bluuebunny/crossref_metadata_2025_split huggingface dataset:
88 Prevalence Of SARS-COVID-19 Serum Igg Antibodies Amongst Staff on An Acute Surgical Unit
Authors: Isheerwood J , Winyard J , Bekhyat Karki B , Chung W Y , Layton G , Issa E , Garcea G , Dennison A 
Published: May 2021

Abstract

Background
The United Kingdom now has one of the highest death rates from COVID 19, with over 40,000 deaths (1). It has been posited that the identification of care workers with immunity or increased resistance could be important in developing future strategies.

Method
This was a retrospectively conducted survey of general surgical staff at a tertiary surgical unit.

Results
We surveyed 215 staff that had undergone antibody testing. Of the 175/215 who reported contact with COVID-19 positive patients, 6/215 had a positive PCR result and 15/215 reported a positive antibody test. Only 3/6 that had a positive PCR test demonstrated antibodies.

Conclusions
Our “immunity” rate of 7% is extremely low and is concerning especially in respect of the anticipated “herd immunity” which would mitigate many of the issues presently being confronted and it is likely to be many months at least before this makes realistic contribution. Continued testing for the presence of COVID-19 antibodies will contribute to crucial seroprevalence data that can be used by public health bodies whose advice will necessarily evolve as increasing data sets become available.
198 Orthopaedic Trauma Services During A National Lockdown and Pandemic: Workload and Outcomes from A UK Major Trauma Centre. The Need for Continuing the Provision of Services
Authors: Donovan R , Tilston T , Frostick R , Chesser T 
Published: May 2021

Abstract

Aim
To review the trauma operating workload, theatre time and outcomes at a time of national lockdown and the beginning of the COVID-19 pandemic, comparing it with 2019.

Method
A retrospective analysis at a single UK MTC. We included all patients undergoing emergency/urgent T&O surgery. Data collected included anatomical injury site, mechanism of injury, operative procedure, anaesthesia, theatre time, complications, and 30-day mortality.

Results
159 operations were performed on 142 patients in April 2019, and 110 operations on 106 patients in April 2020 (national lockdown). This led to a decrease of 30% due to reduced numbers from RTAs and sport-related injuries. Volumes of hip fractures and injuries from low-energy falls remained the same. Operative total theatre time increased by a mean of 14 minutes, and complications and mortality were not significantly changed. The incidence of COVID-19 in the patients tested was 8.5%, which matched the population incidence at the time.

Conclusion
Orthopaedic trauma services must be maintained during a national lockdown. There is no decrease in the volume of patients sustaining falls, including hip fractures. Mean operating time only increases by 14 minutes with the wearing of PPE. This should be part of future planning of any pandemics or national lockdowns.
263 Airway, Voice and Swallow Outcomes Following Endotracheal Intubation and Mechanical Ventilation For COVID-19 Pneumonitis: Preliminary Results of a Prospective Cohort Study
Authors: Miu K , Miller B , Tornari C , Slack A , Murphy P , Ahmed I , Burnay V , Karagama Y 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has placed exceptional demands on Intensive Care Units (ICU) across the world – particularly requiring patients to be intubated and mechanically ventilated. Laryngeal injury following intubation is a common occurrence, therefore this study aims to analyse airway, voice, and swallow (AVS) outcomes of patients intubated for COVID-19 pneumonitis and compares it to intubated non-COVID-19 respiratory patients and other ICU admissions.

Method
We collected data from inpatient records, and follow-up clinics on intubated adult patients discharged from a tertiary care hospital ICU between 01/03/20 and 30/04/20. Patients were assessed with the AVS Scale, Voice Handicap Index-10 (VHI-10), and Eating Assessment Tool-10 (EAT-10).

Results
86 patients were admitted with COVID-19 pneumonitis, 17 patients were admitted with non-COVID-19 respiratory failure, and 26 patients were admitted with a non-respiratory diagnosis.
The COVID-19 cohort demonstrated higher rates of AVS difficulties (airway 59% vs 44% and 31%, voice 40% vs 19% and 19%, swallow 21% vs 6% and 12%). VHI-10 and EAT-10 scores showed no significant differences between groups.

Conclusions
Patients intubated for COVID-19 pneumonitis reported higher rates of AVS difficulties against non-COVID-19 reasons for intubation. Robust prospective screening protocols are essential to improving patient outcomes by highlighting and therefore managing laryngological sequelae that occur following intubation.
266 Mini C-Arm Use in The Emergency Department for Fracture Management During The COVID-19 Pandemic: A Pilot Study in A Tertiary Paediatric Referral Centre
Authors: Rammohun A , Studnicka K , Talbot C 
Published: May 2021

Abstract

Introduction
We introduced the use of a Mini C-arm in managing distal limb fractures to minimise admissions and patient flow within the hospital.

Method
Prospective data collected between April and June 2020. Treatment details and imaging obtained from patient notes and PACS. A matching group from 2019 analysed for comparison.

Results
Mini c-arm was used for manipulation of closed fractures of forearm (9), tibia (2), distal humerus (1), and foreign body removal (1). 11 procedures performed in ED with intranasal diamorphine and Entonox (5), intravenous Ketamine (5), or local anaesthetic (1), two in fracture clinic under Entonox. Fracture position was on average 7° from the anatomical. 1 Distal humerus required surgical correction. 1 admission after sedation. In the control group, 8 patients underwent manipulation under GA (4 ORIFs) and 2 procedures were done under sedation in ED. All patients were admitted. The quality of reduction varied on average 4º from anatomical. No patients required repeated procedures and all were followed up in a face to the face fracture clinic.

Conclusions
Reduced admission rate, need for GA and flow to RD without an obvious reduction in the quality of manipulation resulted from both mini c-arm use and good cooperation with ED facilitating the sedation.
341 The Diagnosis and Management of Appendicitis During the COVID-19 Pandemic: The Pennine Acute Trust Experience
Authors: Idama D , Aldersley G , Connolly M , O'Connor A 
Published: May 2021

Abstract

Introduction
Appendicitis management has evolved recently with more reliance on Computed Topography (CT) and laparoscopic surgery being commonplace. In this project we looked at how the Coronavirus pandemic (COVID-19) had impacted the diagnosis, management and outcomes of patients with appendicitis in our unit.

Method
A retrospective review of patients diagnosed with appendicitis from 1st March – 30th April in 2019 and 2020. Data was collected on diagnosis, management and outcomes.

Results
In 2020, 91 patients were identified (mean 33, range 6-85, F:M 1:1.4). In 2019, 107 patients were identified (mean 32, range 7-69, M:F 1:1.1). There was no significant difference in patients’ symptom duration (p = 0.21), White Cell Count (p = 0.20) or C-Reactive Protein (p = 0.10). More CTs were performed in 2020 (56/91, 61.5%) than in 2019 (40/107, 37.4%). Less patients underwent appendicectomy in 2020 (75/91, 82.4%) than in 2019 (104/107, 97.2%). Open appendicectomies were performed in 64% (48/75) of those operated in 2020 compared with 12.2% (13/104) in 2019. There was no difference in hospital length of stay or re-admissions rates.

Conclusions
The diagnosis and management of appendicitis changed considerably at our trust during COVID-19 with more reliance on CT diagnosis and less use of laparoscopy. Despite this, outcomes remained unchanged.
555 The Unintended Consequences Of COVID-19 on the Quality of Documentation of Operation-Notes
Authors: Camilleri-Brennan J , Lim M 
Published: May 2021

Abstract

Introduction
Operation-notes are crucial as they impact on the care of patients post-operatively. During COVID-19, a sizeable proportion of General Surgical procedures were performed at a local “cold” site private hospital. This study aims to determine the direct impact of COVID-19 on the standard of operation-note documentation at a non-routine site compared to our routine site.

Method
The Royal College of Surgeons Good Surgical Practice guidance highlights 19 key-variables to record within operation-notes. 300 consecutive operations were identified between May and August 2020 and details of electronic operation-notes collected. Throughout this study period, educational emails and posters were introduced at both sites secondary to ongoing audit.

Results
228/300 (76%) operations took place at our main hospital. The remainder were commissioned to the other. Operating surgeons and anaesthetists were similar at both sites. Quality of documentation was poorer for many key variables at the cold site when compared with the main site (operating-surgeons (22% vs 91%), urgency of operation (62% vs 99%), antibiotic prophylaxis (72% vs 99%) and DVT prophylaxis (21% vs 98%)).

Conclusions
COVID-19 has resulted in many unintended consequences including a reduction in the quality of operation-notes. Moving forward, this may be reduced by improving information technology resources and increasing awareness and education.
749 Delivering Safe and Timely Cancer Care During COVID 19. Lessons and Successes from The Transition Period
Authors: Dirie J , Hart E , Mahesan T , Fawcett W , Perry M , Janardanan S , Moschonas D , Krishnaji P , Chedid W A 
Published: May 2021

Abstract

Introduction
Delivering timely cancer care during the COVID-19 pandemic was a major challenge. We analysed our success in addressing this.

Method
A key factor was the proximity of a private hospital (GN) to the primary trust. GN acted as a ‘clean site’. From 6th April 2020, two robots and dedicated staff were relocated to day surgery theatres with direct access to GN. Procedures and post-operative recovery happened in GN. National surgical guidelines were followed related to Covid-19. All theatre staff were swabbed weekly. Patients were risk stratified prior to admittance.

Results
We reviewed operations performed and cancer pathway data from March to June 2020 and compared it to data collected from August to November 2019. From March until June 2020 we performed 369 cancer operations; 120 robotic, 138 endoscopic and 7 open cases. From August to November 2019 we performed 407 cancer operations; 116 robotic, 175 endoscopic and 7 open cases. No elective patient developed symptomatic COVID-19 secondary to admission.

Conclusions
This study demonstrates that with rapid development of separate ‘clean’ and ‘COVID’ sites, we successfully delivered a comparable, safe and effective cancer service. As we potentially face a second wave we share our success to see if these changes can be replicated elsewhere.
764 Human Factors in Operative Theatres During the Covid-19 Pandemic: A Cross-sectional Analysis of Operating Theatre Staff Experiences in a Regional Centre
Authors: Murchison L E , Anbarasan R , Mathur A , Kulkarni M 
Published: May 2021

Abstract

Introduction
In the already high-risk, high-stress environment of the operating theatre, operating during Covid-19 has brought its own unique challenges. Communication, teamwork and anxiety related new operating practices secondary to Covid-19 are hypothesised to have a negative impact on patient care.

Method
We conducted a single-centre online survey of operating theatre staff from 22nd June–6th July 2020. Respondents completed 18 human factors questions related to COVID-19 precautions including communication, teamwork, situational awareness, decision making, stress, fatigue, work environment and organisational culture. Questions consisted of yes/no responses, multiple choice and Likert items. Kruskall-Wallis tests, Chi-Squared, Mann Whitney U tests, Spearman’s correlation coefficient, lambda and Cramer’s V tests were used. Free-text responses were also reviewed.

Results
116 theatre staff responded. Visual (90.5%), hearing/ understanding (96.6%) difficulties, feeling faint/lightheaded (66.4%) and stress (47.8%) were reported. Decreased situational awareness was reported by 71.5% and correlated with visors (r = 0.27 and p = 0.03) and FFP2/3 mask usage (r = 0.29 and p = 0.01). Reduced efficiency of theatre teams was reported by 75% of respondents and 21.5% felt patient safety was at greater risk due to Covid-19 precautions in theatre.

Conclusions
Organisational adjustments are required, and research focused on development of fit-for-purpose personal protective equipment (PPE).
829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?
Authors: Holmes B , Mirza U , Manning C , Cooke R , Jugdey R 
Published: May 2021

Abstract

Introduction
COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this.

Method
We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics.

Results
From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management.

Conclusions
Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.
941 Post-Operative Outcomes of Patients Undergoing Surgery During the Acceleration Period of COVID-19 Infection
Authors: Fifer H , Coe P , Geogloman I , Qaiser R , Saleh A , Adair R , Peter M , Dobbins B , Saha A 
Published: May 2021

Abstract

Introduction
There are concerns around the safety of performing surgery during COVID-19 outbreaks with few sources of robust evidence.

Method
We analysed 5020 consecutive patients who underwent surgery during the acceleration phase of COVID-19 at our hospital from 31st January to 13th April 2020. Data were also analysed for all patients who had a COVID-19 positive test result during the same study period.

Results
156 patients (3%) developed COVID-19 symptoms after surgery; 28 patients (&lt;1%) subsequently had a positive swab result. All-cause mortality was 44 patients (0.9%); 33 deaths (75%) were due to non COVID-19 diagnoses. There were no adverse COVID-19 related outcomes in any of the 648 patients who had cancer operations. Of 28 COVID-19 positive patients, 11 died (8 orthopaedic, 2 urology, 1 vascular surgery) of which 10 had an emergency admission; all were over 70 years of age. Recent surgery was not an independent prognostic factor for survival after COVID-19 infection. 12% of positive COVID-19 swabs were from long-stay patients.

Conclusions
Of 5020 operative patients, 0.2% died from COVID-19 and most complications were not related to the infection. With careful consideration, surgery can be provided safely during times of COVID-19 outbreaks with particular emphasis on avoiding in-hospital transmission.
956 Patient Satisfaction of Teleconsultation in Plastic Surgery During the COVID-19 Pandemic
Authors: Rafii M , Freethy A , Chan J 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has witnessed an increased reliance on telemedicine. Patient satisfaction is a key indicator of whether telephone consultations deliver high-quality care. This study evaluates patient perceptions of telephone consultations conducted in a single plastic surgery outpatient department.

Method
Structured telephone interviews using an adapted Telehealth Usability Questionnaire and the NHS Friends and Family Test were conducted in 98 patients who had undergone outpatient telephone consultations with a plastic surgeon. 13 questions explored domains of usefulness, interaction quality, reliability, patient satisfaction, and future use of telehealth.

Results
72 of 98 (73%) completed the survey. Male(49):Female(23). Mean age 59 (range 17-91). 50.4% Strongly agreed (SA) and 24.3% agreed (A) to questions addressing usefulness of the platform. For interaction quality; 63% SA and 21% A. 47% disagreed with questions pertaining to reliability.
Overall, 75% were either SA/A for satisfaction and 81% would use telehealth again. No significant difference was found in domain scores when comparing sex or age groups.

Conclusions
Overall, patient perceptions were positive towards the usefulness and interaction quality of telephone consultations. However, reliability scored poorly. Most patients were satisfied with the care provided. Comparison to other telehealth mediums e.g. video consultation and patient safety studies are needed.
981 Management of Epistaxis During The COVID-19 Pandemic Our Experience
Authors: Eastwood M , Metcalfe C , Lovett A , Isles M 
Published: May 2021

Abstract

Introduction
Epistaxis is a frequently encountered emergency by ENT services. With the COVID-19 outbreak, examination and procedures on the upper airway may put otolaryngologists at increased risk of infection. ENT UK released new guidance for the management of epistaxis during COVID-19 pandemic to safely manage epistaxis and reduce admissions. We report our experience in managing epistaxis using a locally approved protocol using this guidance.

Method
Prospective audit of management and outcomes of patients presenting to acute ENT services at a large teaching hospital with epistaxis over a 3-month period.

Results
58 patients attended with epistaxis. Various management strategies were used with 50% managed with non-absorbable packing. 15 cases required admission only 8 solely due to epistaxis. Only 5 cases (8.6%) reported re-bleeding within 30 days with one case (1.7%) requiring readmission.

Conclusions
The current guidance appears to be a safe and effective method for managing epistaxis and minimising the number of admissions which may lead to a permanent shift in epistaxis management.
46 The Hidden Truth About Gender Bias in Surgery. A Systematic Review
Authors: Wong C , Lim W H , Jain S R , Ng C H , Tai C H , Devi M K , Samarasekera D D , Iyer S G , Chong C S 
Published: May 2021

Abstract

Introduction
Gender discrimination remains pervasive in surgery, significantly impacting current and future surgeons and population health. This study analyses the gender barriers and critical retention factors for female surgeons and trainees in surgery.

Method
Five electronic databases were searched till May 2020. Titles and abstracts were sieved, followed by a full text review. Data synthesis and inductive thematic analysis were conducted using the Thomas and Harden methodology.

Result
14 articles were included, involving 528 participants. Four themes were generated–unfavourable working environment, male-dominated culture, societal pressures and progress towards gender equality. Females in surgery often faced harassment, disrespect and perceptions of incompetence, resulting in hostile work conditions, which were aggravated by the inadequate support and mentorship. The persistence of male-dominated cultures was observed, with females facing prejudice and exclusion from professional and social circles. Differential treatment and higher expectations of female surgeons also arose from entrenched societal pressures. Despite these, increased acceptance of motherhood and greater recognition of contributions by female surgeons were reported, indicating some progress in gendered culture.

Conclusions
There is a need to increase female surgical leadership and allocate resources to address the deep-rooted causes of biased surgical culture and ingrained perceptions, to achieve greater gender equality in surgery.
114 Reducing Barriers to Learning With eBooks: An Internationally Accessible and Affordable Resource
Authors: Ellis R 
Published: May 2021

Abstract

Introduction
Training in Urology is often limited at an undergraduate level, especially in the wake of the COVID-19 pandemic. It is not uncommon that a trainee’s first experience of Urology is when they encounter urological patients as a clinician and studies have revealed that graduates are lacking knowledge and confidence in managing urological pathology. Many trainees across the world are unable to access vital learning resources to address this gap in knowledge due to exorbitant prices set by publishing companies.

Method
To address the need for affordable standardised education, ‘Urology for Medical Students and Junior Doctors’ was created. This self-published eBook was written and peer-reviewed by urologists to create a relevant learning resource that is affordable for all.

Results
Over 1000 copies of the eBook were downloaded in the first 90 days after publication by trainees across the world. It has been downloaded internationally by a diverse range of allied healthcare professionals. All profits generated from sales are donated to charities investing in medical education.

Conclusions
This eBook stands as an example of how we as educationalists and clinicians can produce affordable learning resources for trainees worldwide; standardising training, improving patient safety and reducing barriers to learning.
234 Remote Surgical Teaching During COVID-19: Early Feedback from Students and Teachers
Authors: Harris H , Khera G , Alanbuki A r , Ray K , Yusuf W , Harvey R 
Published: May 2021

Abstract

Background
On the 23rd March 2020 the government issued a nationwide lockdown in response to COVID-19. Using Microsoft Teams software, Brighton and Sussex Medical School transitioned to remote surgical teaching. We discuss the early feedback from students and tutors.

Method
All students (N = 40) and tutors (N = 7) were invited to complete an online feedback survey.

Results
Twenty students responded. Nine preferred remote teaching. The teaching was described as either good (10/20) or excellent (10/20). Small group teaching, lectures and student lead seminar sessions all received positive feedback. Students preferred sessions that were interactive. One hour was optimal (17/20). There was no consensus over class size. 15/20 (75%) would like remote teaching to continue after the pandemic.
All tutors responded. There was a preference towards shorter sessions: 45 minutes (2/7) one hour (5/7). Tutors found virtual sessions less interactive (6/7). All tutors would like remote teaching to continue after the pandemic. Three suggested extending teaching to remote surgical ward rounds.
Concern was raised by both students and tutors regarding the absence of practical skills.

Conclusions
The value of remote teaching has been highlighted by COVID-19. Our feedback recommends a transition towards blended learning; using the convenience of remote teaching to help augment traditional medical school teaching.