bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP7.2.4 Evaluation of Non-crosslinked Acellular Porcine Dermal Mesh – A Single Centre Experience
Authors: Karri Rama , Aamery Amaar , Singh-Ranger Deepak 
Published: October 2021

Abstract

Aims
We report our experience with a cellular porcine dermal non-crosslinked biological mesh (EGIS®). We conducted a review of indications and outcomes of patients requiring the mesh for incisional hernia/complex abdominal wall reconstruction with component separation, parastomal hernia repairs and ELAPE. Patients were followed for a minimum of 6 and assessed for recurrence, seroma formation and chronic pain. Secondary outcome was the assessment of ease of use by the Surgeon – suturing and pliability.

Method
A retrospective case notes review of patients requiring biological mesh (EGIS®) from 2016 to present. A qualitative survey about ease of use of EGIS® for operations studied was sent to all Consultant Surgeons.

Results
EGIS® mesh was used in 38 patients: 23 Hernia repairs – 13 Incisional, 8 Parastomal, 2 Paraumbilical; 12 Pelvic floor repairs after ELAPE; and 3 abdominal wall reconstructions. Hernia recurrence occurred in 12 (32%), seroma 7 (18%) and chronic pain 7 (18%). The highest complications occurred in the incisional and parastomal hernia groups. Incisional hernia: recurrence in 5 (38%), seroma in 5 (38%) and chronic pain in 3 (23%). Parastomal hernia: recurrence in 3 (38%), chronic pain 2 (25%), seroma 1 (13%). Consultants scored the mesh 4.3 to 4.5 out of 10 for pliability, ease of use and suturing.

Conclusion
Biological mesh is used to reinforce hernia repairs in contaminated or potentially contaminated fields. Non-crosslinked meshes are preferred for their greater cellular infiltration from host tissue with improved integration. Our experience with this mesh shows a high complication rate and requires re-evaluation.
SP8.1.2 The Effect of Ginger Oil on Postoperative Nausea and Vomiting (PONV) After Breast Augmentation Surgery
Authors: Saghir Reyan , Saghir Noman , Sidhu Manu , Okhiria Renee , Okhiria Terrell , Sforza Marcos 
Published: October 2021

Abstract

Aim
Postoperative nausea and vomiting (PONV) is one of the commonest complaints following general anaesthetic. Poorly controlled due to its multifactorial nature most current antiemetics are not effective and have an undesirable side effect profile. As such we have studied the effect of Ginger (Zingiber Officinale), a relatively inert yet powerful antiemetic and its properties in managing PONV.

Methods
A double-blind (surgeon/anaesthetist), randomised, placebo-controlled, single-centre study was carried out in a homogenous 30 female patient cohort undergoing breast augmentation surgery. Participants were randomly allocated to have 3 drops of either Ginger oil (110mg Zingiber officinale) or a simple control oil on the laryngeal mask before insertion. PONV and visual analogue scales (VAS) were used as outcome measures and were plotted against the dose of morphine used in the patient.

Results
Multivariate analysis of variance (MANOVA) was conducted on the data. Using Pillai’s trace, there was a significant effect of ginger on PONV/VAS, V = 0.87, F(3,16)=34.78, P &lt; 0.001. Separate univariate ANOVAs showed: PONV Mean=1.70, PONVSD=0.48 compared with no ginger treatment plan group; PONV Mean=4.20, PONVSD=0.79. VAS Mean= 5.0, VASSD=1.63 for the ginger treatment plan group; and VAS Mean=5.9, VASSD=2.33 for the no ginger treatment plan group.

Conclusion
This study has found that ginger has an important role in preventing postoperative vomiting, reducing postoperative nausea, and is useful in breast augmentation. We have demonstrated a novel application of ginger oil during induction of anaesthesia and have provided evidence of its use in opioid-induced PONV.
SP9.1.4 Management of Small Bowel Obstruction: A Comparison to NASBO
Authors: Ahmed Babur , Thompson Anna , Colgan Aoife , Brindle Rachel 
Published: October 2021

Abstract

Aim
Prompt diagnosis and proactive decisions in management of small bowel obstruction (SBO) can reduce the associated morbidity, in-hospital stay and mortality. Following recommendations of National Audit of Small Bowel Obstruction (NASBO) and Bologna (2017), the “agreed pathway” of The Association of Surgeons of Great Britain and Ireland (ASGBI, 2018) sets clear guidelines to aid timely management of SBO. We aimed to audit our practice to these guidelines and compared outcomes to NASBO.

Methods
Data was collected retrospectively on patients admitted with SBO from July 2019 - December 2019 and presented as percentage, median or interquartile range (IQR).

Results
Median age of 76 included patients was 62.0 years, 53.9% were female. Aetiologies were; adhesions (59.2%), hernia (27.6%), malignancy (10.5%) and others (2.6%). Admission CTs were performed in 92.1% vs. 80.0% (NASBO), with a median time of 3.3 hours vs. 2.2 days (NASBO). Median time to surgery in those managed operatively (n = 35) was 10 hours vs. 1 day (NASBO), while in 72.0% vs. 21.0% (NASBO) of non-settling SBO, water soluble contrast study (WSCS) was performed in a median (IQR) time of 39.0 (20.0-45.4) hours. Adhesional SBO resolved in 85.7% of cases suitable for non-operative approach. Objective nutritional assessment was performed in 94.7% vs. 90.0% (NASBO). In-hospital stay, 30-day morbidity and mortality compared to NASBO were 5.0 vs. 10.7 days, 31.6% vs. 23.0% and 5.3% vs. 8.0% respectively.

Conclusion
ASGBI guidelines provide multi-faceted proactive approach in managing SBO; including early cross-sectional imaging, prompt WSCS use and timely nutritional interventions, promoting improved outcomes.
SP10.1.8 Thrombotic syndrome in COVID-19
Authors: Aggarwal Aditi , Bala Ashok , Slim Hani , Rashid Hisham , Ammar Thoraya , Gambhir Raghvinder 
Published: October 2021

Abstract

Aim
To discuss the varied manifestations of COVID-19 thrombotic syndrome.

Methods
We reviewed all patients referred to vascular surgery with evidence of thrombosis in at least one vascular bed. Electronic patient records were reviewed, patient laboratory and radiological investigations analysed, and COVID-19 status confirmed.

Results
72 patients presented over 8 weeks with systemic thrombosis involving all sized vessels from aorta to visceral to crural arteries. Of these, 15 patients had RT-PCR or radiological evidence of COVID-19 infection. We investigated these 15 patients further. 27% presented with symptoms of thrombosis as the initial presentation of COVID-19 infection. 93% were COVID RT-PCR positive. 7% had evidence of COVID pneumonitis on CT chest but were COVID RT-PCR negative. 47% presented to the Emergency Department, whilst 53% were hospital admitted patients. All patients presented with ischaemic effects and D-dimers were raised in all patients in whom it was performed. 33% were lymphopenic. Fibrinogen levels and hypercoagulability profile was not routinely done for all and where available was negative. Echocardiogram demonstrated normal left ventricular systolic function and no evidence of thrombus in all patients in whom it was performed. 13% were managed with surgery and 6% with thrombolysis or other endovascular intervention. 73% were managed with anti-coagulation alone. 33% died during hospitalisation of COVID-19.

Conclusion
There is evidence that COVID-19 initiates an immuno-thrombotic state. Anti-coagulation alone was the preferred management strategy, as governed by patient co-morbidities. There is high mortality associated with patients with thrombosis and COVID-19 infection.
SP10.2.10Efficacy of Outpatient Appointment Reminders in Colorectal Surgery: A Prospective Analysis
Authors: Abdulhussein Dalia , Luo Rong , Aseem Rabiya , Smith Jason , Pawa Nikhil 
Published: October 2021

Abstract

Introduction
There is increasing mandate to improve attendance in outpatient clinics to support delivery of High-Quality Care. Non-attendance in Colorectal Cancer (CRC) has clinical and financial implications. Patient appointment reminders (letters, text-messages and telephone) have been implemented to reduce non-attendance. We examine the efficacy of patient appointment reminders in CRC patients.

Methods
A prospective study was conducted for 3-months in our CRC department surveying patients on their appointment reminders. Non-attending patients were surveyed via telephone to ascertain cause of non-attendance and preference of patient reminders. Data collected was analysed on SPSS.

Results
547 patients were prospectively surveyed. 19% did not receive appointments letters, from which 73% were made aware via Text message and 25% via Phone calls. 50% received letters &gt; 2 weeks’ notice. 183 patients did not attend (DNA) their appointment from which 100 were successfully surveyed through telephone. 60% of patients did not received an appointment reminder (letter), or received it following the date of their appointment. 79% patients preferred to be contacted via text messaging or an appointment app vs 13% via letters. Cost analysis releveled significant losses due to missed appointments.

Conclusion
Patient appointment reminders are fundamental in reducing non-attendance in clinics. Our study demonstrates that appointment letters are an unreliable method of patient communication. In an ever-increasing digital age, methods such as timely text-messages or an appointment app for CRC patients’ needs urgent implementation as per patient preferences. Further research is required to assess non-attendance and causality in other specialities for comparison.
SP10.2.12 Information Sustainability: The revitalisation and upcycling of 373,342 historic surgical pathology records into the contemporary electronic patient record in one UK NHS Hospital Trust
Authors: Rahman Fatima , Hales Alan , Cable David , Burrill Keith , Bateman Adrian , Rew David 
Published: October 2021

Abstract

Aims
Surgical and Cellular pathology (‘e-pathology’) record sets are a valuable data resource with which to populate the Electronic Patient Record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. They commonly identify the operation, the location and the pathology, even if not to modern reporting standards.

Methods
Since 2010, we have built and implemented a timeline structured EPR for the ‘whole-of-life’ visualisation of the electronic documents (e-Docs) of 2.5M+ patients on our Master Index. Prior to this project, our earliest e-Docs dated to 1995. We tracked down 373,342 inert e-pathology reports from our legacy Ferranti (1990-1997) and Masterlab (1997-2004) systems. These were uploaded into our active file servers, following appropriate data quality and patient identity reconciliation checks.

Results
We have progressively restored 373,342 previously inaccessible e-pathology records to clinical use and to immediacy of access, and in the process extending our “addressable EPR” back to 1990 for living and deceased patients. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20,000 cases with e-pathology records dating back to 1990.

Conclusions
The sustainable revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.
TP1.2.1SeHCAT scan as an investigation for chronic diarrhoea; a single trust experience
Authors: Al-Azzawi Marwa , Darnborough Sally , Devlin Lynsey , Han Sai , Bolster Alison , Nicholson Gary 
Published: October 2021

Abstract

Introduction:
Recent published (British Society of Gastroenterology) guidelines strongly recommended investigating unexplained chronic loose stools with  SeHCAT  scans when available rather than empirical treatment.  SeHCAT  scan was  introduced  at our trust in 2015. We aimed to audit this locally.

Methods
All  SeHCAT  scans that were done at our trust trust from Jan 2015 to March 2020  were included. Patient demographics along with risk factors and duration of symptoms were documented as well as the referred speciality.

Results
55 patients were identified. Average age at time of diagnosis was 50y (18-70y).  M:F  was 1:3.2 . Most scans were requested by the oncology team as part of the “pelvic radiotherapy late effects service” (n = 25), followed by the gastroenterology team (n = 22) and general surgery team (n = 8). The mean duration of symptoms was 4 years. 73% of the scans showed evidence of bile acid malabsorption (BAM)  (n = 40) with bile retention &lt;15%, with the majority of them (n = 30) having severe BAM (retention &lt;5%).  60% of the patients had at least one lower GI endoscopy as part of their workup. The majority of patients were found to have type 3 BAM (n = 37).   60% of patients had symptom improvement on either diet alone or with bile-acid sequestrants (n = 23) and were discharged.

Conclusion:
SeHCAT scan is a useful test to investigate unexplained chronic diarrhoea. It is important to identify patients at risk of developing bile acid malabsorption. It is currently underutilized by our trust, which might be because of funding issues and awareness among clinicians.
TP5.2.13 Perceived risk of pre-operative abdominal aortic aneurysm rupture due to pulmonary function testing: all blown out of proportion?
Authors: Badawy Ayman , Stupalkowska Weronika , Chaudhuri Arindam 
Published: October 2021

Abstract

Aim
Though contraindicated in some respiratory laboratories due to a perceived increased risk of aneurysm rupture, pulmonary function tests (PFT) and cardiopulmonary exercise tests (CPET) are used commonly in preoperative assessment of patients with abdominal aortic aneurysm (AAA) considered for elective repair. We examine whether preoperative PFT/CPET are associated with increased AAA rupture risk.

Methods
A retrospective analysis of a prospective database of patients with AAA ≥50mm who had PFT/CPET/both as part of their preoperative assessment from November 2012 to December 2020 in a single vascular hub before elective AAA repair (open/endovascular). Patients with AAA &lt;50mm, or those who did not have PFT/CPET preoperatively were excluded from analysis. Baseline demographics, AAA size, type of repair, time from PFT/CPET to repair, rupture rate and 30-day post-operative mortality are presented.

Results
A total of 410 patients (mean age 74 ± 8 years, 361 (88%) male) were included in the analysis. The mean AAA size was 63 ±11mm. 350 (85%) patients underwent endovascular repair. 220 (53%) patients had PFT, 69 (17%) had CPET and the remaining 121 (30%) had both PFT/CPET preoperatively. The median time from PFT/CPET to repair was 36 days (IQR 48 days), with no preoperative AAA rupture in this cohort. 30-day post-operative mortality was 3%.

Conclusions
This study strongly suggests that PFT and CPET are not associated with increased risk of AAA rupture and are therefore safe for assessing respiratory function in patients considered for AAA repair without adding to pre-operative rupture risk.
TP5.2.14 A quality improvement project: Engaging and educating our thyroidectomy patients
Authors: Aderombi Adetayo , Mahfouz Yasmin , Wu Fiona , Beatson Kevin , Ahmed Ibrahim 
Published: October 2021

Abstract

Aims
Hypocalcaemia can occur in up to 30% of patients post-total thyroidectomy. Severe hypocalcaemia can lead to life-threatening tetany and seizures. As part of the consent process, risks are discussed typically face-to-face, often with the aid of anatomy illustrations. As tele-consultations become increasingly commonplace, patient-information leaflets (PILs) can be invaluable in enhancing informed consent, and empowering patients regarding their own care. We performed a quality improvement project to assess the feasibility and effects of distributing PILs following consultations to improve patients’ understanding of post-operative complications (specifically hypocalcaemia).

Methods
A retrospective review of post-total thyroidectomy patients was performed from January 2019 to January 2020. A telephone survey was conducted to assess each patient’s understanding of post-operative complications. As tele-consultations began to be utilised during the COVID-19 pandemic, we designed a simple PIL to distribute to patients awaiting elective total thyroidectomy aiming to improve health literacy. Following distribution of PILs, the survey was repeated to evaluate feasibility and effectiveness.

Results

Conclusions
A simple and inexpensive intervention, PILs can be distributed to patients awaiting elective surgery to improve health literacy, and reduce potential patient harm.
TP6.2.12Prognostic significance of symptomatic presentation in patients with Gastro-Intestinal Stromal Tumours
Authors: Nageswaran Hari , Hall Hannah , Kruber Samuel , Satherley Lucy , Powell Arfon , Lewis Wyn 
Published: October 2021

Abstract

Background
Gastro-Intestinal Stromal tumours (GISTs) are rare neoplasms of mesenchymal origin that arise in the GI tract and account for approximately 0.1-3% of all GI tumours. The aim of this study was to determine whether the mode of clinical presentation of GISTs has an effect on outcome.

Methods
Consecutive 143 patients diagnosed with GISTs were identified from the regional network database (median age 67 (21-88) years, 85 male). Data were collected on presenting symptoms, tumour, treatment undertaken, and the primary outcome measure was survival.

Results
The commonest GIST anatomical sites were stomach (69.9%), small bowel (13.3%), and colon (4.9%). Commonest symptoms were abdominal pain (30.0%), dyspepsia (11.8%), and anaemia (11.1%). Symptomatic presentations were associated with older age (p = 0.056) and higher mitotic index (&gt;5 per 50HPF, p = 0.045). On univariable analysis the factors associated with cumulative 10-year survival were age (p = 0.076), the presence of symptoms (78.1% vs. 96.4%, p = 0.028), mitotic index (p = 0.011), and modified National Institutes of Health (NIH) prognostic index (p = 0.010), but not deprivation index, anatomical site or GIST diameter. Symptomatic patients aged over 60 years with mitotic index &gt;5 per 50 HPF had the poorest 10-year survival at 63.6% (HR 2.577, 95%CI 1.132-5.867). On multivariable analysis, NIH index (HR 4.283, 95%CI 1.395-13.149, p = 0.011) and age (HR1.061, 95%CI 1.006-1.118, p = 0.029) were independently associated with 10-year survival.

Conclusions
Age, symptoms, and NIH criteria represent the most important prognostic biomarkers in patients diagnosed with GISTs.
TP6.2.16General practitioner compliance with Scottish cancer referral guideline for Oesophago-gastric cancer
Authors: Chuntamongkol Rongkagorn , Khan Khurram , McCollum Catherine , Forshaw Matthew 
Published: October 2021

Abstract

Aims
The outcome of oesophago-gastric cancer is often poor. Timely referral of suspected cancer is essential for early diagnosis and optimal outcome. This study aims to audit the General Practitioners (GPs) compliance with the Scottish referral guidelines for suspected oesophago-gastric cancer.

Methods
A retrospective cohort study of all newly diagnosed oesophago-gastric cancers who were referred from the primary care and discussed in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and symptomatology audited against the Scottish cancer referral guidelines.

Results
Of the 349 patients, 227 (65.0%) were referred from the primary care. 150 (66.1%) were male and the mean age was 69.5 ± 10.9 years. Mean Scottish Index of Multiple Deprivation was 5 ± 3. 149 (65.6%) had dysphagia and/or odynophagia and 181 (79.7%) were oesophageal cancers. 67 (29.5%) were T4 disease and 87 (38.3%) were metastatic at presentation. Urgency of referral was: 25 (11.0%) routine, 54 (23.7%) urgent and 148 (65.2%) Urgent Suspicion of Cancer (USOC). 192 (84.6%) patients qualified to be referred as USOC, of these 138 (71.9%) were actually referred as USOC. Of the 35 (15.4%) patients who did not qualify for the USOC referral, 10 (28.6%) patients were referred as USOC. The sensitivity was 71.9% and specificity 71.4%.

Conclusions
GP compliance with the adherence with the National guidelines remains a barrier in the USOC in oesophago-gastric cancer. Further GP education and awareness is required to improve their compliance.
TP6.2.17 How good is Edinburgh Dysphagia Score in identifying patients with oesophageal cancer?
Authors: Khan Khurram , Chuntamongkol Rongkagorn , McCollum Catherine , Forshaw Matthew 
Published: October 2021

Abstract

Aims
Due to limited resources and increase in the referral for endoscopy, various scoring systems have been developed in an attempt to identify high risk patients of having oesophageal cancer. The aim of this study was to analyze the utility of Edinburgh Dysphagia Score (EDS) in patients who have presented with oesophageal cancer.

Methods
A retrospective cohort study of all newly diagnosed oesophageal cancers with dysphagia in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and EDS calculated. EDS contained six parameters: age, sex, weight loss, duration of symptoms, localization of dysphagia and acid reflux. Patients divided into lower-risk group (EDS &lt;3.5) and higher-risk group (EDS ≥ 3.5).

Results
Of the 349 patients, 182 (52.1%) had dysphagia at presentation. 149 (81.9%) were referred from the primary care. There were 127 (69.8%) male and the mean age was 69.1 ± 11.0 years. 135 (74.2%) patients had adenocarcinoma, 51 (28.0%) were T4 disease and 58 (31.9%) were metastatic. The median EDS was 7 (IQR 6-8). 178 (97.8%) patients had higher-risk EDS and 4 (2.2%) patients lower-risk EDS.

Conclusions
This study suggests that EDS can positively identify patients who are high risk of having oesophageal cancer in majority of patients. This simple scoring system can be used to vet the referrals in order to reduce the pressure in the secondary care setting to effectively use the available resources.
TP7.2.11 Hypochromia is an early marker of iron deficiency anaemia
Authors: Hwang Inae , Cheong Jeremy , Subramonia Sriram 
Published: October 2021

Abstract

Aim
Microcytosis in iron deficiency anaemia triggers an urgent referral for investigation of suspected gastrointestinal cancers. This study evaluated whether the inclusion of hypochromia as a marker for iron deficiency would lead to earlier referrals.

Method
Consecutive patients referred from primary care under the 2-week wait suspected gastrointestinal cancer pathway with unexplained iron deficiency anaemia between October 2019 and October 2020 were included. Results of red cell indices were obtained from an electronic platform for accessing laboratory test results(Sunquest ICE™, Version 5.4, Sunquest Information Systems). Mean corpuscular haemoglobin (MCH) of 27-32pg and mean corpuscular volume (MCV) of 80-102fL were considered normal.

Results
Seventy nine patients (32 men, 47 women) were included. Median (IQR) age was 73 (62-80) years. 67% (53/79) had a low MCH and 43% (34/79) had a low MCV at the time of referral.
In the preceding months of referral (median [IQR] 4.3 [1.8-7.9] months) 64 patients had a full blood count performed of which 55% (35/64) had a low MCH and 20% (13/64) had a low MCV.
The earliest available full blood count prior to referral (43 patients, median (IQR) of 16.5 (12-37) months) showed that 86% (37/43) had a low MCH compared to 33% (14/43) with a low MCV. A fall in MCH always preceded a fall in MCV at all the three time points analysed.

Conclusion
The inclusion of hypochromia as a marker of iron deficiency in the referral criteria for suspected gastrointestinal cancers would trigger significantly earlier referrals.