bluuebunny/crossref_metadata_2025_split huggingface dataset:
1256 Orthopaedics and The COVID19 Pandemic: Was Achilles Just A “Weekend Warrior”?
Authors: Murphy B , Hurson C 
Published: October 2021

Abstract

Background
The COVID19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions pertaining to sports saw a sudden return to play for many people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. In our institution, we appeared to have a large number of these injuries within a short space of time. We hypothesised that Phase 3 of “Lockdown”, where all sports were allowed to return, led to increased Achilles tendon rupture rates vs. the same period in 2019 due to a prolonged period of inactivity.

Method
Data from electronic theatre logbooks of all operations performed in the trauma theatre from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected.

Results
772 cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 of these occurred after Phase 3. 555 cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2%). 11 of these occurred after Phase 3.

Conclusions
Overall, there was a greater number and greater rate of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. 8 of the 11 occurring after Phase 3 in 2020 occurred in the month of July. This led the authors to believe they were occurring more frequently. In conclusion, the COVID19 pandemic restrictions and subsequent return to play after inactivity does not increase the rate of Achilles tendon rupture.
1274 Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital
Authors: Barman S , Ng H J , Teo S , Blaney E M , Mansfield O 
Published: October 2021

Abstract

Aim
Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020.

Method
Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of &lt; 0.05 was considered significant.

Results
Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p &lt; 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August.

Conclusions
Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.
1294 Online Education for Patients Undergoing Elective Orthopaedic Surgery During A Global Pandemic
Authors: Siddiqui M , Bokhari A 
Published: October 2021

Abstract

Introduction
lective hip and knee joint replacement patients at the East Lancashire Hospitals NHS Trust (ELHT) are required to attend the ‘Hip and Knee Joint School’. This is an award-winning patient education programme. Pre-pandemic, it was a day at the hospital dedicated to introducing patients to the specifics of a hip and knee joint replacement surgery. This takes the patient from the process of anaesthesia to post-operative ward care.

Method
Due to the virulent transmission of COVID-19, strict social distancing rules have been implemented. Therefore, it was decided that converting the joint school into online videos would be the best medium for patient education. Various healthcare professionals contributed to the videos included orthopaedic surgeons, anaesthetists, specialist nurses, healthcare assistants, occupational therapists, and physiotherapists.

Results
Eleven videos were filmed, edited, and approved by the trust’s communications team. These included, ‘Introduction to the Joint School’, ‘You and your surgery’, ‘Leading up to your operation’, ‘Your Operation Journey’, ‘Introducing the Anaesthetist’ ‘Total Hip Replacement Surgery’, ‘Total Knee Replacement Surgery’, ‘Post-op Wound Care’, ‘Your Safe Discharge Home’, ‘FAQ’s’ and ‘COVID-19 Green Pathway’.

Conclusions
The global pandemic has driven innovation and novel ideas in medicine. We have seen similar changes in our trust with the online patient education videos being a prime example. This joint school was originally started in our trust, but now as it had been converted to videos, we believe that it can be modified and used across all trusts in the NHS.
1358 Does A COVID Protected Hospital Within A COVID Hospital Enable Elective Care and Training Opportunities?
Authors: Rashid H , Gala T , Ain Q , Ashraf H , Vesamia S , Vig S 
Published: October 2021

Abstract

Introduction
Elective care in the UK came to a standstill with the advent of the COVID-19 pandemic. A restart could only be enabled with ‘green site’ separation and a ‘covid protected’ zone. A ‘hospital within the hospital’ concept was developed including 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen, and a separated entrance. This model was underpinned with PPE, enhanced infection control and guidance for staff. The study documented the ability to recover elective activity and therefore provide a training environment for surgical trainees.

Method
Data was collected weekly (7/20 to 1/21) through the business informatics system with regard to theatres cases completed compared to the activity achieved in the 11-theatre elective estate pre COVID-19.

Results
Pre COVID-19, an average of 263 cases were completed per week. In the first week of operation, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. This was maintained until the impact of the second wave where activity has reduced to 50% but is not anticipated to reduce further as local anaesthetic and blocks maybe utilised.

Conclusions
This ‘hospital within the hospital’ has enabled elective care to return to above normal levels, with increased efficiencies. This has enabled a rapid return to a training environment for trainees disheartened with deployment to critical care in the first wave.
1408 Virtual Phone Call or Video Consultations: Patient and Clinician Preference During Covid-19
Authors: Kinsella A , Hassan I , Malone C 
Published: October 2021

Abstract

Aim
In response to COVID-19 and social distancing guidelines, healthcare services have evolved. Telehealth is part of this change and many services introduced virtual telephone clinics. The HSE recently approved a video conferencing tool, ‘Attend Anywhere’, however this is not widely used at present. We have received positive feedback from patients, but only a few studies provide information on overall satisfaction of virtual consultations. We aim to validate this by assessing preferences towards virtual telephone and video consultations.

Method
50 patients from the breast care clinic were included. Patients excluded were any new symptomatic patients or those with any incapacity. Questionnaires with Likert scales were used to assess patient and clinician attitudes towards ‘phone’ (PC) or ‘video’ consultations (VC).

Results
The majority of patients (64%) requested a PC rather than a VC (36%). More patients used technology regularly in the VC group (88%) than the PC group (69%), and 94% of VC patients had experience with video calls (47% PC). VC patients felt safe using ‘Attend Anywhere’(94%), said it was ‘more personal’ than a phone call (72%) but preferred face-to-face for future consultations as they ‘liked the reassurance of a physical exam’(78% VC; 59% PC). All clinicians felt the lack of examination in virtual clinics impacts the doctor-patient relationship and would prefer face-to-face consultations where possible.

Conclusions
Our findings demonstrate a positive patient and clinician attitude to virtual clinics, however face-to-face appointments are preferred by both groups. We will repeat this survey following COVID-19 restrictions to determine if attitudes have changed.
1424 Enhanced Consent in Endocrine Surgery in The Era Of COVID-19
Authors: Greene K , Truran P , Bliss R , Ramsingh J 
Published: October 2021

Abstract

Aim
Informed consent is the process by which surgeon and patient agree to undergo a procedure after the risk, benefits and alternative treatments have been discussed. The current COVID-19 pandemic provides unique challenges to the consent process such as the uncertain risk of acquiring the virus and the impact of a second peak on the health services. The aim of this audit was to use an enhanced consent tool to inform patients of specific risks associated with surgery during the pandemic.

Method
At the beginning of the pandemic, elective operating was postponed - these patients were added to a COVID-19 database. With the resumption of services, all patients had a telephone clinic appointment with a 2-fold aim: 1) to ensure they wanted to remain on the waiting list and 2) to discuss consent specifically with regard to COVID-19 using an enhanced consent tool.

Results
Over a 6-week period, 79 patients were contacted. All patients were awaiting thyroid, parathyroid and adrenal operations. Of the 79 patients contacted, 77 (97%) agreed to remain on the waiting list after discussing the risks using the enhanced consent tool. The remaining 2 patients asked for their operations to be delayed. To date, none of our patients have acquired COVID-19 upon the resumption of services.

Conclusions
Despite the uncertain risks of COVID-19, the majority of patients requiring endocrine surgery were happy to proceed. Ongoing review of available literature concerning preoperative risk and COVID-19 is essential for clinicians involved in the consent process. The use of an enhanced consent tool standardised the consent process and enabled patients to make an informed decision concerning their care.
1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future
Authors: Khoury A , Thomson D , Jones M 
Published: October 2021

Abstract

Introduction
Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic.

Method
Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology.

Results
2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia.

Conclusions
Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.
1475 Management of Appendicitis During COVID19 - A Shift to Conservative Management
Authors: Bhattacharya P , Stonelake S , Peterknecht E , Zaman S , Budhoo M 
Published: October 2021

Abstract

Introduction
The COVID19 pandemic posed challenges in dealing with common surgical conditions, by causing a redirect of manpower and resources as well as having correlation of added morbidity if present in patients undergoing surgery

Aim
To find out the proportion of patients undergoing conservative management and their outcomes compared to operative management

Method
Retrospective data collection of patients admitted with appendicitis from 25/03/2020 to 15/07/2020.

Results
A total of 72 encounters had a discharge diagnosis of appendicitis.35 (48.6%) patients were treated with conservative management. while 37 (51.4%) patients had operative management. In the conservative group CT scan was done in 64%, which showed simple appendicitis in 78% and complicated in 17 %, whereas in the operative group CT scan was done in 59.4% , 86 % had simple appendicitis and 9% and complicated appendicitis. Median length of stay in both groups were 2 days. There were no readmissions in the operative group and 84.3% patients had no readmissions in the conservative group in the study in a follow up period up to 6 months. 2 patients initially treated conservative were eventually offered surgery on readmission.

Conclusions
1. Conservative management of appendicitis has proved to be a valuable alternative to surgical management during this pandemic 2. Patients should be offered a choice of conservative management for simple appendicitis with prior discussion of benefits of avoiding surgery versus risk to recurrence (up to 39% reported in literature for uncomplicated appendicitis)
1524 Design and Implementation Of ICE-COVID, A Double-Blind Randomised Placebo-Controlled Trial on The Efficacy of Iota-Carrageenan Nasal and Throat Spray for Covid-19 Prophylaxis
Authors: Lim J Y , Jessop Z M , Gibson J A G , Jovic T H , Combellack E , Dobbs T D , Healy B , Humphreys Ian R , Eccles Ronald , Hutchings Hayley A , Whitaker Iain S 
Published: October 2021

Abstract

Introduction
The severity of Covid-19 infection is associated with viral load. For infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus to attach to the host cell surface receptors. Iota-carrageenan (I-C), a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a range of viruses in clinical trials, through prevention of viral entry into respiratory host cells and in-vitro activity against SARS-CoV-2. Our aim, as an academic surgical department, was to design and implement a clinical trial to investigate whether I-C nasal and throat sprays are effective in reducing the rate and severity of Covid-19 infection.

Method
The study is a single centre, double-blinded randomised controlled trial. Recruitment of 480 participants aged ≥18 years without previous Covid-19 infection and who have not yet been vaccinated, commenced in December 2020. Participants are randomised to either the treatment (0.12% I-C in 0.5% saline spray) or placebo (0.5% saline spray) arm and will prophylactically apply the spray to their nose and throat while completing a daily symptom tracker for a total of 10 weeks. The primary outcome is the acquisition of Covid-19 infection. Secondary outcomes include symptom type, severity and duration, subsequent familial/household Covid-19 infection and infection with non-Covid-19 upper respiratory tract infections.

Discussion
Our hypothesis is that I-C sprays will reduce SARS-CoV-2 attachment to the naso- and oropharyngeal mucosal epithelial cells thus reducing the effective viral infective dose. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population.

Trial registration number
NCT04590365
397 Seasonal Variation in Acute Cholecystitis; An Analysis to Predict Resources Allocation
Authors: Gala T , Venkatesan G , Mohsin M , Abdelkarim M , Murali S , Shahzad N , Morgan R 
Published: October 2021

Abstract

Background
Acute cholecystitis accounts for 20% of Emergency General Surgical admissions. The concept of seasonal variation is still a developing concept in surgical literature. Whether acute cholecystitis also follows a seasonal trend remains to be established.

Aim
Given the struggle healthcare system has been facing towards resource and staff allocation to deliver best possible patient care, we thought this may be a step forward to predict North Wales demand of resources seasonally and make appropriate arrangements ahead of time.

Method
We performed a retrospective analysis of patients across North Wales who had a discharging diagnosis of acute cholecystitis from January 2010 to December 2019. Chi-square goodness-of-fit test was used to analyse seasonality of acute cholecystitis adjusting for variation in number of days between seasons. The number of days for seasons were taken as 92, 92, 91, and 90.25 for spring, summer, fall, and winter, respectively.

Results
Overall, 4100 patients presented to the three hospitals across North Wales with acute cholecystitis during the study period. The frequency of hospital admissions varied between months (minimum February n = 302, maximum July n = 373) and seasons (minimum winter n = 971, maximum spring n = 1067). After applying chi-square goodness-of-fit test to check significant seasonality, we did not find any significant seasonal variation in acute cholecystitis (p-value = 0.262).

Conclusions
Our data failed to show any significant seasonal variation in patients presenting with acute cholecystitis in North Wales. We recommend prospective collection of data at national level to validate our results.
409 The impact of inadequate pain control following chest trauma on hospital acquired pneumonia rate and hospital admission length
Authors: Ong C T , Budha Magar O , Butterworth W 
Published: October 2021

Abstract

Introduction
Patients with blunt chest wall injuries often have severe associated injuries and even isolated chest injuries may have a high mortality and morbidity. The National Audit Office (2010) report estimated that there are 20,000 cases of major trauma per year in England; 5,400 people die of their injuries with many others sustaining permanent disability.

Aim
To assess compliance with trust guidelines for chest trauma pathway and the impact of poorly controlled pain on hospital acquired pneumonia (HAP) rate and hospital admission length

Method
A retrospective audit of all chest trauma between October 2019 to February 2020. Data obtained from electronic patient records and admission notes. Patients notes and imaging records are used to analyse adequate pain control based on local chest trauma pathways.

Results
28 patients identified (M:F 15:13) aged 47-94 yrs old (average age 73) who suffered from chest trauma in a district general hospital in England. Chest trauma was associated with high levels of morbidity (32%) and mortality (7%). 39% of patients were found to have inadequate pain control based on the local chest trauma pathway. 33% of chest trauma patients developed a HAP and 44% of pts with inadequate pain control developed a HAP. The admission length of patients with HAP secondary to chest trauma was on average three times longer relative to uncomplicated patients (15 days vs 5 days).

Conclusions
Chest trauma patients often receive inadequate pain control and delayed specialist team input. This results in an increase in the frequency of HAPs and admission length.
413 The Clinical Efficacy of Intra-Operative Peritoneal Fluid Sampling in Abdominal infections
Authors: Mostowfi Zadeh D , Praveen B 
Published: October 2021

Abstract

Aim
To uncover the practical efficacy of intra-operative peritoneal fluid sampling and the impact on antibiotic prescription and clinical outcomes in patients undergoing emergency surgery due to intra-abdominal infections.

Method
Our retrospective study included all patients undergoing emergency surgery for intra-abdominal infections at Southend University Hospital over 6 months (January – July 2019). Data was collected from electronic patient records, case notes and microbiology reports and included the following information: patient age demographics; type of infection; peritoneal fluid sampling indication; samples taken; details of swab culture report including organisms grown and antibiotic sensitivity; clinical course and incidence of subsequent intra-abdominal infection to include readmission and/or further procedures; the type, duration and route of antibiotic prescribed and duration of hospital stay. This audit was approved by the Departmental Audit Lead.

Results
441 patients undergoing emergency surgery for intra-abdominal infection were identified. After exclusions, intra-operative peritoneal fluid samples were indicated in 77 patients (mean age 39.4 years). Of these only 3 had samples taken (3.9%). The most common organisms isolated were mixed anaerobes followed by Streptococcus angiosus. The most common antibiotic sensitivity was Metronidazole and Penicillin. One readmission occurred due to an intra-abdominal tubo-ovarian abscess.

Conclusions
The study shows that the current practice in our hospital regarding intra-operative peritoneal fluid sampling in intra-abdominal infections reflects the present widely held attitudes regarding its reduced practical utility. Abandoning routine sampling had no significant impact on the clinical course and may be more cost-effective. The study may help surgeons reflect on changing perspectives on this traditional practice.
620 Daycase Appendicectomy and Same Day Discharge After Laparoscopic Appendicectomy
Authors: Gumaa D , Shrestha S , Jenner D 
Published: October 2021

Abstract

Introduction
Laparoscopic appendicectomy (LA) is the most common emergency surgical operation. Recently Same day discharge after uncomplicated LA has been more popular. Our study has sought to assess the safety of same day discharge and creating a pathway for day case appendicectomy.

Inclusion Criteria
Pre-operative: No signs of sepsis. CT proven or clinically suspected mild appendicitis (WCC&lt;15, CRP&lt;150) Intra-operative: Mild appendicitis, No perforation, No Gangrene, No free pus. Post-operative: Pain is controlled with oral analgesia. Patient is tolerating oral intake. No need for post-operative antibiotics according to WSES Jerusalem Guideline for diagnosis and treatment of acute appendicitis 2016. Social circumstances do allow safe discharge.

Method
A prospective case series study was undertaken at a large district general hospital over a 9-month period. 27 patients were included in the study, age range (10-78) years. 74% had ASA 1. 8 patients underwent day case LA & were sent home on oral antibiotics the day before the operation and asked to come back the following morning. 22 patients did not require any post op antibiotics. 5 patients received 1 dose of IV antibiotics post-operative. The 30-day morbidity/ mortality were zero. There were no readmissions during this time and patient satisfaction was high.

Conclusions
Same day discharge after laparoscopic appendectomy is safe and valid. Day case appendectomy should be considered for appropriate patients. Both approaches will decrease patients’ risk of hospital acquired infection and also decrease the burden on the NHS.