bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis
Authors: Gulnaz Nadia , Tasleem Sadia , Abdullah Farooq 
Published: October 2021

Abstract

Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support.
The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard.

Methods
The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests.

Findings
In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out.

Conclusion
Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates.
EP.FRI.495 A retrospective audit of electronic venous thromboembolism risk assessment compliance across three surgical wards in a district general hospital
Authors: Banwaith Tavlene , Qayum Mohammed Kaif , Arun Chokkalingam , Nawaz Ghulam 
Published: October 2021

Abstract

Aims
Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths; with hospital-acquired VTEs accounting for 50% to 60% of all VTEs seen. This project aims to review and improve the number of VTE risk assessments completed for surgical in-patients.

Methods
This retrospective, cross-sectional study involved data collection from surgical in-patients (n = 648) over three consecutive months, using an electronic VTE risk assessment tool. Data was categorised into ‘First VTE prophylaxis risk assessment completed within 24 hours of admission’ and ‘Second VTE prophylaxis risk assessment completed within 48 hours of admission’. This was further sub-categorised into surgical specialties. Results were presented in departmental meetings and educational posters were displayed. The study was re-audited using the same method over one month (n = 216).

Results
Results demonstrated improvement from the initial audit cycle, particularly in relation to the mean number of VTE risk assessments completed for patients undergoing breast surgery (100% from 95.3%), colorectal surgery (93.3% from 90%) and general surgery (88.0% from 86.6%). The mean number of first VTE risk assessments completed in 24 hours across all surgical wards remained above 65%, whilst the mean number of second VTE risk assessments completed in 48 hours improved from 36.1% to 47.6%.

Conclusions
Variation in compliance is still evident across the surgical in-patient wards. Going forward, responsibility to complete outstanding VTE risk assessments will be handed to the FY1 on the late shift. Following this intervention, a further audit cycle will be performed, with the aim of 100% compliance in VTE risk assessment completion.
EP.FRI.510 The Management of Hyperkalaemia in Acute General Surgical Inpatients
Authors: Karadaghi Rezhaw , Sagar Joseph , Bullingham Roberta , Mathur Pawan 
Published: October 2021

Abstract

Aims
Hyperkalaemia is very common in hospitalised patients especially in peri-operative settings. It is associated with increased length of stay, morbidity and mortality. Here we review the management of hyperkalaemia in emergency surgery inpatients compared to the recommended national guidelines. With the identification of any gaps, we will introduce a new protocol to standardize practice as the basis of our educational intervention.

Methods
A retrospective observational study of adult surgical inpatients between July and December 2020. 20 patients with a K+ &gt;5.5 during their inpatient stay were identified. Data on their clinical management was extracted from their electronic data record and handover database and analysed.

Results
Of the 20 patients identified, 13 had mild (5.5-6), 3 moderate (6-6.5) and 4 severe (&gt;6.5) hyperkalaemia. Mortality was 0 and 100% of patients with K + ≥6.5 received timely emergency treatment in line with guidelines. However, there was a wide variation in the type of treatment given with 100% of cases not aligning with current guidelines. Additionally, in only 40% of cases was the hyperkalaemia documented and only 20% of patients received an ECG; a recommendation even in mild cases.

Conclusions
There is a need to standardise practice in the clinical management of hyperkalaemia and align with recent, validated guidance. A clear and easily accessible algorithm reinforced by an educational intervention to junior doctors may improve the management of high potassium in surgical inpatients and improve outcomes. Following this intervention, the standard will be re-audited.
EP.FRI.583 Re-Audit of the Quality of Operation Notes
Authors: McAuliffe Orlaith , Aboulela Ahmed , Mohamed Mohamed 
Published: October 2021

Abstract

Aims
High quality operation notes are crucial for the safe management of surgical patients. The Royal College of Surgeons Good Surgical Practice (2014) describes eighteen separate pieces of information that should be included in operation notes. Our aim was to determine whether the quality of operation notes have improved since the introduction in our hospital in 2015 of an electronic proforma to record these notes.

Methods
We conducted a retrospective audit of operation notes between 28th October and 19th November 2020 based on the RCS guidelines. These results were compared to those of our 2015 audit.

Results
Of the seventy eight operation notes analysed in this re-audit, twenty eight percent were produced using the electronic proforma compared to forty five percent in 2015. In our re-audit a significantly higher proportion of notes had records of whether operations were elective or emergency (p &lt; 0.01), intraoperative diagnosis (p &lt; 0.01) and estimated blood loss (p &lt; 0.05).Compared to the 2015 audit data there was a significant improvement in recording whether or not the surgery was elective or emergency (p &lt; 0.0001).

Conclusion
In this audit we noted a disappointing decrease in proportion of operation notes that were produced using the electronic proforma. We also noted that operation notes produced using the electronic proforma were of higher quality compared to those that were not. We need to increase awareness amongst surgeons in our hospital of the benefits of using the electronic proforma to improve the quality of operation notes.
EP.FRI.614 An Atypical Case of Small Bowel Obstruction in the Virgin Abdomen: Case Presentation and Literature Review
Authors: Chouari Tarak , Khan Hamza , Gala Tanzeela , Ceraldi Serena 
Published: October 2021

Abstract

Aims
The management of post-operative adhesional small bowel obstruction (SBO) has shifted from the historical motto of “the sun should never rise and set on a complete SBO” to a non operative approach in selected patients. Despite this shift, the operative management of patients with SBO with a virgin abdomen is still encouraged.

Methods
We present an atypical case of SBO managed conservatively with resolution, without surgical intervention. A literature review is conducted and our case compared with the current literature. A treatment algorithm is presented.

Results
A 57 year old with a virgin abdomen presented with vomiting and abdominal pain. Computed tomography was consistent with mid to distal SBO proximal to the terminal ileum, in the context of a high riding caecum. He was managed conservatively. Symptoms resolved within 12 hours without gastrograffin. Gastrograffin was subsequently given to ensure contrast was present in the large bowel. At 6 month follow up he remains symptom free.

Discussion
Many advocate surgery is the cornerstone of the management of SBO in the virgin abdomen. There is little evidence to support this. Recent emerging evidence challenges this view. Ultimately the clinical evaluation of the patient is paramount in selecting which patients can be managed conservatively. A longer interval to operation may carry greater risk of ischaemia and bowel resection. Therefore careful patient selection and serial examination is vital and one should have a low threshold for early operative intervention in the patient which isn't settling. Follow up should be tailored to each patient.
EP.FRI.668 Surgical Clinicians’ Views on the Current Admission Booklet in NHS Fife
Authors: Chan Deona Mei Lam , Yalamarthi Satheesh 
Published: October 2021

Abstract

Aim
The use of an admission booklet for hospital admission has become a standardised practice. This survey reflects on the surgical clinicians’ views on the use of our hospital admission booklet in NHS Fife for surgical admissions.

Methods
An online questionnaire was sent to the clinicians (Advanced Nurse Practitioners, junior doctors to consultants) of the surgical department via Google Questionnaire. The clinician’s views on the use of the admission booklet and VTE prophylaxis were surveyed. Data from the responses were collated.

Results
23 clinicians took part in the survey, with an average 18.30 months worked in the department. 77.3% indicated if given a choice they would use the admission booklet. 63.6% prefer the booklet due to familiarity, 54.3% feel the laid out is good and 31.8% prefer it due to the ease of completion. Although a majority of clinicians prefers the use of the booklet, 59.1% indicates they would like the booklet to be changed, in general to a shorter booklet, with more space for relevant past medical history and social circumstances. 68.2% indicated VTE prophylaxis assessment make an influence to their prescribing of VTE prophylaxis.

Conclusion
This survey identified most clinicians are in favour of the use of the admission booklet and VTE prescribing are influenced by the VTE assessment in the admission booklet, although they would welcome some changes to a shorter booklet with more space. We recommend some updates to the admission booklet more tailored to the use for the surgical department.
EP.FRI.700 NCEPOD Acute Bowel Obstruction Report 2019: A pilot study for review of quality of care provided to patients with acute bowel obstruction in a Surgical Emergency Unit
Authors: Dey Abhishek , Rudzats Antons , Gilmour Jeffrey 
Published: October 2021

Abstract

Aims
Acute bowel obstruction is one of the commonest surgical emergencies posing various diagnostic and therapeutic challenges. A review of care titled ‘Delay in Transit’ by NCEPOD delineated inadequacies in the pathway of care for patients with acute bowel obstruction nationwide, highlighting areas of improvement. This audit aims to assess key elements of management pathway in our centre and compare it to national statistics.

Methods
A retrospective case note analysis was conducted for 24 randomly selected patients, aged above 15 years, admitted with a clinical diagnosis of acute bowel obstruction between December, 2018-December, 2019.

Results
Summary of some of NCEPOD recommendations, national and local performance
The mean time to diagnosis was 8.5±6.6 hours, which was delayed if abdominal X-ray preceded the CT. Poor consultant review times may reflect failure to capture on records.

Conclusion
The management pathway, although faring well in some criteria, has scope for further improvement. Plans for an audit with a larger sample size will be implemented along with an enhanced pathway.
EP.FRI.763 Impact of COVID-19 on the rates of emergency laparotomies at an acute general hospital in the United Kingdom
Authors: Wright Curtis , Kirkham Simon , Millward Alex , MacAdam Robert 
Published: October 2021

Abstract

Aims
The aim of this study was to analyse if the COVID-19 pandemic had any effect on the number of emergency laparotomies performed each month at a single NHS Foundation Trust.

Methods
This single-centre retrospective observational study included all patients that underwent an emergency laparotomy that was registered as part of the National Emergency Laparotomy Audit (NELA) at Whiston Hospital in Merseyside, UK, between January 2019 and October 2020. The rates recorded throughout March and April 2020 (COVID) were then compared to the preceding 12 months until the first COVID death was recorded in the UK on March 5th, and the 6 months following the initial national lockdown.

Results
The number of emergency laparotomies performed each month declined from an average of 14.7 (95% CI 13.2 – 16.1) in the preceding 12 months to 5 during COVID (95% CI 5 – 5); a decrease of 65.9%. Following the easing of lockdown rules in early May, this decline was partly reversed with an average of 9.7 (95% CI 8.9 – 10.5) performed each month until October 2020, reflecting a 34.1% reduction from the pre-COVID baseline. The percentage of patients that achieved the NELA best practice tariffs also fell during COVID to 71% from an average of 79.3% (95% CI 76.0 – 82.7) due to fewer high risk laparotomies being admitted to Critical Care post-operatively.

Conclusions
During the COVID-19 pandemic, emergency laparotomy rates fell and have only partially recovered to pre-pandemic rates. Post-operative admission to critical care for high risk laparotomies also declined during this period.
EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast
Authors: Karagiannidis Georgios , Toma Omar 
Published: October 2021

Abstract

Aims
Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast.

Methods
A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017.

Results
83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy.

Conclusions
We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.
EP.FRI.798 Emergency surgery: Acute intestinal obstruction – how are we doing three years post NASBO guidelines?
Authors: Lafaurie Guillaume , Butterwoh James , Iakovou Angeliki , Engeldow Alec 
Published: October 2021

Abstract

Aims
10% of emergency surgical admissions are due to acute intestinal obstruction. If surgery is required, the mortality is raised to 10%. The latest 2017 National Audit of Small Bowel Obstruction (NASBO) has identified several key investigative and therapeutic targets. Our aim is to look into our clinical practice and compare it to the NASBO standards.

Methods
In a district general hospital (DGH), we prospectively collected data of 30 patients coming consecutively with acute small bowel obstruction looking into imaging, conservative management, surgical management and outcomes.

Results
30 patients were included in this study with mean age of 69 years (24-88 years old), with an average hospital stay of 7 days (1 - 46 days). Bowel obstruction aetiology included: 15 secondary to adhesions, 5 hernias, 4 crohns strictures and others. 28 patients had AXR on admission as well as CT with average time to CT of 13.4 hours from admission. A third received water soluble contrast, on average 32.9 hours after admission. A third patients required surgery, undertaken on average 60 hours from admission. The outcomes showed 25 recovering well and going home and a 30-day mortality of 13% (4/30). Seven patients received dietician input, two patients were reviewed by geriatricians before surgery and none post-operatively.

Conclusion
From a previous review of our practice we improved in terms of instigating timely investigations and prompt decision to surgery. However, we need to clearly work towards a more holistic approach including dietician and geriatrician input within the complex post-operative management of these patients.
EP.FRI.835 5 Years, 4 F1s, 3 Registrars, 2 Pandemic Waves, 1 VTE audit: Half a decade of VTE prophylaxis on a surgical ward
Authors: Sylvester Helena Colling , Slim Naim , Okocha Michael 
Published: October 2021

Abstract

Aim
Venous thromboembolism(VTE) is a preventable complication of hospital admission. This audit aims to compare VTE prophylaxis over 5 years in one surgical assessment unit and identify areas for improvement.

Methods
This was a snapshot, 5-cycle audit of the analysis of VTE risk, prescribing practice and prophylactic therapies offered at admission.
We prospectively reviewed notes of patients admitted under general surgery over a snapshot period annually. Data was compared to figures collected over four previous years. Induction VTE prophylaxis teaching was introduced after the first cycle, HCA VTE champions were introduced after the second, digital reminders were introduced after the third, and monthly email reminders sent after the fourth cycle.

Results
VTE risk was documented for 92% of patients in 2017, 65% in 2018, 57% in 2019, 76% in 2020 and 53% in 2021. In the years 2017, 2018, 2019, 2020, 2021, Enoxaparin was prescribed for 96%, 68%, 75%, 55% and 73% of patients respectively. In 2017, 2018, 2019, 2020 and 2021, TED stockings were prescribed for 96%, 68%, 62%, 50% and 73% of patients respectively.

Conclusions
We utilised a multidisciplinary and digital approach against the issue of VTE prophylaxis on surgical wards. Despite best efforts, compliance was highly fluctuant with a drop during the first wave of the pandemic. This has demonstrated that with redistribution of regular nursing and medical staff, new patient filtering systems and increased healthcare pressures, previous mechanisms cannot be relied upon. We have began the process of electronic prescriptions with mandatory VTE prophylaxis checklists.
EP.FRI.840 Lymphopaenia and laparotomy – a predictor of mortality
Authors: Pollock Alasdair , Galbraith Norman , Bleakley Anna , Setford Isobel , Halcrow Elaine , Moug Susan 
Published: October 2021

Abstract

Aims
Immune dysfunction is often seen in patients undergoing emergency laparotomy. Efforts to correct T-cell dysfunction & apoptosis by use of immune checkpoint inhibitors in prospective trials are underway, where lymphopaenia is an indication for therapy. We investigated the association of lymphopaenia in patients undergoing emergency laparotomy as a measure of immune dysfunction and predictor of 30-day mortality.

Methods
Retrospective analysis was performed on emergency laparotomies at the Royal Alexandra Hospital using the prospectively maintained Emergency Laparotomy and Laparoscopic Scotland Audit (ELLSA) database. White cell count (WCC), Neutrophil count, Lymphocyte count and C-reactive protein (CRP) were compared between those who died within 30 days and those who survived using Mann-Whitney-U test (p &lt; 0.05).

Results
Between 2017-2018, 196 cases were analysed for assessed, after 4 patients excluded due to insufficient data. Mean age was 63 years, 86 were male and 108 were female. Eighteen (9.2%) deaths were recorded within 30 days of emergency laparotomy. Non-survivors demonstrated a decreased lymphocyte count on day 3 and 7 following emergency laparotomy when compared to the survivor group (p &lt; 0.05). No significance was found when comparing the WCC, Neutrophil count or CRP of both groups.

Conclusions
Patients who did not survive emergency laparotomy were found to have decreased lymphocyte counts when compared with survivors. This may be a surrogate measure of sepsis or trauma-associated immune dysfunction. Further study into immune related mechanisms may lay the foundation for prospective studies using immune checkpoint inhibitors in the emergency laparotomy population.
EP.FRI.886 Clinicians’ compliance and diagnostic utility of digital rectal examination in acute abdominal emergencies: a prospective, blinded study
Authors: Mifsud Martina , Camilleri Ruth , Abela Andrè , Camilleri-Brennan John 
Published: October 2021

Abstract

Aims
One hundred years ago, Sir Zachary Cope described digital rectal examination (DRE) as ‘extremely important and informative’ in the assessment of the acute abdomen. Medical students have always been taught of the importance of including a DRE as part of the abdominal examination. It has however been observed that DRE is often omitted in clinical practice. The aims of the study are to determine how frequently DRE is carried out in acute abdominal emergencies and also to determine the diagnostic utility of DRE in this setting.

Methods
Patients over the age of 18 presenting to the on-call general surgeons in a teaching general hospital with any acute abdominal symptoms over a 15 day period were assessed prospectively. The performance of a DRE by any clinician at any point up to 24 hours post-admission was recorded, and the findings of DRE were analysed with respect to the final diagnosis.

Results
Out of the 168 patients presenting with an abdominal emergency, 41 (24.4%) had a rectal examination. 70.7% of DRE were done by surgical trainees and foundation doctors. Most DREs were performed when the presenting complaints were constipation, rectal bleeding, and suprapubic pain. The findings on DRE directly contributed to the final diagnosis in 11 patients.

Conclusions
DRE is only preformed selectively during the initial evaluation of surgical patients presenting with acute abdominal symptoms. However DRE remains a key part of clinical examination. The theoretical and practical skills in the performance of DRE should be safeguarded via continuing education and training.