bluuebunny/crossref_metadata_2025_split huggingface dataset:
545 Assessing the Impact Of COVID-19 On the Diagnosis and Management of Bladder Cancer in The United Kingdom – The West Midlands Experience
Authors: Desai C , Ehsanullah S A , Khashaba S 
Published: October 2021

Abstract

Introduction
The British Association of Urological Surgeons (BAUS) issued an interim strategy for the management of bladder cancer as a contingency measure during the COVID-19 pandemic. We aim to assess the actual implementation of these recommendations and deviation from the standard of care in the West Midlands.

Method
A questionnaire was devised and sent to bladder cancer leads of 12 NHS Trusts in the region in June 2020. Responses were analysed and compared with the BAUS COVID-19 strategy.

Results
11 centres were aware of the BAUS COVID-19 strategy. 2 centres were offering teleconsultations only for 2-week-wait referrals, and 6 centres had changed their practice for non-visible haematuria referrals. All centres were offering TURBTs for new and high-risk tumours. 8 centres had clear MDT documentation of NICE risk-stratifications of all bladder tumours and 10 centres were also documenting any changes in treatment. Only 7 centres continued to give BCG to newly diagnosed NMIBC. All centres continued with staging CT for newly diagnosed MIBC. Patients were still being referred for cystectomies, however few were performed. Radiation as curative and palliative intent continued. Of the 5 regional cancer centres, only 1 continued with cystectomies as normal, whereas 2 performed the procedure on a case-by-case basis, and the procedure was delayed/deferred in the other 2 centres.

Conclusions
Diagnostics, and definitive management of bladder cancer has been severely affected by COVID-19. In particular, deferred intravesical BCG and delayed radical treatment can have a dire impact on the long-term outcomes of the patients presenting during the pandemic.
579 Emergency Surgical Admissions During The COVID-19 Pandemic; Comparative Study of Emergency Surgery Outcome Before and During The COVID-19
Authors: Soliman H , Hussain A , Manejwala O , Ghosh A , Shauib S , Hafeez R , El-Hasani S 
Published: October 2021

Abstract

Introduction
There are relatively few studies on emergency surgical practice in the COVID-19 pandemic. Our aim is to analyse the outcomes of emergency surgery before against those during COVID-19.

Method
Retrospectively we collected the emergency admissions to the general surgery department at a district general hospital during November 2019, which is a representative of our regular activity, and April 2020, the height of the COVID-19. The primary endpoint was the number and nature of surgical admissions and procedures. The secondary endpoints were morbidities and mortalities, laparoscopic and procedure approach (laparoscopic vs open), inflammatory markers (white cell count and C-reactive protein), hospital stay, gender and age.

Results
During the two months a total of 332 patients were admitted; 177 during November 2019 and 146 patients during April 2020. The mean age was 51 years in the November group and 49 years in the April group. 146 operations were conducted in November, while 117 procedures were performed in April. Hospital stay average was 5.87 days and 5.43 days for November and April groups, respectively. In the April group, seven patients tested positive for COVID-19. Mortality was slightly higher during April (2.05%) than November (1.6%). Postoperative complications, C-reactive protein level and prevalence of acute cholecystitis were much higher during April, while abscess and diverticulitis prevalence were significantly lower.

Conclusions
Morbidity, mortality and acute cholecystitis were significantly higher during the COVID-19 pandemic, while abscess and diverticulitis were significantly less prevalent likely due to and tendency by patients to avoid hospitals and hence late clinical presentation.
598 Burns Management at A UK Major Trauma Centre During The COVID-19 Lockdown
Authors: Payne A , Campbell E , Welman T , Pahal G , Myers S 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic forced huge changes in healthcare delivery in the UK within a matter of weeks. We report our experience of managing burns presenting to a UK Major Trauma Centre during the COVID-19 lockdown period.

Method
Retrospective patient data was collected on aetiology, severity and management of burns during the first six weeks of the government-enforced lockdown. Data was compared with patients presenting with burns during the same period in 2019 (control) and statistical analysis was performed.

Results
Fifteen patients were treated during the COVID-19 lockdown and fourteen in the control group. Adults treated during the COVID-19 lockdown had a greater total body surface area (TBSA) (9% vs. 2.9%, p 0.035) and were more likely to suffer full thickness burns (40% vs. 0%). In the COVID-19 group all patients that did not require resuscitation, seven of whom met criteria for referral to burns services, were managed locally by the plastic surgery department with good outcomes.

Conclusions
Despite the increase in severity of adult burns seen during the COVID-19 lockdown period, local plastic surgery units have been able to adapt their practice and successfully manage more complex burns. This adaptability will be key as we move through the pandemic.
658 Managing the Acute Surgical Patient – How has COVID-19 Changed Our Approach?
Authors: Wall J , Maguire R , Plotkin T , Kowal M , Peckham-Cooper A 
Published: October 2021

Abstract

Aim
COVID-19 has changed how surgical admissions are triaged and treated. This retrospective cohort study aims to detail the effects of a national lockdown on emergency general surgical referrals at a tertiary centre.

Method
A retrospective search identified all emergency general surgery referrals prior to and during the UK national lockdown. Pre (10-23 Feb 2020;PLG) and intra-lockdown (30 Mar-12 Apr 2020;ILG) groups were compared using descriptive statistics and significance was quantified with Chi-squared.

Results
600 patients were included of which 426 (71%) presented in the PLG. The PLG had proportionally fewer ED referrals (40.8%vs.51.1%, p = 0.02) and less cross-sectional imaging performed (31.5%vs.40.8%, p = 0.03). There was a significant reduction in non-specific abdominal pain (NSAP) during lockdown (25.12%vs.14.94%, p = 0.007). GP referrals (48.8%vs.46.6%, p = 0.61), admission (46.2%vs.44.8%, p = 0.09) and operative intervention (21.4% vs.17.24%, p = 0.25) showed no disparity.

Conclusions
Predictably, the advent of lockdown resulted in a reduction in hospital attendance and surgical referrals. Our data showed a similar proportion of referred patients admitted pre- and intra-lockdown despite a reduction in absolute terms. This may be due to a trend towards later presentation coupled with a focus on conservative management and prevention of admission. The decrease in NSAP raises questions that require further exploration. Cross-sectional imaging was used more freely as an adjunct in the ILG suggesting increasing acuity and delayed presentation or may result from a tendency towards image-guided discharge. Admissions have since trended towards pre-lockdown levels, but it is yet to be seen if a reduction in elective operating will lead to an increase in emergency admissions.
726 Consenting for Surgery During the Pandemic: A Closed-Loop Audit on Discussing and Documenting the Risks of Hospital-Acquired COVID-19
Authors: Kim W A , Wu F , Al-Afifi S , Sebastian J 
Published: October 2021

Abstract

Introduction
There is limited data on the nosocomial transmission of COVID-19. The Royal College of Surgeons (RCS) have published guidance on consenting for surgery, which includes discussing the risks of hospital-acquired COVID-19 with patients as part of the consenting process1. We performed a closed-loop audit on our unit’s consenting practice to assess compliance using the RCS guidelines as the audit standard.

Method
A retrospective case review, including elective and emergency procedures, were identified from June to November 2020. Consent forms were reviewed for evidence of patient counselling for the risks of hospital-acquired COVID-19 using the RCS guidance for comparison. Positive SARS-CoV-2 RT-PCR swabs and radiological imaging suggestive of COVID-19 within 30-days were also assessed.
We undertook the 1st cycle of data collection in September. Following this, we used a local meeting to educate the surgical team. The 2nd cycle (re-audit) was performed in December.

Results
In cycle 1, from June to August 17/29 (59%) case notes documented the discussion of the COVID-19 risk. None of these patients contracted the virus. In cycle 2, from September to November, compliance improved to 28/33 (80%). One (3%) patient had contracted COVID-19. They had a positive SARS-CoV-2 RT-PCR swab and signs suggestive of COVID-19 on their CT chest.

Conclusions
The re-audit demonstrated an improvement in our consenting practice from 59% to 80%. One patient had hospital-acquired COVID-19 during our period of data collection, which reflects current data that suggests nosocomial COVID-19 is rare2. With new advisory guidelines, it is important to discuss these risks.
816 Managing Acute Appendicitis During the First Wave of the COVID-19 Pandemic: A Single-Centre Retrospective Study
Authors: Lotfallah A , Aamery A , Moussa G 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients.

Method
All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay.

Results
Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively).

Conclusions
Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.
824 UK CoPACK Study: Health Care Workers Knowledge and Confidence in Using Personal Protective Equipment (PPE) And Related Anxiety Levels During The COVID-19 Pandemic
Authors: Ismael S , Manoharan G , Al-Kaisi K , George A , Abas S , Al Musabi M , Rao P , Singh R 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic has resulted in significant pressures on the NHS. Healthcare workers (HCWs) are at increased risk of infection. Personal protective equipment (PPE) lowers the risk of infection transmission. However, during the early phases of the pandemic, the information available regarding COVD-19 and the use of PPE has been unclear, with constantly changing guidelines. The aim of this study was to determine the knowledge and confidence about PPE usage among HCWs, in addition to measuring their anxiety levels during the COVID pandemic.

Method
A validated questionnaire was distributed among HCWs in as many UK hospitals as possible, during April 2020. The questionnaire consisted of 13 questions regarding demographics, knowledge on PPE guidance, HCW training and confidence levels in PPE usage and finally anxiety levels measured using the GAD-7 psychometric tool.

Results
1055 responses were received. Nurses (49%), Healthcare Assistants (HCA - 20%), Doctors (17%), Physios (8%) and other (6%). 99% of respondents indicated they were familiar with PPE guidance, but only 1.6% answered all 3 questions on PPE guidance accurately. 86.4% of respondents received mask-fitting checks. 79.7% received donning-doffing training. Despite this, only 46.8% were confident on their familiarity with PPE. 32.5% felt that their hospital communication regarding PPE policy during COVID-19 pandemic was poor or very poor. 30% HCWs experienced severe anxiety.

Conclusions
National guidance and local training on PPE usage during the COVID-19 pandemic has been unsatisfactory, leading to higher anxiety among HCWs. Improved information delivery and training are essential in preparation for the second wave and future pandemics.
902 Safe Elective & Emergency Surgery During the COVID-19 Crisis: Experience of a Large Tertiary Centre During the First Wave of the Pandemic
Authors: Giorga A , Thompson J , Lo T , Baker R 
Published: October 2021

Abstract

Aim
In addition to a reduction in elective surgery, the COVID-19 pandemic has been associated with concerning rates of post-operative mortality in COVID-19 patients highlighting the threat of nosocomial transmission. Relocation of elective patients into a protected cold wing of a tertiary centre, vigilant testing and staff test, and trace were implemented to address these issues.

Method
Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20 was performed. Comparison of numbers of procedures was compared with the same study dates in 2019. Detailed analysis of nosocomial transmission of COVID-19 and mortality was performed using patient notes and death certificates.

Results
5854 procedures were performed in 2020 compared with 13219 in 2019, representing a reduction of 55.7%. The overall mortality in 2020 was 2.7% (135/5069). COVID-19 negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality amongst patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052).

Conclusions
The first wave of the pandemic has predictably caused a significant reduction in elective activity. Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. Continuation of surgical services is important for patient outcomes, and essential for training the surgeons of tomorrow.
977 The Role of Telephone Triage in Head and Neck Cancer Care in a Teaching Hospital
Authors: Turner T , Daniels J , Belloso A 
Published: October 2021

Abstract

Introduction
NHS England sets standards to ensure prompt specialist review, diagnosis, and treatment of cancer. Patients with suspected cancer should receive specialist review within 14 days of referral, diagnosis by day 28 and first treatment by day 62. To reduce transmission during the SARS-CoV-2 pandemic, the NHS recommended telephone triage as the first specialist appointment. The effect of telephone triage on head and neck cancer timeframes in an NHS teaching hospital was assessed.

Method
Four head and neck cancer telephone triage clinics during July 2020 were selected at random. Clinical correspondence and the electronic patient records were reviewed for each patient and cancer pathway timeframes were analysed.

Results
31 patients were referred for telephone triage and 100% received specialist review within 14 days. Subsequently 17 (55%) patients were investigated, 12 (71%) of which received a diagnosis within 28 days. 4 patients received a cancer diagnosis, but none received first treatment within 62 days. 24 (77%) patients were seen in a face-to-face clinic after telephone triage on average 7 days after telephone triage.

Conclusions
In this sample, telephone triage allowed safe initial specialist review by meeting the 14-day standard. However, the 28-day diagnosis and 62-day treatment standards were not adhered to. Telephone triage does not largely reduce overall patient contact, with 77% of patients subsequently reviewed in a patient-facing setting. The addition of telephone triage delayed first clinical examination by a specialist by an average of 7 days, which may be a contributing factor to the delays seen in diagnosis and treatment.
1016 The Impact Of COVID-19 On Prostate Cancer: Is This the Calm Before the Storm?
Authors: McCauley N , Rashid M , Wilson J , Carter A , Cox A 
Published: October 2021

Abstract

Aim
Cancer treatment targets were halted in the COVID-era due to a major re-organisation of services and coincided with a drop in prostate cancer (PCa) referrals, investigations, and diagnoses. This study measures the impact of the pandemic on a PCa diagnostic pathway in a major cancer centre.

Method
Data was collected during the onset of COVID-19 (March to June 2020) and the same months in 2019 for urgent suspected prostate cancer (USPC) referrals. All referrals, PSA tests, multiparametric MRI's of prostate (mpMRI-P), and TRUS-guided biopsy of the prostate (TBP) were recorded.

Results
USPC referrals reduced by 65% from a mean 315 referrals per month to 110 during the pandemic. During March-June 2019 a total of 10,404 PSA tests were conducted in the healthcare trust, which reduced by 39% during COVID-19. Multiparametric MRI of prostate was reduced by 45%. TRUS biopsies were down by 65%, from a mean of 31 to 11 biopsies per month, with only 3 biopsies being conducted in April 2020.

Conclusions
The reduction in PCa referrals and workload in our centre in the COVID-era has been significant. The uncertainty associated with such a drop in demand poses concerns for meeting future cancer targets when prostate cancer referrals return to baseline.
1063 Incidence, Risk Factors, and Outcomes of ARDS in Patients with SARS-CoV-2 Infection
Authors: Devarakonda S , Narayanan S , Lingamdenne P E , Kandasamy S , Korula P J 
Published: October 2021

Abstract

Introduction
Many asymptomatic patients are diagnosed with SARS-CoV-2 infection on screening, which might alter their expected course of illness. We wanted to study the incidence, risk factors, and ARDS outcomes in these patients admitted to our ITU.

Method
A review of all admissions (medical, surgical, and obstetric) to our ITU from May to October 2020 was done after institutional ethics approval. Age, gender, comorbidities, admission diagnosis, APACHE II score, and in-hospital course were studied. ARDS was defined as PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O) in the absence of cardiac failure or fluid overload. Data were analyzed using Statistical Package for Social Services (SPSS) software Version 21.0 (Armonk, NY: IBM Corp).

Results
Of the 832 cases, 119 (14.3%) had SARS-CoV-2 infection. 41 of 119 (34.4%) cases developed ARDS. Among the comorbidities studied, only hypertension (OR 2.6, 95% CI 1.0-6.2) seemed to increase ARDS odds. Patients with Severe Acute Respiratory Illness (SARI) had a higher incidence of ARDS when compared to the asymptomatic ones (P &lt; .05). Patients with sepsis (OR 5.8, 95% CI 2.4-13.7) and APACHE II score ≥10 (OR 5, 95% CI 2.0-12.3) had higher odds of developing ARDS. Age, gender, trauma, and recent surgery did not seem to increase the risk of ARDS.

Conclusions
Even though COVID-19 patients admitted with SARI and sepsis are at a higher risk of developing ARDS, further research will be needed to predict the extent to which SARS-CoV-2 infection will influence the course of their illness.
1075 Paediatric Injuries Pre And During COVID-19 Requiring an Operative Intervention: The District General Hospital Experience
Authors: Howard E , Arshad S , Kabariti R , Roach R 
Published: October 2021

Abstract

Aim
To assess the effect of lockdown and the following summer period on paediatric trauma patients who required an operative intervention in a district general hospital.

Method
A single centre retrospective audit was performed on all paediatric patients &lt;16 years requiring an operative intervention. Two study periods were assessed – pre-COVID (22/03/2019- 30/09/2019) and during the COVID-19 pandemic and subsequent summer period (26/03/2020 – 26/09/2020). Data were collected on patient demographics, type of injury sustained, and intervention performed.

Results
During the COVID-19 pandemic 119 operations were performed, compared to 238 operations performed before the pandemic. Distal radius fractures were the most common injury both during and before the pandemic. However, during the pandemic there was a higher incidence of both hand injuries and lower limb lacerations. The most common type of operation both before and during the pandemic was manipulation under anaesthetic, but there was an increased incidence of washouts performed during the pandemic.

Conclusions
Despite extensive restructuring of services due to COVID-19, 119 operations were performed during the pandemic. However, this is 119 fewer operations than the same period of the previous year. The reduced rate of operations could be a consequence of increased parental supervision, and less outdoor activity during the pandemic period, but further research is necessary.
1154 The Effect Of COVID-19 Pandemic on Mortality Rates in General Surgery in A District General Hospital
Authors: Bhattacharya P , Mobarak D 
Published: October 2021

Abstract

Introduction
WHO declared COVID-19 to be a global pandemic on March 11th 2020. It has has a profound on health care delivery and allocation of resources.

Aim
To find out the effect of the COVID-19 pandemic on mortality rates of patients admitted under general surgery in our hospital.

Method
Retrospective data collection of deaths in all inpatients from March to November 2020 (group A)and comparing it with data collected on inpatients from March to November 2019( Group B).

Results
There were 46 deaths out of 3534 admissions in group A compared to 55 deaths out of 6576 admissions in group B. This meant a rise of mortality from 0.84% in 2019 to 0.94 % in 2020, this is a statistically significant result (p = 0.02). The median age of mortalities in 2020 is 81.5 vs 79 years in 2019 and median documented interval between onset of symptoms to presentation in hospital was 2 days in 2020 as it was during 2019. Perforations accounted for more than half of 2020 deaths ( 29 out of 46) and 6 patients out of 46 were COVID-19 on swab testing.

Conclusions
1. COVID-19 has had a significant impact on mortality rates in general surgery in 2020. 2. Perforations account for a majority of deaths, as evidenced by mean time to presentation at hospital; this may be attributed to delayed seeking of healthcare facilities as a result of lockdown. 3. Public education is required to seek medical attention early to improve outcomes of serious surgical conditions.