bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.93An Overview of the Effect of COVID-19 on the General Surgical Take: Before, During and After the First UK National Lockdown
Authors: Heard Rachel , Kopczynska Maja , Woyton Michal , Allen Elizabeth , Garcia Madeline , Pearce Lyndsay 
Published: October 2021

Abstract

Aims
Emergency general surgical (EGS) services have faced new challenges during the coronavirus pandemic. This study compared all EGS presentations before, during and after the first UK national lockdown between March and May 2020.

Methods
All EGS patients presenting to our centre in four separate weeks were included. These weeks represented ‘pre-lockdown’, ‘early lockdown’, ‘established lockdown’ and ‘post lockdown’ groups. Demographic data, treatment, admission and outcomes were collected for all patients and compared between groups.

Results
178 patients accounted for 214 EGS attendances over four weeks. Attendances decreased from 74 pre-lockdown, to 43 in early lockdown, 32 in late lockdown and rose to 65 in the post lockdown group. Significantly more patients received repeat outpatient reviews in the lockdown groups (p = 0.002). Length of stay was significantly reduced in established lockdown (0.5 days vs. 2 days pre-lockdown, p = 0.042). There was a trend towards conservative management of surgical pathology in the lockdown groups (65% vs 47% pre and post-lockdown, p = 0.10). No very elderly or frail EGS patients presented during the lockdown study period. There was no evidence of delay to presentation.

Conclusions
The COVID-19 pandemic and UK Coronavirus lockdown resulted in a large decrease in EGS admissions and alteration in characteristics of these admissions. New national guidance during the pandemic advocated ambulatory and conservative management of surgical conditions where possible and is reflected in our cohort. These changes reverted almost back to pre-lockdown state the week following the easing of the first UK national lockdown.
EP.WE.118Evaluating outcomes of a WhatsApp teaching platform for doctors: Implications for adopting innovative strategies in medical education during the COVID-19 pandemic[H1] [H1]Should this be a shorter, more targeted title?
Authors: Oyewole Bankole , Animasahun Victor , Chapman Helena 
Published: October 2021

Abstract

Aim
The coronavirus disease 2019 (COVID-19) pandemic has affected an estimated 1.6 billion learners around the world (UN, 2020) and has led to the rapid restructuring of the global education sector due to lockdown restrictions to curb community transmission.
The objective of this study is to examine the effectiveness and sustainability of WhatsApp as a platform to deliver medical education and its implication for the implementation of social media for medical education during the COVID-19 pandemic.

Methods
This was a cross-sectional study conducted with a sample of 358 participants of the WhatsApp study platform known as PLAB[H1] network. Inclusion criterion included participants who completed[H2] the PLAB 1 exam on one of three dates (March 14, 2019; November 7, 2019; March 12, 2020).

Results
A total of 358 respondents, comprising of 60.6% males and 39.4% females, age ranged from 18 to 47 years with a mean age of 30.3±4.4 years.
90.8% passed the PLAB exam, 83.5% scored above the GMC average. 76.3% reported the PLAB network helped them prepare adequately. 90% reported increased their motivation to learn, and 85.2% reported that it encouraged collaborative learning and participation. 78.8% felt the sessions were organised and easy to follow. An estimated 71.5% stated that they preferred learning via the PLAB network.

Conclusion
WhatsApp can be used to deliver sustainable medical education during the COVID-19 pandemic and beyond
Please spell out for first use
Who took and passed – or just took?
EP.WE.126Survey on surgeons’ experience of wearing full PPE in theatres
Authors: Liyanage Aloka Suwanna Danwaththa , Ngo Vivien , Gokul Krishnan , Ainsworth Paul 
Published: October 2021

Abstract

Aims
With the invasion of surgical work space by SARS-CoV-2 virus in 2020, the surgical safety concerns have been escalated to a new height. COVID-19 risk has questioned the adequacy of traditional Personal Protective Equipment (PPE) that has been in practice until now. Full PPE including respirator masks and visors in day today practice by all theatre staff across all surgical disciplines being implemented during and post pandemic time. However this implementation is not without its drawbacks as much as its positive merits. We conducted a survey among surgeons to ascertain their personal experience of wearing full PPE in theatres in day today practice.

Methods
Survey Monkey questionnaire was sent to surgeons at various levels in their carrier in different disciplines in the region.

Results
47 surgeons responded to the questionnaire. 65% of the respondents were from General surgery and 38% of them were consultants. 85% of surgeons considered full PPE uncomfortable. Communication and visibility were main issues. Majority (52%) thinks that full PPE can affect their performance. The length of the procedure makes the negative effects of full PPE worse. More than 50% of respondents were not sure of the beneficial effects of full PPE in theatres.

Conclusions
Full PPE can have impact on the performance of surgeons. Communication being one of the main issues in wearing full PPE, an alternative strategy needs to be developed to improve communication between individuals in theatres.
EP.WE.238Implications of COVID-19 on Laparoscopic General Surgery: a single site experience
Authors: Lawrence Eloise , Stathakis Panos , Goldsmith Paul , Smith Stella , Macutkiewicz Christian , Chan Anthony 
Published: October 2021

Abstract

Introduction and Aims
The COVID-19 pandemic has had an unprecedented impact on service provision in Emergency General Surgery. Due to the unknown risk of COVID-19 transmission, the use of laparoscopic surgery was cautioned against in favour of open surgery or conservative management. This study looks at the impact of service reconfiguration on rates of laparoscopic surgery.

Methods
The management and outcomes were audited of all patients admitted to our unit during the UK COVID-19 lockdown period and compared against the same period last year.

Results
In total, 645 patients (223 COVID-19 period, 422 non-COVID) were included. Less surgery was performed during the pandemic (32.3% vs 39.3%), with only 2 cases of laparoscopic surgery (0.9% vs 16.1%). Despite a change to conservative management, we report no differences in complication rates or length of stay and 30-day mortality (excluding deaths from COVID-19 pneumonitis). Re-admission rates were higher following conservative management (10.6% vs 4.7%).

Conclusion
There is a significant reduction in surgery (particularly laparoscopic surgery) during the COVID-19 pandemic. There are no differences in outcomes, but we show higher re-admission rates for patients treated conservatively. Together with emerging evidence on the safety of laparoscopic surgery, these findings help inform service re-configuration for future pandemic responses.
EP.WE.324Variation Between Observed and Perceived Volume of Antireflux Operations Completed by Upper-Gastrointestinal Surgeons at a University Teaching Hospital
Authors: Ashmore Christopher , Hunter David , Boddy Alex 
Published: October 2021

Abstract

Aims
Increased institutional volume and surgeon experience with antireflux surgery has been shown to improve patient outcomes. We have sought to illustrate the discrepancy between the perceived (self-reported) and observed annual volume of anti-reflux operations completed by each surgeon.

Method
A retrospective questionnaire was delivered to all upper-gastrointestinal (UGI) surgeons performing antireflux surgeries (ARS) at a University Teaching Hospital. Surgeons were asked to estimate the quantity of NHS antireflux cases completed annually. Objective, anonymised data was retrieved from the Surgical Workload Outcomes Audit Database (SWORD) from 2017 to 2020 for comparison.

Results
127 ARS were completed by 6 UGI consultants between January 2018 and December 2020. The median number of ARS completed per surgeon was 5 (2-10) in 2018, 9 (4-11) in 2019 and 10 (1-11) in 2020. Conversely, the median number of self-reported annual procedures per surgeon was 20 (12-35). On average, participants overestimated the number of NHS ARS completed by 14.5 (4-27) cases or a factor of 2.08. No surgeon correctly or underestimated the number of ARS performed.

Conclusion
We conclude that self-reported operation volume should not be relied upon for the purposes of assessment or audit. Estimations of annual ARS procedures could be up to triple that suggested by objective data. Our data supports the importance of local or national data sets like SWORD to give an accurate reflection of practice and to allow individuals to compare their performance against their peers.
EP.WE.338Ambulatory Ultrasound Scans Reduce Inpatient Admissions During COVID-19: A Need for the Expansion of Ambulatory Services
Authors: Cornett L , Davidson S , McElvanna K 
Published: October 2021

Abstract

Aim
With the increased need to manage patients out of hospital during COVID-19, it was anticipated that need for ambulatory imaging would increase. This study aimed to assess the demand for ambulatory ultrasounds (US) during the COVID-19 pandemic and the impact on inpatient admissions.

Methods
A retrospective review of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required an US as first line imaging. Electronic Care Records were used to collect data regarding type of US i.e., inpatient, or ambulatory, time taken for ambulatory US and outcome after imaging. The same period in 2019 was assessed for comparison.

Results
In 2020, 100 patients required an US compared to 88 in 2019. 37% (37/100) of which were discharged for an ambulatory US, compared to 14.8% (13/88) in 2019 (p = 0.006). The average waiting time for an ambulatory US in 2019 was 2 days, this increased to 7 days in 2020. Following ambulatory US in 2020 43.2% (16/37) required further outpatient imaging or assessment; similar outcomes were seen in 2019 with 46.2% (6/13). Overall, there was a 150% increase in the use of ambulatory US, with a 26% decrease in admissions in 2020 vs. 2019.

Conclusions
There was a significant increase in the number of patients discharged from ED to undergo an ambulatory US resulting in reduced inpatient admissions. This increase in demand is reflected by the prolonged waiting time highlighting the requirement for expansion of ambulatory services to meet this clinical need.
EP.WE.410Appendicectomy during the COVID-19 pandemic: an assessment of the change in practice within the West of Scotland
Authors: Al-Azzawi Yassir , Gall Lewis , Miller Gillian , Lowrie Joanna , Thomas Rachel , Macdonald Andrew 
Published: October 2021

Abstract

Aims
The Covid-19 pandemic has significantly impacted emergency and elective surgical activities. Multiple surgical professional bodies initially recommended appendicitis be managed conservatively or with judicious open surgery to mitigate potential risks with Covid-19 transmission. This study compares the investigation, operative findings and outcomes of patients who underwent appendicectomy before and after the National lockdown.

Methods
A multicentre retrospective cohort study of patients who had emergency appendicectomy in four West of Scotland hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK National lockdown of 23rd March 2020 compared to those presenting post-lockdown.

Results
A total of 559 appendicectomies were performed (280 pre-lockdown and 279 post-lockdown) in four hospitals and included in the analyses. More males than females had appendicectomy in the post-lockdown period (60.6% vs 52.1%, p 0.044). Pre-operative CT scanning was performed more often post-lockdown (71.7% vs 56.8%, p &lt; 0.001) and an open approach was adopted more frequently post-lockdown (19.0% vs 3.6%, p &lt; 0.001). The proportion of operations for complicated appendicitis increased post-lockdown (31.9% vs 22.1%, p = 0.009). Median hospital stay was equal in both groups (3 vs 3 days, p = 0.787). Post-operative complication rates were similar in both groups apart from a higher 30-day re-admission rate post-lockdown (7.9% vs 3.6%, p = 0.028).

Conclusion
Covid-19 has resulted in significant modifications to the pre-operative work-up and surgical approach to patients undergoing emergency appendicectomy. Whilst the proportion of patients with complicated appendicitis has increased post-lockdown, overall clinical outcomes remain similar.
EP.WE.577Chest air-leak complications in critically ill COVID-19 Patients: a retrospective single-centre cohort study
Authors: Fong Michelle , Shepherd Sophie , Gandre Priti , Gahir Jasdeep 
Published: October 2021

Abstract

Introduction
COVID-19 has caused a global pandemic with a proportion of patients admitted to intensive care with viral pneumonia and respiratory failure. Spontaneous air leaks have been reported in patients with COVID-19. We report on a phenomenon of significant chest air-leak manifestations on a cohort of critically unwell intubated COVID-19 patients in our single centre.

Methods
All patients admitted to our single-centre intensive care unit during the initial outbreak of COVID-19 in the UK were identified. Individual electronic notes and imaging were screened to look for complications of: surgical emphysema, pneumomediastinum and/or pneumothorax.

Results
158 patients were admitted to our intensive care and eleven (7.0%) of patients were found to have suffered air leak complications unrelated to line insertion. Five suffered surgical emphysema only, one surgical emphysema with pneumomediastinum and two with the full triad of surgical emphysema, pneumomediastinum & pneumothorax. Two patients had unilateral pneumothoraces and one patient experienced a tension pneumothorax. Four patients were managed conservatively and seven had chest drains inserted. Overall outcomes were: one patient was discharged home, one discharged to ward, two transferred to an outside hospital and seven died.

Conclusion
Air-leak complications in COVID-19 patients, both spontaneous and ventilation associated are an under-recognised phenomenon. In the critically ill population literature suggests there is a &gt; 5% incidence and risk reduction strategies should be considered. We advocate for early diagnosis and decompressive therapy with chest drains to avoid tamponade in intubated patients. Virus spread from air-leak should also be considered and health-care professionals adequately protected.
EP.WE.604Communicating with relatives during covid: creating a vision
Authors: Olaleye Oladapo , Joseph Jinto , Smith Stella 
Published: October 2021

Abstract

Aim
The unique situation created by the global pandemic has led us to re-evaluate how we disseminate information about service provision to patients and their relatives. The aim of this project is to create a patient centred video, explaining the Major Trauma (MT) service.

Methodology
Participants who accessed the MT service. from May 2020- July 2020 were approached to evaluate their thoughts on the service through open questions. The raw data was analysed using thematic analysis. The themes generated were the incentivizing force behind the creation of the video.

Results
13 patients participated in the telephone consultation. The main themes identified were ‘knowledge of service,’ ‘communication with family,’ and ‘encouraging holistic inpatient care’. The themes identified a lack of knowledge about the MT service by both patients and their relatives. This led to poor understanding on the utility of the service by participants, and ineffective engagement of the service by relatives.

Conclusion
The video was created in response to our survey and aims to inform and educate its audience about what services the M.T. service provides. The authors foresee a patient centred video series that guides our service users as they engage with the multidisciplinary team through their inpatient stay. The current video will be made available to service users via tablets on the ward and the MT service web page. This can be accessed remotely by relatives. This video represents the expansion of the Major Trauma Services’ digital footprint and a move towards more user-friendly formats.
EP.WE.628The Challenges of Consent and COVID-19: Analysis of Documentation of Risk of Hospital Acquired COVID-19 Infection in a District General Hospital
Authors: Mishra Shashwat , Davis Heather , Tan Wei Jian , Cooke Joanne 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic poses a new material risk to hospital admissions and we must modify consenting practice accordingly. This study assessed documentation of the risk of COVID-19 infection and associated morbidity in consenting practice for patients undergoing general surgical procedures under general anaesthesia at a district general hospital.

Methods
This is was a two-cycle study design. An initial retrospective case-note analysis of 41 inpatient consent forms and operation notes during April 2020 was performed. Data were gathered on points from the Royal College of Surgeons (RCS) guidance, including documentation of risk of COVID-19 infection. Recommendations were then offered including a teaching session from the departmental lead into the importance of documenting risk of COVID-19 infection. A prospective case-note analysis of 45 inpatient consent forms and operation notes during November to December 2020 was then performed.

Results
In cycle one, of 41 cases, 39% (16) had risk of chest infection documented. Of these, 16 (63%) specified COVID-19 in risk documentation. Morbidity related to COVID-19 was documented in 4 (25%) of these 16 cases. Following interventions, of 45 cases, 93% had risk of COVID-19 infection and associated morbidity documented (χ2 = 89.3646, p &lt; 0.00001 significant at p &lt; 0.05).

Conclusion
We initially identified a deviation from RCS consent guidance. The second cycle results show a significant improvement in consenting practice for the risk of contracting COVID-19 for inpatient surgical procedures. We aim to further refine our recommendations to ensure that this material risk is communicated to patients during the initial consent process.
EP.WE.709A local experience of non-operative management for an appendicitis cohort during COVID-19
Authors: Mai Dinh Van Chi , Sagar Alex , Menon Nainika Suresh , Claydon Oliver , Down Billy , Keeler Barrie David 
Published: October 2021

Abstract

Background
During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis. This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort.

Methods
An observational study was conducted in a district general hospital. All episodes of appendicitis were prospectively studied from 25th March 2020 until 26th May 2020 and compared with a retrospective pre-COVID cohort from 27th November 2019 until 29th January 2020. Primary outcome was 30-day treatment failure of simple appendicitis for conservatively managed cases during COVID-19 compared to surgically managed cases pre-pandemic. Treatment failure was defined as any unplanned radiological or surgical intervention.

Results
Over nine weeks, there were 39 cases of appendicitis during COVID-19 and 50 cases pre-COVID-19. Twenty-six and 50 cases underwent appendicectomy during and pre-COVID-19 respectively. There was no difference in 30-day postoperative complication rates and nor were there any peri-operative COVID-19 infections.
Twelve cases of simple appendicitis underwent conservative management during COVID-19 and were compared with 23 operatively managed simple cases pre-pandemic. There was a higher failure rate in the conservative versus operative group (33.3 vs 0% OR = 24.88, 95% CI 1.21 to 512.9, p = 0.0095). Length of stay was similar (1.5 vs 2.0 p = 0.576).

Discussion
Locally, conservative management was more likely to fail than initial appendicectomy. We suggest that surgery should remain first line for appendicitis, with conservative management reserved for those with suspected or proven COVID-19 infection.
EP.WE.782Retrospective analysis of acute surgical admissions during COVID-19 pandemic
Authors: Rajamanikam Shenbaga , Argyropoulos Suzzana , Zadeh Reza Arsalani 
Published: October 2021

Abstract

Background
COVID-19 pandemic has affected the number of surgical admissions and the number of emergency general surgical operations performed. COVID-19 pandemic has also led to changes in how some of the acute surgical patients were managed. Aim of the study was to compare acute surgical admissions and number of emergency general surgical procedures in this period.

Material and Method
We retrospectively analyzed acute surgical admissions during the pandemic from 20/3/20 to 19/4/20 and compared it with acute surgical admissions during pre-COVID-19 period from 1/11/2019 to 30/11/2019.

Results
During the COVID-19 pandemic 97 patients were assessed and admitted by the General surgical team, during the pre COVID-19 period 205 patients were assessed and admitted by the General surgical team. The number of acute surgical admissions during COVID-19 pandemic dropped by 53%. There were 46% less emergency surgeries performed during COVID 19 pandemic period. Length of stay during and before the COVID-19pandemic were 4.1 vs 4.4 days.

Conclusion
During the COVID-19 pandemic number of acute surgical admissions and the number of emergency surgeries were fewer than during pre COVID-19 pandemic. Length of hospital stay was less during COVID-19 pandemic.
EP.WE.802Are we over-zealous in our management of acute diverticulitis?
Authors: Lafaurie Guillaume , Butterworth James , Engledow Alec 
Published: October 2021

Abstract

Aims
Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis. However according to the latest NICE guidance those with diverticulitis who are not systemically unwell may not require either admission or antibiotics. In the financially austere environment facing the NHS within the COVID 19 pandemic, prudence in such resource allocation is of vital importance. We aim to review management of patients with acute diverticulitis over a 6-month period in a district general hospital against the 2019 NICE guidelines.

Methods
29 patients presenting with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed. Biochemical markers, lactate and vital signs were used to assess if attending patients were systemically unwell.

Results
23 patients were admitted and 6 managed as outpatients via the surgical ambulatory unit. Of the 29 patient cohort, 9 (31%) were systemically unwell. All 9 unwell patients received antibiotics. Of the 20 patients not considered systemically unwell, 11 (55%) received antibiotics. 16 (80%) that were admitted did not require admission on retrospective review.

Conclusion
Prompt administration of intravenous antibiotics for septic patients with diverticulitis reduces associated morbidity and mortality and the observed adherence to this principle is encouraging. For systemically well patients, increased clinical discernment is required to consider managing patients in the surgical ambulatory setting, avoiding unnecessary admissions. Similar caution must be used in appropriate use of antimicrobials to avoid unnecessary adverse consequences.