bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.67Management of Acute Appendicitis during the Early phase of the COVID-19 Pandemic: a Single NHS Centre Study
Authors: Buksh Md Mahfooz , Kerans George , Al Samaraee Ahmad 
Published: October 2021

Abstract

Aims
During the early phase of the COVID-19 pandemic, general surgeons were advised to apply conservative management/open surgery for appendicitis. This single NHS centre study has explored the resulted management differences.

Methods
Retrospective study covering prepandemic data over (March-May, 2019) & early pandemic data over (March-May, 2020).

Results
Prepandemic data (43 patients): The mean age was 38.3 years. The mean length of stay was 1.7 days. Preoperative imaging was used in 32(74.4%) patients; this was diagnostic in 28(87.5%). Non-surgical management was used in 4(9.3%) patients; one needed surgery eventually. Surgical approaches in 40 patients were (laparoscopic: 38(95%), open: 2(5%)). Neither significant morbidity nor mortality was reported.
Early pandemic data (35 patients): The mean age was 31.2 years. The mean length of stay was 2.2 days. Preoperative imaging was used in 30(85.7%) patients; this was diagnostic in 26(86.6%). Non-surgical management was used in 8(22.9%) patients; one needed surgery eventually. Surgical approaches in 28 patients were (laparoscopic: 10(35.7%), open: 18(64.3%)). Neither significant morbidity nor mortality was reported, apart from one patient with COVID-19 postoperative infection.

Conclusions
There was a tendency towards applying a conservative approach/open surgery during the early days of the pandemic. Though this was statistically significant (p&lt;0.05), the total number of patients was small to achieve statistically stronger conclusions. Laparoscopy was selectively used during the early days of the pandemic where the benefit outweighed the risks.
EP.WE.83Surgeon’s Acute Stress Disorder During Covid-19: A Case Study with E-Mail Therapy
Authors: El Boghdady Michael , Ewalds-Kvist Béatrice Marianne 
Published: October 2021

Abstract

Aims
A higher surgical trainee combatted patients’ deaths and disasters from COVID-19. The trainee treated daily COVID-19-positive patients. In May 2020, he recognized symptoms of COVID-19. Throat swab test confirmed the suspicion of contagion. We aimed to study the acute stress disorder (ASD) during the COVID-19 pandemic in the surgical trainee.

Methods
The case self-isolated for 2 weeks with an intensifying fear of health deterioration. The case’s isolation and feelings of being in poor health, opened for an e-mail therapy. Sixty open-ended questions were answered in Socratic-maieutic style. The finding of severe (ASD) was validated and confirmed by use of the National Stressful Events Survey Acute Stress Disorder Short Scale. The mail therapy continued until the case felt that the crisis had faded. After 10 weeks a follow up was completed A, B and C times for 7 issues: death anxiety, worries about family after own death, chest pressure, other physical symptoms, stress, depression, other psychological symptoms

Results
Our hypothesis was termed “acute stress reactions”. Our case’s ASD was categorized as “severe”. Friedman test was applied for the related groups A, B and C, indicating an overall symptom improvement (p &lt; .001) which by Page’s L trend test disclosed a significant trend in symptom cutback from A to C (p &lt; .001).

Conclusion
The surgeons’ awareness is required that in some cases, the psychological symptoms escalate during isolation and quarantine periods and may even override the physical awkwardness, urging us to address both types of discomfort simultaneously and intensely.
EP.WE.162Correct consenting for Vascular Patient
Authors: Khalaf Hasan , Behbahani A. , Walsh Aideen 
Published: October 2021

Abstract

Introduction
Surgeons must establish and maintain effective relationships with patients and, where appropriate, with their supporters. Before surgery, surgeons should strive to have an honest and sensitive discussion with patients about their options for treatment that leads to informed and deliberate consent. The aim of this study is to compare our consent practice in the vascular department in Royal Stoke Teaching Hospital against consent guideline in the Best surgical practice and to if we are meeting patient satisfaction.

Method
A prospective study of 30 patients from 21/09/2020 to 21/10/2020. Questionnaire form was designed based on the best surgical practice guideline and was given to the patient to fill. We include patients admitted for elective vascular procedures, wide range ages. The questionnaire

Results
Most of the of the patient (90%) were consented by the professionals who provide the treatment. 63% of the patients asked for further information in the form pf leaflets or websites. 70% of them request to know the recent guidelines of their procedures. Only 13% of them had a copy of the consent prior to surgery.

Recommendations
We must provide the patients with further information, Recent guidelines, and a copy of the consent to take home prior to surgery day. This can be achieved by consenting them before the operation day.
EP.WE.190Post-operative Hypocalcaemia: Analysis of factors influencing and predicting hypocalcaemia post total thyroidectomy
Authors: Ash Javier , Lucas Tylan , Kirmani Naveed 
Published: October 2021

Abstract

Aims
Hypocalcaemia is a severe complication post total thyroidectomy leading to increased morbidity, length of inpatient stay and associated costs. The leading cause is damage or de-vascularisation of the parathyroid glands intra-operatively however this is not always easy to identify and is usually inadvertently performed. Prompt identification of patients likely to become severely hypocalcaemia is difficult for clinicians but is of interest as timely management of hypocalcaemia in these patients is crucial to reduce length of stay and worsening/development of symptoms.

Methods
A retrospective audit of 42 patients who were admitted for a total thyroidectomy at a district general hospital was performed. Data was collected on demographics, indication, post-operative diagnosis and pre- and post- electrolyte levels and calcium supplementation.

Results
Eight patients were identified with severe hypocalcaemia post operatively. Age, indication, post-operative diagnosis or pre-operative electrolyte levels were not statistical significant predictors of post-operative hypocalcaemia. Percentage difference between pre and immediate post-operative calcium levels was a significant predictor of subsequent severe hypocalcaemia and increased length of inpatient stay (p &lt; 0.05).

Conclusions
Reducing patient morbidity and length of stay is of crucial importance to clinicians and patients alike. Commonly post-operative calcium levels are interpreted independently to determine need of supplementation. However, using pre-operative calcium levels in conjunction with the immediate post-operative levels has lead to a better prediction of patients likely to suffer from this complication. We theorise that prospectively identifying these patients and starting treatment early as appropriate will lead to improved patient outcomes.
EP.WE.279Impact of COVID-19 on West of Scotland Colorectal Cancer Services
Authors: Welsh Silje , Al-Ani Ahmed 
Published: October 2021

Abstract

Aim
The coronavirus disease-19 (COVID-19) pandemic has driven unprecedented restriction of the National Health Service to accommodate additional pressures. Our aim was to analyse the impact of COVID-19 on the largest colorectal cancer (CRC) services in NHS Greater Glasgow & Clyde.

Method
Audit data collected from multidisciplinary team meetings for South Glasgow CRC service were accessed. We compared April-June 2020 (‘Lockdown group’) to corresponding months in 2019 (‘Control group’). Statistical analysis by unpaired T-test, Pearson’s χ2 test with post hoc analysis using adjusted Z scores and Bonferroni correction.

Results
There was a 39.5% reduction in CRC diagnoses during lockdown (n = 49) compared to control (n = 81). There was a 34.1% reduction in CRC operations during lockdown (n = 27) compared to control (n = 52). The proportion of patients managed operatively did not differ between groups (p = 0.140). There was no difference in the number of days from diagnosis to first treatment between Lockdown and Control groups (Mean(SD): 40.1±35.3 and 43.2±42.9, p = 0.257). Primary care physicians were the main referral source for both lockdown (52%) and control groups (46%). The cessation of bowel screening programme saw no referrals in lockdown whereas it accounted for 21% of referrals in control group, p &lt; 0.001).

Conclusions
We experienced dramatic reductions in CRC diagnoses during lockdown that was not only accounted for by the cessation of bowel screening. The diagnostic delay in the 39.5% ‘missed’ CRC patients may result in patient morbidity; a severe repercussion of COVID-19. The resurgence of COVID-19 cases poses a real threat to cancer services.
EP.WE.330The role of computerized tomography scan in 2 week wait colorectal pathway during COVID-19 pandemic
Authors: Ali Muhammad , Castelhano Rute , Theofilis Aris , Wass Emily , Alexander Roderick , Owais Anwar 
Published: October 2021

Abstract

Aims
The standard way to investigate patients referred on the two week wait colorectal cancer (2WW) pathway is to do a colonoscopy when patients are deemed fit. Due to limited endoscopy services during the COVID-19 lockdown period, we performed computerized tomography scan of thorax, abdomen and pelvis (CT TAP) for all fast-track colorectal referrals in addition to colonoscopy when service restarted. The aim of this study is to assess the benefit of CT scan in this group of patients.

Methods
All 2WW patients referred to our district general hospital from April 1, 2020 to July 31, 2020 were included in the study. The data were collected retrospectively from GP referral forms and the electronic patient records. Patient demographics, presenting complaints, investigations, diagnosis and treatment were recorded.

Results
A total of 658 patients were included in the study. The commonest presenting complaint was change in bowel habit (62.5%). A total of 414 colonoscopies, 347 CT TAP, 89 flexible sigmoidoscopies and 37 CT colonography were performed. 194 patients had both CT TAP and colonoscopy and another 32 patients had both CT TAP and flexible sigmoidoscopy showing that 34% of patients had both CT TAP and endoscopy. 41 patients were diagnosed with colorectal malignancy (6.2%) and 120 had polyps (18%). CT TAP missed 3 colorectal cancers but picked up 28 patients (4.3%) diagnosed with extra-colonic tumours.

Conclusions
Colonoscopy remains the gold standard for investigating colorectal cancer. However, CT scan have their value in diagnosing extra-colonic tumours in this specific group of patients.
EP.WE.433Assessment of the temporary Surgical ED Study and Audit
Authors: Abdelkarim Mostafa , Nawaz Syed , Venkatesan Gowtham , Murali Sreedut , Asqalan Ahmed , Morgan Richard 
Published: October 2021

Abstract

Aims
To ascertain the effectiveness of the newly formed surgical ED during Covid-19 outbreak in terms of:

Methods/Study design
Retrospective cohort of 992 patients were identified and included from the period of the 5th April to 5th May 2020
Inclusion criteria: All patients attended and triaged in the new surgical emergency department.
Exclusion criteria: Patients who were not triaged.

Results
The temporary surgical emergency department was successful in accommodating all surgical patients categorized 2, 3 and 4 with category 4 being the highest number at 45%.
Hospital services were successfully accessed in 771(77.72%) during patients stay in ED including Bloods and imaging with X-ray as the most service used at 42.33%.
221(22.27%) patients didn’t require any investigations and were discharged after review by the surgical doctor within the 4-hour window.

Conclusion
Presence of a dedicated surgical emergency during the covid period was essential to separate medical patients from non-medical patients.
Having a decision maker on the front line right after triage has reduced the overall number of admissions, number of emergency breeches and unnecessary investigations.
Having a dedicated space with dedicated team could make a huge impact on the service in terms of time, effort and money spent.
EP.WE.561The impact of COVID-19 on infra-inguinal revascularisation in patients with symptomatic peripheral occlusive arterial disease
Authors: Tait Sophie , McGillivray Kay , McKenna Roisin , Hussey Keith 
Published: October 2021

Abstract

Introduction
Standard Operating Procedures were revised in response to the Covid-19 pandemic. There are descriptions from across Europe of increased rates of major extremity amputation. We have explored practice in a regional vascular unit serving two Health Boards in Scotland with specific reference to infra-inguinal revascularisation for patients with symptomatic peripheral occlusive arterial disease.

Methods
A retrospective review of the administrative theatre database was performed. Pre-Covid (1st April–July 31st 2019) and peri-Covid (1st April-31st July 2020) periods were examined and index cases identified. Practice and outcomes were examined.

Results
There was a 50% reduction in scheduled theatre sessions during the peri-Covid period. There were 100 procedures performed pre-Covid and 71 procedures performed during the peri-Covid period. The patient demographics were comparable – mean age 68-years with a male to female ratio of 1.6:1. Intervention for chronic limb threatening ischaemia was much more common in the peri-Covid period than in the pre-Covid period (94% versus 64% respectively). There was a clear change in anaesthetic practice with regional anaesthesia more commonly performed in the peri-Covid period (49% versus 12% respectively). There was no difference in the types of revascularisation performed. The 30-day mortality in the peri-Covid period was less than in the pre-Covid period (3% vs 1.4%).

Conclusion
The Covid-19 pandemic created imperatives that necessitated re-structure of service. Despite a reduction in theatre access we have managed to maintain a limb salvage service for patients with chronic limb threatening ischaemia.
EP.WE.593Cardiovascular risk modification in patients admitted for vascular surgical intervention
Authors: Al-Obaidly Deemah , Khan Mujahid , Aji Aida , Hussey Keith 
Published: October 2021

Abstract

Introduction
Management of cardiovascular risk is fundamental for patients with symptomatic atherosclerosis to reduce both medium and long-term cardiovascular morbidity and mortality. All patients admitted for operative vascular intervention with atherosclerotic arterial disease should be prescribed appropriate secondary prevention.

Methods
This was a single-cycle retrospective audit in a patient population undergoing operative intervention for symptomatic atherosclerotic arterial disease in a single regional vascular unit in June 2020. Episodes of care were examined for the prescription of an antiplatelet agent and statin.

Results
There were 81 procedures identified. The majority of patients were male and the mean age was 63-years. A diagnosis of diabetes was common. Antiplatelet agents were only prescribed to 48 (59%) and statins to 61 (75%). There was no clear pattern that could be defined between elective and emergency admissions [antiplatelet prescription 24 (71%) and 23 (49%); statin prescription 27 (79%) and 34 (72%)], or arterial reconstruction and major limb amputation [antiplatelet prescription 28 (76%) and 19 (45%); statin prescription 31 (84%) and 28 (67%)].

Conclusion
It is a concern that a significant proportion of patients did not have antiplatelet and/or statin therapy prescribed. This implies failure of both primary and secondary care. In secondary care the medicines reconciliation process should be augmented with regular review of the prescription.
EP.WE.620The utility of Computerized Axial Tomography (CT) investigation in two week waits colorectal referral pathway: should it be done more often during the pandemic?
Authors: Bavikatte A , Olugbemi M , Athisayaraj T Winston 
Published: October 2021

Abstract

Aim
Colorectal two week wait pathway investigations have been majorly affected due to Covid 19 especially with regards to endoscopy as well as virtual colonoscopy procedures in comparison to CT scan. We aimed to analyze the CT scan findings of colorectal rapid access patients.

Method
A total of 1900 patients was referred via the straight to test pathway in the year 2020.A retrospective analysis of CT scan investigation performed in these patients was analyzed.

Results
A total of 90 (4.74%) patients had a CT Scan as part of the work.20 patients (22%) of the CT scan revealed malignancy. 10 patients (50%) had metastatic disease on the scan. Among them, 6 (60%) were due to colorectal primary and another 2 (20%) was due to thoracic cancers. The remaining were diagnosed with widespread metastatic disease of unknown origin. Among the remaining 10 patients, Curative surgery was offered to 5 patients with colorectal primary and one patient with hepatocellular carcinoma. The remaining patients were diagnosed with High grade B cell lymphoma, Neuroendocrine tumor, pancreatic mass and primary renal cell carcinoma. One patient had high grade small bowel obstruction due to a band adhesion resulting in emergency surgery and 5% of the patient needed a vascular referral for Abdominal aneurysm.

Conclusion
CT scan in two week colorectal referral patients play a significant role in diagnosis of advanced disease. The ease of the procedure makes it more attractive during the pandemic in contrast to endoscopy and virtual-colonoscopy which has been significantly impacted by COVID 19.
EP.WE.635The Pied-Piper, How Gastroenteritis Led Us Astray. Fibromuscular Dysplasia: A Surgical Perspective of a Rare Vascular Disorder
Authors: Mishra Shashwat , Davis Heather , Adams Lawrence , Culmer Cicely , Shrestha Ashish 
Published: October 2021

Abstract

Case
A 73-year-old female was admitted for abdominal pain after eating an out-of-date pie. She was treated for gastroenteritis for 48 hours, after which she became unexpectedly haemodynamically unstable. Computerised Tomography (CT) suggested mesocolic arterial bleed with a large mesenteric haematoma. CT angiography confirmed false aneurysms of the middle colic artery and multiple beading of coeliac branches, small mesenteric vessels and the inferior mesenteric artery. Opinion was sought from multiple specialties, pseudoaneurysm embolisation was undertaken and steroids commenced for presumed vasculitis. Vasculitis screen was negative, and PET CT scan showed no metabolically active vasculitis. It was felt a diagnosis of fibromuscular dysplasia (FMD) was likely. Steroids were weaned and the patient is under active observation.

Background
FMD is a rare idiopathic condition of abnormal cellular growth in medium/large arterial vessel walls. It has a frequency of approximately 0.02%, predominantly affecting middle-aged Caucasian women. It manifests mostly in renal and cerebrovascular arteries and can present as hypertension or stroke. Complications include aneurysms, stenosis and dissections. Characteristic angiographical finding is a “beads on a string” appearance. There is no current cure, but surgical or interventional involvement by angioplasty and stenting may play a role treatment.

Discussion And Conclusion
This case elegantly highlights the ambiguity in diagnosis of abdominal pain in a general surgical setting; with a wide variety of differentials spanning multiple specialties, it emphasises the importance to consider rare presentations of equally rare pathologies. It is a celebration of the merits of a multi-disciplinary approach to solve complex clinical questions.
EP.WE.690PPI Prescribing in Vascular Discharges
Authors: Hooper Amy , Cheung Fang Yi , Murray Anna 
Published: October 2021

Abstract

Aims
Aspirin and clopidogrel are ubiquitously seen in prescriptions of most attendees to hospitals, especially those being admitted to a vascular unit. Most, if not all, are on at least one anti-platelet agent, and some are on dual antiplatelets (DAPA) or an anticoagulant. These increase the risk for upper gastrointestinal (UGI) bleeds, which lead to significant morbidity and mortality. In order to prevent this, proton pump inhibitors (PPIs) are recommended to be prescribed for patients with increased risk of UGI bleeds.
Our aim for this audit was to evaluate the prescription of PPIs in vascular patients discharged from a major vascular hub.

Methods
Data was collected from a prospectively maintained database of consecutive primary vascular discharges between 01/09/2020 and 31/09/2020.

Results
87 patients discharged in this period (71% Male, Median age 72 (22-92) yrs). 26% of admissions accounted for Diabetic foot infection management, 25% for Critical Limb Ischaemia management and 20% for Thoracic or Aortic Aneurysm management.
70% of patients were discharged with either a single or DAPA.
94% of patients met the NICE guideline for requirement for a PPI. 49% of those patients were not discharged with a PPI.
Of the patients who should have been prescribed a PPI on discharge, 5% suffered UGI bleeds in the follow up period (2/42).

Conclusions
PPIs are often not prescribed when discharging vascular patients, most of whom are high risk for having UGI bleeds. We will re-audit this after education and protocols have been implemented.
EP.WE.712Predictors of remission for type 2 diabetes mellitus after bariatric surgery: a systematic review and meta-analysis
Authors: Kumar Gautam , Narayanasamy Sangara N , Ramesh Vibha , Aspari Ajay , Gumber Ashutosh O 
Published: October 2021

Abstract

Aims
Bariatric surgery has been implicated as a practical therapeutic approach to cure Type 2 Diabetes Mellitus. Hence, the present study aims to analyse the factors that can predict type2 diabetes remission after bariatric surgery and the recent literature to update information by systematic review.

Methods
Search strategy followed PICOS framework and PRISMA standards. PubMed, EMBASE, Cochrane Library, MEDLINE, and CINAHL databases were searched. SPSS version 19 and RevMan 5.0 software were utilised for statistical analysis.

Result
Five articles were eligible for inclusion from 2010 to November 2019. The mean age of the population in the remission group was younger (40.24 years) than the non-remission groups (p &lt; 0.02). Statistically, a significant difference (p &lt; 0.08) was also found with mean HbA1c in the remission group (7.78%) than the non-remission group (8.96%). Mean BMI and duration of DM were different in two groups, but statistical significance was not observed.

Conclusion
ABCD (Age, BMI, C-peptide and duration of type 2 DM) score has been widely used over the years for defining remission in type 2 DM following bariatric surgery. The current analysis statistically identified advanced age and HbA1c levels as an influential factor for non-remission. Though the difference in BMI and duration of DM noticed in two groups, it was not statistically significant. Our analysis is in agreement and the continuation of the review by Wang et al. (2015). He concluded that younger age group, shorter duration of type 2 DM and adequate glycemic control were responsible for remission after bariatric surgery.