bluuebunny/crossref_metadata_2025_split huggingface dataset:
1123 An Audit of Pick-Up Rate of Random Colonic Biopsies
Authors: Zulfiqar S , Baig H , Buksh M 
Published: October 2021

Abstract

Aim
We aimed to evaluate optimal random biopsy criteria are being followed in our institution to increase the diagnostic yield of a subsequent histopathological examination and to reduce the number of unnecessary biopsies in which histopathology is unlikely to deliver clinically useful information and causing a burden on health resources in terms of cost and manpower.

Method
Our study was a retrospective on 419 random colonoscopy biopsies performed over 6 months. Data collection included variables such as age, gender, indications, request of urgency, and histology findings. Data analysis was done descriptively.

Results
Out of 419 random biopsies, only 10.02% had positive findings. The total number of histology results with microscopic colitis was 10. The main indication of the random colonic biopsy was a change in bowel habits (328 cases) followed by significant diarrhea greater than 50 years in 20 cases. In patients with a change in bowel habits, 2.44% of histopathology specimens revealed microscopic colitis. The percentage of random colonic biopsy histology in patients greater than 50 years with significant diarrhea showed microscopic colitis was 10%.

Conclusions
Our study revealed random biopsy during colonoscopy should only be done in selected patients otherwise it has low diagnostic yields biopsy and should only be reserved for patients with risk factors for optimum utilization of health resources and to reduce the cost burden. A scoring system may be helpful to risk-stratify patients in low and high risk for MC to determine which patients qualify for RCB.
1252 A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning
Authors: Fadel M , Hamrang-Yousefi S , Mills S , Warren O , Tekkis P , Kontovounisios C 
Published: October 2021

Abstract

Aim
Colorectal multi-disciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of colorectal cancer. However, there are no gold standards set for this process. The aim of this study is to establish recommendations on the principles, organisation, structure and output of CR MDTs internationally.

Method
The available literature on the role of CR MDTs from January 1999 and March 2020 in the United Kingdom (UK), United States of America (USA) and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient selection criteria, quality assurance, output and outcomes were extracted from data from the UK, USA, and continental Europe.

Results
Fifty studies were identified that specifically met the inclusion criteria. CR MDTs should occur at least once a month with established key members. Generally, all colorectal cancer patients should be discussed and there should be a focus on education. There are noted differences in the lead member of the CR MDT, the use of information technology and storage of MDT information in databases and quality assurance internationally.

Conclusions
The most common issues facing MDTs internationally include a lack of staffing and resources as well as limited information on the patient’s fitness and preference for surgery. These factors are important and urgent improvements are required in these areas in CR MDTs. Quality assurance should be a mandatory component of every CR MDT.
1288 Colorectal Cancer Surgery Service Provision During The COVID-19 Pandemic: An Assessment of a Single Trust
Authors: Hanna J , Khoory C , Manu N , Clifford R , Fowler H , Fok M , Vimalachandran D 
Published: October 2021

Abstract

Aim
Post-operative pulmonary complications in perioperative SARS-CoV-2 infection are associated with significant morbidity and mortality. To maintain a safe cancer service, the Countess of Chester Hospital adopted “Cold-site” operating and maintained ERAS principles for patients undergoing elective colorectal cancer surgery during the pandemic. A comparative assessment of service was undertaken for benchmarking purposes.

Method
A comparative retrospective audit was undertaken of consecutive patients undergoing elective colorectal cancer surgery from June to November 2019 and compared to June to November 2020. The Somerset Cancer Registry and electronic medical case records were used to obtain the dataset. Outcomes measured were approach to surgery; stoma rate; length of stay; level of care required; post-operative complications (&gt;Clavien-Dindo 2) and survival at 30 days. Mann-Whitney U test and Chi-squared were used for analysis.

Results
There were 33 and 24 elective colorectal cancer operations in 2019 and 2020 respectively. There was no difference in the median age (64:69; p = 0.3) or ASA grade (p = 0.9). The median length of stay was 5 and 4 days respectively (p = 0.3). There was a 32.2% reduction in laparoscopic approach to surgery in 2020 (69.7% vs 37.5%; p = 0.02). There was no difference in the stoma rate (p = 0.9), post-operative complication rate (p = 0.7), ITU admission rate (p = 0.3), length of ITU stay (p = 0.6) and 30-day mortality rates (p = 0.4).

Conclusions
“Cold-site” operating allows robust ERAS care to be adopted to ensure comparative outcomes for patients undergoing colorectal cancer surgery and was associated with a non-significant trend to shorter hospital stay during the COVID-19 pandemic.
308 The Effect Of COVID-19 On Hand Trauma Management: A Single-Centre Correlation Study, Inter-Rater Agreement and Functional Outcomes
Authors: Rojoa D , Raheman F , Irvine E , Sharma V , Macdonald C , Cutler L 
Published: October 2021

Abstract

Introduction
Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a ‘one-stop’ clinic on initial presentation. Our aim was to evaluate the effect of COVID-19 on hand trauma management using inter-rater agreement between hand surgeons.

Method
Patients with hand fractures were consecutively assessed from March to May 2020, with atleast 6-month follow-up outcomes. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and clinical history to provide their opinion on optimal treatment. Weighted-kappa analysis was performed for concordance and inter-rater agreement between the two surgeons and actual management.

Results
268 patients were identified, 82 had fractures involving tubular bones of the hand. 62 were male and 20, female. Mean age was 40.3 (SD 19.7). Mechanism of injury was secondary to home-related injuries (34%) and falls (28%). Fractures involving the metacarpals (n = 24) and distal phalanx (n = 20) were most commonly seen. 35 patients underwent surgery whereas 47 were managed conservatively. Overall agreement between actual management and both consultant-1 and consultant-2 was moderate (κ = 0.55, p &lt; 0.0001 and κ = 0.63, p &lt; 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and both consultant-1 and consultant-2 (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p &lt; 0.0001) whilst functional outcomes were comparable as reported by patients.

Conclusions
Our study has shown that overall management of hand fractures remained optimized throughout the pandemic. However, lack of concordance was observed in the management of metacarpals through substantial inter-rater agreement but overall poor agreement.
320 The Initial Impact Of COVID-19 On Paediatric Spinal Services Across Scotland
Authors: Newman M , Garrido E , Tsirikos A 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has meant a significant decline in the activities of the paediatric spinal services in Scotland.

Method
All referrals to the Scottish paediatrics spinal service from 1st January 2020 to 30th June 2020 were analysed. Comparison was made to the same period in 2019. All orthotist initial consultations and all paediatrics spinal theatre activity in Scotland from 1st March 2020 to 30th June 2020 was analysed and compared to the previous year.

Results
There was a 64.3% decline in referrals during the first wave of the pandemic in Scotland to the paediatric spinal service. The mean wait time to be seen in 1st clinic for a new referral was 6.56 weeks in 2020 compared to 10.94 in 2019. There were however 60 patients still waiting to be seen. The number of paediatric spinal operations declined by 34% during March to June 2020 when compared to the same months in 2019 There was a reduction of 50% of new paediatric patients seen by orthotists from March – June 2020 when compared to 2019

Conclusions
COVID-19 has had a significant effect on paediatric spinal services in Scotland. This is likely due to a combination of service delivery factors and patient factors. This is likely to result in delays to children getting the care they require for their spinal condition. There will also be a back-log of patients requiring to be seen when services start to re-establish themselves. There are several options available to department to optimise efficiency, such as video consultants and streamlining referral systems.
331 COVID-19 Mortality After Vascular Procedures During the Initial UK Surge: Moving Forward with Elective Vascular Work
Authors: Liu P , Cheema S , Adeoye I , Theivacumar S , Hussain T , Malina M 
Published: October 2021

Abstract

Aim
Following the initial COVID-19 surge in the United Kingdom, there was a national incentive for elective vascular surgery to be restricted to clean sites in order to reduce perioperative cross infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak.

Method
43 consecutive patients who had vascular (n = 48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures from our integrated interventional radiology department. Median follow-up was 41 days (IQR 8- 58 days).

Results
Three patients (7%) in the vascular group (median age 61 years, all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison, two patients (2%) in the interventional radiology group died from COVID-19, however one was positive prior to their procedure.

Conclusions
Only urgent vascular cases should be performed during a COVID-19 surge, with elective work delayed or continued at clean sites. However, with growing waiting lists for elective surgery currently, further restrictions may not be a viable long-term solution. Resumption of care at hot sites should be considered, if resources allow for it and if safety measures can be implemented. The advantages of minimally invasive surgery may inherently reduce risk as well.
380 To Change or Not to Change? Has COVID-19 Altered Our Adherence to BOAST Guidelines on Management of Ankle Fractures?
Authors: Yeoh T , Dhillon G , Johal K 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic impacted the orthopaedic surgical ethos drastically. There was a lower threshold to manage fractures conservatively, in an attempt to curtail COVID-19 transmission rates amongst inpatients. This retrospective study evaluated our Orthopaedic department’s adherence to BOAST guidelines on ankle fractures, during COVID-19 and pre-COVID-19.

Method
Data on patient’s who presented with ankle fractures during the initial national lockdown in 2020 were compared against similar ankle fracture patterns one-year prior (pre-COVID) over a similar time frame. Patient clerking notes, operative notes, radiographical images and clinic letters were retrieved and compared against BOAST guidelines on ankle fractures. Management plans and time to surgery was extrapolated from these resources.

Result
Ankle fracture incidence rates increased by 79.8% during the COVID pandemic when compared with data from 2019. 28% of ankle fractures in 2020 were managed operatively when compared with 80% in 2019. Average time to surgery during the pandemic improved by 1.64. Adequate documentation for neurovascular status, as per BOAST guidelines, was 30.5% in 2019 and 27% in 2020. Pre- and post-reduction views were available in 87% of cases in 2019 and 83% in 2020.

Conclusions
As a third national lockdown is upon us, evaluation of BOAST guidelines on ankle fractures would be worth revising. Teaching and posters were distributed throughout the department as a strategy to improve adherence to BOAST guidelines on ankle fractures. Furthermore, regular follow up clinics at specific times and post-management follow up clinics would be worth analysing to identify changes in patient satisfaction and clinical outcome.
406 Audit of Current COVID-19 Consent Process
Authors: Goldmann N , Brown C 
Published: October 2021

Abstract

Aim
Contracting COVID-19 increases the risk of serious peri-operative morbidity and mortality. The current best practice for informed consent is to make patients aware of the risk of contracting COVID-19. We aimed to determine if our local orthopaedic unit was meeting this standard of practice.

Method
We performed a single centre, retrospective, closed loop audit. Data was collected using Bluespeir© and Clinical Portal© software. We first audited all emergency and elective consent forms (n = 51) between September-October 2020; mean age 58 years old (range 17-87). Results were circulated to all orthopaedic departmental staff in poster format and given 2 weeks of educational awareness before re-audit of all consent forms (n = 59) in November 2020; mean age 54 years old (range 17-80). Any patient with an Adults With Incapacity (AWI) form in place was excluded.

Results
Initially, COVID-19 was included as a risk in 21/51 (41.2%) of all consent forms; elective procedures 10/24 (41.7%) and emergency procedures 11/27 (40.7%). On re-audit this increased to 32/59 (54.2%) of all consent forms; elective procedures 23/47 (48.9%) and emergency procedures 9/12 (75%). During the audit period, 1 patient tested positive for COVID-19 pre-operatively and 1 patient post-operatively.

Conclusions
This audit improved local adherence to COVID-19 consent guidelines. There remains significant room for improvement, especially in elective practice. Further research is required to determine the true impact of COVID-19 on morbidity and mortality.
426 An Evaluation of The Service of Endoscopic Trans-Sphenoidal Surgery for Excision of Pituitary Lesion During The SARS-Cov-19 Pandemic
Authors: Cernei C , Sinha S 
Published: October 2021

Abstract

Introduction
Since the start of SARS-CoV-2 pandemic many branches of medicine and surgery have undergone changes shifting the focus to prepare for an increase of COVID-19 related admissions. Halting all pituitary surgery services was not feasible particularly if patients present with acute or progressive visual loss due to the mass effect of the pituitary lesion, pituitary apoplexy, or lesions with aggressive features.

Method
An 11-point telephone questionnaire was used to evaluate the service provided between March and September 2020. On a 1-10 scale, patients scored their feelings about remote clinics, the support offered, the clarity of explanations, quality of interaction with their surgeon, and an overall assessment of remote clinics.

Results
20 of the 21 patients who underwent transsphenoidal pituitary lesion resection between the 02/03/2020 and 14/09/2020 participated in the survey. They unanimously felt the introduction of remote consultations was necessary and felt safer. Their surgeon’s communication skills helped their experience the most. It allowed for easier attendances as they did not rely on family or long travelling times. Drawbacks involved the lack of face-to-face interaction particularly pre-operatively, as patients felt they missed the human factor, seeing their scans, and meeting their surgeon in person.

Conclusions
The pandemic has affected people from a biopsychosocial perspective leaving long-lasting effects on the economy and healthcare systems of the world. This service evaluation highlights a positive outcome in terms of patient experience. Moving forward, incorporating remote services as an option for follow-up cases would be welcomed by most patients in the survey.
441 Management of Intracapsular Hip Fractures During Unprecedented COVID Times In A DGH
Authors: Zafar A , Galloway E 
Published: October 2021

Abstract

Aim
NICE published eligibility criteria for Total Hip Replacement (THR) vs Hemiarthroplasty for intracapsular hip fractures. COVID-19 resulted in the BOA publishing emergency guidelines regarding management of patients eligible for THR. If the available surgeon does not routinely perform hip arthroplasty, the patient should undergo a hemiarthroplasty to maximise theatre efficiency and minimise hospital stay. This project will compare Kings Mill Hospitals compliance with these new guidelines.

Method
Retrospective data was collected over a two-month period (24/03/20 – 22/05/20) from patients with intracapsular hip fractures. Notes and records allowed us to determine suitability for THR using NICE guidelines. National statistics were taken from the National Hip Fracture Database. The standards for this project consist of the NICE guidelines for Hip Fracture management and the BOA standards for Trauma and Orthopaedics - Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’.

Results
51 patients were included in this audit. THR compliance dropped during the peak months of COVID 35% to 21.4%. Length of acute admissions stay decreased from 10 days to 8 days. Compared to the national averages, Kings Mills THR compliance rate was 27.3% vs 18.3%. 54.5% of eligible patients were operated on by THR performing consultants but received Hemiarthroplasty's

Conclusions
Some patients were eligible for THR according to the BOA guidelines (1) however received Hemiarthroplasty’s. Better identification may increase guideline compliance. Introduction of a new table in the clerking booklet will be implemented and Re-audited to evaluate effectiveness.
491 Comparison of Pandemic and Pre-pandemic Practices of Managing Acute Appendicitis
Authors: Salih L , Sabaratnam R , Kim H K , Bevan K 
Published: October 2021

Abstract

Aim
Acute appendicitis (AA) is a common indication for abdominal surgery, with more than 30,000 appendicectomies performed in England per year. However, SARS-CoV-2 (COVID-19) changed usual surgical practices following advice to minimise laparoscopic surgery, and instead favouring conservative management, or open surgery for AA.

Method
In this study, we compared the management of 50 patients with suspected/confirmed AA during the first wave of the COVID-19 pandemic at a district general hospital (DGH) with our usual practices, against 50 patients admitted with suspected/confirmed AA during a similar time period, one year prior to the pandemic.

Results
Demographics of patients in both groups were comparable with median age of 34 in the pandemic vs 32.5 in the pre-pandemic group. 74% of patients in the pandemic group (PG) underwent imaging to confirm appendicitis, compared to 58% of patients in the pre-pandemic group (PPG). 64% of PG patients were treated conservatively, compared to 8% in PPG patients. Outcomes demonstrated re-attendance events of 12% in the PG, as compared to 10% in the PPG, although the follow up period was longer in the PPG. Despite a significantly smaller number of patients managed surgically during the pandemic, 27% of patients undergoing appendicectomies had post-operative complications in the PG, as compared to 7% in the PPG.

Conclusions
During the pandemic, more patients at our DGH with AA were treated conservatively, more patients had re-attendance events and post-operative complications when compared to patients in the pre-pandemic group.
520 Can Low Lymphocyte Count Be Used to Predict the Presence Of COVID-19 In Emergency Surgical Patients?
Authors: Munro C , Strong C , Mount A 
Published: October 2021

Abstract

Introduction
With regards to COVID-19, low lymphocyte count (LC) [1] [2] [3] is a recognised feature and can be linked to disease severity [1][4]. This project aims to establish if lymphopenia is predictive of COVID-19 in the acute surgical patient.

Method
All emergency general surgical admissions to the Northumbria NHS Trust 15/4/20 -31/5/20 (n = 152) and 15/4/19 - 31/5/19 (n = 92) were reviewed. Exclusions included ‘Elective’ admissions and non-abdominal complaints.
Statistical analysis was performed using the STATA package. Low LC was compared with COVID-19 status; established through imaging, swab results, or clinical suspicion.

Results
Within the 2020 cohort 76.3% of patients (n = 116) had swabs within a week of admission. 8 patients within that cohort were deemed to have COVID-19, only one had a positive swab. Low LC as a predictor for COVID-19 had a sensitivity of 75%, specificity of 36.2%, PPV of 6.38% and NPV of 96.2%. Mann Whitney statistical analysis was used to identify a relationship between low LC and COVID-19 status, showing no significance (p = 0.91).

Conclusions
Low LC is not a predictor of whether surgical patients have COVID-19, and therefore should not be used for screening. There was no increase the number of patients presenting with lymphopenia in the acute surgical take in the ‘COVID Era’ compared with 2019.
539 Post-Covid-19 Smell Clinic - Management of Patients With ‘Long Covid’
Authors: Gopikrishna D , Rocke J , Chu M , Kumar N 
Published: October 2021

Abstract

Introduction
Olfactory dysfunction following COVID-19 infection is a prevalent issue in the post-viral phase of illness. Around 50% of patient’s self-report loss of sense of smell with COVID-19. Approximately 10% of these patients report no recovery in sense of smell at 4-6 weeks after onset. Patients with olfactory dysfunction often describe life as living in 2D, with lasting effects on eating habits and relationships. The aim of this project was to establish a novel ‘Post-Covid-19 smell clinic’ for patients, which monitored any changes relating to olfactory dysfunction and to provide advice on management of the condition for these patients with “Long-Covid”.

Method
The ‘smell clinic’ was set up based on BRS guidelines. Patients were asked to carry out the ‘UPSIT’ smell test and eODQ questionnaire. Patients were then advised to carry out ‘smell retraining’ for 4 months and pointed to appropriate resources. We analysed patients’ presentations to identify patterns that may identify patients who are likely to suffer long term olfactory dysfunction following Covid-19 infection. Parameters including prevalence of parosmia, cacosmia, dysgeusia, demographics were collected.

Results
Initial data, from 20 patients, showed 40% experienced parosmia and 40% had associated rhinological symptoms such as rhinorrhoea. The range UPSIT score: 22-34, eODQ score: 42-151.

Conclusions
Our initial analysis of the clinic identified symptoms range from anosmia, parosmia and loss of flavour. Parosmia patients experienced this in relation to smells such as excrement and coffee. Future implications involve analysing the possible benefits of ‘smell retraining’ after repeating UPSIT and the eODQ score