bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.157Can Twitter Attention Predict Citation Metrics? A Machine Learning Aided Analysis
Authors: Lumley Emma , Perin Giordano , Baker Megan , Hanton Alice , Mahendran Ashuvini , Saha Arin 
Published: October 2021

Abstract

Aims
Surgical journals have developed social media profiles to increase engagement though it remains unclear as to whether social media attention indices for publications act as a surrogate or predictor of traditional citation metrics. This study used machine learning to determine if there is a relationship between Twitter mentions and number of citations for surgical publications.

Methods
We identified all original research and review papers published in Annals of Surgery, BJS and JAMA Surgery in 2019. Citations data and Twitter mentions were retrieved and the Spearman rank coefficient was used to determine degree of correlation between the two variables. An unsupervised machine-learning hierarchical clustering algorithm was used to define clusters of outlying papers. Quantitative and qualitative analysis of the clusters was completed.

Results
413 papers were selected. Median number of citations was 7 (IQR 3-14), median number of Twitter mentions was 40 (IQR 15-79). No correlation between Twitter mentions and number of citations was observed (Spearman’s rho 0.076 p-value 0.124). Cluster analysis identified one large (cluster 2, 367/413 papers) and six small clusters. Analysis of cluster 2 revealed a weak but significant correlation between citations and Twitter mentions (Spearman’s rho 0.107 p-value 0.041). The remaining six clusters were characterised by an out of proportion number of Twitter mentions compared to citations or vice versa.

Conclusions
Twitter mentions should not be used as a surrogate or predictor of traditional citation metrics. In our database the relationship between social media attention and citations was skewed by a small number of outlying papers.
EP.TU.192Phlegmasia cerulea dolens associated with lung abscess
Authors: Ibrahim Ban , Kattimani Raviprasad 
Published: October 2021

Abstract

Introduction
Phelgmasia cerulea dolens (PCD) is a rare limb and life-threatening condition caused by extensive of deep veins thrombosis of the extremities and it is classically associated with extensive oedema, severe pain and skin mottling which may lead to compartment syndrome, venous gangrene, and death.

Case presentation
We present a rare case of phlegmasia cerulea dolens associated with lung abscess. A 40-year-old male with background history of right femoral vein thrombosis, cardiomyopathy with ejection fraction of only 10% presented with three days history of progressive swelling, pain and purple discoloration of right leg to the accident and emergency department at a district general hospital. He was treated with therapeutic low molecular weight heparin. He was found to have lung abscess 2 weeks after admission for which he was treated with broad spectrum intra venous antibiotics. In view of his poor ejection fraction, he was treated without any surgical intervention for PCD.
Patient succumbed after 3 months of presentation. PCD is a rare vascular emergency condition if not recognized early and treated aggressively may lead to high morbidity and mortality.

Conclusion
Phlegmasia cerulea dolens is an acute limb and life-threatening condition. Early diagnosis and aggressive intervention with thrombolysis and thrombectomy is necessary to prevent morbidity and mortality.
EP.TU.207Maintaining High Quality Surgical Teaching during the COVID-19 Pandemic
Authors: Boardman Charlotte , Moschidis Thomas , Saunders Michael 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic has resulted in many changes to the delivery of undergraduate surgical education. Formal teaching is now online and exposure to the many different aspects of General Surgery is greatly reduced.
We explored how the changes made to the 4-week General Surgery rotation at a district general hospital have impacted on students and their learning.

Methods
Online survey was used to collect feedback from the students and was compared to data collected prior to the pandemic.

Results
A total of 10 survey responses were received. Despite the timetable changes, 80% of students rated the placement as Good-Excellent. The students received more registrar/consultant level teaching than previously and rated the teaching to be of a good standard. They logged more clinical procedures and clerked more patients than previously, but clinic attendance remained poor and operating theatre sessions static.

Conclusion
Despite the added pressures of the pandemic, undergraduate surgical education has been maintained to a high standard. The struggles experienced with the decrease in elective operating lists and fewer surgical clinics does not appear to have impacted significantly when compared to pre-pandemic data. However, this is certainly an area that needs to be improved upon to ensure adequate exposure to surgery. The increase in procedural and clerking experience is perhaps a reflection of greater time spent on the wards. This is certainly of benefit in preparation for foundation training and any missed opportunities for exposure to surgical pathologies have been alleviated by the increase in formal senior-level teaching.
EP.TU.216Golden Patient Protocol: A Closed Loop Audit
Authors: Mactier Mhairi , Bramhall Russell 
Published: October 2021

Abstract

Introduction
Identifying a ‘Golden Patient’ the proceeding day improves emergency theatre efficiency and overall operating capacity.

Aim
Use this strategy to improve theatre efficiency in our Regional Plastic Surgery Department.

Methods
Cycle one:
Interventions:
Cycle two:
Cycle three:

Results
Cycle one:
Cycle two:
Cycle three:

Conclusions
Use of the ‘Golden Patient’ protocol improves emergency theatre efficiency with subsequent effect on overall operating capacity.
EP.TU.373What We Do In The Shadows: Night Surgical Registrars and Abdominal Pain
Authors: Quah Samantha , Cheah Hock Ping , Wong Kenneth 
Published: October 2021

Abstract

Aim
Surgical cover at night differ according to hospitals and are often performed by junior registrars. This can be challenging as a certain amount of independence is required in decision making. Abdominal pain remains one of the most common surgical presentations in the Emergency Department. This study analyses the type of abdominal pain presentations that were reviewed overnight in a regional Australian hospital.

Method
All patient presentations requiring surgical review from 9.00pm to 7.00am over a period of 4 months are prospectively collected and analysed. Patient details collected comprised of gender, date of review, blood tests, imaging results, histopathology, and intra-operative findings.

Results
Of the 114 patients who presented with abdominal pain, the majority of them were undifferentiated abdominal pain (n = 20, 17.1%). This is then followed by appendicitis (n = 17, 14.5%), diverticulitis (n = 13, 11.1%), pancreatitis (n = 8, 6.8%) and cholecystitis (n = 6, 5.1%). Among the others, a total of 8 presentations required urgent surgical review which resulted in three emergency surgeries being performed overnight, a laparotomy for closed loop small bowel obstruction, a Hartmann's procedure and a laparoscopic appendicectomy on a septic patient.

Conclusion
Common presentations for abdominal pain overnight include undifferentiated abdominal pain, appendicitis, diverticulitis, cholecystitis and pancreatitis. Hence education for night surgical registrars should be focused on management of these common conditions and also on surgical emergencies such as closed loop bowel obstructions, septic patients and perforated viscus to ensure optimal patient outcome without the need for close supervision.
EP.TU.425Visceroptosis - obsolete condition or missed opportunity to intervene early?
Authors: Matias Mariana , Kronberga Madara 
Published: October 2021

Abstract

Visceroptosis is defined as displacement or prolapse of abdominal organs below their natural position, most commonly stomach – gastroptosis – or bowel - enteroptosis. It is also known as Glénard’s disease, first described in 1885, when there is evidence of generalised visceroptosis. The aetiology of visceroptosis remains unknown, however some authors have suggested this condition to result from weakness of the ligaments that hold the abdominal organs in their anatomical place. Although patients with visceroptosis are often asymptomatic, this condition can also present with various gastrointestinal symptoms depending on its severity. The most common symptoms reported include anorexia, severe constipation or diarrhoea, abdominal distention, gastroparesia, nausea, intractable abdominal pain.
The aim of this study is to review the most updated literature reporting cases of visceroptosis, the diagnostic approach and its subsequent management, encouraging all surgeons to be more attentive towards and accurately identify visceroptotic habitus.

Method
Literature review using PubMed, Web of science and other reliable sources using the possible combinations of the following key words: visceroptosis, gastroptosis, enteroptosis, gastrointestinal complications, surgery.

Results
Current literature is scant regarding this unusual presentation and it is often referred as a rare complication of Ehlers-Danlos Syndrome. Due to its rarity, it often remains underdiagnosed potentially leading to sub-optimal treatment of patients, and ultimately significant morbidity and mortality.

Conclusion
We believe this condition should be repopularised as serious complications such as visceral torsion might arise from it which may require immediate surgical treatment, affecting quality of life and a high rate of relapses after surgical procedures.
EP.TU.439Falciform ligament torsion – a rare cause of the acute abdomen
Authors: Sabri Shariq , O'Connor Adam , Solkar Maseera , Ramzan Amalia , Solkar Mamoon 
Published: October 2021

Abstract
The falciform ligament attaches the liver to the anterior abdominal wall and diaphragm. Acute falciform ligament related pathology is rare. In this case report we present a case of acute fat necrosis related to the falciform ligament. A 53 year old women presented with acute upper abdominal pain localised to the right hypochondrium. He was tender to palpation in the same region with a positive Murphy’s sign. A provisional diagnosis of acute cholecystitis was made. Blood work revealed raised inflammatory markers but normal liver function tests. Abdominal ultrasound revealed no gallbladder pathology nor gallstones. Thus computed tomogram (CT) scan of the abdomen was performed, showing hyper-attenuation rim signal present within the inferior aspect of the falciform ligament consistent with local vascular occlusion. The patient was managed with intravenous antibiotics with liberal analgesia and went on to make a successful recovery. Only 10 cases have been reported in the literature related to falciform ligament necrosis. We present this unusual pathology encountered on our acute surgical take, to alert surgeons to this rare diagnosis and provide a review of the literature and provide detail of how such a pathology manifests on CT scan.
EP.TU.443Improving the Skills and Safety at Workplace: Training on the Use of the AirSeal Insufflation System in Laparoscopic Surgery
Authors: Win Myat , Ng Oliver , Bharathan Balamurali 
Published: October 2021

Abstract

Aims
According to Good Surgical Practice set by the RCS England, surgeons need to keep themselves up to date and maintain the competence in all areas of their practice. Literature and guidelines recommended the use of AirSeal insufflation in laparoscopic surgery for the safety during the first surge of Covid-19. Our objectives were to measure the level of knowledge and confidence of surgical trainees in using the AirSeal insufflation system in laparoscopic surgery at our institution and to help trainees achieve competence.

Method
Multiple small group training sessions were delivered to 14 surgical doctors adhering to safety protocols. The concept of the AirSeal insufflation system, its benefits, limitations, set up and troubleshooting were delivered using lectures, videos and hands-on training. The change in level of knowledge and confidence in practical skills were assessed by analyzing the responses to the questionnaire completed before and after the course.

Results

Conclusion
The dramatic improvement in self-perceived confidence of practical skills and knowledge of the AirSeal system was achieved among surgical doctors. Adaptation to the situation and introduction of this advanced technology to the trainees in elective and emergency settings helped promote the skills and safety at workplace during this pandemic especially with the support of flexible training sessions.
EP.TU.566Virtual Interactive surgical skills classroom – An Ongoing Randomized Controlled Trial
Authors: Nathan Arjun , Fricker Monty , Asif Aqua , Patel Sonam , Georgi Maria , Hang Kien , Monks Massimo 
Published: October 2021

Abstract

Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method
72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.

Results
Data collection will be completed in February 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusion
To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development of further resource-efficient training programs during the COVID-19 pandemic and afterwards.
EP.TU.569Improving Confidence and Technique When Preparing Nipple Smears for Cytology
Authors: Gandhewar Rishikesh , Jiwa Natasha , Leff Daniel 
Published: October 2021

Abstract

Aims
To create a sustainable means of educating breast surgeons on how to prepare nipple smears for cytology when investigating nipple discharge.

Methods
A nation-wide questionnaire of 51 doctors conducted in 2020 identified low confidence and competency in preparing a nipple smear slide. A 3-minute training video was subsequently created and published to the Association of Breast Surgery (ABS) website for universal access. Doctors were prompted to complete a questionnaire after watching the video to assess understanding, confidence, and obtain video feedback. Results were collected and analysed using Qualtrics software.

Results
31 doctors completed the survey (10% foundation doctors, 77% specialist trainees, 13% consultants). The mean±StD nipple smears prepared per year was 1.74±0.95. The percentage of doctors who felt confident in their technique increased from 44% to 100%. Ninety-seven per cent correctly identified how to store and label the sample, previously 45%. The percentage of doctors aware of where to place the sample on the slide increased from 37% to 100%. Eighty-seven per cent were aware of the optimal fluid volume in comparison to 10% previously. All respondents felt the video was valuable and 71% of respondents indicated they would also benefit from a written list of instructions.

Conclusions
The preparation of nipple smear slides has historically been an area of clinical uncertainty. An educational video was successfully created to educate all grades of doctors and made universally accessible through the ABS website.
EP.TU.571Is the pen mightier than the scalpel? Improving the quality and efficiency of Major Trauma ward rounds
Authors: Patton Ethlinn , Olaleye Dapo , Smith Stella 
Published: October 2021

Abstract

Aims

Methods
Data was collected retrospectively between October to December 2020. Patient paper notes were reviewed on three dates before and after implementation of the ward round sticker, gathering data from 26 and 27 patients respectively. Data was collected across a series of weeks to ensure a variety of clinicians present on ward round, in order to accurately reflect current practice.

Results
An improvement in rate of documentation was seen in 10 out of 12 key clinical variables. Some of the largest increases were seen in consideration of VTE status; 96.3% (n = 26) from 7.69% (n = 2), and recording oral intake; 85.2% (n = 23) from 23.1% (n = 6.)

Conclusions
We know that poor quality documentation is associated with increased rates of adverse events for patients,[1] so it is imperative to address both what is being covered, and how it is being recorded. Staff reported that the use of ward round stickers improved legibility of documentation and made it easier to locate important information. This simple, cost effective intervention has improved the consistency of daily reviews, and streamlined communication within the multidisciplinary team.
EP.TU.581Cholecysto-colonic fistula – A rare complication of gallstone
Authors: Loganathan Santhosh , Singh Amal , O'Connor Adam , Antony Martin 
Published: October 2021

Abstract
We present a 90year old male patient presenting to the emergency department with complaints of PR bleed for a month with no associated abdominal pain. He described that the blood was mixed with stools and dark in colour. He has a significant past medical history with multiple comorbidities. The patient is known to have gallstones and had ERCP with sphincterotomy in 2017 as a definitive treatment, as he wasn’t a fit candidate for surgical intervention. On clinical examination, his abdomen was soft and non-tender and per rectal examination showed stools mixed with the blood but no active bleeding or fresh blood.
His haemoglobin was 72 g/L, inflammatory markers were significantly elevated with deranged liver enzymes and normal bilirubin. The medical team were involved in the management of this patient because of pneumonia and extensive medical issues. A gastroscopy was performed as there was a suspicion of UGI bleed, which was normal. Given a deranged liver function and there was a suspicion of biliary sepsis patient had MRCP and Computed tomography of the abdomen which confirmed that there is haematoma in the gallbladder with gas in the biliary tree, with possible cholecysto-colonic fistula, with a large gall stone (2.7cm lamellated structure within rectum) in the rectum.
As the patient was not a surgical candidate decision was made to manage him conservatively with antibiotics under medical care. The cholecysto-colonic fistula is a rare complication of gallstone disease, and very few cases have been reported in the literature.
EP.TU.601Improving extended venous thromboembolism prophylaxis prescription compliance at discharge for colorectal cancer resection patients
Authors: Lewis-Lloyd Christopher , Brewer Hilary , Hall Craig , Adiamah Alfred , Humes David 
Published: October 2021

Abstract

Aims
Extended venous thromboembolism prophylaxis (exVTEp) is used to reduce venous thromboembolism (VTE) incidence following colorectal cancer (CRC) resection. Within our tertiary care centre patients undergoing CRC resection should receive an electronic VTE risk assessment (eVTE) within 24 hours and exVTEp at discharge, compliance targets set at 95%. Our aim was to improve absolute compliance rates of exVTEp prescription at discharge following CRC surgery.

Methods
Data were collected prospectively on CRC resection patients pre and post an educational intervention for doctors during surgical induction, with posters placed in key areas highlighting discharge exVTEp importance. Patients discharged between August-December 2019 served as pre-intervention and those between December 2019-March 2020 as post-intervention cohorts. Time periods reflected junior doctor rotating periods within the country’s healthcare system thus providing more comparable data sets. The service evaluation was registered within the Trust (19-562Q)

Results
Of 80 pre-intervention and 40 post-intervention eligible patients: 81.25% vs. 92.68% received exVTEp at discharge, 70.19% vs. 72.34% had a valid eVTE and 32.50% vs. 36.59% had exVTEp recorded in the post-operative note. Those missing exVTEp documentation in the post-operative plan were significantly less likely to receive exVTEp at discharge with an 80% decrease in exVTEp prescription compared to patients with exVTEp documented within the post-operative note (unadjusted-OR 0.2051, 95%CI 0.0431-0.9773; p = 0.0276).

Conclusions
Educational and visual interventions have shown improvement in exVTEp prescription at discharge. Despite suboptimal eVTE scores true service quality in delivering exVTEp is high. The relationship between exVTEp post-operative instruction and exVTEp prescription needs further investigation.
EP.TU.682Antibiotic Stewardship Within A General Surgery Department – A Quality Improvement Project
Authors: Fadipe Toks 
Published: October 2021

Abstract

Background
Antimicrobial stewardship involves a coherent set of actions geared towards responsible use of antimicrobials. NICE antimicrobial stewardship guidance forms the basis for trust wide standards; the surgical department inconsistently complies to these standards.

Aims
Use of PDSA framework to improve departmental antibiotic prescribing practices.

Methods
Data collection via Meditech™ prescribing records and documentation. ‘Snapshots’ of antibiotic prescriptions for surgical inpatients taken collecting the following data:
Cycle 1 data collection in August/September 2020, followed by a presentation distributed to junior doctors detailing importance of accurate prescribing. Cycle 2 data collection in October/November 2020 was followed by a summary of documentation/prescribing guidelines being circulated to surgical juniors. The final data collection period took place in November 2020. Analysis via Chi-Squared test.

Results
Interventions improved prescribing of correct antibiotics (75 to 89.3%), and documentation of IV antibiotic prescriptions with courses longer than 72 hours (p &lt; 0.05). Similar insigificant improvements observed with reviewing prescriptions within 72 hours and samples sent to microbiology.

Discussion
Low frequency of samples sent to microbiology as antibiotics often used for surgical prophylaxis and continued post-operatively without prior cultures. Brief documentation on the ward round, accentuated by constraints enforced by Covid-19 pandemic.

Conclusion
Positive changes can be achieved from simple interventions. Sustainable changes in prescribing practices require engagement of entire clinical team and amendments to electronic prescribing.