bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.356Can day case elective operating lists provide efficient training opportunities for general surgical trainees?
Authors: Coulson Rachael , Gilmore Catherine , Sheridan Catherine , Murray Anna , McCain Scott , McAllister Ian 
Published: October 2021

Abstract

Introduction
During the COVID-19 pandemic there has been a reduction in trainee hands-on learning opportunities due to curtailment of elective workload. Our study aims to assess the impact of non-consultant led operating on theatre list efficiency.

Methods
Prospective data collection over an eight week period of consecutive elective day case hernia lists at a newly established regional centre of excellence for day surgery. Specifically recording of key time points in surgical cases including time ready, knife to skin, last suture and exit theatre. This was achieved using the Theatre Management System (TMS).

Results
46 patients underwent open unilateral elective inguinal hernia repair. 54% (N = 25) of cases were trainee led. Median trainee time was 53 minutes, vs 51 minutes for consultant led procedures; no significant difference (p &gt; 0.05).

Conclusion
Day case elective hernia lists can be efficient training opportunities for general surgical trainees. Our results demonstrate that trainee-led operating in this setting have not resulted in significantly increased surgical time or operative theatre inefficiency. It is widely acknowledged there is benefit to training in performing the same technical skill within a short time frame.
EP.TU.364Intravenous fluid prescribing – common pitfalls and suggestions for improvement
Authors: Makhort Alexei , Ma Jennifer , Ng Stephanie 
Published: October 2021

Abstract

Aim
Intravenous fluids are no doubt most prescribed treatments in surgical practice. It is also an area where junior doctors’ performance is commonly found deficient. There appeared to be a gap in general knowledge of fluid and electrolyte management. Our audit aims to assess the competency of surgical juniors in fluid prescribing as compared to recommendations set out by GIFTASUP 2011. FY1s have also been asked to complete a survey on fluid and electrolyte management.

Method
We included all adult surgical inpatients (28) admitted over one week to our DGH who were started on IV fluids for maintenance only. We retrospectively audited their prescription charts and medical notes. FY1's in the department have been also asked to fill out a short survey testing their knowledge on fluid and electrolyte requirements. Following this, we held a tutorial on fluid management of surgical inpatients for FY1's. We also made fluid management algorithm available in SAU for reference.

Results
Data was tabulated and outcomes compared with CG174 guidance. Cycle 1 showed poor compliance with only about 50% patients being prescribed appropriate intravenous fluid volumes. FY1’s completing the survey scored 54% on average. Often previous fluid prescription was copied. Cycle 2 showed some improvement in appropriate volumes and choice of maintenance fluids prescribed, and better survey score of 64%. There was also improvement on the understanding of daily fluid and electrolyte requirement from the FY1 cohort.

Conclusions
We suggest implementing varied educational approach to improve on fluid prescribing and patient outcomes in hospital.
EP.TU.371The introduction of standardised ward round notes in the Acute Surgical Unit
Authors: Johns Jonathan , Rahman Atiqur , Pearson Katherine , Howse Frances , Berry David 
Published: October 2021

Abstract

Introduction
A standardised approach to note-keeping has been shown to improve patient care and experience.

Aims
This repeated audit cycle assesses the compliance with the introduction of a standardised proforma.

Method
Data collection was prospective. Round 1 (n = 83) after introduction of a ward round proforma, Round 2 (n = 94) following result analysis / education, Round 3 (n = 62) following proforma changes.

Results
(% Compliance with proforma)

Conclusions
Some improvements were seen in Round 2. A notable improvement was observed in EDD and CFD when a tick box option was implemented in Round 3. Successful implementation of a standardised note-keeping requires repeated analysis, education and modification of the proforma.
EP.TU.393Management of Suspicious Neoplastic Rectal Lesions in Octogenarians by a Specialist Early Rectal Cancer MDT
Authors: Altaf Kiran , Gahunia Sukhpreet , Sochorova Dana , Andrews Timothy , Sarkar Sanchoy , Ahmed Shakil 
Published: October 2021

Abstract

Aims
To assess management of early rectal cancers in octogenarians going through a regional Small and Early Rectal Cancer MDT observing oncological outcomes, morbidity, mortality and quality of life after treatment

Methods
Consecutive octogenarian patients treated via the SERC MDT between Dec 2013 and Dec 2019 were examined retrospectively from a prospectively maintained database. Patients underwent transanal endoscopic microsurgery (TEMS), endoscopic submucosal dissection (ESD), contact radiotherapy or hybrid combinations. Patient demographics were recorded and outcomes assessed including pre and post-operative oncological staging, morbidity, mortality, length of stay and FISI scores

Results
85 patients were assessed. 38 had TEMS, 40 had EMR, ESD or hybrid procedures and 7 had contact radiotherapy. Of the 38 patients who underwent TEMS, there was minor morbidity in 5 patients, one cancer recurrence and no cancer related mortality. FISI scores pre- and post-procedure were markedly different with deterioration in control of flatus and mucus, but no faecal incontinence. Of the 40 patients who underwent EMR, ESD or hybrid procedures, 2 had minor morbidity and 3 had adenocarcinomas detected requiring further treatment

Conclusions
Management of octogenarians with early rectal cancer via a specialist MDT provides a safe option with minimal morbidity and no mortality in a subgroup of patients who would otherwise constitute a high risk cohort for surgical intervention. A deterioration in continence in this group highlights the need for careful counselling of patients to achieve the optimal balance between oncological outcomes and quality of life
EP.TU.414Development and introduction of a multi-modal Major Trauma Ward nursing course
Authors: Knight Chris , Smith Stella 
Published: October 2021

Abstract

Introduction
In 2018, the National Major Trauma Nursing Group (NMTNG), published a set of competencies for nurses working on Major Trauma Wards (MTW). They recommended that nurses evidence their knowledge and skills to this framework and that local education packages are created to support this.

Methods
Nurses working on the MTW completed a survey to self-assess their competency and level of knowledge against the NMTNG framework. An intensive, in-house, 2-day pilot course was designed for nurses, incorporating lecture-based teaching, practical skills and simulation. The content was fully mapped against the NMTNG key competencies, and also addressed the survey responses and local policy. Nurses were then asked to repeat the survey following the course.

Results
5 nurses and 2 student nurses attended the pilot course. The majority of attendees (4/7) had been working on the major trauma ward for over 6 months and none had previously completed any nationally accredited major trauma training. Following the course, an improvement in self-assessed knowledge was recorded across all aspects of the competency framework. The highest percentage increase in knowledge was 76% in maxillo-facial trauma and the mean increase across all areas was 48% (range 20-76%).

Conclusion
Attendance at the course significantly increased the nurses self-perceived knowledge and competency in all key areas. Feedback will be used to further develop the course and an associated mentorship scheme, ensuring all nurses working within Major Trauma will have access to ward-based, major trauma specific education.
EP.TU.480Novel virtual near-peer surgical teaching for foundation doctors
Authors: Hughes Andrew , Choi Sarah , Olabisi Oluwafisayo , Torkington Jared 
Published: October 2021

Abstract

Aims
Studies have shown that new medical graduates feel unprepared for their role as clinicians. Courses and teachings have been cancelled due to COVID-19. Our aim was to assess demand for surgical teaching and provide a new surgical course delivered virtually to fill this gap.

Methods
FY1 doctors from a large teaching hospital were invited to fill in a questionnaire to assess their preparedness for surgical specialties and subsequent appetite for near-peer teaching. The findings were used to create a virtual surgical teaching course. A post-course questionnaire was distributed to assess the success of the course.

Results
Fifteen FY1 doctors completed the questionnaire. 73% (11) felt they had not had sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on managing surgical patients in foundation training. None felt ‘very confident’ managing patients peri-operatively. None felt ‘very confident’ managing surgical complications. 66.7% (10) and 53.3% (8) said they had not had any teaching from SHOs or SpRs respectively. Of those who had, 66.7% (4) and 85.7% (6) found it ‘very useful’. 100% (15) said they would be interested in surgical teaching delivered by CSTs. Twelve FY1 doctors completed the post-course feedback. 83% (10) found the course ‘extremely useful’ and relevant to their surgical ward based jobs.

Conclusion
FY1s are not confident in managing surgical patients on the wards. There is a demand for surgical teaching for FY1s. Virtual lunch-time teaching is an effective way to encourage and continue surgical teaching throughout the pandemic.
EP.TU.493Attitudes of Irish General Surgery trainees to Robotic-Assisted Surgery
Authors: Ramjit Sinead , O'Connell Lauren , Donlon Noel , Neary Paul , O'Riordain Diarmuid , Hafeez Adnan 
Published: October 2021

Abstract

Background
While the use of robotic-assisted surgery is now mainstream for procedures such as robotic prostatectomy, its role in general surgery is less well established. Access to training in robotics for general surgery trainees in the Republic of Ireland is variable. Further, there is no data on attitudes of Irish trainees towards the role of robotics. We aimed to establish attitudes of Irish general surgery trainees towards the perceived utility of robotic surgery as well as access and satisfaction with training.

Methods
A survey was disseminated to trainees in the Republic of Ireland enrolled in a General Surgery training scheme via email and social media. Data collected included stage of training, intended subspecialty, interest in developing robotic skills, previous exposure to robotic surgery, satisfaction with current access to robotic training and opinion on formally incorporating training in robotics into the general surgery curriculum.

Results
The response rate was 44.8%. Of these, 83% reported interest in training in robotics and 69% anticipated using the technology regularly in consultant practice. Previous exposure to robotic-assisted surgery was significantly predictive of interest in developing the skillset (p = 0.014). Over 71% of trainees reported that they were not satisfied with access to robotic training. Of those satisfied with access, 40% felt there was a role for incorporating robotic training into the curriculum, compared to 68% of those dissatisfied.

Conclusion
Irish general surgery trainees perceive robotic-assisted surgery to be highly relevant to their future practice. There is an unmet need to provide additional training in the skillset.
EP.TU.4973 year oncological outcomes of robotic-assisted versus laparoscopic rectal cancer resections – a single centre experience
Authors: O'Connell Lauren , Ramjit Sinead , Nugent Tim , Neary Paul , Hafeez Adnan , O'Riordain Diarmuid 
Published: October 2021

Abstract

Background
Robotic-assisted minimally invasive surgery (MIS) for rectal cancer is a relatively new technique. Studies to date suggest that short term outcomes including TME quality, margin status, lymph node retrieval and 30-day morbidity and mortality are equivalent in robotic-assisted and laparoscopic MIS for rectal cancer. By contrast, there is a paucity of data on the medium and long-term oncologic safety of robotic-assisted comparative to laparoscopic surgery for rectal cancer.

Methods
A retrospective review was conducted of all robotic-assisted (n = 31) and laparoscopic (n = 23) rectal cancer cases performed at our institution between January 2016 to December 2018. Inclusion criteria were patients scheduled electively for a laparoscopic or robotic-assisted resection of rectal cancer (anterior resection or abdomino-perineal resection). Patients with distant metastases at presentation, those who proceeded to surgery as an emergency and those with a non-colorectal primary were excluded from analysis.

Results
A total of 54 (n = 54) cases met the inclusion criteria and were included in the final analysis. The median follow-up was 34 months. Of the 54, 21 patients received neoadjuvant chemoradiotherapy prior to definitive surgery.
No significant difference was detected in local recurrence rates (p = 0.5), overall survival (p = 0.7) or disease-free survival (p = 0.8) between the robotic-assisted and laparoscopic cohorts.

Conclusion
In this series, robotic-assisted rectal cancer resections were associated with equivalent medium term oncological outcomes as laparoscopic procedures.
However, given the small numbers in this cohort, outcomes from larger scale datasets will be required to confirm these results.
EP.TU.505Does a foundation interim year one post improve confidence in general surgery in a tertiary centre?
Authors: George Jayan , Mathew Alok , Botsford Edward , Al-Mukhtar Ahmed 
Published: October 2021

Abstract

Aims
1. Understand the confidence levels of current foundation year one (FY1) doctors.
2. Understand whether a foundation interim year one (FiY1) post improves confidence.

Methods
FY1s were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
28.6% (30/105) of FY1s completed the survey.
20% (6/30) did not undertake a FiY1 post but 80% (24/30) did.
Confidence levels were similar between FY1s who had a FiY1 post and those that did not for: dealing with acute general surgical patients, non-specific abdominal pain, appendicitis and prescribing fluids for maintenance as well as resuscitation.
Confidence levels were higher for FY1s who did not have a FiY1 post compared to those that did in managing those with hepatobiliary disease.
Confidence levels were lower for FY1s who did not have a FiY1 post compared to those that did in scrubbing for theatre, speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown.

Conclusions
FY1s who have had a FiY1 post in a tertiary centre have more confidence in most areas but not all. This data shows the value of the FiY1 post however work needs to be done to improve the experience to the role.
EP.TU.517Is a foundation interim year one post better for improving confidence in the care of the dying in general surgery in a tertiary centre or a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Botsford Edward , Ardley Rohan , Al-Mukhtar Ahmed 
Published: October 2021

Abstract

Aims
1. Understand the confidence levels of current foundation year one (FY1) doctors who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH).
2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH.

Methods
FY1s were surveyed throughout August – December 2020. Six questions used Likert scales (1 to 5: not at all confident to very confident) over some common palliative themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
16.7% (4/24) from a DGH and 83.3% (20/24) from a TC had a FiY1 post.
Confidence levels were higher for FY1s who had a FiY1 post in a TC than a DGH in managing pain control, psychological distress, spiritual health.
Confidence levels were higher for FY1s who had a FiY1 post in a DGH than a TC in dealing with social issues, speaking to the family of a patient in the last days of life.

Conclusions
FY1s who had a FiY1 post in a TC had better confidence in three areas as opposed to a DGH in two areas. The experience of the FiY1 should be more standardised to ensure the growth of confidence across all areas identified in the survey.
EP.TU.524Does a foundation interim year one post improve confidence in the care of the dying of general surgical patients in a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Ardley Rohan 
Published: October 2021

Abstract

Aims
1. Understand the confidence levels of current foundation year one (FY1) doctors.
2. Understand whether an interim foundation year one (FiY1) post improves confidence.

Methods
FY1s were surveyed throughout August – December 2020. Six questions used Likert scales (1 to 5: not at all confident to very confident) over some common palliative themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
28.6% (8/28) of FY1s completed the survey.
50% (4/8) did not undertake a FiY1 50% (4/8).
Confidence levels were higher for FY1s who did have a FiY1 post compared to those that did not in managing pain control, psychological distress, spiritual health, social issues, speaking to family and the patient in the last days of life.

Conclusions
FY1s who had a FiY1 post had greater confidence levels than those that did not in a district general hospital. This data suggest the value of the FiY1 post however work needs to be done to improve the experience to the role.
EP.TU.526Is a foundation interim year one post better for improving confidence in general surgery in a tertiary centre or a district general hospital?
Authors: George Jayan , Mathew Alok , Robinson Edward , Botsford Edward , Ardley Rohan , Al-Mukhtar Ahmed 
Published: October 2021

Abstract

Aims
1. Understand the confidence levels in caring for general surgical patients of current foundation year one (FY1) doctors in who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH).
2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH.

Methods
FY1s doctors were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
20% (6/30) from a DGH and 80% (24/30) from a TC
Confidence levels were higher for FY1s who had a FiY1 post in a TC as opposed to a DGH in dealing with acute general surgical patients, appendicitis and scrubbing in theatre.
Confidence levels were the same in both a TC and DGH for FY1s in managing those with hepatobiliary disease, prescribing fluids for resuscitation and maintenance as well as speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown.

Conclusions
FY1s who had a FiY1 post in a TC had better confidence levels in more areas as opposed to a DGH. The experience of the FiY1 post should be more standardised to ensure the growth of confidence across all areas identified in the survey.
EP.TU.533A rare clinical presentation of Goblet Cell Adenocarcinoma of the appendix: Recommendations for safe & effective management
Authors: Ramsamy Ganeshan , Slack Zoe , Tebala Giovanni 
Published: October 2021

Abstract

Background
Goblet cell carcinoma (GCC) is a rare mixed neoplasm arising from the appendix, consisting of glandular and neuroendocrine tissue. It typically presents in adults with a mean age of 55-65 years old. Diagnosis is usually incidental via histopathological examination after 0.3% to 0.9% of all appendicectomies. Literature remains sparse on classification and prognosis of GCC, and cases documented in younger patients.

Aims
To highlight an interesting clinical presentation and intra- and post-operative management of GCC. To increase awareness for future practice when managing patients with GCC.

Methods
A 37 year-old male presented with left sided abdominal pain, constipation and fresh rectal bleeding. Computed Tomography demonstrated extensive SMV thrombus causing small bowel ischaemia. On the Intensive Care Unit, he underwent thrombolysis through a Transjugular Intrahepatic Porto-Systemic Shunt. A few days later, he developed bowel obstruction, necessitating a small bowel resection secondary to an ischaemic stricture. 9 months later, he presented with clinical signs of appendicitis. After an uneventful appendicectomy, he was diagnosed with GCC upon histopathological examination of the specimen.

Results
The patient made an uneventful post-operative recovery. A multidisciplinary team (MDT) decision was made to perform a completion right hemicolectomy, with histology confirming pT3N1M0 GCC. Adjuvant chemotherapy with 5-Fluorouracil was started.

Conclusion
This case highlights GCC with a preceding clinical course not yet published in the literature. It stresses the importance of the MDT in managing GCC. Although primarily diagnosed histologically, a clinical suspicion of GCC of the appendix is worth considering in pro-thrombotic patients.
EP.TU.560Improving surgical handover by implementing a dynamic handover sheet
Authors: Stienstra Roxane , Wilson Michael , Kynaston James 
Published: October 2021

Abstract

Aim
Safe and effective handover is paramount to ensuring good patient care and patient safety. The aim of this study was to identify key issues with the current handover sheets and implement a new comprehensive sheet aimed to improve quality of handover and reduce safety issues within a busy DGH general surgery department.

Methods
A prospective dynamic study was performed. Retrospective data was obtained by sending out questionnaires to all junior and senior staff. The questionnaire aimed to assess key issues with the original handover sheets and collect qualitative data of perceived safety and efficiency. A dynamic handover sheet was developed using Microsoft Excel and Microsoft Visual Basic. After 2 months of using the new handover sheet, repeat questionnaires were sent out to assess its impact.

Results
There were 26 responses to the pre-intervention and 14 to the post-intervention questionnaire. 14/26 (54%) reported safety issues, mainly patients being missed at weekend ward rounds or missing handovers from elective teams. Post introduction of the comprehensive sheet 6/14 (43%) reported safety issues, mostly related to user error. Subjective list accuracy improved from 59.0% to 65.3% and accuracy for weekend wardrounds improved from 58.4% to 61.3%. Subjective efficiency of the list improved from 52.5% to 71.5%.

Conclusion
The new, dynamic handover sheet has led to an overall improvement in safety and efficiency of handover. An easy to understand instruction sheet has been designed to further improve usability and to ensure a lasting effect to mitigate against the inherent risk of junior doctor change-over.