bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.673Optimising the referral process to the Surgical Emergency Clinic through mutual education of primary and secondary care teams: an audit cycle
Authors: Cheung Tiffany , Muneer Faiza , Freeborn Michael , Cross Katie 
Published: October 2021

Abstract

Aims
The Surgical Emergency Clinic (SEC) in our Hospital facilitates access to General Surgical consultant-led emergency assessment. Anecdotally, referrals are often (likely inadvertently) inappropriate and / or incomplete, which may delay assessment by the correct specialist.
We audited the quality of GP referrals to the SEC against four standards:

Methods
Retrospective analysis of 50 GP referrals to the SEC between November - December 2017, after recording data pertinent to the above standards in a spreadsheet. Results were presented at a local GP development day, a re-designed referral form incorporating GP feedback received was uploaded onto the Trust’s intranet and an email inbox created for e-referrals. 50 further referrals between September - November 2018 were analysed.

Results
Full completion of the referral form increased from 0% (initial audit) to 29% (re-audit), and appropriateness of referrals from 62% to 90%. The proportion of patients having had specified blood and urine tests in advance improved overall also.

Conclusions
Our experience demonstrates that primary and secondary care teams actively communicating and working closely together can improve the referral process for both parties, and most importantly enhance patient access to timely, appropriate specialist care.
EP.TU.701Colon Capsule Endoscopy versus Computed Tomographic Colonography for identifying Colorectal Cancer and Polyps: a systemic review and meta-analysis
Authors: Gumber Ashutosh , Kumar Gautam , Narayanasamy Sangara Narayanan , Ramesh Vibha , Aspari Ajay , Shalli Kawan 
Published: October 2021

Abstract

Aim
Early diagnosis and treatment of Colorectal Cancer can improve outcomes. Polypectomy with colonoscopy has failure and incompletion rates with risk of aerosol-generation. Computed Tomographic Colonography, second investigation, is limited by radiation exposure and aerosol generation. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding the discomfort and aerosol-generation.
Our aim is to compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions.

Methods
Review followed PRISMA standards. Electronic database (EMBASE, MEDLINE, PubMed, CINAHL) searched for RCTs and Observational studies. MedCalc Statistical Software used for the synthesis of results. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model.

Results
We found one RCT and three observational studies. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990- 1.937), p-value-0.057. Per-Patient Sensitivity Analysis of showed overall effect of 1.928 (0.995-1.892), p-value-0.054. Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), p-value-0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value-0.676.

Conclusion
CCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. A careful decision can be made in current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.
EP.TU.740Implementing a departmental handbook to improve induction for FY1s during COVID-19 pandemic
Authors: Annett Jessica , Neminathan Tabitha , Fisher Simon , PhD Barney Stephenson 
Published: October 2021

Abstract

Aims
The 2020 cohort of FY1s qualified during the COVID-19 pandemic; most prequalification placements were cancelled. Induction provides crucial information for new FY1s. We assessed the impact of redesigning the General Surgery induction handbook at Hereford County Hospital.

Methods
A 40-question survey, designed against standards in ’Recommendations for safe trainee changeover’ published by the Academy of Medical Royal Colleges, was sent to all FY1s commencing General Surgery in August 2020 two weeks following induction. The survey contained 5 sections: introduction; testing your knowledge parts A and B; team atmosphere; and demographics. Answer modalities included: binary answer; multiple choice; Net Promoter Scores (NPS); and free text. Submissions were made electronically via Microsoft Forms.
Feedback guided redesign of the induction handbook which was sent to FY1s rotating December 2020. Information included: how to contact seniors; requesting investigations; referring to specialties and expected duties. A repeat survey was sent to FY1s 4 weeks following induction.

Results
10/11 FY1s responded during the first rotation; 9/11 during the second. FY1s felt more confident requesting bloods (NPS +50 to + 90), requesting imaging (NPS –20 to + 70), completing discharge summaries (NPS +30 to + 80) and referring to specialties (NPS –40 to + 60). There was a better understanding of different shift types (NPS –40 to + 30). More FY1s correctly recalled on call bleeps for the medical registrar (from 56% to 75%) and the anaesthetic registrar (from 50% to 78%). Most (78%, NPS +78) felt they had enough support from other FY1s which remained the same (NPS +78) through the second rotation. As a result of the COVID-19 pandemic, prequalification experience varied greatly between individual FY1s.

Conclusion
Overall, FY1s were more confident requesting investigations, referring to other specialties and completing discharge summaries after redesign of the induction handbook. Considering disruptions in pre-qualification training as a result of the COVID-19 pandemic, a thorough departmental induction handbook can be an invaluable resource tool to aid rotation into a new specialty.
EP.TU.833The F2 Cohort of COVID19: The impact on Career development – a survey analysis
Authors: Whitton Charlotte 
Published: October 2021

Abstract
In March 2020 the coronavirus outbreak was announced as a global pandemic by WHO, in response to the pandemic the NHS underwent huge changes. This included recalling foundation doctors and cancelling the changeover into their final rotations. There have been studies into the impact of the pandemic on junior doctor training and wellbeing, however none looking specifically at their career development. An online survey was distributed to a cohort of Foundation Year 2 Doctors (F2s) in one NHS trust. This specifically asked about the impact of not rotating, specialty tasters, courses and the overall impact of the pandemic. The results of this study show that F2 doctors report weaker specialty applications alongside missed career development opportunities. However, the main influence of COVID-19 was reported to be on the cohort’s personal lives. This study concluded that the COVID-19 pandemic negatively affected both F2 doctor’s professional and personal lives, and it would be useful to follow up the cohort’s career development in the long-term as well as investigate the impacts in other NHS foundation trusts in the country.
EP.FRI.8 Hajibandeh index predicts nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology: A multicentre cohort study
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Shah Jigar , Mansour Moustafa 
Published: October 2021

Abstract

Aims
To develop and validate intraperitoneal contamination index, Hajibandeh Index (HI), derived from combined levels of CRP, lactate, neutrophils, lymphocytes and albumin in predicting the nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology.

Methods
A multicentre cohort study was conducted to develop and validate an index to predict presence of purulent and feculent contamination and risk of postoperative mortality in patients with acute abdominal pathology. All adult patients with acute abdominal pathology requiring emergency laparotomy between 2014 and 2020 were included. The index was developed in a primary cohort and was validated in retrospective and prospective validation cohorts. ROC curve analysis was performed to determine discrimination of the index and cut-off values of HI that could predict nature of peritoneal contamination and postoperative mortality.

Results
737 patients were included (234 in primary cohort, 234 in retrospective validation cohort, and 269 in prospective validation cohort). The analyses identified HI of 24.76 as cut-off value for purulent contamination (AUC:0.78,P&lt;0.0001;sensitivity:82.4%,specificity:60.9%); HI of 33.84 as cut-off value for feculent contamination (AUC:0.78, P&lt;0.0001;sensitivity:82%,specificity:67.8%), and HI of 33.47 as cut-off value for postoperative mortality (AUC:0.70,P&lt;0.0001;sensitivity:72.7%, specificity:58.47%). The results of the primary cohort and validation cohorts were comparable.

Conclusions
HI predicts presence of purulent and feculent contamination in patients with acute abdominal pathology and risk of postoperative mortality in patients undergoing emergency laparotomy. Future studies should investigate the effect of HI on accuracy of preoperative prognostic scoring tools and on patient selection for operative or non-operative management of underlying abdominal pathology.
EP.FRI.12Meta-analysis of demographic and prognostic significance of right-sided versus left-sided acute diverticulitis
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Smart Neil J , Maw Andrew 
Published: October 2021

Abstract

Aims
To compare the demographic and prognostic outcomes of right-sided versus left-sided acute colonic diverticulitis

Methods
We performed a systematic review in accordance with the PRISMA statement standards to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis. We used the ROBINS-I tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data.

Results
Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients (MD:-14.16,P&lt;0.00001) and more male patients (OR:1.33,P=0.02) compared with left-sided diverticulitis. Smoking (OR:2.23,P&lt;0.0001), alcohol consumption (OR:1.85,P=0.002) and co-morbidity (OR:0.21,P&lt;0.00001) were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group (OR:0.21,P=0.001). More patients in the right-sided diverticulitis group had modified Hinchey stage I disease (OR:10.21,P&lt;0.0001) while more patients in the left-sided group had stage II (OR:0.19,P&lt;0.00001), stage III (OR:0.08,P=0.009) or stage IV disease (OR:0.02,P&lt;0.00001). Right-sided diverticulitis was associated with a lower risk of recurrence (OR:0.49,P=0.04), failure of conservative management (OR:0.14,P=0.0006), the need for emergency surgery (OR:0.13,&lt;0.00001) and shorter length of hospital stay (MD:-1.70,P=0.02).

Conclusions
Right-sided acute colonic diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.
EP.FRI.57 Audit of Medical Records on Structure and Content of T&O Documentation
Authors: Yoganathan Sanjeevan , Raghavendra Ram , Joseph Ignatius , Sharma Ajay 
Published: October 2021

Abstract
The aim of the audit was to assess if Trauma & Orthopaedic admission documentation and record-keeping met the national standards. Standards used included the ‘Royal College of Physicians-Generic Record Keeping Standards 2, 4, 6, 10’ and ‘Professional Records Standards Body, Section 2 Admission Record’. Seventeen admission criteria and eight documentation criteria where audited from the respective standards.
Retrospective data were collected using A&E clerking documents, GP referral letters, admission clerking proformas and continuation notes from hospital admission.
Initial data showed that only 41% of pages of documentation had appropriate patient identification details listed. Of the 17 admission criteria audited, only 7 criteria scored above 90%. The major downfalls were in vital signs (38%) and assessment scales i.e. Abbreviated Mental Test Score (18%) and venous thromboembolism assessment (32%). With regards to subsequent separate entries, the main failure was entries not listed in chronological order (48%), with only two criteria scoring above 90% (entries dated and legibility). Following the implementation of an updated admission proforma and education on documentation; only 5 of the 17 admission criteria scored 90% or above. However, 46% of pages had the correct patient identification details on admission. On subsequent ward entries, 7 out of the 8 sections had improved, with 62% of notes in chronological order. Furthermore, 4 out of the 8 documentation criteria scored above 90%.
Informing staff on correct documentation helped improve doctors’ entries in patients’ notes. Improvements in the admission proforma need to be made to help meet record-keeping standards.
EP.FRI.147 Abdominal Variant Lemierre’s Syndrome: A Case Study and literature review
Authors: Rawes Catherine , Badas Vanessa , Aylward Kathryn , Whittle Annika , Brown Peter , Andreou Alexandros 
Published: October 2021

Abstract

Background
Lemierre’s Syndrome (LS) is a rare condition with a prevalence of around 0.6-2.3 cases per million of population. Typically, LS starts with a Fusobacterium Necophorum oropharyngeal infection which spreads rapidly causing infective thrombophlebitis, classically of the internal jugular. This is a life-threatening condition which left untreated has a mortality of 90%.
In less than 10% of LS cases thrombophlebitis occurs outside of the internal jugular vein. These atypical presentations can result in delay in diagnosis thus treatment and hence have an increased risk of mortality.

Case Report
Here we present a case report of a patient with Abdominal Variant Lemierre’s syndrome. A 47-year-old female with no past medical history was admitted to the emergency department with severe epigastric abdominal pain. The patient was stable, her National Early Warning Score (NEWS) was 2, blood tests on admission showed thrombocytopenia (Hb 121g/dl, Platelets 50x109/l, WCC 17.1x1012/l), raised CRP 299mg/l and deranged Liver Function Tests (Total protein 56g/l, Bilirubin 45mg/dl, ALT 94U/L, AlkPhos- 121U/L). A Venous Blood Gas was abnormal with Lactate 2.1mmol/l. A sepsis pathway was initiated. The blood cultures grew Fusobacterium Necophorum. MRI Imaging confirmed the diagnosis of Abdominal Variant Lemierre’s Syndrome. Haematology and Microbiology were consulted. The patient was treated with antibiotics and anticoagulation and was discharged 29 days later, she has made a full recovery.

Conclusion
This case highlights the importance of sepsis vigilance in Acute General Surgery admissions and emphasises that multidisciplinary teamwork is essential to achieve effective and prompt treatment for patients.
EP.FRI.175 Outcomes from the introduction of routine Geriatrician review for General Surgical patients over 65 years old undergoing Emergency Laparotomy at a large District General Hospital
Authors: Shamsiddinova Amira , Kiang Joanne , Jegard James , Bajracharya Abhijit , Himpson Rebecca , Bafadhel Leila 
Published: October 2021

Abstract

Aims
The National Emergency Laparotomy Audit (NELA) results show that only 28.8% of all patients over 65years having emergency laparotomy had Geriatrician input. Advancing age predisposes to more complex medical needs due to a higher prevalence of co-morbidities, polypharmacy, cognitive impairment, and physiological frailty. Introduction of perioperative geriatrician input has been demonstrated to significantly reduce post-operatively mortality (national average 9.5%, rising to 20-40% in older age). We introduced a Geriatrician led liaison team with the initial aim to reduce 30-day mortality in older patients undergoing emergency laparotomy.

Methods
Prospective database was maintained of all eligible patients reviewed by the new service. Data on Rockwood Clinical Frailty Score (CFS), NELA risk prediction score, length of stay, mortality and complications were analysed. In this service development pilot we specifically assessed age and frailty demographics, expected mortality, and actual mortality in the cohort.

Results
All NELA patients 65 and over were reviewed by the service between September and December 2020, 35 in total. Median age 77 years; Median CFS 3 (range 2-6); Median NELA mortality risk 12% (range 0.9%-55.8%). Inpatient mortality was 2.9% and 30-day mortality 2.9% during this study period, compared to 18% in the previous year.

Conclusion
Our pilot study demonstrates that development of an embedded Geriatrician liaison service for patients undergoing emergency laparotomy is achievable in a district general hospital. Consistent with other larger scale studies we demonstrated significant mortality reduction in older adults undergoing emergency laparotomy with the new service offering enhanced inter-disciplinary Surgical, Critical Care and Geriatrician team-working.
EP.FRI.253 Outcomes of treatment of anal squamous cell carcinoma over a 10-year period
Authors: Ayantunde Abraham , Noureldin Khaled , Edison Daniel , Haq Hafizul , Praveen Bandipalyam 
Published: October 2021

Abstract

Background
We evaluated our 10-year experience with the treatment and outcomes of patients with anal squamous cell carcinoma (ASCC).

Patients and Method
Clinical and pathological data of patients with ASCC were analysed between January 2011 and December 2019. All patients underwent the standard workup according to the anal cancer network guidelines and treated accordingly. Patients were followed up clinically and with imaging according to the network protocol. The outcome measures were clinicopathological characteristics, treatment modalities, recurrent disease, disease-free and overall survival.

Results
117 patients were diagnosed with ASCC over the 10-year period. 14 patients with adenocarcinoma(11), melanoma(1), Paget disease(1) and carcinoid tumour(1) were excluded. Median age of 103 patients included was 68 (38-101) years with a Male to female ratio of 1:2. Four patients were HIV positive and 42.7% of the patients had AIN of varying degree of dysplasia. 66% (68/103) of the patients had radical chemoradiotherapy with curative intent while 9 patients with tumour ≤2cm underwent wide local excision. Six patients underwent palliative therapy and the remaining 20 were on supportive palliative care. 61.2% of the patients treated with radical chemoradiotherapy had complete response while 10.7% had partial response. Four patients with incomplete response underwent salvage APER. 13% (10/77) of the patients treated with curative intention developed recurrence.
The overall mean survival time was 77.9 (95% CI 66.73-89.06) months with 5-year survival rate of 59%. The overall mortality rate was 42.7% and disease-specific mortality was 26.2%.

Conclusion
ASCC responds well to radical chemoradiotherapy with enhanced survival rate.
EP.FRI.265 Laparoscopic Right Hemicolectomy with Complete Mesocolic Excision for a T4 Caecal Tumour with Associated Phlegmon
Authors: Afzal Zeeshan , Stupalkowska Weronika , Davies Richard , Wheeler James , Saverio Salomone Di 
Published: October 2021

Abstract
A 67-years-old female presented with right lower abdominal pain and raised inflammatory markers. A computed tomography scan showed marked inflammatory changes with collections adjacent to terminal ileum. Patient was managed with intravenous antibiotics initially. Subsequent colonoscopy showed a bulky 8cm caecal pole tumour involving ileocaecal valve. Histopathology confirmed a diagnosis of moderately differentiated adenocarcinoma. Staging CT was negative for distant metastases. The patient subsequently proceeded to laparoscopic right hemicolectomy with complete mesocolic excision (CME). Intraoperatively the ileocolic vein was clipped just at the level of its confluence with superior mesenteric vein. The ileocolic artery was divided at its origin form superior mesenteric artery followed by division of right colic artery. The caecal mass was dissected off the abdominal wall. Proximally small bowel was resected 25cm form the ileocaecal valve and distally colon was divided up till mid transverse point. The specimen was extracted through a 9 cm Pfannenstiel incision. An intracorporeal isoperistaltic ileocolic side to side anastomosis was performed using a novel technique.1 The patient made full recovery and proceeded to adjuvant chemotherapy. Histology showed moderately differentiated T4 adenocarcinoma with tumour free lymph nodes. This case demonstrates intraoperative steps of laparoscopic complete mesocolic excision. CME is now becoming a standard due to improved oncological outcomes as it yields higher number of resected lymph nodes and better tumour clearance margins. This approach can be challenging due to variability in vascular anatomy, however, in experienced hands it is feasible and safe resulting in extensive lymphadenectomy and better oncological radicality. 1.https://www.ncbi.nlm.nih.gov/pubmed/28833963/
EP.FRI.271 The impact of Surgical Assessment Unit on emergency and ambulatory surgical care in a district general hospital
Authors: Liyanage Aloka Suwanna Danwaththa , Apter Philip , Causer Gemma , Gokul Krishnan , Ainsworth Paul 
Published: October 2021

Abstract

Aims
There has been a paradigm shift in the delivery of emergency and ambulatory surgical care necessitated by paucity of beds, improved expedited diagnostics and delayed transit in Emergency departments. The objective of a surgical assessment unit (SAU) is to reduce the number of semi-urgent admissions, provide direct access to urgent surgical admissions bypassing the ED, expeditious assessment by senior clinicians and to reduce the number of OPD follow up. In our setting, the SAU came into existence on all 5 working days at 12-hour daily schedule and its impact was evaluated retrospectively.

Methods
Prospectively maintained data base over a 2-month period was examined. Pre and post SAU figures were compared to judge any quantitative improvement in surgical services.

Results
During the audit period of 2 months there were 156 emergency patients and 190 ward attenders for follow up care. Majority of these patients were assessed within 4 hours and discharged or ambulated. Numbers being admitted overnight purely to facilitate investigations showed a decrease of 44.6% post SAU establishment. There was a reduction in post discharge outpatients appointments when compared to a similar time period pre SAU (14% difference).

Conclusion
The SAU, although initially conceived and designed purely to cope with increased admissions and to minimise breaching of emergency department targets, has shown quantitative and qualitative improvement in emergency and ambulatory surgical care delivery.