bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.380Compliance with delirium guidelines in older surgical patients and susceptibility to improvement
Authors: Toe Ko Ko Zayar , Pressler Marc , Lees Nick , Vardy Emma , Price Angeline 
Published: October 2021

Abstract

Aim
Delirium in older hospitalised adults is both common and serious, particularly following surgery. It is associated with increased mortality, prolonged admission and greater care needs. All patients ≥ 65 years should have a delirium assessment within 24 hours of admission, and again post-operatively. Where delirium is identified, a thorough assessment of reversible causes should be undertaken using validated tools. Despite clear guidelines, delirium remains under-recognised and inconsistently managed. A study was undertaken to determine compliance with delirium assessment and management guidelines for older surgical patients in one acute hospital, and their susceptibility to improvement.

Methods
A QI project was undertaken using the PDSA cycle. 50 patient records were reviewed retrospectively. Multidisciplinary educational sessions were delivered. A further 50 patient records were audited after 1 month. Primary outcome: delirium assessment (4AT) within 24 hours of admission. Secondary outcome: TIME bundle completed where delirium identified.

Results

Conclusion
Delirium assessment and identification is improved through the use of a standard tool (4AT) and targeted educational sessions. As a common post-operative complication, delirium assessment is an important aspect of routine post-operative care. Further work is needed to improve compliance with use of the TIME bundle when delirium is present.
EP.TU.411Thinking Ahead: Improving Documentation of Treatment Escalation Plans for Surgical Patients
Authors: Tregidgo Laura , Sutton Grace , Mukhtar Hasan , Cave Charlie 
Published: October 2021

Abstract

Aims
The GMC recommends early decision making on CPR status for all acutely unwell patients admitted to hospital. An audit was undertaken of documentation of treatment escalation plans (TEPs) for general surgical patients at a District General Hospital.

Method
A retrospective study looking at documentation of TEPs in patients (n = 55) admitted under the care of the general surgical team over a one month period. Documentation from the surgical admission clerking and the first consultant ward round were reviewed for evidence of a TEP.

Results
Of 55 patients admitted only 24% had a TEP documented within 48 hours of admission under the general surgeons. Of those that had a TEP recorded (n = 13), twelve were in the admission surgical clerking and one was completed on the post-take consultant ward round.

Conclusions
This project highlighted the lack of TEP documentation for surgical patients within 48 hours of admission to hospital. Our recommendation is to develop a specific ‘post-take ward round’ proforma with mandatory TEP, to be filled out within 24 hours of patient admission. This updated process will then be reassessed for improved compliance with TEP documentation. We anticipate this will improve early decision making regarding escalation status and facilitate TEP discussions with patients. Overall this process should help ensure a more patient-centered approach to care planning.
EP.TU.426Evaluating the Efficacy of Online Teaching for Neuroscience, Neurology & Neurosurgery
Authors: Ali Yousif , Sheppard Jack , Parvez Ameerah , Vasilica Anca Mihaela , Kurpyte Gabriele 
Published: October 2021

Abstract

Aims
The current climate brought forth by the COVID-19 pandemic has caused considerable changes in academic teaching at the undergraduate and postgraduate level. Online teaching and webinars over video conferencing platforms have become the new standard for delivery of material. Here we evaluate the efficacy of online webinars in the area of Neuroscience, Neurology and Neurosurgery.

Methods
We delivered 10 online webinars across 10 weeks, with one or two speakers, covering a range of topics across the fields of Neuroscience, Neurology and Neurosurgery. Feedback was gathered anonymously using an online feedback form following the event. Results were statistically analysed and significance reported using the Wilcoxon signed-rank test.

Results
Our results show a statistically significant increase in the attendees’ self-reported knowledge on the subject, before and after the webinar (P &lt; 0.0001, n = 117); this represents a 57.3% increase in self-reported knowledge. Our feedback indicated that of all attendees across the 10 webinars, 82.9% rated the event overall “Very Good”, 79.5% were “Very Satisfied” with the organisation of the event, 84.6% with the speaker(s), 76.9% with the content of the event and 82.9% with the format of the webinar.

Conclusions
In summary, our analysis shows that delivering Neurological and Neurosurgical teaching via an online platform is a viable and effective method of delivering knowledge. This finding has significant implications not only in the current response to the COVID-19 pandemic, but also in the future provision of medical education at the undergraduate and postgraduate level.
EP.TU.465Role of CT scan as initial investigation in colorectal rapid access patients
Authors: Athisayaraj T , Bavikatte A , Olugbemi J , Sebastian B , Mishra A 
Published: October 2021

Abstract

Background
We looked into CT colonoscopies and CT abdomen and pelvis which were booked as initial investigation in patients referred via the colorectal rapid access pathway. These tests were directly booked following the referral after a nurse led triage.
As per our colorectal straight to test protocol (STT) any patients over the age of 75 or unfit individuals will have a CT colonoscopy (virtual colonoscopy) instead of colonoscopy. CT trunk was used during COVID pandemic as the initial investigation when the aerosol generating procedures were stopped. CT trunks are also the initial investigation as per the STT protocol when patients are referred with suspected abdominal mass, weight loss or abdominal pain.

Methods
Retrospective analysis of prospective electronic data base of colorectal STT referrals from Feb 2020 to end of October 2020.

Results

Conclusion
CT colonoscopies and CT trunks form part of initial diagnostic tool in the colorectal rapid access patients. They are particularly useful in high risk patients who cannot tolerate colonoscopy. These investigations complement the lower GI endoscopy. These scans also identify non-colorectal malignancies and retroperitoneal pathology such as AAA.CT trunks were useful tools during COVID 19 Pandemic.
EP.TU.481Quality of Surgical Ward Rounds in a District General Hospital: an audit
Authors: Davis Heather , Achunine Portia , Jesuthasan Julia , Chowdhury Ashim , Harinath Gandrasupalli 
Published: October 2021

Abstract

Aims
The fast-paced surgical ward round, alongside numerous competing distractions and demands, can result in poor rounds and subsequent imperfect documentation. This carries significant medico-legal implications. This audit assessed the standard of surgical ward round documentation at a district general hospital, against Royal College and other published guidelines.

Methods
A retrospective data collection of adult general surgical patients was undertaken over a period of eight weeks. We excluded bank holiday, weekends and paediatric cases. Documentation during ward rounds in patient notes were analysed and compared against the guidelines.

Results
166 patient notes were included. Percentage compliance was assessed as a total, minus cases where not applicable.
Good compliance ( &gt; = 75%) was achieved in the majority of data points, including: date (100%), time (83%), ward round lead (99%), legibility (88%), early warning score (78%), current issues (80%) and management (100%).
Poor compliance ( &lt; = 25%) was seen in: presenting complaint (25%), fluid balance (16%), intravenous fluid review (21%), catheter review (23%), radiology results (25%), urinalysis (4%), beta HcG (0%), drug chart review (23%), antibiotic review (15%), assessment of venous thrombo-embolic risk (0%) and ceiling of care (1%).

Conclusion
Accurate, clear and complete documentation is crucial for patient safety and continuity of care, as well as for medico-legal reasons. This study shows there are several areas requiring improvement. The authors propose a proforma including the essential criteria to be integrated into the daily ward rounds.
EP.TU.521Does a foundation interim year one post improve confidence in general surgery in a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Ardley Rohan 
Published: October 2021

Abstract

Aims
1. Understand the confidence levels of current foundation year one (FY1) doctors.
2. Understand whether an interim foundation year one (FiY1) post improves confidence.

Methods
FY1s were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using google docs and analysed in Microsoft Excel.

Results
32.1% (9/28) of FY1s completed the survey.
33.3% (3/9) did not undertake a FiY1 post where 66.7% (7/9) did.
Confidence levels were mostly the same between FY1s who had a FiY1 post and those that did not for dealing with patients with hepatobiliary disease, non-specific abdominal pain, appendicitis, speaking to a family when a patient is dying prescribing fluids for maintenance as well as resuscitation.
Confidence levels were higher for FY1s who did not have a FiY1 post compared to those that did in managing the deteriorating patient.
Confidence levels were lower for FY1s who did not have a FiY1 post compared to those that did in speaking to a patient when their diagnosis is unknown.

Conclusions
FY1s who have had a FiY1 post in a district general hospital have more confidence in most areas but not all. This data shows the value of the FiY1 post however work needs to be done to improve the experience to the role.
EP.TU.542Enterolith ileus secondary to small bowel diverticulum: a rare cause of small bowel obstruction
Authors: Dey Abhishek , Elmasry Mohamed , Marshall Robert 
Published: October 2021

Abstract
Small intestinal diverticula are rare and possibly acquired secondary to bowel dyskinesia, abnormal peristalsis or high intraluminal pressures. Enterolith formation within these diverticula and intra-luminal bowel obstruction from them are a less encountered complication.
A seventy-five year old man, with no history of abdominal surgery, presented with 10 days of colicky right iliac fossa pain and recurrent episodes of bilious vomiting. He initially reported diarrhoea but complained of eventual absolute constipation for last 5 days. Physical examination revealed distended abdomen with right-sided tenderness and no mass or faeces were noted on rectal examination. Biochemistry indicated raised inflammatory markers and an acute kidney injury. Abdominal CT scan revealed a 3.5 cm calculus in the distal ileum causing obstruction initially flagged as gallstone ileus. No gallstones or pneumobilia were identified although some intrahepatic duct dilatation was noted. An emergency laparotomy was conducted, where the radiological findings were reinforced and the calculus was extracted via enterotomy. There were no abnormal communications between gallbladder and intestinal tract suggestive of passage of gallstone to ileum. The small bowel traced from duodenojejunal flexure to terminal ileum did not reveal any further calculi or diverticula. FTIR spectrum analysis of the extracted specimen indicated similarities to enterolith. Retrospective analysis of radiological images revealed a possible duodenal diverticulum.
The case highlights the diagnostic conundrum and therapeutic challenges of small bowel diverticular enterolith.
EP.TU.651Training Opportunity In A Non Covid Private Hospital During The Initals Phase Of Sars-Cov-2 Pandemic-Our Experience
Authors: Bhandari Mayank , Virupaksha Suvi , Gopalakrishnan Palanivel raju , Rao Milind , Bussa Gopinath , Ahmed Ish 
Published: October 2021

Abstract

Aim
We would like to share our experience in the unique opportunity our surgical trainees had, while operating in a NON COVID private hospital.

Methods
We did a retrospective data collection from 1st of April till 31st May 2020. The data was collected about the patients who underwent elective surgery in a non COVID private hospital selected by our NHS trust. The selected patients were asked to self-isolate for 2 weeks prior to surgery date. They also underwent 2 swab tests, the first one a week before and another one 48 hours before the surgery date along with a chest X-ray. Only the patients who tested negative on swabs were operated in the private setup.

Results
There were 17 elective laparoscopic cholecystectomies and 42 breast surgeries performed. The primary operating surgeon were trainees in around 80 percent cases. Ours was the first NHS trust to start this in the North East England. There was no increase in operating time, but the turnover time was nearly doubled because the guidelines for safe anesthesia and surgery during this pandemic were strictly followed. We did not have any complications or readmission related to surgery in this cohort of patients. There was no reported SARS-CoV-2 infection to patients and the involved medical staff.

Conclusion
The opportunity for continuity of surgical training in a private setup is a possibility and should be explored more in future.
EP.TU.657Scoping the role and content of a simulator-based endosim curriculum
Authors: Eley Catherine , Hawkes Neil , Lewis Wyn 
Published: October 2021

Abstract

Background
Endoscopy training requires simultaneous acquisition of practical skill and knowledge. Virtual reality Simulators, such as EndoSim (SurgicalScience), offer the opportunity to deconstruct a skill into fundamental components (1), to allow repetitive practice, and achievement of task-specific objectives. Trainees with the least endoscopy experience benefit most from early simulated training (2,3), supporting the introduction of a simulation curriculum into SPRINT: Structured PRogramme for INduction and Training, an existing initiative to improve endoscopy training delivery in Wales. (4) The aim of this study was to design a pilot simulator curriculum for the EndoSim (Surgical Science, Gothemberg) simulator.

Methods
A focus group completed all EndoSim modules. Each EndoSim exercise was cross-examined against the relevant DOPS tool “Direct Observation of Procedural Skill” used by the Joint Advisory Group for Endoscopy Training and Certification. Exercises were chosen that represented each DOPS domain to teach basic skills in endoscopy scope handling.

Results
12 exercises were chosen. These exercises addressed the insertion and withdrawal, and visualisation components of the JAG DOPS tool. Pre-procedural skills, management of findings, post-procedural skills and endoscopic non-technical Skills (ENTS) are beyond the scope of this simulator and require additional taught sessions to provide the context for current simulation training.

Discussion
This is the first step in developing and refining appropriate exercises to inform the proposed curriculum. The next step will be validating the chosen exercises against expert benchmark performance.
EP.TU.947Rectosigmoid Cancer Resection in a District General Hospital – A single centre experience
Authors: Lim Jieqi , Khan Sharib Ziya , Sasapu Kishore 
Published: October 2021

Abstract

Aims
To identify common factors amongst patients who had undergone rectosigmoid cancer resections

Materials & Methods
This is a single centre retrospective study including patients who underwent recto-sigmoid cancer resections by a senior colo-rectal surgeon from year 2012 to 2018. Patients’ data were identified through a local trust database. Patients’ variables were subjected to Mann Whitney, Chi Square analysis and survival function plots.

Results
Of the 102 patients, we observed a mean age of 66 years with a slight male sex predisposition(58%) . Two-thirds were referred through the 2 week-wait GP pathway with predominant symptoms being bleeding and change in bowel habits (70 and 60% respectively).
Male sex was associated with longer length of stay (LoS), younger age at surgery, higher T-staging and tumour size. Patients who had laparoscopic surgery converted to open and those with stoma had the longest LoS.
Histological results of higher Dukes, T and N stage were associated with higher patient mortality rates. Advanced N and Dukes staging were also related to higher propensity of disease recurrence with new metastases.
In those with positive circumferential resection margin (CRM) on histology, there were higher correlation with local and distal disease recurrences as well as higher post-op mortality rate (all the above had p-values &lt;0.05).

Conclusion
The factors identified in previous large scale studies do correlate with our experience in a district general hospital and identification of sub-groups of patients at higher risk of adverse outcomes can be identified in further studies.
EP.TU.1068Developing a Major Trauma Nursing Education Framework in Manchester
Authors: Honey Carly , Smyth Victoria , Wee Lisa , Ellis David , Smith Stella , Chan Anthony 
Published: October 2021

Abstract

Aims
The opening of the Major Trauma Ward (MTW) at Manchester University Hospitals NHS Trust represents a key milestone for managing major adult trauma within the Greater Manchester conurbation. We present an overview of the development of a novel Major Trauma Nursing Education Framework incorporating both the induction and continuing professional development of trauma nurses.

Methods
The MTW nursing skillset combines elements from acute surgical specialities and rehabilitation medicine. A framework for education was constructed from the Adult Nursing Competencies for the Major Trauma Patient (National Major Trauma Nursing Group) and the Trauma Intermediate Life Support curriculum. An induction programme was developed with a Competencies Workbook for an interim period including external courses for band 5 (Nurse Trauma and Critical Care course) and senior nurses (ALS and Neonatal, Adult and Paediatric Safe Transfer and Retrieval Course). An annual training programme will renew these competencies.

Results
Feedback from the first cohort for the induction programme has been positive, particularly with the third of nurses who did not feel confident managing trauma patients prior to induction (Wilcoxin-signed rank test, p = 0.00116). Free text comments ranged from the completeness of the topics covered to the delivery methods of the curriculum and how to work effectively within the wider multidisciplinary team.

Conclusions
The development of a formal Major Trauma Nursing Education Framework is necessary for a modern trauma workforce. Feedback has so far been positive. Continual audit of the framework will be necessary to ensure and improve the quality of delivery of education.
EP.FRI.32 Emotional Resilience and Bariatric Surgical Teams: a Priorityin the Pandemic
Authors: Graham Yitka , Mahawar Kamal , Riera Manel , Omar Islam , Bhasker Aparna , Wilson Michael 
Published: October 2021

Abstract
The infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as ‘inducing or suppressing feelings in order to perform one’s work’, and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline.
EP.FRI.35 Traumatic abdominal wall hernia (TAWH) in a 16 year old boy
Authors: Ahmed Elmurtada , Shaw Simon 
Published: October 2021

Abstract

Definition
Traumatic abdominal wall hernia is defined as: herniation of viscera through disrupted musculature & fascia associated with forceful trauma without skin penetration & no evidence of prior hernia defect prior to trauma

Introduction
There are only about 30 reported cases of TAWH due to handlebar injury, it is a rare complication of blunt abdominal trauma it involves disruption of abdominal wall muscles with bowel loops herniating through the abdominal wall defect & may be accompanied by serious or lethal complications

Case report
A 16 year old boy received trauma while cycling at about: 5 miles/hour & landed in the handle-bar with his right lower abdominal wall against the handle, the patient's vital signs were stable but there was bruising in the area, the diagnosis was missed by A&E doctor, but I saw him O/E there was a positive cough impulse & the diagnosis was confirmed by US examination, his haematological & biochemical investigations were normal, patient was taken to theatre & the hernia was repaired (image 2 & 3)

Conclusion
our case highlights the importance of clinical examination in blunt abdominal trauma & high index of suspicion plus using US/CT as appropriate to rule out mesenteric or visceral injury
EP.FRI.42 REBOA associated iatrogenic AV fistula
Authors: Gambhir Raghvinder , Grainger Charlotte , Davies Monica , Harris Matthew , Sudarsam Abhilash 
Published: October 2021

Abstract

Aim
To discuss a rarely reported complication of Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a trauma patient with exsanguating haemorrhage.

Case description
A 15 year old male sustained was brought in as a cod Red, following multiple stab injuries to his Rt thigh. A REBOA was inserted via the contralateral Femoral artery on the scene to control the bleeding. Once proximal and distal control was obtained on the Right leg, the REBOA was deflated and removed. The right leg needed an interposition vein graft and ligation of femoral vein. The patient had received 12 units of transfusion.
Post-operative CT-angiogram demonstrated an AV fistula between the Left Profunda femoris artery and Common femoral vein on the side of REBOA insertion. A Duplex scan showed flows of 2600ml/min on duplex and AVF diameter of 2.6mm. It was decided to wait for spontaneously closure as patient underwent rehab. At 6 weeks the AVF flow had reduced to 460ml/min however further expectant management did not lead to spontaneous closure of the AVF and he underwent surgical tie off during his next school holidays 6 months later.

Conclusion
AV fistula formation as a complication of REBOA insertion has not been reported in paediatric population. It highlights the need for a CT angio after surgical stabilisation. These post traumatic AVFs may need surgical repair if it does not spontaneously close in 3-6 month time.