bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP1.1.12Post laparotomy rectal sheath catheter analgesia, systematic review
Authors: Hatem Fady , Mostafa Samir 
Published: October 2021

Abstract

Midline laparotomy is still performed in high proportion of patients during elective and emergency procedures. Effective analgesia is essential for enhanced recovery programs especially with the focus of multi-modal opioid sparing analgesia with its benefits in reducing opiate related side effects. Many centres adopted the use of rectal sheath catheters (RSC) in all patients undergoing laparotomy, yet its use not been standardised as there is no hard evidence supporting its use.
We aim from this systematic review to explore the effectiveness of RSC in post laparotomy analgesia and to compare between different techniques of insertion.
We performed a systematic review in accordance with PRISMA standards. Search of electronic information data base (Medline, Embase, Cochrane, Library, Dynamed).

Results
(45) studies reviewed. (33) included with (1326) patients.

Conclusion
There is lack of high level evidence investigating RSC rule in post laparotomy analgesia, nonetheless which is the most effective technique (USS vs surgically inserted), in spite of large heterogeneity in methodology and scarcity of trials; the consensus of the reviewed studies concluded that it decreases opiates requirements by at least (70%) in patients receiving PCA and as good as ED but with less side effects.
SP1.1.14Future Insights on Virtual Reality Potential Uses as a Care Package for Colorectal Patients
Authors: Gendia A , Rottenburg H , Hutton M , Cota A , Clark J 
Published: October 2021

Abstract

Aim
To provide an insight on current applications of immersive virtual reality (VR) on patients undergoing surgery and to project the potential uses of these applications on colorectal population.

Methods
A non-systematic literature search of PubMed using key subject “Virtual Reality and Surgery” to identify relative articles. On reviewing applications of VR in surgery we identified four main areas of interest: preoperative education, perioperative support, postoperative pain management and rehabilitation.

Results
VR technology showed promising results in all three stages of patient’s journey ; In pre-surgery, VR was used as a powerful educational tool for vascular patients. Intraoperatively, it showed promising results as a distraction method to relief stress and discomfort in patients undergoing colonoscopy and gynaecology procedures. Postoperatively, VR was utilized in pain management in orthopaedics, cardiothoracic populations with acceptable results. Moreover, physical rehabilitation showed a strong outlet of the technology due to its engaging properties.

Conclusion
VR has been showing applicable benefits in different stages of patient’s care undergoing surgery. With proper future development of Its applications, VR potentials in colorectal population could be numerous; education on stoma and type of surgery with help of 3D environment, distraction tool for colonoscopy screening and postoperative pain. In addition, VR could help with enhanced recovery inform of physical and mental rehabilitation. Future uses of VR in colorectal population could be a key in improving outcomes and overall satisfactions. However, formulated studies and validated applications should be tackled to apply the technology safely in the standard care of colorectal patients.
SP1.1.15Long-term Outcomes of Open Verses Closed Rectal Defect After Transanal Endoscopic Microscopic Surgery
Authors: Altaf Kiran , Gahunia Sukhpreet , Slawik Simone , Andrews Timothy , Kehoe Ashley , Ahmed Shakil 
Published: October 2021

Abstract

Aims
Management of rectal defect after TEMS is a matter of debate. Data are lacking on the effect of these techniques on long term outcomes and continence of patients. We sought to analyse these in our patient cohort.

Methods
Patients who underwent TEMS between 2012 and 2019 were examined retrospectively from a prospectively maintained database. These were divided into two groups – open and closed rectal defect. Patient demographics were recorded and outcomes assessed including oncological staging, morbidity, mortality, length of stay and FISI scores.

Results
170 matched patients were included, with 70 patients in the open and 100 in the closed rectal defect group. Short-term complications were 18.8% with no significant difference between the two groups. Most of the defects were well healed upon endoscopic follow-up; more unhealed/sinus formation was noticed in the open group (p = 0.01); more strictures were encountered in the closed group (p = 0.04). Overall, there was a significant difference in pre and post TEMS FISI scores in all three groups (p &lt; 0.00001, p &lt; 0.00001, p = 0.02). Comparing the open and closed defect groups, there was no difference in the functional outcome of patients in those who developed sinus or stricture but a significant difference in those with healed scar, with those in closed rectal defect group with worsening function (p = 0.02)

Conclusion
Both the approaches of rectal defect management are associated with pros and cons. Long term complications should be expected and actively followed up for. Patients should be thoroughly counselled about these and possible deterioration in continence post-TEMS
SP1.1.17The relationship between colorectal neoplasia and body composition in a bowel screening population
Authors: Di Rollo Domenic , Morton Christopher , McMillan Donald , Horgan Paul , Mansouri David 
Published: October 2021

Abstract

Aims
Conflicting evidence exists as to the effect of elevated BMI in the development of colorectal neoplasia. Yet BMI is a crude measure of adiposity. The present study investigates the association between CT derived measures of body composition including sarcopenia, subcutaneous fat index (SFI) and visceral obesity and colorectal neoplasia.

Methods
358 consecutive patients undergoing CT virtual colonoscopy (CTC) as part of the Scottish Bowel Screening Programme were eligible for inclusion. Demographic data and the above measures body composition were calculated using previously published CT derived methods. Medical records were examined for colonoscopic findings and pathology reports.

Results
121/358 (34%) were males. Median age 65. 126/358 (35%) patients were found to have a colorectal neoplasia. 84/126 (67%) had advanced neoplasia. 26/358 (7%) had adenocarcinoma. On multivariable analysis, both male sex and visceral obesity was associated with the presence of colorectal neoplasia, OR 2.62, [95% CI 1.51-4.55, p = 0.001] and OR 2.83, {95% CI 1.25-6.41, p = 0.01] respectively. The relationship was dose dependent with an increased risk of colorectal neoplasia in the 3rd [OR 2.13 95% CI 1.09-4.14 p &lt; 0.05] and 4th [OR 3.77 95% CI 1.96-7.26 p &lt; 0.001] quartiles of visceral fat area. BMI, SFI and sarcopenia were not associated with colorectal neoplasia in the present study.

Conclusions
Male sex and in particular, visceral obesity is associated with increased risk of colorectal neoplasia. In addition to the known cardiovascular and metabolic dangers of visceral obesity, the present work suggests that visceral obesity may also play a role in colorectal neoplasia formation.
SP1.2.7Developing a fast- track pre-assessment pathway for laparoscopic cholecystectomy
Authors: Karar Shoura , Berry Stephanie , Dear Carin , Day Anne-Marie , Jones Natalie , Berry David 
Published: October 2021

Abstract

Aims
To develop a safe and reliable assessment process for patients undergoing laparoscopic cholecystectomy and negate the need for formal pre- assessment.

Methods
A system consisting of a health screening questionnaire completed by patients (previous general anaesthesia, cardiac and respiratory history, bleeding disorders and medications) along with a functional capacity assessment (Duke Activity Status Index), allied with screening blood tests was developed. Only patients who passed all 3 components were fast-tracked to surgery while the remainder proceeded to formal pre-assessment.

Results
Data was collected and analyzed on 90 consecutive patients.
An interim analysis identified the format of some questions needed to be altered to facilitate patient completion, resulting in 59% (rather than 36%) of patients successfully fulfilling the fast-track criteria and not excluded by incomplete entries.
Overall, 40 of the 90 patients (44%) successfully completed the fast-track assessment of whom 38 underwent surgery (2 waiting). Six patients incorrectly passed the assessments due to misinterpretation of the Duke Activity Status Index but proceeded to surgery. All 38 patients had an uneventful peri-operative course.
45 of the 50 patients who failed fast-track assessments subsequently passed formal nurse-led pre-assessment, as did 4 of the remaining 5 patients after anaesthetic review – all had an uneventful peri-operative course.

Conclusion
Pre-assessment driven by a health screening questionnaire, activity index and simple blood tests is safe, reduced formal pre-assessment by 44% and avoids delays. Such tools may have a significant resource impact in appropriate patient populations. The health screening questionnaire needs further revision.
SP1.2.9To Evaluate the Analgesic Efficacy of Intraperitoneal Tramadol Vs Placebo for Post Operative Pain Relief Following Laparoscopic Cholecystectomy, A Double Blind Randomized Control Trial
Authors: Handa Siddhartha , Sangolli MS , Panchal Sanjay 
Published: October 2021

Abstract

Aim
To study the effectiveness of intraperitoneal instillation of tramadol for postoperative laparoscopic cholecystectomy (LC) pain relief and improve incidence of adverse effect.

Methods
Double blinded randomized controlled trial over 1 year. The Ethical Clearance was obtained from Institutional Ethics Committee. 60 patients scheduled for LC were enrolled in the study. Patients were randomly assigned into 2 groups using computer generated random numbers. Group T: Received intraperitoneal tramadol 100 mg (diluted in 20 mls distilled water). Group S: Received 20 ml of intraperitoneal normal saline. Pain was assessed using VAS. The assessment was done at 0, 15, 30, 60 minutes, 4, 8, 12, 16 and 24 hours. Incidence of adverse effect were observed.

Results
In group T, the mean pain scores at all the intervals were significantly low (p &lt; 0.050) except at 24 hours (p = 0.210). Analgesia requirement was significantly high in group S compared to group T immediate post op, 15, 60 minutes, 8 and 12 hours (p &lt; 0.050). The mean requirement of analgesia immediate post op, 15 minutes, 4 and 8 hours was significantly low in group T compared to group S (p &lt; 0.050). 30% patients in group T did not require analgesia at all compared to S (p &lt; 0.001). Incidence of adverse effects at 4 hours was 43% in group S compared to 40% in group T (p &gt; 0.050).

Conclusion
Intraperitoneal instillation of tramadol in LC has beneficial effect in terms of postoperative pain relief following LC and lower requirement of analgesia. However, the incidence of adverse effects was comparable in both the groups.
SP1.2.13Prediction of malignant progression of colorectal adenomatous polyps – A complete systematic review and meta-analysis
Authors: Altaf Kiran , Gahunia Sukhpreet , Zhao Sarah , Ahmed Shakil 
Published: October 2021

Abstract

Aims
Only 5% of colorectal adenomas (CA) progress to cancer. Identifying these is highly relevant for colorectal cancer screening risk. Currently, no biomarkers exist that predict this malignant progression. We looked at the effectiveness of common genetic aberrations as potential biomarkers through systematic review and meta-analyses.

Methods
MEDLINE, EMBASE and Cochrane Library were searched to identify all studies that assessed p53, APC, p21, BRAF, MLH1, MSH2, CIMP and Kras mutations as prognostic markers in CA. Main outcome measure was the development of colorectal cancer.

Results
109 clinical studies were included. P53 mutation [DOR 8.37 (5.21-13.42), sensitivity 55% (52-58%), specificity 85% (83-87%), PLR 4.23 (2.60-6.88), NLR 0.57 (0.57-0.64), AUC 0.7532] was found to be superior to all other mutations. Mutations of APC [DOR 0.57 (0.16-2.01), sensitivity 19% (4-25%), specificity 71% (66-76%), PLR 0.71 (0.33-1.54), NLR 1.19 (0.84-1.69)], BRAF [DOR 0.38 (0.22-0.67), sensitivity 12% (11-14%), specificity 60% (58-62%), PLR 0.57 (0.38-0.84), NLR 1.27 (1.12-1.44)], Kras [DOR 1.22 (0.72-2.0), sensitivity 33% (30-37%), specificity 74% (71-76%), PLR 1.17 (0.81-1.68), NLR 0.94 (0.83-1.07)], MLH1 [DOR 2.48 (1.05-5.84), sensitivity 26% (23-30%), specificity 82% (79-84%), PLR 1.74 (0.95-3.19)], MSH2 [DOR 1.06 (0.53-2.13), sensitivity 22% (17-27%), specificity 88% (84-90%), PLR 1.03 (0.62-1.70), NLR 0.99 (0.91-1.07)] and CIMP [DOR 1.88 (0.25-13.88), sensitivity 30% (23-36%), specificity 76% (72-80%), PLR 1.31 (0.29-5.99), NLR 0.76 (0.40-1.45)] failed to demonstrate any advantage over p53.

Conclusions
p53 mutations effectively predict malignant progression in CA. Panel of biomarkers would be more suited for surveillance programme. This needs confirmation in prospective clinical trials with cost-efficiency analyses.
SP2.1.2Online near-peer practical skills teaching for medical students: A cross-sectional study
Authors: Thirupathirajan Vikram Ajit Rajan , Georgi Maria , Hajra Ankita , Myint Fiona 
Published: October 2021

Abstract

Aims
Medical students have reduced small-group teaching due to the COVID-19 pandemic. Online teaching typically involves large-groups and covers theoretical topics rather than practical skills. We investigated the effectiveness of a six-part online small-group tutorial series, teaching key practical skills to medical students in their first clinical year.

Methods
Tutors taught using Microsoft Teams, with a tutor:student ratio being between 1:3 to 1:5. Tutorial themes were: examinations (Cardiovascular & Respiratory, Abdominal), A-E assessment and imaging (Thorax imaging & Histology, AXR & CT). Tutees completed a post-tutorial feedback form; the primary outcome was confidence improvement on the subject content. Likert Scales were used to measure the primary aim, with 1 corresponding to the worst outcome, and 4 corresponding to the best outcome.

Results
152 tutee feedback responses were analysed, a 60.0% response rate. Response numbers were lowest in the examinations tutorials. Mean tutee confidence improved markedly, from 1.954(SD 0.7918) to 3.414(SD 0.5572, p &lt; 0.0001). This was highest in imaging tutorials (p &lt; 0.05). Mean scores for effectiveness of delivery and effect of technical issues were 3.868(SD 0.3762) and 3.908(SD 0.3327) respectively. From tutors’ feedback, 100% preferred teaching small-group over large-group sessions. However, only 33.3% prefer to teach online over face-to-face. Mean student engagement was rated at 3.417(SD 0.5149).

Conclusions
Small-group teaching improves students’ confidence in practical skills. Conducting this online is more effective for skills with little physical examination components and is something that can be expanded to a bigger cohort to maximise use of the online platforms.
SP2.1.5Does the introduction of ward round stickers improve surgical ward rounds?
Authors: Sharma Vivek , Fitz-patrick Emma , Sharma Dhiraj 
Published: October 2021

Abstract

Aims
With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care.

Methods
Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism (VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4 week period. Ward round stickers were then implemented and a second cycle was completed 2 months later over another 4 week period.

Results
Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items &gt; 85%.

Conclusion
This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.
SP2.1.7Navigating surgical training: a game of trust
Authors: Shah Adarsh P , Walker Kim , Hawick Lorraine , Walker Kenneth G , Cleland Jennifer 
Published: October 2021

Abstract

Introduction
One premise of the Improved Surgical Training (IST) pilot is delivery of better quality of early years surgical training. However, the quality of the trainee-trainer relationship can positively or negatively impact trainees’ experiences of the specialty. Trust is a key determinant of the relationship, which is influenced by trainers’ level of risk aversion and trainees’ motivation. Game theory provides a framework to understand cooperation amongst rational ‘players’. This study explores how trainee-trainer relationships impact trainees’ experiences through the IST curricular reform.

Methods
Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken.

Results
Forty-six trainees participated. Trainees and trainers regularly interacting in clinical activities demonstrated growing levels of trust, aided by: specialty rotations of 6 months or more duration, working at junior registrar level with structured weekly clinical activities and direct consultant supervision, individual goal-setting and regular progress check, and meaningful and timely feedback. Cooperative relationships led to individual fulfilment, growth, and trainee autonomy. Factors hindering development of trust included: temporal and/or geographical distance between trainee-trainer, poor communication and understanding of expectations and training needs, and lack of interest and enthusiasm from either party.

Conclusion
Cohesive trainee-trainer relationships demonstrated cooperative equilibrium; both trainees and trainers met each other’s expectations and positively impacted on trainees’ experiences. On the contrary, ‘players’ in relationships deficient in trust achieved the minimum to ensure trainee progression. Addressing factors fostering a cooperative trainee-trainer relationship positively impacts trainees’ experiences.
SP2.1.8Novel ultra low-cost laparoscopic trainer design and development
Authors: Schaffer Sierra , O'Neill Parker 
Published: October 2021

Abstract

Aims
The high cost of laparoscopic training kits is a major barrier for trainees of any level to learn basic laparoscopic skills. Research shows that consistent practice is more effective than intensive training sessions, therefore having access to an at-home training kit provides surgical trainees optimised learning opportunities. During the current pandemic when access to hospital training centres is limited, at-home training kits have become an increasingly vital component of surgical education.

Methods
A scoping review of current laparoscopic training kits was conducted and based on the results, medical students designed and built ultra low-cost laparoscopic graspers and training kits.

Results
The laparoscopic training kits were reviewed and approved by a surgical consultant and senior surgical registrars and are currently being trialled in a virtual training course at a tertiary care centre. Each kit cost £10 and was created using commonly available materials.

Conclusions
The ultra low-cost laparoscopic training kits were successfully created and remain one of the most cost-effective to date. These training kits provide a cost-effective solution for providing trainees with the opportunity for extended practice of basic laparoscopic skills, further improving surgical education worldwide.
SP2.1.11Real-world use of workplace-based assessments in surgical training: a UK nationwide exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training
Authors: Beamish A.J. , Rabie M , Johnston M.J. , Nally D , Humm G , Mohan H 
Published: October 2021

Abstract

Background
The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees.

Methods
An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members.

Results
Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers.
Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets.

Conclusions
UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.
SP2.1.13Does Health Insurance Status Affect Patient Outcome After Emergency Surgery?
Authors: Quah Samantha , Cheah Hock Ping , Wong Kenneth 
Published: October 2021

Abstract

Aim
Under the Australian Medicare Scheme, Australian residents are covered for many hospital-related costs. Patients with private insurance presenting with appendicitis can elect to be admitted as a private patient. Despite the stereotypes, little is known on whether the patients’ health cover actually affect clinical outcomes. This study aims to compare the differences in patient outcomes between public and private patients after undergoing operative management for appendicitis.

Methods
A multi-centre prospectively collected health service database of all appendicectomies performed over a 16-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon, complications and mortality rates were analysed.

Results
Of the total of 652 patients who underwent an appendicectomy, 203 patients were private, 444 patients were public, and 5 were overseas patients. During the post-operative period, public patients had higher rates of representation to the Emergency Department (ED) for post-operative symptoms (public 12.8% vs private 4.4%, p 0.0007, two-tailed chi square test). In comparison, the rate of post-operative complications with Clavien-Dindo (CD) score ≥ 2 is similar in both groups (p = 0.18, public 4.5% vs private 2%). There were no mortalities recorded for both groups.

Conclusion
Public patients have higher representation rates to the emergency department after an appendicectomy however post-operative outcomes are similar in both groups in our health system. The difference in complication rates were not significant with both groups recording low complication rates of under 5%.