bluuebunny/crossref_metadata_2025_split huggingface dataset:
74 Does the SPIKES Protocol and Formal Teaching Increase Clinician Confidence When Breaking Bad News During the COVID Pandemic?
Authors: Olukoya O , Ishak P , Ali A , McLaughlan D 
Published: October 2021

Abstract

Background
Breaking bad news is often a daunting and complex task that we must all perform as part of our clinical duties. Given the current climate with the coronavirus, this task has unfortunately become an even bigger part of the day-to-day practice of many of us.

Aim
To establish how confident clinicians felt they were at breaking bad news, their familiarity with the SPIKES protocol and if they had a consistent approach they employed. Additionally, to ascertain if formal training in this, at any stage, corresponded to increased confidence with this task.

Method
A questionnaire was distributed to doctors and surgeons of all grades, primarily within the hospital. The questionnaire asked the responders how confident they felt at breaking bad news, how frequently they had to break bad news in an average month, if they had had any formal training in breaking bad news, and their familiarity with the SPIKES protocol.

Results
There were 58 responses. 60.4% had to break bad news 2 or more times in an average month. 86.2% had received formal training in breaking bad news. 60.3% felt confident or very confident. 53.4% had a consistent strategy and 58.6% were aware of the SPIKES protocol. 69% expressed they would like additional teaching with the SPIKES protocol.

Conclusions
Formal training does not guarantee knowledge of the SPIKES protocol or a consistent approach but has some impact on perceived confidence with the task. This task is, however, one most feel requires continued training to perform well.
227 Multiple Outbreak Of SARS-COVID-19 In Surgical Wards at The Tertiary Hospital
Authors: Karki B B , Mohammad S , Chung W , Eltweri A , Sauodi T , Dennison A , Garcea G 
Published: October 2021

Abstract

Background
Since the second surge of SARS-COVID-19 on 18th of September, additional several measures were introduced, and pathways created in order to execute safe surgical practices and protect both patients and staff from SARS-COVID-19. Despite these measures, there have been reported cases of outbreaks in various parts of UK amongst patients and clinical staff.

Method
Three outbreaks in the past 6 weeks (10, September 2020 to 21, October 2020) were reported in our surgical wards and we compiled the timing, initial source, number of affected individuals and immediate management steps taken.

Results
Following the first outbreak on wards, 28-day surveillance helped us understand responsible variants. Several staff members were found walking out of hospital, in groups once they had removed their PPEs. Communal lunching with inadequate social distancing, attending work with symptoms (albeit atypical for COVID), sharing cars to/from work or not wearing PPE correctly were highlighted in the subsequent investigations. The reduction in number of affected individuals during the last two incidents reflected a degree of efficacy of the implemented preventative measures, which were reviewed again following the subsequent incidents.

Conclusions
In the present climate, a robust and prompt response to outbreaks is required. Continual iteration with regards to the need for PPE, adequate social distancing and avoiding over-crowding in communal areas is paramount to reduce the probability of ward outbreaks and inter-professional transmission. Asymptomatic staff testing, particularly in high-risk areas could also be considered but would require adequate laboratory capacity and rapid turnaround of test results.
493 An Examination into The Impact of Sleep Deprivation on Surgeons
Authors: Antoniou V , Booth C C , Parry D 
Published: October 2021

Abstract

Background
Lack of sleep amongst surgeons is significant and worrying. It poses short- and long-term risks to surgeons’ health and negatively impacts patient outcomes. Previous studies have examined sleep deprivation amongst health care professionals. The aim of the present study was to examine impact in a specific population of surgical doctors.

Method
A questionnaire-based study completed in the anatomy department of King’s College London University. Surgical subjects spanned the United Kingdom. Subjects completed 14 questions regarding sleep habits. Data was compiled, calculating a sleep deprivation score.

Results
Valid responses were obtained from 66 surgical subjects of varying seniority. Mean age of subjects was 33.7 years old. 59.1% of subjects had rota commitments changing on a weekly basis. Average sleep amongst subjects amounted to 6.15 (± 1.26) hours per night. Daily sleep did not present differences dependent on seniority level (p = 0.186). 25.8% of subjects took &gt;30 minutes to fall asleep. Our subjects woke 1.67 (± 1.21) times a night. Mean sleep deprivation score amongst our surgical population was 16.5 (± 4.26) demonstrating moderate negative impact on daily activities. 28.9% accumulated ≧20 sleep deprivation score demonstrating severe impact of sleep deprivation on life.

Conclusions
Our study has demonstrated reduced quantity and quality of sleep amongst our subject population. With protecting the health of both patients and surgeons in mind, we must place higher importance on improving sleep amongst surgical professionals.
1103 How to Report Noise in The Operating Theatre
Authors: Thompson N , Hampton T , Everett S , Krishnan M 
Published: October 2021

Abstract

Introduction
The reporting of operating theatre noise in the surgical literature dates back almost 50 years. The existing standards for noise and sound reporting in healthcare settings is heterogenous and there is a need for greater uniformity of reporting to support our growing understanding of the significance of communication and human factors on surgical performance.

Method
This presentation summarizes the existing Surgical and Acoustic Engineering industrial expertise to provide a narrative review of literature, grey reports and guidelines and then demonstrates appropriate reporting standards during Noise level recording in an operating theatre environment.

Results
We describe LAmax, LA90and LAeq expected levels. We compare our own theatre noise levels against these recommended standards for comparison. This presentation also suggests a suitable “ambient noise” (LAeq 65dB) level over which any communication devices or communication studies should benchmark when developing interventions to overcome noise in the operating theatre.

Conclusions
This paper proposes possible unified reporting standards and expected sound pressure levels against which future studies in this field could benchmark.
1227 The Impact of COVID-19 on the Wellbeing of Surgical Junior Doctors in a Tertiary Referral and Teaching Hospital
Authors: Griffin F , Heelan M , Kumar M 
Published: October 2021

Abstract

Introduction
Protecting the wellbeing of staff in the NHS is becoming ever more critical as we progress through this pandemic. We sought to identify the impact of the pandemic and changes in working pattern on wellbeing of doctors in training in a teaching hospital.

Method
Cross sectional study, with primary data collection using a web-based survey. Questionnaire was designed to identify issues relating to the personal wellbeing before and since the onset of the pandemic (Nov 2019-Feb 2020 vs March 2020- June 2020). Trainees in all surgical specialities were invited to participate.

Results
Thirty-six doctors responded. Across the timepoints there was a marked increase in reports of the following: constant fatigue (+500%), headaches (250%), loss of motivation (+500%), loss of interest in hobbies/friends (+566%), anger (+500%), loss of focus (+320%) and heightened emotional state (+700%). Almost 70% reported difficulty sleeping in the preceding month, with only 50% feeling they received adequate rest between shifts. Feelings of ‘too tired to drive’ increased by 216% with accidents or near misses increasing by 500%. Use of alcohol as coping mechanism increased by 500%, and comfort eating rose by 244%. 50% considered leaving their post.

Conclusions
These findings are significant and point to a dangerous trend if left unchecked. The causes of these outcomes are multi-factorial; changes to working patterns, cancellation of leave, redeployment, and anxieties around career progression were noted. The long-term health implications on the workforce should not be overlooked. This requires a collective response and action by employers, training and regulatory bodies and government.
1340 Is Displaying Mandated Information in Clinic Harming Patient and Society?
Authors: Herron J , Alleway P 
Published: October 2021

Abstract

Aim
The CQC has mandated certain pieces of information are displayed in a clinic and the staff know where to find them. This is in addition to the mandatory training that staff members undergo with increasing repetition. The UK Armed Forces is no exception to this, in addition wall space is often used as opportunistic education for patients.

Method
We counted the number of posters that were displayed in a CQC good, rated clinic, worked out the average cost to produce, produced a questionnaire of staff and patients to see how many times people engaged with the information and the carbon footprint of compliance. We looked timed how long it took for someone new to the clinic to spot the lifesaving information.

Results
140 items of literature took on average 65 minutes ±240 to produce, with an average of 9 pages per item ±190. Average cost was 10 pence per page when lamination was included, totalling £126. At 6000kg CO2/paper page and 1500kg CO2/laminate page, the total carbon footprint was 9,450,000 Kg CO2. Staff members engaged zero times with the literature and only one patient engaged. The time to spot the critical information in a clean room was 0.8 second, in a normal clinic room was 4.3 seconds.

Conclusions
Distractions can be detrimental in emergency situations and with human factors interplay this can cost people their lives. A 3.5 second delay may seem inconsequential but compounded could be devastating. The cost and Carbon footprint is extraordinary for little benefit.
249 Laparoscopic Assisted Enterolithotomy: A Viable Option in The Management of Gallstone Ileus
Authors: Angamuthu N , Alagaratnam S , D'Souza R , Varcada M 
Published: October 2021

Abstract

Introduction
Gallstone ileus (GSI) is a rare cause of small bowel obstruction in patients over the age of 65 years. We report a case of GSI treated successfully with a laparoscopic assisted enterolithotomy.

Case report
A 75-year-old female presented with two days of abdominal distension and vomiting with a non-peritonitic abdomen on examination. A computerised tomography scan demonstrated small bowel obstruction due to an obstructing stone in the distal ileum. Three port laparoscopy and small bowel assessment confirmed a solitary enterolith (4cms) in the distal ileum with upstream dilated loops. An infra-umbilical 6 cm midline incision was made and the localised bowel loop was delivered. An enterotomy was made proximal to the point of obstruction, stone retrieved, and a single layer interrupted closure was performed. Ten weeks post-operatively, patient had a virtual follow-up consultation and is doing well.

Conclusions
GSI often presents in elderly patients with multiple co-morbidities. A laparotomy with enterolithotomy is the initial treatment of choice with biliary intervention as a second operation, if needed, at a later date. Clearly, a conventional exploratory laparotomy in this cohort of patients carries a high risk and therefore the use of less morbid and less invasive procedure like laparoscopy should be considered. Although a total laparoscopic approach would require advanced laparoscopic skills particularly due to dilated bowel loops limiting the intra-abdominal space for suturing, a laparoscopic assisted approach as described above should be considered as a reasonable option within the remits of an emergency general surgeon.
290 Quality of Clinical Practice Guidelines for Laparoscopic Surgery: Systematic Review
Authors: Leung J , Leong J , Yeung K A , Hao D , Mclusky A , Kayani Y , Gurusamy K 
Published: October 2021

Abstract

Aim
Guidelines on laparoscopic surgery are essential for providing guidance to achieve safe and effective treatments. In this systematic review, we investigated the true extent of the grades of recommendation which were supported by evidence in the guidelines and whether this extent depended upon the quality of the guidelines.

Method
We searched PUBMED and EMBASE for laparoscopic surgical guidelines published between 1st March 2016 and 1st March 2019.To determine the extent of the grades of recommendation supported by evidence, we determined the disagreement in the grading between the guideline author and independent evaluation. We used the AGREE-II Tool ‘rigour of development’ and ‘clarity of presentation’ domains to assess the quality of guidelines. We performed a mixed effects generalised linear regression modelling using binary distribution and logit link in the GLIMMIX procedure of Statistical Analysis System (SAS) software.

Results
We analysed 1905 guideline statements from the 63 guidelines retrieved. The median of the scores for the ‘rigour of development’, ‘clarity of presentation’, the ‘editorial independence’ domains in the guidelines were 0.43, 0.72 and 0.63. The interquartile ranges were 0.094, 0.25 and 0.38. The ‘rigour of development’ domain was the only determinant of disagreement in the grades of recommendation guideline statements between the guideline authors and independent evaluation.

Conclusions
There is variation in the grades of recommendation in the guidelines. The ‘rigour of development’ domain can be used to predict quality of the guidelines. Guideline users should use the ‘rigour of development’ domain to assess the quality of the laparoscopic guidelines before developing local clinical policies.
486 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report
Authors: Tan M T , Akhter Rahman M M , Sasapu K 
Published: October 2021

Abstract

Introduction
Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis.

Presentation of the case
A- 9-year-old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management.

Discussion
The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment.

Conclusions
A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases.

Key Statement
Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.
1422 Are Blood Group and Antibody Screening Necessary Before Elective or Day Case Laparoscopic Cholecystectomy?
Authors: Bhambra T S , Pannu A , Jalal Q , Shah N , Rajput I 
Published: October 2021

Abstract

Aim
Laparoscopic cholecystectomy is generally safe with low rates of intraoperative bleeding. At present, there are no national guidelines on pre-operative blood group and antibody screening (G&S) for this procedure. The aim of this study is to establish the incidence of intraoperative haemorrhage requiring transfusion during laparoscopic cholecystectomy. This will indicate the necessity of routine preoperative G&S.

Method
Retrospective data collection of all patients having laparoscopic cholecystectomy at a large tertiary hospital from January 2015 to January 2020 (5 years). Patients having emergency procedures were excluded. The transfusion department records were used to identify any patients receiving a transfusion intraoperatively.

Results
2894 laparoscopic cholecystectomy procedures were performed over the 5-year period. 150 patients having emergency surgery were excluded. The final group consisted of 2744 patients. 1392/2744 (50.7%) patients were managed as a day case. 1352/2744 (49.3%) patients underwent elective surgery. 5/2744 (0.002%) patients received an intraoperative transfusion of blood products for the management of pre-existing haematological disorders.

Conclusions
No patients required transfusion for surgical haemorrhage. The small number of patients requiring transfusion were predictable because of clinical status. Our data is one of the largest series available. The results demonstrate that routine preoperative G&S is not justified. Instead, a selective approach would ensure high risk patients are appropriately screened. In event of vessel injury and major haemorrhage, O negative blood can be used. Furthermore, we estimate that elimination of a routine second G&S sample could have saved our institution approximately £5200 per year.
72 Increasing Radiotherapy Induced DNA Damage by Inhibiting Repair Proteins
Authors: Atkinson B , Wilson J 
Published: October 2021

Abstract

Introduction
Fanconi anaemia (FA) is a rare genetic disorder displaying higher incidences of head and neck squamous cell carcinoma (SCC). The surgical excision of these cancers is challenging and often supplemented with radiotherapy. One novel concept to improve survival rates is to increase the susceptibility of SCCs to radiotherapy. ATR is a protein responsible for homologous recombination repair (HRR) within the FA pathway and has been identified as a possible target for cancer therapy. Inhibition of ATR induces subsequent DNA damage. The primary objective of this study was to identify whether the inhibition of ATR can be achieved by exposing SCCs to mild hyperthermia. This novel concept aims to improve survival rates of patients with SCCs who require surgical excision and subsequent radiotherapy.

Method
By using a HRR assay it was possible to examine levels of DNA repair in various SCC cell lines following the exposure to radiation. These were compared to cells treated with heat, an ATR inhibitor and a mixture of both to determine whether heat reduces HRR.

Results
Repeated HRR assay’s showed SCC’s treated with heat, ATR inhibitor and a mixture of both before exposure to radiation underwent significantly lower levels of HRR compared to cells within the control.

Conclusions
Reduced HRR following exposure to heat increases the susceptibility of SCCs to radiotherapy. It is hoped that in combination with the surgical excision, this study will help to improve the outcomes of patients with head and neck carcinomas by improving the efficacy of radiotherapy.
270 A Retrospective Analysis of The Impaction Status of Mandibular Third Molars as A Risk Factor for Fractures of Angle or Condylar Region of The Mandible
Authors: Al-Harbawee A 
Published: October 2021

Abstract

Background
the position and angulation of mandibular third molars have both been found to influence the angle and condylar fractures. Objective: To identify whether there is an association between the depth and angulation of third molar impaction and the relative risk of fracture of the mandibular angle and condyle.

Method
Four-hundred and eighty-two panoramic dental radiographs were assessed for the period from January 2012 to June 2020. The study variables included the presence of mandibular third molars, position and angulation. The outcome variables were angle and condylar fractures.

Results
the mean age was 28.5 years (range 15-89) and 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted wisdom tooth (M3) ( p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with wisdom teeth classified as class II ( p = 0.026) and position B ( p = 0.05). In contrast, class I wisdom molars were more frequently associated with condylar fractures. With regards to the angulation of wisdom teeth, angles between 80 o – 100 o were highly correlated with angle fractures ( p = 0.020) whereas M3 angulations of 60 o – 80 o were related to condylar injuries (p = 0.025).

Conclusions
fractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I third molars were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80-100) and (60-80) respectively.
452 Dermal Filler Injection Leading to Facial Cellulitis: A Case Report
Authors: Baldock E , Devine C , Holden A , Colbert S 
Published: October 2021

Abstract

Background
Aesthetic medicine is a rapidly expanding field that is progressively becoming a normal part of society’s health and beauty regime. Hyaluronic Acid dermal filler injections are the second most widely performed aesthetic procedure, following Botulinum Toxin type A. Although serious complications are rare, they can have a detrimental impact on aesthetic outcome and general health. Infections following dermal fillers can be difficult to treat and have the potential to require hospital admission, intravenous antibiotics and surgical intervention.

Case description
We present a case of a 41-year-old female who suffered from facial cellulitis as a consequence of palpebro-malar groove dermal filler injections. The patient had 0.1ml of Monalisa dermal filler injected over her right malar prominence and suffered complications 6 days later, which eventually lead to the need for hospital admission on day 12 following the procedure for intravenous antibiotics. The management of this aesthetic procedure complication is outlined to highlight the risks and serious complications of these procedures.

Conclusions
Facial cellulitis is a rare adverse event following facial filler injection; however, it is an important risk factor to discuss during the consent process for these procedures. In addition, it is important that a highly trained and skilled professional performs these injections using a sterile non-touch technique due to the potential for serious complications and the anatomical proximity to vital structures.