bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP1.1.13Assessing quantitative FIT within the colorectal two-week wait pathway as a triage tool to focus endoscopy services
Authors: Gendia A , Rottenburg H , Tam A , Faux W 
Published: October 2021

Abstract

Aims
Quantitative Faecal Immunochemical test (qFIT) is highly specific for luminal colonic pathology. This study models the potential impact on health care services of its introduction as a tool of triage for the 2-week wait referrals pathway. The Model utilises the recently published NICEFIT tudy.

Methods
All symptoms and results for patients within the colorectal two-week wait pathway are prospectively collated into a relational database. We modelled the impact of introducing targeted FIT testing to those patients without anaemia, rectal mass or overt rectal bleeding. Based on the recent NICEFIT Study, we set a population positivity value of 37% at 2µg/g with sensitivity of identifying colorectal cancer of 97%.

Results
4240 patients were referred in 12 months up to till July 2019. 1333 referrals met the modelled criteria. These 1333 patient events generated 1619 investigations in 1227 patients. Malignancy was found in 4.3% of the investigated referrals (2.8% colorectal, 1.5% extracolonic). By applying FIT to the selected demographics with a positive value of 37%, the number of colonoscopies would fall by 63% (from 815 to 303) with estimated cost saving of £192,000. The FIT negative group would be investigated by selective cross-sectional imaging, with selected use of endoscopy as needed.

Conclusion
The high sensitivity of FIT permits its application as a screening tool in selected symptomatic patients. This can reduce the number of colonoscopies performed by almost 63% within a defined patient group. This would reduce the waiting time for positive high-risk patients as well as cutting overall costs.
SP1.2.1The use of first-line CT scan in the Suspected Colorectal Cancer Pathway at a District General Hospital during the COVID-19 Pandemic
Authors: Connolly Thomas , Nicoll Jennifer , Hall Claire 
Published: October 2021

Abstract

Aim
During the initial phase of the COVID-19 pandemic the British Society of Gastroenterology and Joint Advisory Group on GI Endoscopy published guidance to halt all non-emergency endoscopy. CT was used as the first-line investigation with delayed completion endoscopy. We reviewed the efficacy of this change to determine its influence on future practice.

Methods
All patients referred via the suspected colorectal cancer pathway (SCCP) to our district general hospital from 15/04/20-15/05/20 (initial COVID-19 lockdown) were included. Retrospective analysis of patient records was performed. Results were analysed using χ² statistic. Significant incidental pathology (SIP) was defined as non-colorectal pathology requiring referral to different speciality or further imaging.

Results
There were 115 patients for analysis, mean age 68 years. 2/115 (1.7%) demonstrated a colorectal malignancy on CT, with no further diagnoses at completion colonoscopy. CT imaging detected SIP in 31/115 (27%). This included 8/42 (19%) who would have otherwise been referred direct to endoscopy alone based on symptoms and fitness.
Subgroup analysis by presenting complaint showed SIP was most likely to be detected in those presenting with weight loss (13/36, 36.1%, p = 0.049) or anaemia (12/31, 38.7% p = 0.084).

Conclusions
CT is a valuable first-line investigation in SCCP patients. In this cohort, no colorectal malignancies were missed on CT that were later detected at endoscopy and 27% detected SIP. Weight loss demonstrated a statistically significant correlation with incidental pathology. These findings suggest CT as a possible first-line investigation in patients presenting with weight loss, anaemia or where there is delayed access to endoscopy.
SP1.2.4A Single Centre experience in Robot-assisted Colorectal Surgery: First 70 cases
Authors: Rea William , Singh Sandeep , Nai Shaun , Kukreja Neil , Wegstapel Hendrik 
Published: October 2021

Abstract

Aim
To analyse the short-term outcome of robot-assisted colorectal surgery (RACS) in a single centre.

Methods
All the patients who underwent RACS using the DaVinci Xi platform between June 2018 and December 2020 were included in our study. RACS was performed by two consultant team. Data was collected from a prospectively maintained database.

Results
Over the 31-month study period, 70 RACS were performed with no 30-day mortality. Male to female ratio was 4:3, with mean age was 66 years (SD 12). The mean body mass index was 28.7 (SD 5.1). Pre-operative American society of anaethesiology (ASA) score was reported as 1-2 in 65% of patients and 35% as 3.
Indication for surgery was malignancy in 89% (62/70) of patients and the remainder benign pathology. Type of surgery performed was high anterior resection (AR) in 39% (27/70) patients, low AR 33% (23/70), right hemicolectomies 21% (15/70), Hartmann’s procedure 3% (2/70), abdominoperineal resections 3% (2/70), and left hemicolectomy 1% (1/70).
The mean operating time was 295 minutes (SD 92), with only 1 reported case of conversion to open. Complete resection (R0) was achieved in 95% (59/62) of malignant resections. The mean lymph nodes harvested were 19 (range 7-36).
Post-operative complications occurred in 23% (16/70) of patients, including 6% (4/66) anastomotic leaks. The mean length of stay was 8 days (range 1-53), with readmission rate of 14% (10/70).

Conclusion
The robotic minimally invasive technique can be safely introduced for major colorectal resections without excessive morbidity.
SP1.2.5Robot-assisted Colorectal Surgery: Short-term Outcome of First 70 cases at Different Time-intervals along the Learning Curve
Authors: Singh Sandeep , Rea William , Nai Shaun , Sollei Tamas , Kukreja Neil , Wegstapel Hendrik 
Published: October 2021

Abstract

Aim
To analyse the evolution of robot-assisted colorectal surgery (RACS).

Methods
All the patients who underwent RACS between June 2018 and December 2020 were selected. Study period was divided into 3 intervals along the learning curve; group A represents the 1st 10 months, group B 2nd 10 and group C last 11.

Results
Over the 31-month study period, 70 RACS were performed. Male to female ratio was 4:3, with mean age of 66 years and BMI 28.7. ASA score was reported as 1-2 in 65% patients and 35% as 3.
Indication was malignancy for 89% patients and the remainder benign pathology. High or low anterior resection performed were 72%, right hemicolectomies 21%, Hartmann’s 3%, abdominoperineal resections 3%, and left hemicolectomy 1%.
RACS performed in group A was 20 compared to 19 in B and 31 C. Type of RACS performed, BMI, ASA, complications, anastomotic leaks, R0 resections and harvested lymph nodes were unrelated to selected time-intervals along learning curve. Mean total duration of procedure dropped down to 247 minutes in group C from 375 in group A (p = &lt;0.001). No significant difference in mean length of stay and readmission rate was observed in 3 groups (p = 0.7, p = 0.59).

Conclusion
The study demonstrates that introduction of this new surgical technique is safe even in the early phase of adoption with no significant difference in pre-and post-operative morbidities. Significant difference in time taken for surgery was observed with reduction of 88 minutes in average operating time between the start and end of the study.
SP2.1.9Augmented terminal feedback influences cognitive ability of surgical trainees: a randomised controlled trial
Authors: Riaz Mohammad , HO Rachel Phing , Tang Benjie , Alijani Afshin 
Published: October 2021

Abstract

Introduction
Formative assessments in the form of Global assessment (GAS) and procedural based assessment (PBA) are the current methods used for feedback in British laparoscopic surgical training. Video error signature feedback (VESF) has been proposed as an alternative approach to enhance motor skills in laparoscopic training through influencing cognitive approach.

Methods
Twenty laparoscopic novice students were randomised into Current standard feedback (CSF) and VESF groups. Both groups tied laparoscopic double square knots in four sequential stages. Standard human reliability assessment method (HRA) was utilised to assess unedited video recordings for errors. A validated scoring system by expert trainers assessed proficiency gain. Similar assessment was performed for both groups. Unedited video recordings of the VESF group were annotated for errors at each stage and provided as feedback through video hosting website. CSF group received assessment sheet as their feedback, comparable to current practice. Error numbers, time execution and proficiency gain were the outcomes. Inter-rater reliability among trainers for error detection was established.

Results
A total of 6490 movements were studied with 1613 errors detected. VESF group committed significantly less errors as compared to the CSF group [1011/1613 (63%) vs 602/1613 (37%), p &lt; 0.01]. VESF group gained proficiency earlier. Time execution was similar. Inter-rater reliability for error detection was high (p = 0.96).

Discussion
VESF effects cognitive framework of a laparoscopic task in trainee’s mind, ultimately reducing errors. This work demonstrated the practical application of video error signature feedback by demonstrating a simple laparoscopic task and analysing its learning process through novice brains.
SP2.2.4National multi centre cohort study of transferable skills acquired among redeployed core surgical trainees to intensive care units during the COVID-19 pandemic
Authors: Vyrides Yiannis , Golpe Antonio Leyte , Shirazi Shahram , Bogdanova Anna , Daum Peter , Wan Andrew 
Published: October 2021

Abstract

Aim
Due to the COVID-19 pandemic a large number of core surgical trainees have been redeployed to intensive care units across the country. This study analyses the procurement of transferable skills by trainees mapped to the ISCP curriculum among a large national cohort.

Methods
An anonymous questionnaire mapped to common areas in the ISCP syllabus, including basic sciences, post-operative care, critical care and management of the dying patient, was administered to a nationwide group of core surgical trainees redeployed to ITU. The results were compared with responses from a cohort of trainees that were not redeployed. Subgroup analysis was also performed on the redeployed cohort to compare skills before and after redeployment.

Result
A total of 72 complete responses from among 3 deaneries nationwide were received, 39 who were redeployed, and 33 who were not. Mean age (24.5 vs 24.9 years) and time post-graduation (37.5 vs 38.2 months) were similar in each group. The average length of redeployment was 12 ±0.157 weeks. The mean score in those not redeployed was 1.85 ±0.167, compared to 4.02±0.175 in the redeployed cohort (p &lt; 0.05). Among those redeployed, scores prior to redeployment were significantly lower 1.89 ±0.122 (p &lt; 0.05).

Conclusion
This study demonstrates that even a brief period of intensive care experience significantly increases knowledge of key aspects of the ISCP curriculum. It is the authors’ opinion that a module of intensive care experience during core surgical training should be considered. Our cohort will be followed to assess performance in postgraduate examinations.
SP2.2.9Using high fidelity simulation to improve hospital-based medical student education
Authors: Huttman Marc , Koo Hui Fen , Boardman Charlotte , Saunders Michael 
Published: October 2021

Abstract

Introduction
The evidence shows that experiential learning has multiple benefits in preparing medical students for foundation training. An immersive ‘on call simulation’ session was designed for final-year medical students at a district general hospital. The aim of this project was to assess how beneficial the sessions were and how they can be improved.

Methods
Pairs of students received 12 bleeps over 2 hours directing them to wards where mock patient folders were placed. Students prioritised bleeps involving deteriorating patients, chasing results and dealing with nursing queries. Simulated senior input was available from the session facilitator. A structured debrief session allowed discussion of each case. Quantitative feedback was gathered using a sliding scale (measured in percentage) for confidence before and after the session. Qualitative feedback was gathered using a free-text box.

Results
Four sessions were held between October 2020 and January 2021 for a total of 28 students, of which 26 provided feedback. Average confidence increased from 38% to 66%. 96% of students were ‘extremely satisfied’ with the session. Feedback included: “Incredibly immersive and fun” and “I was made to think through my priorities and decisions”. Improvements could be made by using actors/mannequins to simulate unwell patients and by use of skills models.

Conclusion
High fidelity simulation training is valuable and should be considered a standard part of the student curriculum. It is particularly suited to final year students who have the required clinical knowledge for foundation training but are still developing confidence in clinical decision making and prioritisation.
SP2.2.14Evaluating the benefits of increasing exposure to the operating theatre for Foundation Year One Trainees in General Surgery
Authors: Fardanesh Armin , Boardman Charlotte , Al-Whouhayb Maitham , Mathur Pawan , Klein Martin 
Published: October 2021

Abstract

Aims
Many foundation year one (FY1) doctors report little exposure to the operating theatre. Surgical departments welcome FY1s in theatres, but ward duties often prevent them from achieving direct exposure to operations. Following the implementation of specific days on the timetable dedicated to attending the operating theatre, this project aimed to reflect on the impact on FY1 training in General Surgery.

Methods
Structured interviews were held with the 9 FY1 doctors who were 2 months into their rotation in General Surgical block.

Results
All FY1s believed that assisting in operations added to their experience of the specialty. They reported increased understanding of the procedures and recovery pathways for their patients, which improved their ability to manage these patients peri-operatively.
As expected, seven FY1s confirmed that they did not have the opportunity on non-allocated days to attend theatre due to “being busy on the ward” and not wanting to “give the others more work”. Two FY1s who intend on pursuing a career in surgery described additional benefits including the opportunity to gain practical skills and build a surgical logbook.

Conclusion
One of the main barriers for FY1s wanting to attend theatre sessions is an excessive ward workload. By allocating theatre days on the rota this challenge was overcome and the benefits of attending theatre are evident. Regular exposure to the operating theatre improves foundation training in General Surgery by increasing understanding and confidence in managing surgical patients and assisting prospective surgical applicants with early, supervised surgical skills practice.
SP2.2.18UK Surgical Training in the Independent Sector During COVID-19 – A Snapshot Survey
Authors: Kolaityte Valdone , El-Sayed Charlotte , Burke Josh 
Published: October 2021

Abstract

Aims
In response to the COVID-19 pandemic and the cancellation of elective surgery, the Independent sector (IS) has been utilised to provide COVID-light sites. On average operative log book numbers have been reduced by 50% due to a reduction in operative exposure. The Four Educational Bodies continue to support training within the independent sector. This study aimed to qualitatively assess access and barriers to UK surgical training in the Independent Sector.

Methods
A snap-shot online survey was distributed to ASIT members of all training specialities and grades between 21/10/2020-11/11/2020 . Data measures included participant demographics, frequency of access, participation in training opportunities including outpatient clinic, theatre lists and endoscopy and any barriers encountered. A mixture of Likert scale and short answer questions were utilised.

Results
249 complete responses representing all grades and specialities were included in the final analysis (34.29% CST and 56.3% HST). 35.7% of trainees reported access to the IS. 22.9% had access to at least one operating list whilst 70.3% had none. Access to outpatient clinics and endoscopy was negligible. 75% of trainees ‘strongly agreed’ that when access was achievable, it was beneficial to their training. Multiple barriers were identified including Human Resource requirements and local service provision.

Conclusions
Within the sample, access to the IS has been poor. There is wide variation in barriers to access across the 4 nations and IS providers. Trainees and Trainers should maximise training opportunities in the IS. Where barriers exist, they should be reported to local Training Programme Directors.
SP3.1.14 NELA; what happens after discharge?
Authors: Mohamed Sarah A , Silva L , Strong P , Dietrich A , Cornish J 
Published: October 2021

Abstract

Aims
NELA has been instrumental at improving perioperative care and 30–day mortality following emergency laparotomy (EmLap); long-term outcomes and follow-up are less well reported. This study aims to establish the unscheduled and scheduled service use of EmLap patients after discharge.

Methods
This is a single-centre service evaluation. Patients were included if they had an EmLap recorded from 2016-2019 at our local institute and were alive on discharge. Outcomes were 30-day readmission rate and outpatient follow-up.

Results
944 patients were included. 11.9% re-presented to the surgical department within 30-days; 58.0% of these needed readmissions. The most common causes for re-presentation (n = 112) were management of a wound issue (15.2%), ongoing pain without evidence of complication (10.7%) and ongoing intra-abdominal sepsis (9.8%).
1-year survival was 81.4%. Of these (n = 856); 74.3% were invited to outpatients; DNA rate was 8.8%, with only 67.8% of patients having a follow-up review. Median time to follow up was 9 weeks. Patients were more likely to be invited for outpatient review if they had a new stoma (OR 2.56, 95% CI 1.81 – 3.56), and less likely if adhesiolysis was the primary procedure (OR 0.55, 95% 0.39-0.76).
Patients who failed to attend an appointment were significantly younger (median age 53 vs. 60 years, p = 0.0033) and from more deprived areas (average WIMD 673.6 vs 977.3, p = 0.002).

Conclusion
This study demonstrates higher levels of unscheduled care and lower levels of scheduled care than expected. Care standards should be extended beyond the 30-day milestone to fully appreciate the morbidity associated from EmLap.
SP3.2.2 Closed Incision Negative Pressure Wound Therapy reduces Surgical Site Infection following Emergency Laparotomy: A Propensity Matched, NELA Registry Study
Authors: Hawthornthwaite Emma , Cheong-Chung Jordan Ng- , Watkinson Tom , Blyth Ursula , Harji Deena , Griffiths Ben 
Published: October 2021

Abstract

Aims
Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in people undergoing emergency surgery. Prophylactic closed incision negative pressure therapy (CINPT) has been shown to reduce SSI rates in patients undergoing elective laparotomy however there is limited evidence for their use in the emergency setting. This study aimed to determine whether prophylactic CINPT provides comparable SSI rate to SSD for midline incision following emergency laparotomy.

Methods
A registry-based, prospective cohort study was undertaken using data from National Emergency Laparotomy Audit (NELA) database at our centre. The primary outcome measure was SSI as defined by the Centers for Disease Control (CDC) criteria. Secondary outcomes included 30 day post-operative morbidity and grade using Clavien-Dindo (CD) classification and the Comprehensive Complication Index, length of stay, 30 day mortality and readmission rates. CINPT and standard surgical dressing group were compared with respect to peri-operative characteristics and post-operative outcomes. A propensity- score matching (PSM) was performed to mitigate for selection bias.

Results
A total of 1484 patients were identified. Following PSM, a matched cohort of 474 patients were identified with 237 patients in each arm. SSI rate in CINPT cohort was found to be significantly lower compared to the SSD cohort (16.9% vs. 33.8%, p &lt; 0.001). The rate of superficial and deep infections were higher in the standard dressing arm compared to the CINPWT, p &lt; 0.001. There were no overall differences in 30-day morbidity and grade of post-operative complications.

Conclusion
Prophylactic CINPT in the emergency laparotomy is associated with reduced SSI rates.
SP4.1.2 Appendicitis during the COVID pandemic – Are we seeing more complicated presentations?
Authors: Wadham Bianca , Connolly Tom , Beer Phoebe , Ainsworth Paul 
Published: October 2021

Abstract

Aims
Studies have suggested a decrease in emergency presentations of appendicitis during the COVID-pandemic along with a nationwide fall in non-COVID related presentations to A&E. We therefore hypothesised that those treated for appendicitis had later presentations resulting in increasing incidence of ‘complicated appendicitis’ and post-operative complications.

Methods
We retrospectively analysed all patients ≥16years, undergoing emergency appendicectomy during 3-month period of UK national lockdown (pandemic cohort). Data was compared to the same period one year previously (pre-pandemic cohort). Primary endpoint was nature of appendicitis (uncomplicated or complicated). Secondary endpoints were operative approach, LOS and post-operative complications. Statistical analysis was performed using Fisher’s Exact Test.

Results
A total of 31 patients (median age 35years) underwent emergency appendicectomy in the pre-pandemic cohort and 30 patients in the pandemic group (median age 37). 9/31 (29%) and 18/30 (60%) were found to have complicated appendicitis in each group respectively (p = 0.021). Open procedures took place in 2/31 pre-pandemic, and 12/29 (4 of which were converted from laparoscopic procedures) in the pandemic cohort (p = 0.002). Median LOS was 2 in each group, though the pandemic cohort had a much wider range (0-7 vs 0-25 days). Post-operative complications occurred in 1/31 and 5/30 patients respectively (p = 0.104) with 1 mortality within 30 days.

Conclusions
Despite overall volume and demographics of patients remaining the same, the COVID-19 pandemic has resulted in a statistically significant increase in complicated presentations of appendicitis to our hospital. Subsequently this has resulted in increasing incidence of open operations and post-operative complications.