bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.1063Independent Risk Factors influencing healing times in pilonidal sinus excision surgery
Authors: Bhome-Dhaliwal Shona , James Rhodri , Arun Chokkalingam 
Published: October 2021

Abstract

Aims
Pilonidal Sinus excision surgery is commonly accompanied by a complex healing process. This study assesses the risk factors associated with poor wound healing from pilonidal excision surgery, and which patient demographics would benefit from assisted healing interventions, such as vacuum assisted closure, to enhance recovery times in a cost effective manner.

Methods
OMIS Theatre databases were used to identify primary pilonidal sinus excision procedures between January 2016 and January 2018 with a 32-patient cohort. Clinical workstation highlighted the time of wound healing based on date of clinic discharge. Risk factors for poor healing including smoking status, BMI, Diabetes, Vascular disease, gender, immunocompromised status, Chronic Renal impairment and ASA classification were identified.

Results
Of the 32: 16% have not healed at present and require further surgical intervention and 10% had not been followed up. The median duration for wounds healed was 105.5 days. The risk factors highlighted for complicated wound healing was gender, smoking status and diabetes. Median time for current smokers (30%) was 187 as opposed to 96.5 within the non-smoking population. Males (65%) had a longer healing time of 111 in comparison with females (75 days). Diabetic patients (9%) had a median time of 196.5 in comparison with non-diabetes patients with 96 days.

Conclusion
The highest risk factors for a prolonged healing process are the male gender, presence of diabetes and current smoking status. Therefore consideration of assisted healing interventions should be taken for patients with these demographics, implementing a cost effective approach to complex wound healing procedures.
Moy.01HOXB9: an emerging novel prognostic marker and potential target for gene-therapy in colorectal liver metastases
Authors: Martinou Eirini , Moller-Levet Carla , Angelidi Angeliki , Bagwan Izhar , Karanjia Nariman 
Published: October 2021

Abstract

Aims
Homeobox (HOX) proteins are emerging as promising biomarkers and targets for gene-therapy in cancer; however, their role in colorectal liver metastases (CRLM) is unknown. This study aims to investigate the role of HOXB9 as prognostic marker and potential therapeutic target in CRLM.

Methods
Two patient-cohorts were included: a) Patients with colorectal cancer (CRC) from the National Cancer Institute, Tissue Cancer Genome Atlas (TCGA) database (n = 614) and b) Institutional patient cohort who underwent liver resection for CRLM (n = 110) between 2007-2014. Primary outcome was 10-year overall survival (OS). COX regression and Kaplan-Meier survival analyses were performed including HOXB9 expression, demographics, clinicopathological and treatment-related variables. HOXB9 gene expression was modulated to assess its impact on CRC cell growth in vitro. Therefore, we conducted experimental studies using plasmid-vector and siRNA-interference to overexpress and knockdown HOXB9 respectively.

Results
Univariable TCGA analysis showed that HOXB9 did not predispose to poor OS (HR = 1, 95%CI:0.92-1.1, p = 0.620). On the contrary, univariable analysis in the CRLM patient cohort showed that high HOXB9 levels, right sided CRC, CRLM number≥4, CRLM diameter≥5cm, and intrahepatic recurrence were associated with significantly increased risk for worse OS. On multivariable models, only high HOXB9 expression (HR = 3.82, 95%CI:1.59-9.2, p = 0.003) and intrahepatic recurrence (HR = 4.28, 95%CI:1.88-9.72, p = 0.001) retained significance as independent prognostic factors after liver resection. Experimental studies showed that HOXB9 overexpression increased cell proliferation (p &lt; 0.001) whereas HOXB9 inhibition markedly supressed CRC cell growth (p &lt; 0.001) in vitro.

Conclusions
HOXB9 demonstrates oncogenic properties and may serve as novel prognostic marker and potential target for gene-directed therapy in CRC/CRLM.
BJS.04PreciSSIon: A collaborative initiative to reduce incidence of SSI after elective colorectal surgery
Authors: Clayphan Benjamin , Biggs Sarah , Dixon Lauren , Jordan Lesley , Dalton Stephen , Pullyblank Anne 
Published: October 2021

Abstract

Aims
Surgical Site Infection (SSI) is common after colorectal surgery where rates are reported as high as 30%. The aim of this project was to assess whether a collaborative approach to implement a 4-point care bundle could reduce SSI rates across a group of hospitals.

Methods
PreciSSIon is a Quality Improvement Project (QIP) involving 7 NHS hospitals, with a design based on the Institute for Healthcare Improvement’s Breakthrough Series collaborative model. The Public Health England SSI surveillance questionnaire was used to measure patient-reported SSI at 30 days post-op. An evidence based bundle of care was introduced including: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; and a second dose of antibiotics after 4 hours.

Results
All hospitals had implemented the care bundle by February 2020. By December 2020 6/7 hospitals had reduced SSI. Mean patient questionnaire response rate = 84.8%. Mean compliance with each of the above bundle components are as follows: 91%; 72%; 85%; and 92% respectively.

Conclusions
Implementing an evidence based care bundle, using a collaborative approach to QIP, was effective in reducing the rates of patient-reported SSI following colorectal surgery. The success of this project in the West of England suggests that similar methodology could be used to improve patient outcomes in other regions.
EP.TU.2Standards in Operation notes
Authors: Alfred Joshua , McClean Simon , Nita George , McNicol Frances , Ugur Suha 
Published: October 2021

Abstract

Guidelines exist for operation notes from the Royal College of Surgeons of England but compliance has been shown to be variable.

Aim
The authors performed an audit of compliance with RCS standards in a colorectal department.

Methods
Thirty random operation notes were selected from a conserved pool. Their compliance was recorded against RCS good surgical practise record keeping and also looked particularly at fistula surgery and there documentation.

Result
Compliance was found to be poor and recommendations were put in place and the following was re audited.

Conclusion
As some specialities are developing operation note standards specific to individual procedures, the findings are compared with previous similar published work.
EP.TU.4Performance at Medical School predicts success in the Intercollegiate Membership of the Royal College of Surgery (MRCS) examination
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter 
Published: October 2021

Abstract

Aims
Identifying predictors of success in post-graduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance at medical school as quantified by the Educational Performance Measurement (EPM) and scores from the Situational Judgement Test (SJT) used for selection into Foundation Training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination.

Methods
We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first-attempt. Logistic regression identified independent predictors of MRCS success.

Results
For every additional EPM decile point gained the chances of passing MRCS at first attempt increased by 52% for Part A (odds ratio 1.52 [95% confidence interval (CI) 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). For every point awarded for additional degrees in the EPM, candidates were 29% more likely to pass MRCS Part A first time (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS Part A or Part B success after adjusting for sociodemographic factors (P = 0.182 and P = 0.125 respectively).

Conclusions
This, the first study to investigate the relationship between medical school and success at a high stakes UK postgraduate surgical examination found that medical school performance deciles are the most significant measure of predicting later success in the MRCS.
EP.TU.7A cross-sectional study examining the association between MRCS performance and surgeons receiving Fitness to Practice sanctions
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter 
Published: October 2021

Abstract

Aims
Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons.

Methods
FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis.

Results
Of 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no considerable differences between MRCS performance identified.

Conclusion
In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
EP.TU.40Tendon Repair Training: An Alternative Approach
Authors: Moori Parisa , Rahman Shafiq 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic has seen reduced training opportunities for surgical trainees. Tendon repair is an important surgical skill for all core surgical trainees. It is particularly essential for those training within Plastic and Orthopaedic surgery. Tendon repair simulation often involves the use of expensive materials or animal tissues, posing ethical predicament. Here we aimed to devise a simple and reproducible method for tendon repair simulation.

Methods
Our tendon simulation model is an inexpensive and easily set up arrangement consisting of edible strawberry laces.

Results
The tendon simulator gives reasonable replication of a tendon, with the laces depicting an inner and outer core of a severed tendon. In addition the materials are easy to acquire, handle, dispose of and are free from ethical limitations.

Conclusions
Surgical trainees will be able to practice varying tendon repair techniques on this model, applying basic surgical principles such as instrument and tissue handling and develop their expertise.
EP.TU.44Improving Access to Surgery: The F1 ‘Theatre Day’ Programme
Authors: Nunn Rebecca , Jeyarajah Santhini 
Published: October 2021

Abstract

Aims
To identify barriers in theatre attendance, facilitate access and maximise learning opportunities for surgical F1s (Foundation Year 1 Doctors) at a DGH (District General Hospital).

Methods
Between December 2019- December 2020, each F1 doctor was offered a day to spend in elective theatre during their General Surgery rotation (excluding emergency COVID rota periods). This was following feedback from the August- December 2019 cohort. Each ‘Theatre Day’ was scheduled during normal working hours when there was sufficient staff. Post-participation questionnaires were completed.

Results
Prior to implementation of the Programme, 3/8 F1s surveyed had not attended any elective surgery lists (1 had not attended theatre at all). All indicated that they would have been interested in attending a timetabled elective theatre day; 88% highlighted a ‘lack of staff’ and 63% indicated that ‘feeling guilty’ were barriers in attending theatre.
21 F1s were offered a ‘Theatre Day’: 17 agreed to participate and 16 completed post-participation questionnaires. Only 47% confirmed that they were considering a career in surgery prior to participation: all agreed that spending time in theatre was a useful learning opportunity and 94% agreed that the Programme should be continued.

Conclusions
Spending time in theatre appears to be valued as a useful learning opportunity for F1s, whether or not they are aspiring surgeons. Common barriers to self-organised theatre attendance appear to be an anticipated ‘lack of staff’ or feelings of ‘guilt’. A senior-led scheduling of one day in theatre should circumnavigate these barriers and ensure that access is available to all.
EP.TU.70The Conservative Management of Perforated Diverticulitis Based on Abscess Size and Presence of Distant Air
Authors: Isswiasi Sanad , El-Zahab Sarah , Drye Elisabeth 
Published: October 2021

Abstract

Aims
To determine the effectiveness of conservative management in perforated diverticulitis (PD) in a single District Hospital based on the size of the abscess and the presence of distant air (DA).

Methods
Data on 112 Patients who were admitted between 2013-2018 with PD was collected retrospectively. CT scan reports were used to document the size of abscess and presence of DA. Failed conservative management with antibiotics (ABx) was defined as the need for another therapeutic option after 48 hours of admission or readmission within 90 days.

Results
Overall, 40 patients (36%) needed operative management, 12 patients (11%) required washout, 6 patients (5%) underwent radiological drainage and 8 patients (7%) were offered best supportive care. In total, 46 patients (41%) were successfully managed with ABx only. ABx were tried on 45 patients who had &lt;4cm abscess and no DA. This was successful in 30 of them (66%). However, 6 out of 17 patients (35%) with &gt;4cm abscess and no DA were treated with ABx only. Despite presence of DA, 8 out of 17 (47%) cases with &lt;4cm abscess were successfully treated with Abx only. Only 2 patients out of 19 (10%) with &gt;4cm and DA were successfully treated with ABx only.

Conclusion
Abscess size and presence of DA in PD should be considered in predicting the outcome of the management. Even in presence of DA, nearly half of patients with small abscesses (&lt;4cm) diverticular abscesses were successfully managed conservatively. The majority of patients with larger abscesses with DA failed ABx treatment.
EP.TU.79Assessed and Discharged - An Audit of Discharge Summaries Completion During On-Calls
Authors: Ma Jennifer , Oyewole Bankole , Belgaumkar Ajay 
Published: October 2021

Abstract

Aim
Effective health care provision is heavily dependent on timely, reliable transfer of patient information. Failure of this communication between professionals could result in redundancy of tests, delay in treatment, which may in turn endanger patient safety. The NHS Standard Contract requirements state discharge summaries should be completed within 24 hours of hospital assessment and discharge. Discharge summaries for patients who were reviewed but not admitted have been observed to be poorly completed during on-calls and this audit aims to clarify this.

Method
On-Call Patient Lists between 1 December to 14 December 2020 were studied retrospectively. Patients who were assessed by the on-call surgical team but not admitted were included in the audit. Patients referred to other specialties were excluded. Hospital electronic system was reviewed for electronic records from the encounter including clinical note or discharge summary.

Results
In total, 47 patients were identified during the 2 week- period. 40/47 patients were referred from AE and 9 of these patients were discharged from AE directly. 3 of the patients had a clinical note or discharge summary completed on the hospital electronic system.
Overall, 18 of the 47 (38.3%) patients had a clinical note or discharge summary on the electronic system, with 6 (12.8%) of them being recorded as discharge summaries.

Conclusion
The overall completion of discharge summaries for this group of patients was poor. Awareness of this failing and the importance of professional communication should be highlighted with the juniors during surgical meeting to improve compliance.
EP.TU.156Frailty in the Emergency General Surgical Cohort, could we being doing more?
Authors: Hunter Ross 
Published: October 2021

Abstract

Aims
Frailty, a state of diminished diminished physiological capacity to deal with external stimuli, is being seen ever increasingly in the aging emergency general surgical cohort. Length of hospital stay, morbidity and mortality are shown in the literature to dramatically increase in the frail population. Outcomes in this cohort are shown to improve significantly with specialist frailty input from geriatricians, physiotherapy and occupational therapy teams. The authors aimed to assess the burden of frailty in emergency surgical admissions in a District General Hospital, and the frailty specialist care these patients received.

Methods
A snapshot survey of all acute surgical admissions during a single 24 hour period was performed. Frailty was defined as a Rockwood Clinical Frailty Scale score of 5 or above. The management of these patients was then compared to national standards and recommendations made on how the treatment of the clinically frail could be improved upon.

Results
73% of patients in the sampled cohort (19/26) were found to be clinically frail. Only 2 (10%) of these patients had been reviewed by the frailty specialist teams within the hospital. Following implementation of recommendations, namely an improved referral system, reminders within initial clerking paperwork and raising departmental awareness, specialist input was shown to increase threefold to 32% (10/31) within the same patient group.

Conclusions
A significant cohort of emergency general surgical patients are classified as clinically frail. Optimal care for these patients involves a multidisciplinary approach, the uptake of which can be increased significantly with intra-departmental education and increased awareness.
EP.TU.184A story of a successful hunt for long-lost needles
Authors: Ibrahim Ban , Chowdhury Sabyasachi , Dordea Matei 
Published: October 2021

Abstract

Introduction
There are various case reports of intraluminal foreign body following a clear history of ingestion commonly presenting in paediatrics or in patients with a psychiatric background.

Case presentation
We present a rare cause of unusual foreign bodies evident within the abdomen, radiologically. There was no history of ingestion nor insertion.
70-year-old male has been suffering from chronic abdominal pain, presented to the emergency department with acute lower abdominal pain. He had previous splenectomy with distal pancreatectomy 23 years ago and laparotomy (adhesiolysis) 5 years back. He sought medical opinion on several occasions whereby, based on his intricate surgical history, adhesions were a possible culprit. This admission with acute pain warranted a thorough review of past history and a closer radiological investigation. These showed historical presence of sewing needles for 3 years.

Conclusion
Foreign body can manifest as acute reactions with inflammatory response, however if not removed can cause scarring and chronic pain as seen in this case. Although evident in radiological images over period of pain recurrence, this was not identified as a cause. We emphasize the need for direct communication between surgical and radiological teams in an unusual case scenario like these, to prevent incidence of symptoms from foreign bodies.
EP.TU.260Retained appendiceal tip and abdominal wall appendicolith - a rare combination of post appendicectomy complications
Authors: Dey Abhishek , Symons Nicholas 
Published: October 2021

Abstract
Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately.
An 29 year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis.
On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed.
The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief.
This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.
EP.TU.270Improving Treatment Escalation Plan (TEP) Completion Rate for General Surgical Patients
Authors: Yii Eric Yuen Ing , Bradley Alison 
Published: October 2021

Abstract

Aims
Treatment Escalation Plan (TEP) is essential for recognition of patients’ ceiling for care in the event of clinical deterioration. It should be clearly documented to ensure continuity of care, especially during Covid-19 pandemic. This audit aims to evaluate and improve the TEP filling rate for general surgical patients.

Methods
A prospective data collection was performed for one week in July 2020 in general surgical wards. Data on patients’ gender, age, presence of DNACPR form and date of TEP completion were collected from patients’ clinical notes. Data was analysed using SPSS statistic software. Educational posters were displayed in the ward and presentation was done to emphasise the importance of TEP documentation. Second audit cycle was done in August 2020 to assess for improvement in TEP filling rate.

Results
In the first cycle, 60 patients were included with a mean age of 60. Only 11.7% patients had TEP form filled in with a mean delay of 2.7 days since admission. In the second cycle, 57 patients were included with a mean age of 66. 28.1% patients had TEP form documented with a mean delay of 1.7 days. This has shown a 140% improvement in completion rate of TEP form and 59% reduction in the delay in TEP documentation.

Conclusions
TEP is essential to ensure that patients received optimal care when their condition deteriorate. Simple intervention such as educational posters will help to improve the TEP completion rate. However, continuous auditing is required to ensure improvement in TEP documentation for surgical patients.