescribed, transferring from a VRII back to oral medications and appropriate fluid prescribing.
Re-Audit – 18 charts were audited following intervention. Of these, 66.7% (12/18) were completed correctly. There was a significant improvement in appropriate fluid prescribing and long-acting insulin prescriptions.

Conclusions
Understanding the factors involved throughout the chain of how VRIIs are prescribed has helped to implement a positive intervention in our department. The improvement has been significant (100% better) however there is still further work required to improve compliance.
EP.TU.226Removal of a pepper shaker from the rectum using a Foleys catheter, a novel technique of balloon trawling
Authors: Mewse Jacob , Liyanage Aloka Suwanna Danwaththa , Smith Richard 
Published: October 2021

Abstract

Background
Foreign bodies inserted into the rectum often pose a challenge to the emergency surgical teams due to the unforthcoming nature surrounding the object inserted. Its shape, size and the position within the rectum and the associated bowel and sphincter injuries often determine the route of extraction and the need for further intervention. Trans-anal extraction risks anal sphincter injury, however, circumvents the need for a laparotomy and a potential stoma.

Case history
Here we describe a case of a ceramic pepper shaker inserted into the rectum of a 41-year-old male. Removal was undertaken under general anaesthesia and required evaluation of the matching salt shaker in theatres to creatively design a manoeuvre to extract the shaker via trans-anal route without risking it breaking inside the rectum.

Methods
A 20 French Foleys catheter was of an appropriate size to be able to thread through the opening at the bottom of the salt shaker. Under optical sigmoidoscopic guidance, the catheter was inserted into the rectum and passed through the hole in the bottom of the pepper shaker. The balloon of the Foleys catheter was then inflated with 30ml of saline and trawled out of the rectum intact.

Conclusion
Extraction of foreign bodies via trans-anal route in most instances avoids prolonged morbidity. Successful removal of these difficult foreign bodies with minimum morbidity often requires strategic planning and creative thinking.
EP.TU.269Management of preoperative anemia with Iron Therapy in colorectal cancer patients- a Systematic Review and Meta-Analysis
Authors: Narayanasamy Sangara Narayanan , Gumber Ashutosh , Kumar Gautham , Aspari Ajay Raghunath , Ramesh Vibha , Thomas Pradeep 
Published: October 2021

Abstract

Background
Nearly half of colorectal cancer (CRC) patients are diagnosed with anemia at the initial assessment (Ferlay et al., 2015). Anemic patients require blood transfusion, which increases cancer recurrence (Acheson et al., 2012). Hence iron therapy for anemia correction reduces postoperative morbidity and mortality.

Aims
To review randomized controlled trials on iron therapy for preoperative anemia in CRC patients.

Methodology
Includes formulating a review question, analyzing, quantifying the inclusion and exclusion criteria, literature search, quality assessment, data extraction and data synthesis, bias rectification, results interpretation and summarizing the evidence. Cochrane Handbook of Systematic Reviews and acronym PICO has been used for formulating review questions and study design (O’Connor et al., 2011).

Selection Criteria
Systematic reviews and RCTs with higher level of evidence were included in this review

Data Extraction
Quality assessment and data collection were done using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analysis) checklist. Data extraction and analysis done by REVMAN Manager (Higgins et al., 2011).

Results
Two trials reported that iron therapy reduces the need for blood transfusion, but with insignificant result. All three studies showed that hemoglobin rise occurs with iron therapy postoperatively. None of the studies analyzed the quality of life.

Recommendations
RCTs with larger sample size to be done for more relevant and accurate reports, aiming at the primary and secondary outcomes like morbidity, mortality and quality of life. Oral iron with fewer side effects has to be experimented for best efficacy.
EP.TU.281Mind the Gap: Improving the Quality of Neurosurgical Discharge Summaries
Authors: Esemen Yagmur , Uberti Micaela , Singh Navneet , Karamitros Andreas 
Published: October 2021

Abstract

Aims
A discharge summary is a permanent record of a patient’s hospital visit and the primary means of handover between care providers. Studies show they often lack precision and omit important information. This may compromise quality and continuity of care yet they are frequently written by the most junior clinicians on a ward with little guidance or formal education on how to write one. The aim of this study was to develop some specific guidelines to improve the quality of discharge summaries in a busy neurosurgical unit.

Methods
A survey was designed to identify the challenges faced by junior medical staff in writing discharge summaries. The essential components of a good neurosurgical discharge summary were identified by group of senior neurosurgeons. Summaries were retrospectively audited against these components. We then designed a simple visual aid and placed it above computer stations in the junior doctors’ offices. Formal departmental teaching session followed. After three months we re-audited the discharge summaries retrospectively to measure any effect of our intervention.

Results
Half of the neurosurgical team rated summaries as below expectations. Challenges included poor ward round documentation and a lack of clear expectations regarding structure and essential components. After the intervention, ward round documentation and discharge summary quality improved dramatically.

Conclusions
Although various recommendations about writing good discharge summaries exist, they are generally vague and not specific to neurosurgical practice. The development of a simple specialty specific discharge summary guide can improve discharge summary quality and should be encouraged in all specialties.
EP.TU.304The Role of the Surgical Senior House Officer: A Quality Improvement Project
Authors: Boardman Charlotte , Klein Martin , Saunders Michael 
Published: October 2021

Abstract

Aim
The role of the surgical Senior House Officer (SHO) is very variable and evidence reports that many surgical SHO posts do not meet national quality standards. SHO is an active training role in which the doctor should be exposed to all aspects of General Surgery to prepare them to become a registrar. However, in a busy surgical department this can be difficult to achieve whilst ensuring that acute inpatient care is not compromised. A quality improvement project was undertaken to increase the quality and quantity of training opportunities available for the surgical SHOs in a district general hospital.

Methods
All of the SHOs in the general surgery department were asked to complete a survey about their experiences as an SHO. A timetable with personalised allocations to on-call cover, theatre sessions, clinics and ward work was introduced. After one month, further survey data was collected to re-assess.

Results
Prior to the implementation of the new timetable, the SHOs did not understand their role within the department and had minimal exposure to the elective aspects of General Surgery. One month after implementation, job satisfaction was greatly increased and attendance in clinics and theatres had doubled.

Conclusion
The implementation of this timetable resulted in a significant improvement in training for the surgical SHOs and clarification of their role within the department. By specifying activities within a formal rota, overcrowding of SHOs in theatre sessions and clinics was avoided and it ensured that all SHOs were provided with equal and adequate training opportunities.
EP.TU.310Dancing in the rain: early experience of Enhanced Stress Resilience Training
Authors: Luton Oliver , James Osian , Mellor Katie , Eley Catherine , Egan Richard , Lewis Wyn 
Published: October 2021

Abstract

Aim
Core Surgical Training (CST) programs are associated with a 60% risk of burnout and failure to progress. This study aimed to assess the influence of a novel Enhanced Stress and Resilience Training (ESRT) course delivered alongside a focused induction at the start of CST in a single UK Statutory Education Body.

Method
All CST1s were invited to participate in a six-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. Primary outcome measures were compliance with ESRT programme and degree of burnout measured using Maslach Burnout Inventory (MBI) scoring.

Results
Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate (63.2%; male 13, female 11, median age 28 yr.) Burnout was identified in 23 trainees (60.5%) with no evident difference in baseline MBI scores between participants or not (p = 0.77, median 4 [0-11] vs. 4 [1-11]). MBI scores were comparable before and after ESRT in the intervention cohort (p = 0.63, median 4 [0-11] vs. 4 [1-10]). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas and time pressures related to academic curriculum demands. Despite these challenges, 22 (91.6%) considered the course valuable, 14 (58.3%) continued to use the techniques in daily clinical work there was and unanimous support to continue the program in future.

Conclusion
ESRT was feasible and further research is warranted to determine its medium-term efficacy.
EP.TU.435A Rare Case of Granulomatous Appendicitis
Authors: Alhabsha Osama , Kudchadkar Shantata J. , Sagar Jayesh 
Published: October 2021

Abstract
Granulomatous appendicitis is a rare form of appendicitis due to a variety of causes such a foreign body, fungi, parasites, mycobacteria, Yesinia, Crohn's pathology and delayed appendicectomy. Definitive diagnosis necessitates histopathological analysis.
We present an unusual case of granulomatous appendicitis in a young gentleman, incidentally detected at histopathology, along with a brief literature review.
Patient presented with a classical clinical history and examination findings suggestive of acute appendicitis and underwent an emergency laparoscopic appendicectomy, followed by an uneventful post-operative recovery. Histopathological examination showed features of acute on chronic transmural inflammation with epithelioid granuloma, confirming diagnosis of granulomatous appendicitis.
We hereby, aim to emphasize the significance of increased awareness required among general surgeons and pathologists, as patients with granulomatous appendicitis needs to be investigated further due to the likelihood of them having an underlying Crohn’s disease or developing it in future.
EP.TU.440Managements of blood thinning medications in elderly populations presenting with rectal bleeding: Are we doing it right?
Authors: Prasannakumar A Bavikatte , Uwaoma S , Zahid M , Herath D , Olugbemi M , Sebastian B 
Published: October 2021

Abstract

Purpose
Rectal bleeding is a common adverse effect of blood thinners in elderly patients resulting in admission. Our aim is to review the management of bold thinning medications in populations.

Methods
A retrospective analysis of patients admitted with per-rectal bleed from 2018 to December 2020 was performed. All patients above the age of 60 years on blood-thinning medications were analyzed in terms of management and discharge.

Results
A total of 93 (54.71%) patients out of 170 were included in the study. The median age was 83 years. The majority of them were on Direct Oral-Anticoagulants (DOAC) (35.4%), Clopidogrel (26.8%) and Aspirin (32.5%) with remaining on warfarin (14%) and dual anti-platelets (3.2%). On admission DOAC and warfarin was stopped in all the patients and antiplatelets was stopped in 76% of them. Identical percentage of patients in all the groups required blood transfusion. At discharge, DOAC was restarted in 33% of the patients with similar percentage discontinued. 6% were switched to alternative and the rest were due to outpatient review. Warfarin and antiplatelets was restarted in 61% and 62% of the patients respectively. Alternative medications were initiated on 7.6% of patients on warfarin and 5.4% on antiplatelets. Readmissions were mainly seen in patients on antiplatelets (10%). No patients in the study developed thrombotic complications.

Conclusion
Individual patient circumstances lead to variations in the management of blood thinning medications with per-rectal bleed. Larger trials are needed to ensure uniformity. Readmissions were mostly seen in patients on antiplatelets.
EP.TU.520ISC0Re Begins: An independent research group for junior doctors
Authors: Cheah Hock Ping , Wong Kenneth 
Published: October 2021

Abstract
Research is often a difficult component of training for many surgical trainees and junior medical officers (JMOs) wanting to apply for surgical training in Australia. In 2014, we established an independent research group called Institute of Surgical Collaboration for Research (ISCoRe) to develop a research culture amongst surgical trainees and junior medical officers (JMOs). The group was chaired by an unaccredited surgical registrar with a strong interest in surgical research and a general surgeon with a wealth of experience in presentations and publications in an advisory role.
Being a small independent research group allows us to work very closely with JMOs and surgical trainees to identify their career interests, coming up with research topics and ideas and guiding the research group members through the process of data collection, analysis, writing up abstracts and submitting abstracts to conferences.
We have had a good initial success with the research output from the group, with multiple research abstracts accepted and presented in various international conferences in our first two years of the formation of the group.
However, being an independent group does have its disadvantages. The biggest challenges we face involve manpower and financial support. We are hopeful that by training up JMOs who have been with us for one or two years, they will in turn be able to help us guide new group members.
EP.TU.575One Man's Meat: Nutritional guidance for ileostomy care should consider pre-existing comorbidities
Authors: Tan Yan Yu , Subramonia Sriram 
Published: October 2021

Abstract

Aims
(1) To assess the prevalence of comorbidities which can be influenced by dietary changes in a cohort of our patients with ileostomies and (2) To compare the standard dietary recommendations for these conditions against nutritional advice for patients with ileostomies.

Methods
We performed a cross-sectional study of patients with ileostomies identified from a prospectively maintained database in January 2020. Patient demographics, comorbidities and records of formal nutritional advice were analysed. Dietary recommendations for common chronic illnesses were obtained through a literature review.

Results
Twenty-one patients (15 men, 6 women) were included. Median (IQR) age was 63 (51-73) years. The median (IQR) length of time for which patients had ileostomies was 60 (24-144) months. The most common chronic illnesses include hypertension (38%), diabetes (24%) and chronic kidney disease (14%). All patients received standard dietary advice for ileostomy management without consideration of pre-existing comorbidities. Literature review revealed a lack of high-quality evidence for dietary recommendations in patients with ileostomies and conflicting advice for those with comorbidities.

Conclusion
Existing nutritional guidance for patients with ileostomies lacks a firm evidence base and does not consider the potential modifications required for pre-existing comorbidities.