bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP7.2.3 Documentation of risk discussions prior to elective inguinal hernia surgery, is it standardised for all?
Authors: McLellan Morag , Stewart Brian 
Published: October 2021

Abstract

Aims
Obtaining consent is fundamental to surgical practice. Rising levels of litigation have led to increased scrutiny of the process. The Royal College of Surgeons (RCS) recommends a structured consent process enabling patients to make better informed decisions, increasing the legal robustness of the process. Our aim is to audit the documentation of risk discussions prior to elective inguinal hernia repair (EIHR).

Methods
Data was collected retrospectively for all patients who had undergone EIHR in a single surgical unit between January 2019 and 2020. Outpatient clinic letters and consent forms were reviewed. The grade of surgeon and documentation of consent discussions were recorded. The results were then analysed using basic statistical analysis.

Results
146 patients (137 male and 9 female) were included in the audit, with an average age of 63 years (range 20-89 years). 77% of clinic letters recorded a consent discussion. Of these, chronic pain was the risk most commonly documented (62%), followed by recurrence (56%). 19.8% of clinic letters included the level of risk quoted. 86% of consent forms were legible. Documentation of risk was significantly more detailed on consent forms compared to clinic letters (p &lt; 0.05). On these, infection was the most commonly documented (97%), followed by bleeding (91%). Overall, there was no significant difference in documentation relative to surgical grade.

Conclusions
This study has demonstrated considerable variability in consent process prior to EIHR. This can have both legal implications and impact upon patient experience. Adopting a strategy to ensure a consistent approach is essential.
SP8.1.3 Primary care practitioners have a high level of satisfaction with the current breast referral pathway but the majority would support a change to patient self-referral
Authors: Russell Thomas , Cooper Jemma , McIntyre Mairead , Ramzi Sa'ed 
Published: October 2021

Abstract

Aims
Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to specialist breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP’s views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates.

Methods
An electronic survey was sent out to PCPs in South West England via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral.

Results
79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs had a high level of satisfaction with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations.

Conclusions
PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.
SP8.1.6 The role of staging imaging prior to neo-adjuvant chemotherapy (NACT) for breast cancer
Authors: Muir Duncan , Gathani Toral , Dodwell David , Remoundos Dennis 
Published: October 2021

Abstract

Aims
The Royal College of Radiologists (RCR) guidelines state that there is no evidence base for routine imaging in patients with early breast cancer (≤T2 and ≤N1 disease) planned for NACT. Standard practice in our unit is to routinely stage all patients scheduled for NACT with CT chest/abdomen/pelvis and MRI marrow. Our aim was to assess the utility of this practice in this group of patients.

Methods
All patients who received NACT for breast cancer from 2017 to 2020 were included. The imaging reports were reviewed to identify whether metastatic disease had been detected, or further investigations were required.

Results
127 patients were identified. 51 patients met the current RCR criteria for imaging and were excluded.
Of the remaining 76 patients with ≤T2 and ≤N1 disease, metastatic disease was found in 13. This was detected by CT in 9 patients, by MRI in 1 patient, and by both modalities in 3 patients. Indeterminate findings requiring further investigation were present in 17 with 6 patients requiring at least one further scan.

Conclusion
Routine staging investigations detected metastatic disease in almost one in five patients with early breast cancer about to start NACT, impacting on their treatment planning. A similar proportion of patients required further investigations due to indeterminate findings. We believe that routine staging using our current criteria for NACT patients should continue. In the absence of evidence from prospective trials, there is a need for ongoing audit of the utility of systemic staging in early breast cancer.
SP8.1.8 Factors influencing the post-operative upgrade of ductal carcinoma in situ (DCIS) to invasive cancer
Authors: Khan Aminah , Tzortzidis Tiffany , Tzortzidis Natasha , Brown Douglas , Macaskill Jane , Pitsinis Vassilis 
Published: October 2021

Abstract

Aims
Ductal carcinoma in situ (DCIS) can be upgraded on pathological histology to invasive cancer and require a subsequent sentinel node biopsy (SNB). This second procedure increases the morbidity and costs of treating DCIS. Our study aims to establish the proportion of preoperatively diagnosed DCIS that is upgraded and identify factors associated with this upgrading.

Method
A retrospective review was conducted of 122 consecutive patients undergoing surgery following diagnosis of DCIS on percutaneous biopsy at our institution, from 1st January 2017 to 30th November 2019. Histological upgrade was evaluated against clinical, radiological and pathological parameters.

Results
Of the 122 patients, 31 (25.4%) were upgraded, with 11 (9.1%) having microinvasive disease (T1mi) only. A third of the upgrade group (n = 11) did not have a SNB during the initial surgery. Upgraded patients were younger (median 54yrs v 62yrs P = 0.005), had a higher BMI (median 28.9 v 26 P = 0.02) and more likely to have a palpable lesion (41.9% v 14.9% P &lt; 0.001). Multivariate logistic regression analysis showed that mass detected on ultrasound (OR 3.6 P = 0.04), a palpable lump (OR 5.2 P = 0.03) and finding high grade DCIS on percutaneous biopsy (OR 11.9 P &lt; 0.001) were independently associated with final tumour upgrade. In contrast, patients undergoing vacuum assisted biopsy were less likely to be upgraded after surgery (OR 0.23 P &lt; 0.001).

Conclusion
Patients that have a higher BMI, palpable lump, mass on ultrasound and percutaneous biopsy showing high grade DCIS are at increased risk of harbouring invasive cancer and should be considered for SNB at initial surgery.
SP9.1.12 Bone protection in neck of femur fracture patients in a DGH without a fracture liaison service
Authors: Brock James , Yoganathan Sanjeevan 
Published: October 2021

Abstract

Introduction
In England and Wales, there are approximately 75,000 proximal femoral fractures per year. Bone protection is vital in these patients and a key recommendation of NICE guidelines (CG124) for multidisciplinary approach in hip fracture management.

Method
Data were collected retrospectively using clinical portal, admission records and medication charts. The data were inputted into the FRAX calculator to calculate a patient’s risk of developing an osteoporotic fracture; depending on their risk they would be appropriate for bone protection or DEXA scanning for further assessment. As certain data criteria were not available for the FRAX calculation, risk calculation was underscored i.e. if parental hip fracture status was not known.

Results
A total of 59 patients were audited between July and October 2019. Of those patients, 25 were calculated as high risk, however, only 6 patients had adequate bone protection. 19 patients were deemed intermediate risk and would benefit from a DEXA scan for further assessment. Of those 19 patients, only 8 had adequate bone protection. DEXA scan was only requested for 2 of the patients who were intermediate or high risk. In the year following, 4 patients have had another fracture, with 3 of those patients not on any bone protection medication and had a high risk FRAX calculation.

Conclusion
Following a local meeting; a proforma was piloted to identify patients at risk and requiring bone protection. With the help of a dedicated orthopaedic pharmacist and nurse practitioners, continuity of care can be achieved to aid patients long-term wellbeing.
SP10.1.2 Increased Access to Computed Tomography Reduces Acute Surgical Admissions: Lessons Learnt During the COVID-19 Pandemic
Authors: Davidson S , Cornett L , McElvanna K 
Published: October 2021

Abstract

Aim
With increased bed pressures due to COVID-19, keeping patients out of hospital became critical. Computed Tomography (CT) utilisation was increased to aid in the assessment of acute surgical patients. The aim of this study was to assess if increased access to CT reduced inpatient admissions.

Methods
A Retrospective audit of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required a CT scan. Data collected from Electronic Care Records and NIPACS, including patient destination at time of CT and decision following CT. For comparison, the same time-period in 2019 was assessed.

Results
In 2020, 301 patients required a CT compared to 207 in 2019. 84.7% (255/301) had a CT direct from ED in 2020 vs. 56.5% (117/207) in 2019 (p &lt; 0.001).
Of those who had CT direct from ED in 2020 18.4% (47/255) were discharged, compared to 1.7% (2/117) in 2019 (p &lt; 0.001). 9.8% (25/255) were directed to an alternative specialty in 2020 vs. 2.6% (3/117) in 2019 (p = 0.014).
2.7% (8/301) were discharged for an ambulatory CT in 2020, an increase from 0.5% (1/207) in 2019 (p = 0.07).
Overall, there was a 24% reduction in the number of patients requiring acute surgical admission in 2020 vs. 2019.

Conclusions
There was a significant increase in the number of CT’s carried out directly from ED. This enabled a significant number of patients to be discharged or transferred to a more appropriate specialty. These results demonstrate that increased access to CT can reduce the need for acute surgical admission.
SP10.1.3 The presentation, management and outcomes of acute appendicitis: a comparison of patients presenting during the COVID-19 pandemic and those presenting in a pre-COVID-19 period
Authors: Davenport Matthew , Clarke Alex , Smith Stella , Stathakis Panos , Macutkiewicz Christian , Chan Anthony 
Published: October 2021

Abstract

Aims
This study assesses the impact of COVID-19 on the presentation and management of acute appendicitis (AA). Patients presenting with AA during the first wave of the COVID-19 pandemic are compared to a pre-COVID-19 cohort.

Methods
Patients admitted to a single acute NHS hospital with AA between April and July in 2019 and 2020 were retrospectively identified. Data on presentation, treatment and outcomes was collected.

Results
56 patients were identified in 2019, and 37 in 2020. A greater proportion of patients presented later (&gt;3 days of symptoms) in 2020 (2019=15.6%, 2020=32.4%, p &lt; 0.05). There was no significant difference in the proportion of patients presenting systemically unwell (pyrexial & tachycardic) or with high inflammatory markers (CRP &gt; 50 and white cell count &gt; 15). In 2020, more patients were managed conservatively (2019=7.1%, 2020=35.1%, p &lt; 0.05). Among those who were managed operatively, 75% underwent open appendicectomy in 2020, compared to 7.7% (including cases converted to open from laparoscopic) in 2019. Patients managed operatively during the COVID-19 pandemic had significantly more post-operative complications (2019=17.3%, 2020=50%, p &lt; 0.05). Common post-operative complications in 2020 were abdominal collections (16.7%) and wound infections (12.5%). Median duration of admission was similar (2019=3 days, 2020=2 days) and there was no significant difference in 30-day readmissions (2019=8.9%, 2020=13.5%, p = 0.48).

Conclusions
AA patients in the COVID-19 pandemic were more likely to present later and were more likely to be managed conservatively or with open appendicectomy. There was a higher rate of post-operative complications for patients in 2020. Duration of stay and readmission rates were similar.
SP10.1.6 Benefit of Two week colorectal cancer referrals of patients who had colonic imaging within the last 5 years: do they improve the colorectal cancer outcome?
Authors: Bavikatte prasannakumar A , Nathan C , Kundrapu K , Dennis H , Athisayaraj T.W , Sebastian B 
Published: October 2021

Abstract

Purpose
There has been a significant rise in the number of colorectal rapid access referrals. These referral results in additional demand for hospital services as well as delays assessment and management of other patients. We analyzed the outcome of colorectal fast tract clinic re- referrals on bowel cancer outcome in patients with recent colonic imaging.

Methods
We retrospectively analyzed 1000 consecutive colorectal rapid access pathway referrals in 2019.Patients with complete colonic imaging within the preceding 5 years were included. We assessed their clinical outcome and colonic imaging when performed.

Results
In total, 82 (8.2%) patients out of 1000 met the selection criteria. Among these 12 patients (14%) did not need any further colonic investigations. A further 12 patients (14%) were already on the colorectal surveillance program, including a patient with recently diagnosed rectal cancer. Hence 24 patients (29.2%) referral was not indicated. 58 patients had further colonic imaging in the form of colonoscopy or virtual colonoscopy following clinic consultation. 32 (55.17%) of them had normal colonic imaging. 14 patients (24.1%) were identified with colorectal polyps with only one identified as tubular adenoma. The remaining 12 patients had non neoplastic pathology.

Conclusion
No new significant colorectal pathology was identified in this group of patients. We suggest that symptomatic patients who had complete colonic imaging within 5 years be referred to routine colorectal clinic in order to make the colorectal rapid access referral pathway more effective especially during these unprecedented times.
SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic
Authors: Montauban Pierre , Balakumar Charannya , Rait Jaideep , Zarsadias Prizzi , Iqbal Sara , Aravind Biju 
Published: October 2021

Abstract

Background
Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19.

Methods
This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients.

Results
27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy.

Conclusion
In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.
SP10.2.5 It SOCS: Surgical On-Call Simulation for final year Medical Students
Authors: Castelhano Rute , Gurung Pratha , Win Khine Myat , Waters Christopher , Coleman Nichola , Scheneiders Hannah 
Published: October 2021

Abstract

Introduction
Simulation is a well-known method of effectively teaching Medical students. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks.

Method
Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment.

Results
The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call.

Conclusion
This project demonstrates how simulation is also effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.
SP10.2.6 The Quantitative Impact of COVID-19 on surgical training in the United Kingdom
Authors: Clements Joshua , Burke Joshua , Hope Carly , Nally Deirdre , Griffiths Gareth , Lund Jon 
Published: October 2021

Abstract

Aims
COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom.

Methods
Anonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI).

Results
5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more than emergency surgery (0.88; 95% CI 0.86-0.89). Regional variance with reduced operative activity was demonstrated across all specialities. 1 in 8 in their final year of training have not been able to achieve curriculum requirements and have had training extended. 1 in 4 trainees entering their final year of training are behind their expected training trajectory.

Conclusion
COVID-19 continues to have a significant impact on surgical training in the UK. Urgent, co-ordinated action is required by key stakeholders to mitigate for these effects and maintain future surgical training.
SP10.2.7 Preparing foundation trainees for surgical on-calls
Authors: Boyle Mark , Thu Khine , Mroczek Thomas , Scicluna Matthew , Byrne Aodhan 
Published: October 2021

Abstract
Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical oncalls.
Key areas of concern are; assessing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs.
Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw these presentations to ensure quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered; suturing, knot tying, laparoscopic principles and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training.
Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%.
All trainees that attended the course displayed marked improvement in their confidence and competence.
We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.
SP10.2.9 An audit of consenting practice for elective surgical procedures and patients overall satisfaction
Authors: Noureldin Khaled , Mehmood Afsheen , Ayantunde Abraham 
Published: October 2021

Abstract

Introduction
We evaluated our consenting practice for surgical procedures and patients’ satisfaction.

Patients and Methods
100 patients were evaluated for the timing, details, understanding and satisfaction with the consenting process. Procedures were elective general and colorectal operations. Patients’ overall satisfaction level was rated on visual analogue score.

Results
54 males and 46 females were included, median age was 65 (16-93) years. The mean time between consenting and surgery was 29 (0-358) ± SD 73 days. Legible writings in 88% with completed details in 51%. The names of the responsible surgeon were missing in 49%. All patients fully understood the intended procedure and its possible outcomes. 99% were comfortable with the consenting environment. One patient preferred a different setting and an earlier date. Two patients felt the consenting process was performed in a hurry, but all patients submitted that they had enough time to reflect on the consent and the procedure before surgery. The overall satisfaction levels were excellent in 93% (9&10), good in 5% (7&8) and fair in 2% (5&6). One patient with low satisfaction score was unhappy with the anaesthetist.

Conclusion
Improvement in the legibility and completeness of the consent form are to be encouraged. The overall patients’ satisfaction was good to excellent.