bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP2.1.15Consensus recommendations on balancing educational opportunities and service provision in surgical training: An Association of Surgeons in Training Delphi study
Authors: Pucher Phillip , Nally Deirdre , Peckham-Cooper Adam , Fleming Christina , Mohamed Walid , Mohan Helen 
Published: October 2021

Abstract

Background
Ensuring high quality surgical training remains a challenge as demands on the NHS rise. This study aimed to explore the differences and potential conflicts between service provision and dedicated training activity and recommend solutions.

Methods
Participants were drawn from the Association of Surgeons in Training national council. Nominal Group Technique (NGT) was employed by members of the ASIT executive addressing 3 key domains (1) defining differences between training and service tasks, (2) impact of service-provision on training and (3) ways to improve training. A two round Delphi process was conducted via electronic survey to ASIT council. Consensus was considered achieved for any statement where 80% or more of respondents indicated agreement.

Results
47 statements, generated through NGT, were put to the Delphi process. Consensus was reached on a total of 24/47 statements. Educational or training tasks were identified as those which progressed a trainee’s skill set, could be tailored to a trainee’s own ability, or involved training more junior colleagues. The negative impact of excess service provision included training quality, trainee mental health, and surgical trainee recruitment. Potential measures to improve training included increasing hospital staffing and resources, protected training times, trainee-specific or competency-based learning and training or incentivising trainers.

Conclusion
This trainee-based study provides several consensus recommendations on the characteristics that define surgical training and how a balance between service provision and training can potentially be achieved. Policy makers and health systems may be guided by these to ensure high quality training and a satisfied workforce.
SP2.2.2Analgesia prescribing in acute surgical admissions - dual-centre cross-sectional study
Authors: Makhort Alexei , Gavrila Ana , Hill Frances 
Published: October 2021

Abstract

Aim
Pain is a common presenting complaint of acute surgical inpatients and has a great impact on their subjective wellbeing and the perception of care they receive if not addressed promptly and efficiently. It is also a common cause of patients’ complaints if not properly addressed. We set out to evaluate if analgesia is prescribed locally in accordance with WHO analgesia ladder and NICE CKS analgesia guidelines for mild-to-moderate pain.

Method
We performed cross-sectional studies of adults aged 16 and over, admitted under general or vascular surgery in two DGHs (2018-2020) with complaints of pain on admission. 30 patients were included in both studies with an average age 53/56 years. We undertook notes review, checked observation charts and drug charts for pain grading and analgesia prescribing following initial clinical assessment.

Results
In the first study, average pain score of 6 was obtained. Only 19/30 patients (63%) had regular analgesia prescribed. Only 2/30 (6%) were started on regular weak opioids, with further 8/30 (26%) on as required/PRN weak opioids. 17/30 (56%) patients had PRN Oramorph prescribed. Only 2/30 (6%) were started on PRN NSAIDs despite only 46% having cautions/contraindications. 5/30 patients with pain scores of 9-10 not had any regular analgesia prescribed.
Comparable results were achieved in the second hospital we audited.

Conclusions
This study shows significant under-prescribing of analgesia, especially regular analgesia for surgical patients with moderate-severe pain, and skipping of weaker opioids/NSAIDs in favour of Oramorph. There is significant scope for improvement following educational session implementation.
SP2.2.10Barriers to Compliance of the WHO Safe Surgical Checklist in an Ethiopian Tertiary Referral Centre
Authors: Hunter Ross 
Published: October 2021

Abstract

Aims
Ethiopia is the world’s 12th most populous country, with a health care system currently undergoing significant development. Current data shows perioperative mortality at 7%, compared to the 0.4– 0.8% reported in more economically developed countries. In 2008 the WHO created the Safe Surgical Checklist (SSC), globally shown to dramatically improve perioperative mortality and used throughout Ethiopia since 2010. The author aimed to review compliance to this checklist within emergency theatres in Ethiopia and assess potential barriers to its use.

Methods
A prospective observational study was undertaken at Felege Hiwot Referral Hospital, a tertiary referral hospital in Northwest Ethiopia, over a six-week period. 70 emergency operations were directly observed.

Results
The SSC was used in 0 out of 70 cases, no surgical pauses were observed and during each operation, a member of the anaesthetic team was observed to tick each box incorrectly as completed while finalising paperwork at the end of the case. Interviews with surgical and anaesthetic staff members revealed poor compliance to be secondary to a lack of knowledge of the benefits of the checklist and no training in its use.

Conclusions
After its introduction in 2008 compliance with SSC was poor globally, with the published data revealing this to be secondary to poor initial implementation from senior hospital staff and a lack of staff training. While compliance has improved in more economically developed countries, the same barriers are still faced in Ethiopia. These barriers must be targeted in order to improve perioperative outcomes.
SP2.2.11Improving the quality of the documented weekend surgical handover: Implementation of a handover sticker within an urban teaching hospital
Authors: Gall Lewis , Meney Laura , Macdonald Andrew 
Published: October 2021

Abstract

Aim
Effective, high-quality patient handovers between the surgical team are essential for safe transfer of responsibility for patient care whilst ensuring continued patient-safety and supporting good clinical governance. Weekend handovers provide a particular challenge, with error potential, when patients are cared for by multiple different healthcare professionals. This project aimed to improve the documentation of the weekend handover for the surgical inpatients of a busy UK teaching hospital.

Method
Quality Improvement project performed within a single General Surgical department between August and October 2020. An initial casenote audit on 3 consecutive Fridays compared available handover information against RCS guidance. A comprehensive surgical weekend handover sticker was designed and all members of the surgical team educated in its use. Following sticker introduction, handover quality was similarly re-audited. **=p&lt;0.00001 using Chi-squared/Fisher exact.

Results
138 inpatient records were evaluated in cycle 1 and 135 in cycle 2, with the proportion containing a weekend handover increased post-intervention (96 vs. 82%,p=0.0004). Handover quality improved following sticker introduction with more frequent documentation of: diagnosis (96 vs. 21%**); need for imaging review (94 vs. 29%**); intravenous fluid plan (84 vs. 21%**); blood test requirements (94 vs. 24%**); mode of nutrition (90 vs. 24%**); antibiotics (90 vs. 30%**); drug monitoring (90 vs. 1%**); discharge planning (94 vs. 44%**) and escalation plan (87 vs. 0%**).

Conclusion
Introduction of a sticker has significantly improved the quality of documented handover available to the responsible on-call team. Future work will assess sticker impact on quality of care and clinical outcomes.
SP2.2.13Audit to evaluate the use of tumor marker CEA in a level 3 hospital
Authors: Murphy Gearoid , Fatima Iayla 
Published: October 2021

Abstract

Background
Tumor markers play an important role in cancer cases and their application in practice needs an understanding of its pathophysiology, testing techniques, range of values and their role in any given malignancy. The appropriate use of tumor marker testing is facilitated by national and international guidelines, inappropriate use increases both the laboratory workload and cost.
In this study, we evaluated the appropriateness of ordering the tumour marker Carcinoembryonic Antigen (CEA) in a Model 3 general hospital.

Methods
A single centre retrospective audit was conducted between 1st to 31st October 2020. Patients demographics and admitting consultants details were obtained through HSE online Lab Web Enquiry system. Files were reviewed for indications using the guidelines by the Association of Clinical Biochemists Ireland (ACBI).

Results
A total of 52 tests were ordered over the month, 38 (73.1%) of these tests were ordered correctly following ACBI guidelines. The remaining 14 (26.9%) tests were ordered inappropriately.
50% (26/52) of the total tests were ordered by oncology, 31% (16/52) by General Surgeon and the remaining 19% (10/52) by other specialities.
No inappropriate tests were ordered by Oncology, inappropriate tests ordered by General Surgery were 35.7% (5/14) and 64.3% (9/14) by other Specialities.

Conclusion
Nearly 26% of the tests were ordered inappropriately and did not comply with published ACBI guidelines and cost 294 Euros.
The tumour marker CEA is not useful as the initial work up of nonspecific complaints. Its main use is surveillance after curative resection and for monitoring treatment for patients with advanced colorectal cancer.
SP2.2.17The leaning tower of pasta: lessons in team performance and creativity from a core surgical training boot camp design challenge
Authors: Eley Catherine , Mellor Katie , Luton Oliver , James Osian , Robinson David , Lewis Wyn 
Published: October 2021

Abstract

Aims
Unity of effort is an important component of strategic leadership and management theory associated with Core Surgical Training (CST) outcome. The aim was to determine the impact of team diversity on task completion: a creative design challenge, during CST Boot camp.

Methods
Attendees (n = 44) at a single Statutory Education Body’s CST Boot camp were stratified into teams related to specialty theme, and set a design challenge as described by Peter Skillman, to build the tallest free-standing tower out of spaghetti (20 pieces), tape (1 m), and string (1 m), with a marshmallow on top in 18 minutes. Primary outcome measure was tower height.

Results
Five teams (50%) completed the task with the tallest tower measuring 70cm (median 51, range 0-70). Median satisfaction with the simulation exercise was 4 (2-5) on a scale of zero to five, with five corresponding with highest satisfaction. Successful task completion was associated with team surgical specialty (p = 0.032), ethnicity ratio (p = 0.010,), and gender ratio (p = 0.003), respectively. On multivariable analysis, only team gender ratio was independently associated with tower height (HR 0.515, 95% CI 0.350 - 0.759, p = 0.001).

Conclusion
Modern leadership theory emphasises the important dynamic relationship between individual team members, the team, and task completion. General surgery themed teams with a gender mix were most successful in completing the design challenge; whether relative simulation performance predicts strategic organisational skill and career progression will be the next question.
SP3.1.1Research Priorities in Emergency General Surgery
Authors: Vaughan Elizabeth , Pearson Robert , Wohlgemut Jared , Knight Stephen , Wilson Michael 
Published: October 2021

Abstract

Aims
Delphi methodology can be used to achieve consensus opinion amongst experts in a particular field. This study used a modified Delphi approach to identify research priorities in emergency general surgery (EGS). The aim was to establish a research agenda using a formal consensus-based approach in an effort to identify questions relevant to EGS that have been prioritised by relevant stakeholders with an equal voice.

Methods
Three rounds were conducted using an electronic questionnaire and involved health care professionals, research personnel, patients and their relatives. In the first round stakeholders were invited to submit clinical research questions that they felt were priorities for future research. In rounds two and three, participants were asked to score individual questions in order of priority using a 5-point Linkert scale. Between rounds an expert panel were asked to analyse results before forwarding questions to subsequent rounds.

Results
Ninety-two EGS research questions were proposed in Phase 1. Following the first round of prioritisation, 47 questions progressed to the final phase. A final list of 17 research questions were identified from the final round of prioritisation. These included questions on peri-operative strategies, EGS outcomes in elderly and frail patients as well as non-technical and technical influences on EGS outcomes.

Conclusion
Our study provides a consensus delivered framework that should determine the research agenda for future EGS projects. It may also assist setting priorities for research funding and multi-centre collaborative strategies within the surgical subspecialty of EGS.
SP3.1.2 The influence of frailty on outcomes for older adults admitted to hospital with benign biliary and pancreatic disease
Authors: Thomas Michael , Baltatzis Minas , Price Angeline , Pearce Lyndsay , Fox Jenny , Vilches-Moraga Arturo 
Published: October 2021

Abstract

Aims
To study the prevalence and complications of biliary disease with increasing age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay.

Methods
Prospective observational cohort study of patients aged 75 years and over admitted with acute biliary disease between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission.

Results
200 patients with a median age of 82 (75-99), 60% females, 154 (77%) were independent for personal and 99 (49.5%) for instrumental activities of daily living. Acute cholecystitis was the most common diagnosis (43%), acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1-4) and 101 were frail (F= CFS ≥5).
104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%).
Frailty was associated with worse clinical outcomes. F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%).

Conclusions
: Higher frailty scoring is associated with increased mortality in acute biliary disease. Individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.
SP3.1.6 Operative difficulty grading scale for laparoscopic appendicectomy: A novel tool
Authors: Smigielski Michelle , Mackenzie Scott , Dent Owen , Giles Anna 
Published: October 2021

Abstract

Aims
Acute appendicitis is a common emergency surgical presentation accounting for approximately 30,000 emergency operations annually in Australia. There is need for a clinical grading tool that can quickly and reliably assess the severity of appendicitis at the time of surgery and predict the difficulty of the operation.

Methods
Over 12 months, 111 questionnaires relating to the difficulty of laparoscopic appendicectomy operation, anatomical and pathological features, time taken, and need for senior assistance were completed by surgeons and trainees of varying seniority. Construction of a scale of the difficulty of operation was by the method of summated ratings. The final scale was generated utilising further item analysis, principal components analysis, internal consistency reliability analysis and concurrent validity analysis.

Results
A scale of 8 anatomical and pathological features that predict the difficulty of laparoscopic appendicectomy was formed. These include the presence of acute adhesions, gross pathology of the appendix, quality of the appendix, mesoappendix, appendix base and retroperitoneum, visibility of the appendix artery, and adherence of the appendix to adjacent structures. The scale has high internal consistency reliability, and both individual items and the scale has been validated by comparison with the surgeons’ perceived difficulty, the length of the operation and the need to call for senior assistance.

Conclusions
This appendicectomy grading scale based entirely on readily identifiable laparoscopic findings is able to predict the difficulty of the operation and can be used to facilitate operative planning as well as to improve criteria for assessing operative competency in trainee surgeons.
SP3.1.7 Performance of ultrasound in the diagnosis of cholecystitis and prediction of the “difficult cholecystectomy”
Authors: Room Hywel , Wood Anna , Ji Chen Chen , Dowell Hannah , Toh Simon 
Published: October 2021

Abstract

Aims
Ultrasound has long been the radiological investigation of choice for right upper quadrant pain for the detection of gallstones and cholecystitis. However, previously reported sensitivity, specificity and other diagnostic metrics have varied widely and the underlying patient numbers have been small. We present robust and exhaustive diagnostic metrics based on a large series of 793 patients.

Methods
All laparoscopic cholecystectomies at our university hospital were prospectively logged between 2017 and 2020. The ultrasound findings, Nassar operative difficulty and histopathological findings were all collected in addition to patient biometrics.

Results
In our large patient series, sensitivity of ultrasound for cholecystitis was lower than previously reported at 75.7% for acute cholecystitis, 34.6% for chronic cholecystitis and 42.7% overall. Moreover, we show that sensitivity degrades with the time between ultrasound and cholecystectomy, falling below 50% at 140 days. Finally, we show that ultrasound strongly predicts Nassar difficulty grade of cholecystectomy and that its ability to do so is greatest where the interval between ultrasound and cholecystectomy is less than 27 days.

Conclusions
We present robust diagnostic metrics for ultrasound in the diagnosis of cholecystitis. These should caution the clinician that ultrasound may miss a quarter of cases of acute cholecystitis and over half of all cases of cholecystitis. Conversely, the finding of a thickened gallbladder on ultrasound can predict a “difficult cholecystectomy” and highlight the need for appropriate expertise and resources. Both this prediction and the diagnostic sensitivity are best if the ultrasound is done less than 27 days before cholecystectomy.
SP3.1.8 What happens to patients with acutely symptomatic hernia in the UK? Findings from the MASH study
Authors: Proctor Victoria , Group MASH Steering , Collaborators MASH 
Published: October 2021

Abstract

Aims
Acutely symptomatic abdominal wall and groin hernias (ASH) are a common reason for acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high risk patients.

Methods
A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on investigations, specific surgical intervention, in-hospital morbidity and mortality, and quality of life was measured. 30 and 90-day follow-up phone calls collected complications and quality of life. Descriptive analyses were performed to describe population and outcomes.

Results
Twenty-three acute Trusts recruited 264 patients. Inguinal (37.9%) and umbilical (37.1%) were the most common hernia locations. 17% were awaiting elective surgery and 17% had been previously declined intervention. CT was performed in 47%. 82% of patients had surgery within 48 hours, with 95% of procedures performed open and 93% under general anaesthesia. 3/11 laparoscopic procedures were converted to open. Mesh was used in 55%, this was typically synthetic non-absorbable (86%). Complications were infrequent; 2% developed pneumonia or delirium. Surgical site infection occurred in 3% and mortality was 1.2%. Quality of life improved between baseline and 30-days following repair.

Conclusions
There is variation in the management of ASH in the UK, particularly with repair techniques, use of mesh and laparoscopy. One in five patients was awaiting repair; this might indicate a need for expedited pathways and reprioritising of elective hernia repair.
SP3.1.10 Surgical Emergency Assessment Unit and Emergency Surgeon of the Week’ : A Paradigm shift to providing Emergency Surgical Care
Authors: Pangeni Anang , Mohamed Hesham , Imtiaz Mohammad , Shah Ankur , Fernandes Roland , Aravind Biju , Shrestha Ashish Kiran 
Published: October 2021

Abstract

Aims
Ever increasing number of A&E attendance and admissions cause immense strain on hospital beds with drainage of our finite health resources. This prompted the need for implementation and review of alternative schemes: Surgical Emergency Assessment Unit (SEAU) and ‘Emergency Surgeon of the Week’ (ESW) and its impact on our depleted health system.

Patients and Method
Retrospective analysis of a prospectively collected data from SEAU activity logs, patient information center and friends and family questionnaire following implementation of SEAU (November 2014) and ESW (November 2017) in a large DGH.SEAU operates on a five day policy (Monday – Friday, 0800-2000) aided by dedicated imaging pathway and ESW works on a 1:5 (Monday – Thursday, 0800-1800) rota with full complement of the surgical team.

Results
SEAU has attended to 16057 patients (New 9811; Follow Up 6246) from November 2014-October 2019. Emergency general surgical admission pre and post SEAU implementation was 309* and 202*/month respectively, a drop of 35% with a further reduction after introduction of ESW by another 24% to 153*/month. Thus, a total reduction of emergency admission by almost 60%. Stay in SEAU was 4* hours and re-admission rate was 6%. SEAU received 98% friends and family recommendation to others.

Conclusions
A paradigm shift in providing emergency surgical care is required in the face of a strained health care system; the positive outcome achieved after implementation of SEAU and ESW could be the answer to relieving bed capacity and financial pressures, possibly a solution to providing high quality and safe patient care.